LGBTQ+ Affirmative Therapy Practices

This assignment delves into the crucial role of LGBTQ+ affirmative therapy in promoting mental well-being within the LGBTQ+ community. It examines the historical context, theoretical underpinnings, and practical applications of this therapeutic approach. Key concepts such as minority stress, cultural competence, and client-centered care are discussed, alongside strategies for addressing specific challenges faced by LGBTQ+ individuals. The assignment also highlights the importance of therapist self-awareness, ethical considerations, and ongoing professional development in providing effective and affirming therapy.

Running head: CASE STUDY ON CROSS CULTURAL COUNSELING COMPETENCIES
Case study on Cross Cultural Counseling Competencies
Name of the University
Name of the Student
Author Note

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Introduction
There are numerous instances of neglect, discrimination, racism and prejudices against
cross-cultural people in most countries. It is important for a counselor to be culturally competent
in order to deal with patients belonging to multicultural societies. People with different ethnicity,
culture and social and sexual preferences comprise the vulnerable group. The LGBT community
is probably the most neglected section of the group (Bradshaw et al., 2015). The society has
neglected, discriminated and prejudiced them since the time of their origin. It is a sad truth that
no country in the world is free from this menace. Filmmakers of different nationalities have
portrayed these issues in their films.
The given essay offers a deep insight into this issue taking the case of Harvey Milk, the
main character from the movie ‘Milk’ that was released in the year 2008 (Imdb.com, 2017). It is
based on true events. The film portrays the life and struggles of gay people in the United States
of America during the 1970s and 1980s. It also demonstrates the feelings and superior sensitivity
of the gay people in comparison to other heterosexual individuals. In addition, the film shows
how the then society expressed an attitude of disgust for the community. Harvey Milk’s
character in the movie portrayed by Sean Penn demonstrates confidence and belief that a rightful
representation of the LGBT in the higher ranks of the socio-political arena was necessary to
address their issues justifiably.
The essay tries to analyze the main character chosen for the case study and evaluate the
required competencies needed for counseling cross-cultural people. Further, it identifies the
major presenting problems that the character of Harvey Milk brings to counseling. The essay
also highlights the therapeutic approaches that can be effective in dealing with the character.

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This includes the possible challenges that the counselor might come across in professional and
personal filed.
Overview of Harvey Milk’s character
Sean Penn, who plays the character of Harvey Milk in the movie, does complete justice
to it as he brings out the minutest emotions of a gay individual. Milk lived in an era when being
gay or lesbian was deemed illegal or semi-legal in most parts of the US. The general acceptance
for LGBT community was a myth in that era and many belonging to the community preferred to
hide their sexual orientation. Milk too was conspicuous of his vulnerable position as a gay but
gradually opened up after witnessing the increasing atrocities against the community. This aspect
of his character may pose a difficulty to the counselors looking to communicate with him as a
client. It is because Milk, at that stage of his life he was reluctant to talk about his sexual
preferences. In addition, the 70s was an era that was extremely hostile to the LGBT community
that would have made it difficult for the counselor to approach Milk openly.
Milk strongly felt the need to have a voice at the higher ranks of politics that would
represent the gay people and provide them justice (Donahue, 2014). He was very critical of the
police brutality against homosexual men. The discrimination against the gay men prompted him
to take steps towards voicing their troubles. A turning point came in Milk’s life when he met
with his long-time boyfriend, Scott Smith, played by James Franco, for the first time. He was
able to express his anger and emotions about his present situation and the overall condition of
gays to Scott. They both decided to move to San Francisco and be more open about their
relationship. Milk was able to garner support from other gay men in the Castro locality of San
Francisco. He devised plans to boycott businesses that were hostile to gay men. Gradually he

