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CSJ   Blog.

The CSJ blog serves as a space for longer-form updates and informational posts
​in between CSJ newsletter publications. 

Gender-Affirming Care Ban Considerations

4/8/2024

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By Dr. Marcus D. Smith, PhD, LCPC + Karli Bigler, M.A., LPC + Ziling Ni (倪子凌 in Chinese) Counselor In Training from Northwestern University
  • Plume, 2023: The Attorney General of Missouri sought to place serious restrictions on access to gender affirming healthcare in the state from 4/27/23-2/2024.This emergency rule that is being issued would enforce numerous rules, steps, requirements, and barriers before being able to prescribe gender affirming hormone therapy.  Some major restrictions and concerns shall be discussed here. 
  • First, it is required that patients should have undergone at least 15 one-hour-long sessions of therapy over the course of 18 months before seeking and receiving gender affirming care. Not only does this enforce a longer time gap before the care that could be implemented, but it further prevents people who were previously without enough medical resources from getting services. Especially for transgender populations, they often face higher rates of unemployment and poverty, which makes it even more challenging for them to afford ongoing therapy (McKinsey & Company, 2021; National LGBTQ Task Force, 2013). According to a survey cited by McKinsey & Company, nearly 30 percent of transgender people in the United States are not in the workforce, and they are twice as likely to be unemployed compared to the cisgender population (2021). 
  • Moreover, the implementation of this policy hinders the opportunity to offer help in emergency contexts to relevant patients, giving rise to higher rates of deteriorating mental health and depression, or even suicidality. Previous studies have suggested a negative association between the age period of gender-affirming care initiation and the mental health status of transgender populations, with later initiation being associated with higher odds of past-year suicidal ideation and past-month severe psychological stress (Turban et al., 2022).  
  • Most importantly, implicit discrimination and “conscientious objection” could be invoked by this policy for suggesting that transgender and nonbinary people are experiencing an “illness” that should first be “treated” with therapies. And gender-affirming care shall only be a last resort. It further implies the cultural values that our society is complicit in providing reactionary care versus prevention.  
  • Similar implicit discrimination also arises in other major emergency rules that refrain patients from getting gender-affirming therapy. It is required that patients who would like to receive gender-affirming care must be screened for autism and complete an annual gender dysphoria assessment. They also must have gender dysphoria for at least 3 years for moving on to care receiving. With gender dysphoria being identified as a mental disorder in DSM, similar implications apply that gender-affirming care is only for people who have developed a mental illness. In lieu of delaying gender-affirming care, nonbinary and trans communities continue to experience suppression in their identity development.   
  • At the same time, to be able to receive treatment, trans patients appear as though they need to prove they aren’t experiencing “social contagion”. This once again denies the authenticity of the transgender and nonbinary populations and their legitimacy of receiving treatment by implying that they are probably just following the herd. This minimization continues to precipitate identify fragmentation (Velez & Beal-Spencer, 2018). According to research with gay black men in the black church in the Chicagoland area, this fragmentation of needs, prevention of access to services in turn impacts individual worth (Smith, 2021).  
  • And Even for a part of the patients who managed to get treatment, chronic psychological stress may arise as physicians must track the “adverse effects” of gender-affirming care for at least 15 years. All the restrictions systematically alienated, excluded, and discriminated against transgender and nonbinary populations and their legitimate right for autonomy over medical decision-making. 
 
  • Plume, 2023: Florida also issued Bill SB 254, adding new restrictions for individuals seeking gender affirming care, especially limiting youth’s access to care services, despite it being evidence based on organizations including WPATH, American Medical Association, American Academy of Pediatrics, APA, and others. The bill includes that 
  • Patients must be 18 years older or have received an informed consent from Florida Board of Medicine and Osteopathic medicine for receiving care. This would, again, pose increased mental health risks, such as depression, anxiety, and suicidal ideation, especially to transgender youth for restricting and delayed access to necessary care (Turban et al., 2022). Thus, it could worsen the significant healthcare disparities that transgender populations are already facing, leading them to the situation of being underserved and at a greater risk for poor mental health outcomes. 
 
