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Sex, gender, and affectional orientation are complex issues; scientific research has long investigated the etiology of gender variance and affectional orientation. Although some interpret this research as contributing to a viewpoint of LGBTQI+ as abnormal, biological research can also be viewed as a confirmation of the natural human variance and adaptability that different gender identities and affectional orientation serves. Research supporting a biological basis for sexual attraction, gender identity, and affectional orientation is presented. © 2017 by the American Counseling Association. All rights reserved.

The term two-spirit refers to persons who identify as indigenous to the Americas and as having a gender and/or affectional variance. Historically recognized by most Native tribes, two-spirit persons were seen as a blessing to their tribe, having high social and spiritual value. Native spirituality and the history of two-spirit persons are explored within this chapter. Because of colonization, much of these traditional beliefs have been lost or distorted, leaving LGBTQI+ people within Native communities experiencing high levels of bias and abuse. Increased physical and mental health challenges due to these significant minority stressors are discussed. Specific counseling skills and techniques for working with this population are explored. © 2017 by the American Counseling Association. All rights reserved.

Persons who are born with ambiguous or a combination of both male and female genitalia are referred to as intersex. The biological nature of intersex conditions, or disorders/differences of sex development, are reviewed in this chapter. Issues of bias for people who are intersex are discussed, as children are often made to feel abnormal and required to keep their difference a secret. Parents and families may also experience mental health symptoms, such as traumatic reactions, at their child's birth, when a gender cannot readily be assigned to their child. Although, doctors have (and some still continue) to recommend genital surgery without the child's consent, this is considered unethical by many advocacy organizations for intersex people. Physical issues and the standard of care recommended by advocacy organization and ALGBTIC are discussed. The role of a counselor working with a family with an intersex infant is discussed, as are specific counseling techniques for working with intersex clients of all ages. © 2017 by the American Counseling Association. All rights reserved.

This chapter talks about Michael and Ethan's case study, where two people were involved in being in an interfaith relationship. The author's primary goal was to help each become empathic and to understand the other's position on coming out and being a public couple. A secondary goal was to increase their communication in articulating their feelings surrounding coming out officially. Working from an existential approach, the author encouraged them both to explore their meanings associated with religion, their families, and each other. He used the Emotionally Focused Couples Therapy (EFCT) approach, and insights of integrating sexual orientation and religious identities, spiritual interventions, and dealing with discrimination. Building on the strength-based model, the author identified positive assets that each brought to the relationship individually and in a partnership. Each was willing to develop a plan that represented a middle ground between their two positions. © 2015 by the American Counseling Association. All rights reserved.

LGBTQI+ youth face an identity struggle that is dissimilar to their heterosexual and/or cisgender peers. While family and community acceptance impacts the process of understanding one's own affectional orientation and/or gender identity, all LGBTQI+ persons typically engage in a process of understanding and eventually accepting their affectional and/or gender variance. The authors review LGBTQI+ Identity Formation Models, as well as the influence of intersectionality on identity. The benefits and challenges of coming out are explored, as counselors need to understand this delicate process and how to support clients who are considering coming out. Counselor work with families is also reviewed. © 2017 by the American Counseling Association. All rights reserved.

The issues surrounding working with clients who are predisposed to share affection with people from more than one gender. Terminology, as well as prevalence are discussed. Bisexual identity development and relationships are explored. Experiences of bias, including bisexual erasure, biphobia, and bisexual invisibility are discussed. Bisexuals may encounter monosexism and marginalization in both heterosexual and queer communities, among people who do not identify with non-binary identities. Intersectional identities can be subject to increased oppression. Authors explore how minority stress contributes to greater physical and mental health issues in bisexual clients. Although there has been little research on affirmative counseling techniques for bisexual clients, a general strength-based approach with feminist and social justice techniques is recommended. © 2017 by the American Counseling Association. All rights reserved.

Authors review the current state of Evidence Based Practice (EBP) for counseling LGBTQI+ clients. Although there is an identified need for more research in this area, the research supports a general affirmative approach. Strategies for building rapport, assessment, and interventions are reviewed. Specific attention is given to the importance of cultural accommodations and adaptations of EBPs that have not been tested directly on the LGBTQI+ population. Authors also explore how integrative and creative therapies may hold helpful strategies for work with these communities. © 2017 by the American Counseling Association. All rights reserved.

The issues surrounding working with clients who experience a disconnect between their gender identity and their designated sex at birth are discussed. Gender and gender identity terminology are thoroughly discussed, including terminology that should be avoided. The complex issues surrounding terminology, gender, and changing terms are explored. The cultural history of third gender people, as well as the impacts of colonization, are discussed. Authors also present the prevalence and identity development of transgender persons. Transgender persons face a significant risk of experiencing bias incidents, indicating a significant increase in minority-based stress. Focusing specifically on transgender persons who wish to transition, the authors explore physical and mental health challenges that clients may face. Special considerations with the DSM and use of the Gender Dysphoria diagnosis, are explained. Affirmative counseling strategies, including preparation and counseling practices, with transgender persons are examined. Special attention is given to intersectional issues, such as age and ethnicity. © 2017 by the American Counseling Association. All rights reserved.