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began organizing street speeches where good number of people attended to hear him. The chief
elements of his speeches included a call to the gay community to come out openly and support
him in his endeavor to end the prejudices.
To a counselor, approaching a client like Harvey Milk would not be easy, as he has to be
understood in terms of his sexuality as well as his political interests. The counselor has to have a
thorough understanding of the issues relating to gays and the problems that confront them.
Discrimination and prejudice displayed in the movie
In the opening scenes of the movie, the gay men are seen rounded up by the police and
beaten up. The gay men are shown hiding their faces out of embarrassment and shame while the
police keep bashing them. The scene was shot in black and white reel with newspaper headlines
flashing attack on gay bars following it. It can be understood thus, from the opening scene itself
how the gay people were discriminated and prejudiced (Baruth & Manning, 2016). In another
scene, a liquor storeowner confronts Scott and Milk when they opened their camera shop at
Castro Street in San Francisco and conveys his displeasure. He warns them that they are not
allowed to do business there, as the police would not allow them. When Milk tells him that they
are not breaking any law, the storeowner coldly replies that the laws are meant for men only.
This scene clearly depicts the prejudice against the gay people.
The movie exhibits various other incidences that expose the brutality of prejudices and
discrimination carried out against the gay community. In one of the narrations, a scene from
1973 shows the unending atrocities of the police on gays as they carry on reining havoc on their
bars and other establishments. The fear amongst LGBT community reached to a level when gay
men decided to wear whistles and blow it whenever they witnessed any injustice done against

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their fellow members (Herek, 2015). In one of the scenes, Milk was seen arguing with a cop as
shown through the reflection on a pool of blood of a dead gay teen. The argument revealed the
cop’s prejudice against gay people as he dismissed the incidence as the fault of the dead gay.
Throughout the film, there are instances where the people in power violated the basic
human rights of gay community. Through the chief negative characters of the film, Anita Bryant-
her original archival footage was used- and Dan White played by Josh Brolin, the intolerant
mentality of the people in power against homosexuals are portrayed. Anita even managed to
compel the policy makers to pass laws that designated homosexuals as criminals and barred them
from getting any protection from the law in Florida. Dan White, a homophobe, goes to the extent
of assassinating Milk in the end (Kite & Whitley Jr, 2016). There are other subtle inferences of
other forms of discriminations and prejudices prevalent at that time. Characters like Rick Stokes
demonstrated the demarcation between rich and the poor although he too was a gay.
Hofstede’s theory of cultural dimension: the Uncertainty avoidance index
Multicultural differences pose either a threat or an opportunity to counselors to delve
upon the client’s background and understand his problem more concisely. In case of the LGBTs,
it becomes even more important to be sensitive and knowledgeable towards the client hailing
from this background. The movie ‘Milk’ that has been selected as the topic of the case study
displays the issues concerning the LGBT community during the late 20th century. The LGBT
community can be termed as vulnerable group that needs proper counseling. To achieve this, a
relevant theory has to be applied to this issue.
Geert Hofstede’s theory on cultural dimension has been identified as the best theory
relevant to the case study. Hofstede, a social psychologist of Dutch origin devised this theory

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during the late 20th century that revolutionized the way counselors approached people from
differing cultural backgrounds (Mazanec et al., 2015). His cultural dimension theory comprised
four dimensions initially with two ore added later. These are power distance index, individualism
versus collectivism, masculinity versus femininity, uncertainty avoidance index, pragmatic
versus normative and lastly, indulgence versus restraint.
The dimension that concerns the chosen case study is however the Uncertainty
Avoidance Index. Attempting to foresee and stay away from injury is universal and element of
fundamental human instinct. Humans have fear of many things that can be categorized as innate
fear and fears molded by the society and cultural tradition. The fear that arises from the society
gradually takes the shape of prejudice and discrimination. In the movie, this fear relates to the
‘abnormal’ homosexuals. They are regarded as unnatural and unsuitable for the society and
hence must be destroyed and not allowed to enjoy any rights or freedom (Mereish, O’Cleirigh &
Bradford, 2014).
According to Hofstede’s theory, the level of uncertainty avoidance depends on how
different cultures deal with unusual occurrences using particular rules. Hence, the Uncertainty
Avoidance has been categorized into strong and weak uncertainty avoidance. Societies vary in
terms of the rules they tend to follow more. To give an instance, some countries have culture that
requires them to follow social rules and moralities. On the other hand, some countries tend to
follow pre-written or pre-dictated institutional rules. Now, in connection to the movie, this
variance in the uncertainty avoidance can be applied successfully (Lev, 2013). The movie
conveys the rigidity of the American society during the 70s and 80s regarding general acceptance
of people with dissimilar sexual orientations (Goldblum et al., 2016). The then society