  • ABC News, 2023:  https://abcnews.go.com/US/map-gender-affirming-care-targeted-us/story?id=97443087  
  • States including Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Iowa, Kentucky, Mississippi, Missouri, Oklahoma South Dakota, Tennessee and Utah and more have passed laws/policies that restrict gender affirming care for both youth and adults.  
  • These bills are only some of the 321 anti-LGBTQ bills introduced or debated in 2023 which surpasses a record 315 from 2022. This brings huge concern to the field of counseling and to the gender queer community as these initial steps could imply justification for further restrictions and decline in care. Thus, leaving the community and its providers with hypervigilance and despair.  
  • Gender affirming care includes puberty blockers, HRT (Hormone Replacement Therapy), social/legal transitions, surgeries, and more. Clinicians in these states have to grapple with the best care to give their clients as it is known that state laws most times contradict ethical codes of conduct in counseling. In these restrictive states, clinicians are also left with limited protection due to the risk of colleagues and third parties that align with the bands reporting their discovery of affirming care.   
 
  • UCLA, 2023:  https://williamsinstitute.law.ucla.edu/publications/bans-trans-youth-health-care/  
  • Williams Institute estimates that 156,500 trans youth live in 32 states where access to care has been restricted or is at risk of becoming so. These steps have clear ramifications in client care. Mental health agencies all over would be at risk of causing harm to this entire demographic. The counseling field should question whether it is truly upholding ethical standards in autonomy, beneficence, nonmaleficence, justice & fidelity. Specific ethical decision-making models of counseling encourage clinicians to process where their duty lies in providing care (Sileo & Kopala, 1993). We the bans in affirming care, clinicians have a duty not only to clients and self, but the field of counseling. Continuing to ignore the needs of gender queer communities could cause a decline in individuals seeking therapeutic support and maintaining a culture of clinicians complicit in being selective when advocacy and human rights should be acknowledged and honored.  
 
Recommendations: 
 
  • Training & Supervision:  
Educate yourself and stay up to date on gender affirming care bans in your state. These bans           impact gender expansive individuals, the healthcare community, and the Queer community. In supervision and personal therapy for practicing, clinicians shall be mindful to explore potential      implicit bias with queer communities. Implicit bias comes from three preferences (neutral, positive, or negative) (Tyner, 2019). Usually, implicit bias doesn’t favor our explicit or declared values (Kirwan Institute, 2018). Even if our bias towards queer communities is neutral that can lead to distance or disinterest. This disinterest then can lead to neglect which leads to potential harm concerning clinical environments. The parallel is that clinicians may not engage in advocacy for individual needs and engage in maltreatment with the assumptions this population presents with severe mental illness when in actuality these individuals are engaging in flexicurity (Berntson, 2008), which is a concept in developmental psychology that explains how minority clients aren’t failing in their development but in actuality they are successfully navigating systems that don’t have their best interest.  
 
  • Advocacy:  
 
Community & Federal 
Clinicians may want to partner with nonprofit organizations and explore community grants to enable free access to community care for Queer folk.  Communities could also create local LGBTQ+ support groups and other supporting organizations that provide information, resources, and emotional connections and support to Queer individuals and their families. 
 
Academia  
Support research efforts that demonstrate the efficacy and safety of gender-affirming      care. This data can be used to inform federal policies and challenge discriminatory practices. 
 
Clinician 
Clinicians should stay updated on the latest news and regulations of gender affirming care bans and consciously checking in with their clients about their current concerns or mental responses on related issues.  
 
Clinicians should actively collaborate with other professionals or providers who are    supporting gender affirming care, which involves referring clients to supportive medical            providers, legal experts, or community organizations, and have a resource list available for clients. Along the lines of additional professional development, clinicians should consider membership with organizations such as SAIGE (Society for Sexual, Affectional, Intersex, and Gender Expansive Identities) and WPATH (World Professional Association of Transgender Health) to increase knowledge and skills concerning standards of care.  
 
Clinicians may want to consider using integrative models to support clients externalize experiences of oppression as they are not innate. Also, these models would encourage clinicians to process      with queer clients how they can cope with discrimination outside of an individualistic lens. For example, The Multiple Minority Stress Model (Rich et al., 2020) explores how prejudice and inequity of a queer persons’ identity impact how they cope with psychological, biological and social challenges.    
 
