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Gay, lesbian, bisexual, , and queer people who seek professional help for personal or psychological problems often find that the field of mental health is fraught with controversy surrounding glbtq issues. After all, it was only until recently that "homosexuality" was a diagnosable mental disorder.

Although attitudes are changing and progress is being made, depending on one's geographical location it can be difficult to find counselors who are knowledgeable about diversity in terms of gender expression and sexual orientation, let alone who are glbtq-affirmative in their therapeutic practices.

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Mental Health and the Glbtq Community

To understand attitudes in the counseling professions towards people of diverse genders and sexualities, it is first necessary to look to the past. In the late nineteenth century in Europe and the United States, the regulation of sexuality began to shift from religious and legal jurisdiction to the realms of medicine and psychiatry. Accordingly, people who engaged in same-sex sexual relations were not necessarily viewed simply as sinners or criminals, but rather were seen as suffering from a disease.

However, even then there were some researchers who felt that homosexuality should not be seen as a pathology. For example, Havelock Ellis believed that people could be born homosexual, and thus it should not be seen as a sickness. Sigmund Freud also rejected the disease model, arguing that people start off life inherently bisexual and then develop heterosexual or homosexual orientation based on interpersonal interactions.

Later psychoanalysts did not follow Freud and instead maintained that homosexuality was a problematic deviation that reflected unhealthy early relationships with family members. Although the claim that homosexuality itself was a pathological condition was supported by decidedly unscientific research methods (for example, extrapolation from clinical or incarcerated samples to the general population), this idea persisted throughout much of the twentieth century and greatly influenced the therapeutic relationship.

In spite of the widespread belief in the sickness model for homosexuality, as the years passed increasing numbers of studies were published that challenged this view. For example, Evelyn Hooker's groundbreaking 1957 study decisively showed that homosexuality was not intrinsically correlated with mental disease and that homosexuals and heterosexuals generally had the same levels of psychological functioning.

By 1973 increasing anti-pathology arguments, as well as the strong lobbying efforts by gay rights groups, resulted in the removal of the category of "homosexuality" from the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.

However, a controversial new diagnosis, "Ego-dystonic homosexuality," was created for the DSM's third edition in 1980. This disorder was characterized by distress felt by individuals who were struggling with unwanted homosexual urges. This category was criticized by mental health professionals, however, who claimed that holding negative feelings about one's homosexuality was to be expected in a and society.

Accordingly, ego dystonicity itself could not be an accurate indication of whether a gay or lesbian individual was mentally fit or not. As a result of lobbying by professionals and activists, the diagnosis was removed from the DSM in 1986.

Like homosexuality, transgenderism moved from being viewed as a sin to being seen as indicating a pathology in the late nineteenth century. As such, over the past one hundred years clinicians have generally sought to treat or cure "gender deviant" behavior. Unlike homosexuality, "transvestism" continues to be listed in the DSM as a mental illness, as is "Gender Identity Disorder." In addition, the Harry Benjamin Standards of Care, a widely used treatment protocol, requires who desire sex reassignment surgery to first undergo psychotherapy.

The association of homosexuality and transgenderism with mental disease has had serious implications for therapeutic counseling, as both types of "deviance" have generally been viewed as illnesses to be modified or alleviated. It is only in recent years that there has been a push for glbtq-sensitive counselor training and glbtq-affirmative counseling, which, although occurring slowly and encountering resistance, marks a significant move in a positive direction.

Counseling Issues

People who are gay, lesbian, bisexual, or transgendered will often see a counselor to deal with the same kinds of problems that affect the general population, such as depression, codependency, anger management, and substance abuse. However, there are numerous issues that uniquely impact the glbtq community.

For example, "coming out" refers to the process of self-identifying as gay, lesbian, bisexual, transgendered, or , or disclosing as such to others. Some people, whether due to preference or necessity, choose to conceal this part of their identity and remain "in the closet." The degree to which a person can be "out" must be weighed against potential negative consequences, and can be influenced by any number of factors, including internalized homophobia or , family of origin, work situation, and support network.

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