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demonstrated a strong uncertainty avoidance index as it decided to follow the unwritten rules that
men should be romantically involved with women only.
Analyzing potential presenting problems
The movie is set in the 1970s and that era looked at LGBT community as criminals and
expressed disgust over their presence. Harvey Milk took the initiative to end this prejudice and
was even killed in the process. To a health professional providing counseling to Milk, there is
bound to occur complexities. The problems faced by homosexuals differ largely from the
heterosexuals. One major reason for this is the stigma associated with their community.
Although the general perception of the people has changed with time, cases of prejudice and
discrimination are still relevant and happening.
In addition to that, health professionals often lack proper knowledge and training needed
to deal with LGBT clients (Whitman & Bidell, 2014). While providing counseling to Milk, thus
might not be easy as he is not only a gay but also an activist who is fighting for the community’s
development. Milk’s character presents daunting problems for the counselor, as he is not
someone who is willing to go down and succumb to society’s pressure. Counseling someone like
Milk would require the health professional to have a deep understanding of the struggles and
dilemmas of the homosexuals.
Analyzing potential challenges and issues
Providing counseling to homosexuals is not an easy task to do for the health professionals
and needs extreme care. During the 70s, the era of tragedies and revolutions in the US, health

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professionals were discovering ways to understand mental health and illness of clients hailing
from different cultures. Health professionals needed to be culturally competent to address issues
related to mental health of the cultural minorities or the vulnerable groups (Filip-Crawford &
Neuberg, 2016).
Various studies have revealed that a lack of training access is there amongst health
professionals that might assist them in attending to the needs of the LGBT community. To
provide an instance, many health professionals have raised the concern that the cultural
competency training for counseling LGBT community people lacks methodological severity in
its intend and valuation (Meyer, 2016). Likewise, although medical schools have raised the bar
for medical students to acquire cultural competency especially since the beginning of the 21st
century, problems remain with the acquisition of knowledge during the training and its
assessment. Additional challenges are posed by the by the lack of the need that all medical
students must learn LGBT counseling techniques (Boroughs et al., 2015).
It has also been found through the post-training assessment that major portion of the
cultural competency training are forgotten by the counselors over time (Reyna et al., 2014).
Other limitations include the absence of interest of the health professionals or psychologists to
receive additional training for LGBT community as many have opined that the additional
training does not prove beneficial for them. This indicates a clear lack of enthusiasm amongst
psychologists to attend to LGBT people and counsel them properly, addressing all their issues.
In the selected movie, the lead character demonstrates immense will power and
confidence while fighting all odds. However, a deep study on the character reveals his
vulnerability and ambiguity regarding his identity. Milk displays multitude of skills and portrays

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himself as a romantic lover who is not afraid to open up about his sexual orientation. However, it
was evident from the initial stages of his life as shown in the movie that he was reluctant to
reveal his identity and had to leave New York due to it.
The counselor might be faced with a gamut of issues and challenges while dealing with
Milk because of the concerns mentioned earlier. in addition to those, other emerging issues that
confront the health professionals are the problems of the new LGBT generation. Incomplete and
causal research, lack of clinical skills and most importantly sensitivity towards the gays might
prove to be the biggest hurdles for the health professionals to counsel LGBT people (Martell,
2014).
Health professionals are also faced with a grave challenge of gay men being heavily
diagnosed with HIV (Skinta et al., 2015) The use of protease inhibitors by the young gay men to
indulge in unsafe sex is posing a serious challenge to professionals as to how they would be
counseled (Ncbi.nlm.nih.gov, 2017). There is an increased need for health professionals, as
evident from the growing incidences of problems of the homosexuals, for an advanced training
on cultural competency. In order to work effectively with gay men like Harvey Milk, an all
encompassing knowledge and training about varying range of problems related to his community
is vital.
Effective therapeutic approaches
Counseling a gay individual would require a thorough understanding of the person’s
background, his interests and dislikes, his problems and such. Counselors dealing with LGBT
people are often trained to cope with the challenges faced by them during counseling. Many
theorists and psychologists have developed various therapies to deal with LGBT issues.