Clinicians should create and provide an open and safe counseling environment for clients to discuss topics or concerns related to gender-affirming care. Besides ensuring the confidential nature of the conversations and the limits of confidentiality, simple cues of always asking and using a client’s pronouns and self-identified names would contribute to a sense of validation and safety for transgender and gender non-conforming clients. Also, clinicians could display visible signs of inclusivity in the workspace, including transgender pride flags or artworks or books related to authenticity. 
 
Trans & Binary Persons
 
Prioritize personal mental health by actively seeking support from therapists, clinicians, or community organizations specializing in gender identity issues. Stay informed about relevant mental and legal resources in local areas or those in more supportive states if possible. And educate oneself and practice self-care routines that promote emotional well-being. 
 
Find and join inside and outside supportive networks and groups, including friends, families, forums, online communities for Queer populations, and local LGBTQ+ groups, to strengthen ties, share personal experiences, and exchange resources. 
 
Engage in advocacy activities of awareness campaigns and educational events and share personal stories and experiences if comfortable to promote humanizing the issue and bringing it into public awareness. Reach out to community leaders, local representatives, or lawmakers to express concerns about the bans and the importance of gender-affirming care. 
 
Resources:  
  • Human Rights Campaign: 
  • https://www.hrc.org/resources/attacks-on-gender-affirming-care-by-state-map?utm_medium=ads&utm_source=GoogleSearch&utm_content=GACMap-General&utm_campaign=GoogleGrant&utm_source=GS&utm_medium=AD&utm_campaign=BPI-HRC-Grant&utm_content=657195962805&utm_term=anti%20trans%20bills&gclid=CjwKCAjwjYKjBhB5EiwAiFdSfqSLnyKTgDZ9j480F5_GuqLYvMzGi3TrKORORZ6H-UhZo663lYqoyRoCzcYQAvD_BwE  
  • UCLA Williams Institute: 
  • https://williamsinstitute.law.ucla.edu/publications/bans-trans-youth-health-care/  
  • SAIGE: 
  • https://saigecounseling.org/ 
  • WPATH  
  • https://www.wpath.org/soc8  

References: 
 
  • Kirwan Institute. (2018). Implicit Bias Module Series. Kirwan Institute for the study of race and ethnicity. https://kirwaninstitute.osu.edu/implicit-bias-training 
  • Sileo, F. J., & Kopala, M. (1993). An A-B-C-D-E worksheet for promoting beneficence when considering ethical issues. Counseling and Values, 37(2), 89–95. doi:10.1002/j.2161- 007X.1993.tb00800.x  
  • Smith, M. D. (2021). The Lived Experience of Gay Black Men in the Black Church Through the Lens of Intra-Racism and Toxic Masculinty (Order No. 28313965). Available from ProQuest Dissertations & Theses Global. (2494892169). http://turing.library.northwestern.edu/login?url=https://www.proquest.com/dissertations-theses/lived-experience-gay-black-men-church-through/docview/2494892169/se-2  
  • Tyner, A.R. (2019). Unconscious bias, implicit bias, and microaggressions: What can we do about them?  American Bar Association. https://www.americanbar.org/groups/gpsolo/publications/gp_solo/2019/july-august/unconscious-bias-implicit-bias-microaggressions-what-can-we-do-about-them/ 
  • Velez, G., Beal-Spencer, M. (2018) Phenomenology and Intersectionality: Using PVEST as a Frame for Adolescent Identity Formation Amid Intersecting Ecological Systems of Inequality   
  • https://www.nytimes.com/2023/04/15/upshot/bans-transgender-teenagers.html  
  • https://abcnews.go.com/US/map-gender-affirming-care-targeted-us/story?id=97443087 
  • https://getplume.co/blog/urgent-support-for-our-community-in-florida-sb254/ 
  • https://getplume.co/blog/no-cost-emergency-support-for-missouri/  
  • National LGBTQ Task Force. (2013, September 6). Transgender Workers at Greater Risk for Unemployment and Poverty. Retrieved November 1, 2023, from https://www.thetaskforce.org/transgender-workers-at-greater-risk-for-unemployment-and-poverty/  
  • McKinsey & Company. (2021, December 15). Transgender people twice as likely to be unemployed. Retrieved November 1, 2023, from https://www.mckinsey.com/  
  • Turban, J. L., King, D., Kobe, J., Reisner, S. L., & Keuroghlian, A. S. (2022). Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults. PLos one, 17(1), e0261039. 
 