The intersectionality of ethnicity and affectional orientation is discussed within this chapter, with special attention given to specific challenges faced by queer people of color (QPOC). Four elements of African American culture that may negatively impact queer-identified persons are: heterosexism, masculinity, issues surrounding HIV, and the role of the Black Church. In Latin Americans, concepts of machismo and marianismo, Catholicism, familismo, and respeto, are discussed in terms of their impact on LGBTQI+ persons. Authors also discuss elements of Asian culture that will impact queer-identified Asians: stigma, complementarity, collectivism and conformity, and shame. The importance of culture specific counseling is underscored. © 2017 by the American Counseling Association. All rights reserved.

Asexual persons experience little to no sexual attraction to others, although they may still experience romantic attraction and a desire to bond with others. Asexual people often experience bias and marginalization from allosexuals (persons who experience sexual attraction) within heterosexual and queer communities. Asexuals may also face bias from well-intentioned therapists who assume their lack of sexual attraction is due to trauma or a disorder. Although little research has been performed on counseling asexual persons, the authors review appropriate diagnostic counseling criteria for arousal and sexual disorders versus an asexual identity, and affirmative and strength-based techniques appropriate for work with this population. © 2017 by the American Counseling Association. All rights reserved.

When providing counseling to a LGBTQI+ client, counselors must understand their ethical obligations, as well as attend to the multiple sets of counseling competencies. Using a multicultural and social justice counseling framework, counselors can situate their learning into very specific areas for LGBTQI+ clients: self-awareness of attitudes and beliefs, knowledge of issues faced by LGBTQI+ people, counseling skills, and action. Understanding common terminology, the history of the LGBTQI+ population, and modern issues faced by these communities can help lay the foundation for counselors working with LGBTQI+ persons. © 2017 by the American Counseling Association. All rights reserved.

When religion or spirituality is present, it likely impacts the needs a LGBTQI+ person may bring to counseling. First, the LGBTQI+ person's identity development is likely altered in significant ways, either positively or negatively. Research on this topic is reviewed and the FAITH model for working with LGBTQI+ clients struggling with their faith is presented. Ethical issues arising between disaffirming religious beliefs and counseling LGBTQI+ clients are also reviewed. Authors review affirming and semi-affirming religious organizations within the United States. Additional counseling issues are also explored. © 2017 by the American Counseling Association. All rights reserved.

Many LGBTQI+ clients have been explicitly harmed by religious leaders and those using religious doctrine. This experience can go beyond discrimination and oppression; a person may have experienced serious emotional and spiritual abuse at the hands of faith practitioner attempting to condemn affectional orientation and/or gender identity variance in order to comply with religious doctrine. The current religious conflict with LGBTQI+ issues is briefly reviewed. Authors define and explore spiritual abuse, as well as the experience of spiritual abuse as experienced by a LGBTQI+ person. Counseling challenges and strategies are described. Specifically, the use of a trauma informed counseling approach as applied to clients who have experienced spiritual abuse is explored. © 2017 by the American Counseling Association. All rights reserved.

Due to their stigmatizing and marginalized experiences, as adults, LGBTQI+ people have variant developmental experiences for identity and intimacy. Their collegiate and occupational experiences may also be impacted by these negative experiences surrounding their LGBTQI+ identity. Experiences within the military are also covered within this chapter. The authors also discuss mid-life experiences for those within the LGBTQI+ population, including relationships, marriage, family planning and raising children. Issues facing the LGBTQI+ elderly population are also covered. © 2017 by the American Counseling Association. All rights reserved.

The issues surrounding working with gay men in counseling are reviewed within this chapter. Prevalence, identity development, and relationships are explored. Gay males experience a significant amount of bias and discrimination; they are the largest single target of hate crimes within the LGBTQI+ population reported to the FBI every year. This risk is greater when intersectional minority identities are also present; more gay males are targets for hate crimes when they present as gender non-conforming, are men of color, as well as live in a rural area of the country. Authors explore physical and mental health issues related uniquely to gay male clients, as a result of the heightened minority stress. Affirmative counseling techniques for working with gay male clients is reviewed, with special attention given to developing counselor self-awareness, developmental counseling, and empowerment strategies. © 2017 by the American Counseling Association. All rights reserved.

LGBTQI+ people face significant increased stress and marginalization surrounding their gender and/or affectional identities. The minority stress model (Meyer, 2003) serves as a helpful framework when understanding negative coping behaviors, and poor physical and mental health. Microaggressions, marginalization, discrimination, abuse, harassment, and experience of bias incidents all add to the LGBTQI+ person's stress. Intersectional identities may exponentially increase this stress, as is the case for queer persons of color. Authors consider general physical health and mental health risks for lesbian, gay male, bisexual, and transgender clients. Barriers to quality health care and protective factors are also covered. © 2017 by the American Counseling Association. All rights reserved.

In addition to traumas that heterosexual and cisgender people experience, queer and transgender people face a heterosexist and cissexist culture, in which marginalization and trauma against them is normalized or minimized. In this chapter, the experience of hate crimes and violence, relational and interpersonal trauma, religious based-trauma, and sociocultural and political-based trauma are covered in relation to how it impacts Lesbian, Gay, Bisexual, Trans, and Queer (LGBTQ) people. Clinical and counseling implications are discussed. The increase in mental health challenges is explained via the minority stress model. Implications for diagnosis and trauma-informed practices for queer and transgender people are discussed. Additionally, the role of the mental health professional as a social justice advocate is explored, including how social justice frameworks can be incorporated in the counseling environment. © 2023 Springer Publishing Company, LLC and 2012. All rights reserved.