Counseling Licensure Practice Plan for LGBTQ Youth Mental Health

Introduction

The professional identity of mental health counselors is very important. Before anyone chooses a profession such as mental health counseling, they need to carefully weigh all available options and understand what is required of them. This paper is focused on the development of a practice plan for a mental health counselor serving the LGBTQ population. It begins with a historical background section covering the motivation and expected rewards for a mental health counselor serving this group, as well as key developments in counseling for LGBTQ individuals. Next, the paper explores the various mental health networks available for the LGBTQ population and identifies a specific professional niche. It then describes a plan for receiving post-master's clinical supervision and situates that plan within the relevant professional community. Finally, the paper identifies several organizations that will facilitate the practice of mental health counselors serving this population.

Historical Background

Sexual orientation has not always been a source of fear, distress, hate, or ridicule. However, as social freedoms have expanded, groups divergent from the conservative heterosexual norm have become more visible. These individuals fall under the LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Pansexual) umbrella. Research indicates that they frequently suffer from social stigma imposed by community members who identify as heterosexual and who view any other sexual orientation as wrong, sinful, or deviant. Counseling services are central to the LGBTQIA+ group: research shows that teens with a non-heterosexual orientation have a higher rate of suicidal ideation (Baams, Grossman, & Russell, 2015). The motives for suicide and self-harm are largely driven by the discrimination they face from society. Ybarra and colleagues (2015) found that LGBT-identified teens were at higher risk of victimization and bullying and were more likely to have contemplated suicide than their heterosexual counterparts. The LGBTQIA+ community needs ongoing counseling because repeated acts of discrimination, sexual assault, and physical and verbal bullying can lead to chronic stress and mental health deterioration (Akibar & Langroudi, 2021). This need motivates my commitment to being available and providing counseling to members of the LGBTQIA+ group when they seek therapy.

Developments in mental health care for the LGBTQIA+ group have been closely tied to legal and policy advancements related to the recognition of the group in law. Several recent changes in the legal and political landscape have helped improve access to care and insurance for LGBT people and their families. These include the passage of the Affordable Care Act (ACA) and the repeal of a large portion of the Defense of Marriage Act (DOMA) in United States v. Windsor, as well as the subsequent ruling in Obergefell v. Hodges, which legalized same-sex marriages across the country (Kates et al., 2015). The ACA expands access to health insurance for millions of Americans, including LGBT people, and includes specific safeguards related to sexual orientation and gender identity. However, subsequent executive actions have sought to reduce some of these protections. The 2013 Supreme Court ruling on DOMA resulted in state recognition of same-sex marriages for the first time and paved the way for broader recognition across the country, further expanding access to health coverage.

Prior to the expansion of same-sex marriage rights in the USA, various healthcare facilities and professionals had attempted to deliver mental health care to LGBT individuals. Unfortunately, these efforts were often unsustained due to the lack of a supportive legal framework. One of the first LGBT mental health centers in the US was the Eromin Center, which opened in 1973 in Philadelphia (Blackwood, 2019). Historically, LGBT people struggled to find psychological care that did not treat deviations from sexual and gender norms as signs of psychopathology. The Eromin Center's proactive stance not only supported people in need of mental health care but also advanced a new model of LGBT-affirmative clinical practice (Blackwood, 2019). The center closed in 1984, but it had made a crucial impact on the broader recognition of the importance of counseling for the LGBT community.

Network and Practice Niche

LGBTQIA+ persons primarily deal with depression, anxiety, and substance abuse related to the process of coming out to their family and friends (Baams, Grossman, & Russell, 2015). This underscores the need for safe spaces where members of the LGBTQIA+ group can receive support in making this important decision and planning for coming out. Various services are available for LGBT persons, including family therapy, couples therapy, domestic abuse counseling, individual therapy, and violence counseling, among others ("LGBTQI," 2021). A range of networks also exists, including the American Psychological Association (APA), the Association of Gay and Lesbian Psychiatrists, the LGBT National Help Center, the Trevor Project, and the Family Acceptance Project ("LGBTQI," 2021).

With the growing acceptance of LGBT persons in the USA — particularly following the legalization of same-sex marriage — the psychological challenges associated with being LGBT are comparatively less pronounced among adults than among youth. Young LGBT persons experience depression, anxiety, substance abuse, suicidality, and eating disorders (Lothwell, Libby, & Adelson, 2020). These factors are major contributors to mortality and morbidity among young people (Lothwell et al., 2020). Accordingly, I would like to specialize in working with LGBT youth in my practice. As specified by the Occupational Outlook Handbook, a Master's Degree is required to practice as a mental health counselor. According to O*NET, the skills required include critical thinking, social perceptiveness, and effective communication. The average annual earning for a mental health counselor in my state in 2019 was $46,650.

Conclusion

Mental health among LGBTQIA+ youth is an increasingly important need, as it has been linked to several of the mental health challenges facing this group. This is a niche I would like to specialize in for my practice. There are several advancements in the area, particularly following the legalization of same-sex marriages in 2013. However, much remains to be done, primarily because of the ongoing stigma that LGBT youth face. To gain licensure, I will engage in clinical supervision in line with APA and ACA requirements and secure membership with the relevant professional organizations. My Professional Counseling Disclosure Statement is presented in Appendix A.

References

Baams, L., Grossman, A. H., & Russell, S. T. (2015). Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth. Developmental Psychology, 51(5), 688.

Ybarra, M. L., Mitchell, K. J., Kosciw, J. G., & Korchmaros, J. D. (2015). Understanding linkages between bullying and suicidal ideation in a national sample of LGB and heterosexual youth in the United States. Prevention Science, 16(3), 451–462.

Akibar, A. P., & Langroudi, K. F. (2021). Intersectionality, lived social realities, and LGBTQ PoC health. In Heart, Brain and Mental Health Disparities for LGBTQ People of Color (pp. 27–39). Palgrave Macmillan.

Kates, J., Ranji, U., Beamesderfer, A., Salganicoff, A., & Dawson, L. (2015). Health and access to care and coverage for lesbian, gay, bisexual, and transgender (LGBT) individuals in the US. Kaiser Family Foundation.

Blackwood, K. (2019, November 25). Study reframes the history of LGBT mental health care. Cornell University. Retrieved from https://news.cornell.edu/stories/2019/11/study-reframes-history-lgbt-mental-health-care

"LGBTQI." (2021). National Alliance on Mental Illness. Retrieved from nami.org/Your-Journey/Identity-and-Cultural-Dimensions/LGBTQI

Lothwell, L. E., Libby, N., & Adelson, S. L. (2020). Mental health care for LGBT youths. Focus, 18(3), 268–276.

American Psychological Association. (2014). APA guidelines for clinical supervision in health service psychology. Retrieved from http://apa.org/about/policy/guidelines-supervision.pdf

Clayton, S., & Bongar, B. (1994). The use of consultation in psychological practice: Ethical, legal, and clinical considerations. Ethics & Behavior, 4(1), 43–57.

Appendix A: Professional Counselor Disclosure Statement

I earned my Master's Degree in Clinical Psychology in 2018. I am currently a Licensed Professional Associate Counselor (LPCA) and a Licensed Associate Counselor in Clinical Mental Health (LCMHCA). Over the last three to four years, I have gained experience providing individual, family, and group counseling services for children, adolescents, and adults across a variety of settings. Per legal requirements, I have received training in individual, group, couples, and family therapies. My particular interests include adjustment issues, family counseling, relationship issues, self-esteem, developmental concerns, parenting, life transitions, community programs, and communication skills. If I do not have the knowledge or training to address a client's particular situation, I will provide referral information as necessary.