 
 
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Community & Ecological Lens in Addressing Black Men's Suicidal Ideation

3/23/2023

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From 1991-2017, black adolescent suicide attempts rose 74%. In 2014, 80% of suicide deaths came from men in the Black community. One in ten black men experience incarceration before the age of 32. Students of color with mental health challenges or disability are more likely to experience adultification bias and receive punishment versus mental health support. Systemically, for many Black men this may imply that they do not have permission to express relational and emotional needs. Because of these realities, its imperative counselors challenge current attitudes and methodologies in reaching Black men in the counseling field. 
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Signs of Suicide: 
  1. ​Becoming withdrawn 
  2. Difficulties with sleep
  3. Difficulty in school
  4. Decline in work performance 
  5. Loss of interest in activities once enjoyed 
  6. Hopelessness 
  7. Substance Misuse 
  8. Preoccupation with death/morality
  9. Mood Swings 
  10. Obtaining Means/Plan for taking life 

Cultural & Historical Impact 
  • Archetypes:
    • In examining American history, Black men have a long relationship of being told how to exist based on the fear of threatening continued prosperity of white supremacy. Some tactics to control black men aimed at projecting the following archetypes: docile, aggressive and hypersexual.
    • Promoting this image that black men were unintelligent, lazy, and malleable leaves black families without a protector. Promoting the idea that Black men are aggressive, robs them of their humanity and stresses urgency to control their bodies from larger systems. Being hypersexualized again promotes the inhumanity of Black men and discourages any opportunity to see them beyond monetary value or entertainment.
    • Somehow over time, these archetypes have been distorted, repackaged and internalized in the Black community. As a result, it manifests in maintaining a perception of masculinity that was never obtainable, practiced or mastered by white supremacist in the first place.
    • Moreover, Black men may struggle in reframing or existing outside of this perception of masculinity projected onto them. Hence difficulties in counseling that may present itself with communicating emotions, tenderness and vulnerability.
  • Masking:
    •  In alignment with the archetypes of Black men in US history listed above, typically the only outlet for Black men to cope is substance use, work, and sex. These outlets are known as masking behaviors as they provide pseudo and brief escapes from stressors.
  • A limitation in counseling research includes the lack of psychoeducation on the continuum of drug use. This continuum of use for persons outside of counseling can be viewed as the development of use. Unfortunately, the encouragement in male culture continues to underestimate how even small consistent use changes brain functioning which can lead to severe cases of depression.
  • As we continue to undermine how embedded masking behaviors are promoted in culture for Black men, we may continue to see statistics rise in suicide attempts. Validating the use of masking behaviors as a form of protection while exploring alternative coping skills minus the emotional, social, and financial consequences can be a start at maintaining retention of Black men in counseling relationships. 
Academia & Community
Some Black men may discontinue services for the fear of being unable to relate based on seen/unseen identities of the clinician. We know representation matters, and not being able to see yourself in the counseling profession may create challenges for Black men to feel safe and begin their wellness journey. This issue challenges the gate keeping that occurs in academia and the need to recruit more heterosexual BIPOC men in counseling training programs. Currently, majority of literature on black men’s mental health come from Black women. While this research brings huge value to the community, receiving support from other black men may provide a corrective experience that they also can be held in community by other Black men as well. A testament to this power is displayed in dialogue of Black Men’s mental health among individuals like Chicago’s very own, Chris LeMark founder of Coffee Hip Hop & Mental Health, Chicago Rapper Vic Mensa, and  State Rep., Lamont Robinson of IL. 

