Assessment of Emotional Issues and Sexuality of LGBTQ
There are different views on sexuality in other parts of the world. Canadian society accepts LGBTQ members well and treats them with dignity and respect. However, it is illegal in some other countries. Sexuality is also a big part of psychotherapy assessment and treatment. For example, we often provide psychotherapy for clients who suffer from depression, body dysmorphia, and PTSD. They also identify as lesbian, gay, bisexual, transsexual, or queer (LGBTQ).
According to the social determinants of health, the issue of sexuality becomes even more complicated with a client who suffers from a mental health disorder. It is more significant if one has refugee status or another precarious immigration status. However, most refugees go through considerable stress related to their sexual issues even before coming to Canada. According to the Washington Post, Homosexuality is illegal in countries such as Yemen, Iran, and Mauretania come on Nigeria, Saudi Arabia, Qatar, Somalia, UAE, and Afghanistan. We often see in our practice how clients have been traumatized following interaction with the law enforcement officials back in their home countries. Homosexuals are frequently victims of torture, stoning, public humiliation, stigmatization, bullying, social isolation, and out casting.
The individuals who were afraid to disclose their sexuality back home, where the law and society are against them, will be scared to admit that they are homosexual in Canada. Our job as mental health professionals becomes even more critical during assessing sexuality with the newcomers. First and foremost, it's essential to establish a solid therapeutic alliance, so the clients will be comfortable disclosing these issues to the therapist. It's imperative to explain that healthcare-related matters are confidential in Canada. In my practice with refugee clients, I often observe that clients are scared to come forward with personal health information. They're afraid to be diagnosed with a mental illness, fearful of the repercussions. It is also a significant issue among youths in Canada. LGBTQ youth often become the target of bullying and social isolation. The experience is so profound, but often this leads to self-harming behaviour. So, it's crucial to reassure the purpose of a visit and that the assessor is trying to help someone who needs help. In assessing sexuality, it's essential to collect information about gender identity, meaning how one identifies currently with their gender and sexual orientation.
Exploration of one’s sexuality also includes past experiences with the same sex, when the attraction started, and what were the early experiences and traumas. It's essential to screen for comorbidities such as PTSD, body dysmorphia, and eating disorders. Studies show that homosexual men often have comorbidities such as major depression, social phobia, and alcohol or drug dependence. In addition, they frequently screen positive for mood disorders and anxiety disorders that affect their quality of life and contribute to disability. A study from the UK also shows how profoundly the youth are affected by sexuality-related issues.
More so, the study showed that the social determinants of self-harm and suicidality are a real issue in LGBTQ youth populations
. The study found that youth affected by homophobia and unable to talk about their emotions had a greater chance of planning and attempting suicide. It was the stress associated with hiding their LGBTQ identity.
It's essential to administer psychometric tests as part of objective measures. However, there are not many tests that help assess sexuality. For example, I have adapted several tests at our clinic that help with that. These tests are essential for clients and crucial as a part of their psychotherapy assessment report. However, the therapist must also be skilled in other objective assessment techniques. Constructing the timeline of events is very important. Therefore, it is essential to be observant when dealing with youth, especially if there are any cuts on the forearms, as it would indicate self-harming behaviour. For example, adolescents sometimes want to hide their self-harming behaviour, and they may cut their thighs. It's essential to screen for hidden signs of domestic abuse and intimate partner violence. Does your client appear scared, subdued, or are they disheveled?
It's essential to design the proper treatment plan to help the client accept their sexuality and move forward with life. If a trauma component is associated with clients presenting symptoms, it's essential to offer trauma therapy. However, talk therapies such as CBT and interpersonal psychotherapy are often helpful. They help clients navigate role transitions and adapt cognitive skills to deal with their intrusive thoughts. For example, how exactly will the treatment look? For example, suppose one uses interpersonal therapy. In that case, one may focus on the role transitions aspect or perhaps even interpersonal disputes in some instances. For example, let's say a person is trying to accept themselves in their new role as a young lesbian. For example, suppose it's a transgender youth trying to fit in the society.
Conclusively, the role transition aspect of interpersonal therapy will be vital in this case. The individual trying to adjust to a new, stressful role with many unknowns attached to it. For example, suppose this is a Individual who has recently become a homosexual to their family. It may have caused a particular strain in their relationship, especially if the family comes from a strict, conservative or religious background. It may have already caused disputes between the client and the parents and siblings. Therefore, it is necessary to address these issues in the context of the interpersonal conflict of IPT. We will help the client adjust and accept themselves, help them maintain and improve their interpersonal relations and recruit the necessary support networks that will act as protective factors for the client.
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Ibrahim Ismayilov for CrocusCare Solutions Inc.
Sources: Ibrahim Ismayilov used the references listed below and his experience and knowledge as the Registered Psychotherapist and health administrator to write this blog.
Bearak, Max, and Darla Cameron. “Analysis | Here Are the 10 Countries Where Homosexuality May Be Punished by Death.” The Washington Post. WP Company, December 1, 2021. https://www.washingtonpost.com/news/worldviews/wp/2016/06/13/here-are-the-10-countries-where-homosexuality-may-be-punished-by-death-2/.
McDermott, Elizabeth, Elizabeth Hughes, and Victoria Rawlings. “The Social Determinants of Lesbian, Gay, Bisexual and Transgender Youth Suicidality in England: A Mixed Methods Study.” Journal of Public Health 40, no. 3 (2017). https://doi.org/10.1093/pubmed/fdx135.
Wang, Jen, Michael Häusermann, Vladeta Ajdacic-Gross, Peter Aggleton, and Mitchell G. Weiss. “High Prevalence of Mental Disorders and Comorbidity in the Geneva Gay Men’s Health Study.” Social Psychiatry and Psychiatric Epidemiology 42, no. 5 (2007): 414–20. https://doi.org/10.1007/s00127-007-0190-3.