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The LGBT-affirmative theory is a new therapy that is being combined with the Cognitive
Behavioral Therapy (CBT) to find better results in dealing with the LGBT people (Demner,
2016). In order to proceed with the explanation of LGB-affirmative cognitive behavioral therapy,
one has to understand the CBT first (Leichsenring et al., 2013).
Cognitive Behavioral Therapy can be said to the modified version of the Behavior
Therapy that is based solely on research findings. This type of therapy requires the patient to
achieve particular goals in a specific period. These goals include, change in habits, feeling, and
thinking, manner of dealing with medical and physical issues and so on. The reason why CBT
might prove to be effective while dealing particularly with gay men is that the therapists focus
more on their personal views rather than their personality traits. Cognitive Behavior Therapists
ensure replacement of a lifestyle that failed to work with a lifestyle that has more potential
(Zapor & Stuart, 2016). CBT also ensures that people develop the ability to control their lives.
CBT infuses a positive thinking in the clients who complain of stress and depression. It provides
a way for the clients to shift from negatively obsessed thoughts to positively dominated feeling.
One of CBT’s best advantages is its short-term treatment plan.
When it comes to gay men, they face wide-ranging issues that are not just confined to
neglect, discrimination or prejudice. They also go through internal problems such as lack of
commitment from the other partner, absence of acceptance from the family and a sense of guilt.
Therapists might be faced with the challenge to approach them and make them feel comfortable.
They will also have to understand that gay men too have similar issues as do others (Stenger &
Roulet, 2016).

10CASE STUDY ON CROSS CULTURAL COUNSELING COMPETENCIES
CBT can be said to be the best therapy to solve the issues of LGBT people. However, it is
important for the therapists to identify the underlying issue facing their clients and treat them
accordingly. In order to deal with LGBT people more sensitively, the LGBT Affirmative
Therapy has been introduced to affirm these people receive proper treatment (Proujansky &
Pachankis, 2014). With a view to treat the LGBT people with respect and dignity and resolve
their issues without hurting their sentiments, it was necessary to blend CBT and LGB-
Affirmative therapy. The LGB-Affirmative Cognitive Behavioral Therapy can be the best
therapeutic approach to work with gay men (Pachankis et al., 2015).
Conclusion
It can thus be said that the need for cross-cultural competency is evidently growing and
therapists around the world are applying various techniques to be competent enough. The above
essay while describing the character and plot of the chosen movie ‘Milk’ highlighted the areas
that therapists need to focus on while counseling gay men. The essay also provides an overview
of the central character of the movie, Harvey Milk and throws light on the aspects of his
character. In addition, his transition from being shameful and scared of his sexual orientation to
leading the fight for gay rights have been discussed. Hofstede’s cultural dimension theory has
been explained as the relevant theory appropriate to describe the movie. Disparities between the
LGBT community and the society persist today and many instances of prejudice and
discrimination are reported from all around the world. The depiction of discrimination and
prejudice for gay men and privileges enjoyed by non-LGBT people in the movie has been
highlighted in the essay as well. Further, the essay chose LGB-affirmative Cognitive Behavioral
Therapy as an effective therapeutic approach to work effectively with gay men. Although
theorists differ in their opinion as to what constitutes the best therapy for counseling LGBT

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people, all have agreed to the fact that being culturally competent is a must while dealing with
anyone belonging to minority culture or vulnerable group. Differences in the choice of best
therapeutic approach is also evident amongst experts but it is also true that unless a congenial
and complete therapy for the LGBT community is introduced, the CBT will continue to be the
perfect therapy to help them.