Another missing component from Counseling research is the benefit in revamping Community Psychology Competencies. Its current limitations appear to miss the importance of building trustworthiness and access for marginalized communities. Part of the reason for climbing numbers in Black men suicide is because there isn’t adequate programming in neighborhoods Black men live in. Trying to persuade individuals to commute far from their neighborhoods and receive help can be problematic. Organizations like Sista Afya providing mental health to Black women in Chicago understand this mission. Lastly, there is some emphasis in the competencies on building working relationships with policy makers to support access. Perhaps community programing that is supported by state and grant funding can address the sustainability issue Black men face. This way, maintaining mental wellness is possible regardless of their financial standing.

Given these considerations, Black men may have improved opportunities to preemptively address their mental health needs. 

Resources:
  • American Association of Suicidology: www.suicidology.org
  • Brother You’re On My Mind Toolkit: https://www.nimhd.nih.gov/docs/byomm_fulltoolkit.pdf
  • Ring the Alarm: The Crisis of Black Youth Suicide in America: https://theactionalliance.org/resource/ring-alarm-crisis-black-youth-suicide-america
  • National Suicide Crisis Hotline : https://988lifeline.org/help-yourself/black-mental-health/

References:
Douglas, P. (n.d.). Black Boys, Black Men, and Suicide. Health.maryland.gov.  https://health.maryland.gov/bha/suicideprevention/Documents/Session%201A%20-%20BLACK%20BOYS,%20BLACK%20MEN,%20AND%20SUICIDE.pdf

Kendi, I. X. (2016). Stamped from the beginning: The definitive history of racist ideas in America. Nation Books.

Leblanc, D. (2022). Black indigenous and People of Color (BIPOC) Mental Health Fact Sheet.  Rtor.org. https://www.rtor.org/bipoc-mental-health-equity-fact-sheet/?gclid=CjwKCAjwiOCgBhAgEiwAjv5whAj_4l4ZIlJ_VzcTBZ7VYwuCzH2sC71JgsDJiLB-9CVe4STKep0ZTBoCIBkQAvD_BwE

Society for Community Research and Action (2023). Competencies for Community Psychology Practice. Communitypsychology.com. https://www.communitypsychology.com/competencies-for-community-psychology-practice/

- By Dr. Marcus D. Smith, PhD, LCPC 

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Celebrating Black Women's Leadership in ACA

2/28/2023

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     As we end Black History month and head into Women’s History Month, I would like to send a special shout out to all the girls that run the world. We have certainly come a long way which is evident in the current leadership of our parent organization, the American Counseling Association, and our divisions. This year, 17 out of the 19 divisions of ACA have women at the helm. Furthermore, I am proud to say that almost half of our divisions are currently led by Black women. So, on this last day of Black History Month join me in saying the names of the Black women who have led us and continue to lead our professions forward for the 2022-2023 year.




​Dr. Kimberly Frazier, President – American Counseling Association (ACA)
Dr. Natoya Haskins, President – Association for Counselor Education and Supervision (ACES)
Dr. Angela Coker, President – Association for Multicultural Counseling and Development (AMCD)
Dr. Ebony White, President – Counselors for Social Justice (CSJ)
Dr. Valerie Russell, President – American Rehabilitation Counseling Association  (ARCA)
Dr. Dannette Berksteiner, President – Military and Government Counseling Association (MGCA)
Dr. Lakeisha Matthews, President – National Career Development Association (NCDA)
Dr. Tamekia Bell, President – Society for Sexual Affectional Intersex and Gender Expansive Identities (SAIGE)
Dr. Martina Moore, President – International Association of Marriage and Family Counselors (IAMFC)



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In Memory of Mark Pope - CSJ Founder

2/7/2023

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It is with enormous personal sadness that I tell you that Mark Pope died last week. Mark had a long list of professional accomplishments, most notably as a founder and leading author in the area of cultural diversity issues in our field, especially GLBTQ career development.   He was president of ACA, NCDA, and many other organizations. He received the National Career Development Association’s highest honor, The Eminent Career Award, and ACA”s Humanitarian award. Mark was the Thomas Jefferson Professor and Curators’ Distinguished Professor Emeritus at the University of Missouri-St. Louis.

Mark described himself in an interview for Rich Feller, for the NCDA Newsletter, as, ‘A poor gay Cherokee with Spina Bifida from southeastern Missouri.” The accomplishments of this man, who had in some views, many strikes against him, are awesome. But more important to me was his unrelenting friendship. He found time for a loving relationship with his husband, Mario Carlos. He had many friends, mentored countless students and other new professionals, wrote prolifically, and ‘walked the talk.’ He was a founding member of CSJ, always came to the annual luncheon, and was a staunch supporter of social justice in everything he did. He was my friend. I shall miss him.

Jane Goodman - CSJ Retiree Representative
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A Message from CSJ President Dr. Ebony White - Black History Month

2/1/2023

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“We have come over a way that with tears have been watered, We have come, treading our path through the blood of the slaughtered, Out from the gloomy past, Till now we stand at last”
​
The above quote is a stanza from The Negro National Anthem written by James Weldon Johnson. I chose this stanza because to me, the African American story is one of overcoming and triumph. It is a story of pushing through and making a way out of no way. And while Black History month celebrates the joys and peaks of our story, we must also acknowledge the pain, and state of grief in which we often find ourselves on this soil and abroad. 
In the wake of the killing of Tyre Nichols, and the countless other lives brutally taken, we are reminded of the lack of value of Black lives. This is yet another tear in the wound we carry, that never has a chance to heal. The political agenda to remove African American studies from curriculum because it “lacks educational value” is yet another reminder of the lack of value placed on the contributions and histories of African Americans. It is evidence that supports our need to yell “Black Lives Matter.” This affirmation is not simply a slogan, but it is a reminder of our humanity and value to others and ourselves in juxtaposition to other lives. 

In spite of the continued atrocities and attacks on the African American spirit, I still have joy. I am full of joy today because I know this agenda to keep us down continues to be recycled because we won’t stay down. With each barrier that is built, we break it down, over and over again. We not only thrive in every field in which society has tried to marginalize us, but we have created joy within our own circles. We are trendsetters, gamechangers, and wavemakers. Yes we have pain, and we turn that pain into purpose, progress, and power. 

As president of Counselors for Social Justice, and as a Black woman in America, it is my mission to support the mental health and wellness of the Black community, and that extends to all oppressed communities that have been misrepresented, misdiagnosed, and made invisible in our mental healthcare system. All oppression is connected. Given our sociopolitical climate, mental health should be at the forefront of all of our minds. As providers,  ask yourself, “how am I contributing to the pathologizing of the communities I serve?” As counselor educators ask yourself, “how am I marginalizing the voices of my students of color?” And then make a commitment to educate yourself and take action, remembering that advocacy is core to the counselor identity. 

On this first day of Black History Month, I honor the tears that have been watered and the blood of the slaughtered, that makes it possible for me to stand at last. I hope you all join me in standing up for equity and justice in our profession and in our society. I hope you reject the comfort of silence and the posture of “just listening.” And to my fellow Black Americans, I leave you with a remix of a remix. Can’t nobody take our pride, can’t nobody hold us down. Oh no, we got to keep on moving!
Happy Black History Month #Black365 
 
Ebony White, PhD, LPC, NCC, ACS
President, Counselors for Social Justice
2021 Recipient of the ACA Dr. Judy Lewis Counselor for Social Justice Award
Commissioner, Anti-Racism Taskforce – American Counseling Association
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#CSJSpotlight - Emma Giordano

12/11/2022

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​Check out our newest #CSJSpotlight - Emma Giordano, MHC-LP! 

Emma is from Long Island, New York. She works as a DBT therapist in Manhattan and is Marketing & Communications Officer of CSJ. Emma developed a deep passion for social justice issues through her love of books, inspired by the #WeNeedDiverseBooks movement which highlighted the need for marginalized authors and their stories in young adult literature. As a counseling student, her graduate program left an impact with it’s strong focus on serving clients from minoritized populations and social justice advocacy. She says, “I joined CSJ to utilize my skills in social media to promote the essential work of this organization and continue spreading awareness for social injustices that continue to plague our profession and the world as a whole.”

Emma’s work for the CSJ Marketing & Communications committee involves designing flyers to promote CSJ-sponsored events, updating our website and social media accounts, collaborating with our blog writers to create social posts on social justice issues, and handling communication between CSJ members and committees. Her goals for CSJ include expanding our Marketing & Communications committee (which we are currently accepting new members for! Check out our recent post on how to join) and continuing to create engaging content that highlights the importance of justice, advocacy, and awareness.