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References:
Baruth, L. G., & Manning, M. L. (2016). Multicultural counseling and psychotherapy: A lifespan
approach. Routledge.
Boroughs, M. S., Bedoya, C. A., O'cleirigh, C., & Safren, S. A. (2015). Toward defining,
measuring, and evaluating LGBT cultural competence for psychologists. Clinical
Psychology: Science and Practice, 22(2), 151-171.
Bradshaw, K., Dehlin, J. P., Crowell, K. A., Galliher, R. V., & Bradshaw, W. S. (2015). Sexual
orientation change efforts through psychotherapy for LGBQ individuals affiliated with
the Church of Jesus Christ of Latter-day Saints. Journal of sex & marital therapy, 41(4),
391-412.
Demner, A. R. (2016). Cognitive-Behavioral Therapy. Pocket Guide to Addiction Assessment
and Treatment, 259.
Donahue, D. M. (2014). Learning from Harvey Milk: the limits and opportunities of one hero to
teach about LGBTQ people and issues. The Social Studies, 105(1), 36-44.
Filip-Crawford, G., & Neuberg, S. L. (2016). Homosexuality and pro-gay ideology as
pathogens? Implications of a disease-spread lay model for understanding anti-gay
behaviors. Personality and social psychology review, 20(4), 332-364.
Goldblum, P., Pflum, S., Skinta, M., & Balsam, K. (2016). Psychotherapy With Lesbian, Gay,
and Bisexual Clients: Theory and Practice. Comprehensive Textbook of Psychotherapy:
Theory and Practice, 330.

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Herek, G. M. (2015). Beyond “homophobia”: Thinking more clearly about stigma, prejudice, and
sexual orientation. American Journal of Orthopsychiatry, 85(5S), S29.
Imdb.com. (2017). Milk (2008). IMDb. Retrieved 23 November 2017, from
http://www.imdb.com/title/tt1013753/
Kite, M. E., & Whitley Jr, B. E. (2016). Psychology of prejudice and discrimination. Psychology
Press.
Leichsenring, F., Salzer, S., Beutel, M. E., Herpertz, S., Hiller, W., Hoyer, J., ... & Ritter, V.
(2013). Psychodynamic therapy and cognitive-behavioral therapy in social anxiety
disorder: a multicenter randomized controlled trial. American Journal of
Psychiatry, 170(7), 759-767.
Lev, A. I. (2013). Transgender emergence: Therapeutic guidelines for working with gender-
variant people and their families. Routledge.
Martell, C. R. (2014). The Hybrid Case Study of" Adam": Perspectives from Behavioral
Activation and the Influence of Heteronormativity on LGB-Affirmative
Therapy. Pragmatic Case Studies in Psychotherapy, 10(2), 106-116.
Mazanec, J. A., Crotts, J. C., Gursoy, D., & Lu, L. (2015). Homogeneity versus heterogeneity of
cultural values: An item-response theoretical approach applying Hofstede's cultural
dimensions in a single nation. Tourism Management, 48, 299-304.
Mereish, E. H., O’Cleirigh, C., & Bradford, J. B. (2014). Interrelationships between LGBT-
based victimization, suicide, and substance use problems in a diverse sample of sexual
and gender minorities. Psychology, health & medicine, 19(1), 1-13.

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Meyer, I. H. (2016). The elusive promise of LGBT equality.
Ncbi.nlm.nih.gov. (2017). Retrieved 23 November 2017, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532395/
Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A., & Parsons, J. T. (2015).
LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A
randomized controlled trial of a transdiagnostic minority stress approach.
Proujansky, R. A., & Pachankis, J. E. (2014). Toward formulating evidence-based principles of
LGB-affirmative psychotherapy. Pragmatic case studies in psychotherapy: PCSP, 10(2),
117.
Reyna, C., Wetherell, G., Yantis, C., & Brandt, M. J. (2014). Attributions for sexual orientation
vs. stereotypes: how beliefs about value violations account for attribution effects on anti‐
gay discrimination. Journal of Applied Social Psychology, 44(4), 289-302.
Skinta, M. D., Lezama, M., Wells, G., & Dilley, J. W. (2015). Acceptance and compassion-based
group therapy to reduce HIV stigma. Cognitive and Behavioral Practice, 22(4), 481-490.
Stenger, S., & Roulet, T. J. (2016). Pride against prejudice? The stakes of concealment and
disclosure of a stigmatized identity for gay and lesbian auditors. Work, employment and
society, 0950017016682459.
Whitman, J. S., & Bidell, M. P. (2014). Affirmative lesbian, gay, and bisexual counselor
education and religious beliefs: How do we bridge the gap?. Journal of Counseling &
development, 92(2), 162-169.

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Zapor, H., & Stuart, G. L. (2016). Affirmative Cognitive Behavioral Therapy for a Male with
Depression Following Sexual Orientation Discrimination. Clinical Case Studies, 15(2),
143-156.