When Emma is not working for CSJ, you can find her, exploring New York City with friends, taking dance clases, devouring the next book from her favorite authors, and making YouTube videos sharing her thoughts on her recent reads.

Give it up for Emma and the amazing work she is doing for CSJ’s online presence!

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Attending to LGBTQIA+ Communities: Response to Colorado Springs

12/9/2022

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In the month of November during a time of gratitude with loved ones, a tragic occurrence disrupted the LGBTQ community in Central Colorado. Currently, it appears many news platforms search for blame and motive of the perpetrator. There are even opportunities to see the good in our society by highlighting those that came to rescue. Other platforms unfortunately seek the opportunity to have discussions for political division. But small in number, are there conversations that explore how LGBTQIA+ communities & providers are held after horrific events such as this one. As a result, this piece will serve as a brief list of responses for those in the counseling field who support current survivors of violence in the LGBTQIA+ community.

According to USA today, there have been 526 mass shootings since 2006 (USA Today, 2022). & yet, it is unclear how many of these shootings have been directed to queer communities and the possibility of those being underreported.  Needless to say, we have an issue in US society. Until macro change is initiated in gun control and LGBTQIA+ protection, it is important clinicians, community organizers, researchers, and counselor educators remain creative & curious how to hold space for LGBTQIA+ communities. Here are some beginning steps to start this holding process below:

Clinicians
  • Approach:
    • Validation & Acknowledgement of grief. There is more emerging research on the benefit of grief work to navigate multilayers of loss LGBTQIA+ communities experience.
    • Encourage tenderness as they may re-experience trauma. This might involve practicing self-compassion in addition to self-soothing and mindfulness techniques following session.
    • Cultivating a tribe. Exploring with clients current and new healthy relationships that are supportive and avoid making them feel like a burden. It also supports maintaining community vs. getting stuck in isolation.
    • Be mindful of sleep hygiene. Exploring methods to maintain good sleep can support an individuals’ ability manage fatigue and decrease vigilance.
    • Staying Informed. Explore with clients to find a balance of being informed while not being consumed by the news.  
  • Education: Click the link for a guide of literature clinicians working with LGBTQIA+ communities would want to have.
    ​
Community Organizers
  • Support Groups & Community Events: Organizations such as BEAM (Black Emotional And Mental Health Collective) do a wonderful job at providing peer support, training resources, and events that facilitate meditation and regulation practices. Ongoing funding for initiatives like this across the US for LGBTQIA+ folks can be invaluable.
  • Support Groups for LGBTQ mental health providers: Wellness in providers can lead to effective care and client satisfaction for LGBTQIA+ communities. Although it shouldn’t be assumed all clinicians have great health coverage, there is a benefit of having resources for free collective healing.

Researchers
  • Researcher & Community Matching: Literature states research became a site of collecting voices, experiences, and knowledge that were then either appropriated or showcased (Smith, 2012). Because of this, there is value in ensuring primary investigators of research identify with the community being explored & have awareness of their own positioning.
  •  Decolonize Research Methodologies: According to Tuck & Yang (2014), decolonization is not a metaphor. But instead, it is the act of reparation and reconnecting to land. In this case, land is synonymous with lived experiences. As a result, research methods would take steps to adjust traditional methodologies and analyses that honor the authentic voices and needs of LGBTQIA+ communities “as is” without filtering through research teams.

Counselor Educators
  • Healing Spaces for Students: Allow collective healing in class instruction or affinity circles so students directly and indirectly affected by the events can explore its impact.  
  • Healing Spaces for Educators: Based on what is known in the literature about vicarious trauma, space for educators is just as impactful as it can be for students. Counseling ethics on self-care would also support the modeling educators can provide for students in training.
  • Social Justice Curriculum:  By incorporating a social justice framework, students can be challenged to practice effective assessment skills for LGBTQIA+ needs versus being guided on individual biases and assumptions.
  • Program Effectiveness: Consistently assess program responsiveness & implementation of LGBTQIA+ experiences in term evaluations for students
 
In closing, below you will find additional resources those in the counseling field can use in support of LGBTQIA+ survivors of violence.

Additional Resources
  • The Trevor Project Crisis Helpline | 24 Hour Telephone (866) 488-7386
  • Trans Lifeline | (877) 565-8860
  • Blackline | (800) 604-5841 | 24/7 Text of Call Hotline: a space for peer support, counseling witnessing and affirming the lived experiences to folxs who are most impacted by systematic oppression with an LGBTQ+ Black Femme Lens. 
  • Apply for Mental Health Funding in 2023 | Applicants can receive financial assistance to mental health services
 
By Dr. Marcus D. Smith, PhD, LCPC
 
References

National Queer & Trans Therapist of Color Network. (2022, November 29). Radical Syllabus. NQTTCN. https://nqttcn.com/en/2021/05/03/radical-syllabus/

Smith. (2012). Decolonizing Methodologies : Research and Indigenous Peoples (2nd ed.). Zed Books.
Tuck, E. and K.W. Yang. (2014b). ‘R-Words: Refusing Research’ in D. Paris and M. T. Winn (Eds.) Humanizing Research: Decolonizing Qualitative Inquiry with youth and Communities. Thousand Oakes, CA: Sage Publications.

USA Today (2022, August 18). Mass killing database: Revealing trends, details and anguish of every US event since 2006. https://www.usatoday.com/in-depth/graphics/2022/08/18/mass-killings-database-us-events-since-2006/9705311002/

Wood, A., & Conley, A. (2014). Loss of religious or spiritual identities among the LGBT
population. Counseling and Values, 59(1), 95-111. doi:10.1002/j.2161007X.2014.00044.x 

2 Comments

CSJ Celebrates Veterans Day - Veterans Mental Health & Treatment

11/11/2022

2 Comments

 
 November 11 is a day that we take to remember and honor all veterans. These individuals have demonstrated their love for their country by their willingness to serve.

As we reflect on their sacrifices, let us take a moment to reflect on our overall wellbeing. The general well-being of us as a collective can influence our quality of life. Quality of life can be represented by various factors that are unique to everyone. However, everyone is tasked with identifying ways to improve their own quality of life, which might include addressing obstacles that can create roadblocks to obtaining an improved quality of life. Some of these obstacles can be related to mental health.

For veterans, who are often more susceptible to negative mental health outcomes due to exposure to distressing events among other factors, face challenges that need to be addressed effectively by health providers. These health challenges can occur simultaneously and share the same risk factors. The term comorbidity is utilized to describe this phenomenon.

Health challenges that are commonly faced by veteran populations can include the following:
1. Substance abuse
2. Posttraumatic stress disorder
3. Depression
4. Suicide
5. Traumatic brain injury

The experiences of veterans consisting of significant transitional periods can create additional challenges towards improved quality of life. Veterans often experience a period of adjustment to society. This process of reintegration into the community presents can create challenges for veterans in reconnecting with loved ones, finding employment, and returning to school (Institute of Medicine, 2014). Mental health related symptoms can also make it harder for veterans to reintegrate into society.

Families of service members also undergo a period of adjustment post-deployment. For example, household responsibilities or parental roles might need to be readjusted when service members return home. An effective tool that can help ease this transition period includes open communication and reciprocal support (Institute of Medicine, 2014).

It’s important for veterans to seek help as necessary to help them navigate these challenges and in being equipped with tools to better manage mental health symptoms. Therapy can be the first step or tool that veterans can access and utilize to help them effectively address these challenges.

The following include evidence-based sources of support for veterans:
  1. Engagement of peers in treatment
  2. Mindfulness-Based Stress Reduction (MBSR)
  3. Strong social support
  4. Psychological protective factors, such as resilience
  5. Exposure therapy
  6. Pharmacotherapy
  7. Suicide crisis lines
  8. Comprehensive suicide programs
  9. The Screening, Brief Intervention and Referral to Treatment (SBIRT) model

Therapy delivery can be modified to fit the needs of the individual in need of services while
considering their accessibility as well. Face-to-face therapy is a common therapeutic treatment option. However, that option may not be cost effective (e.g., traveling) and people may be more heightened to stigma of receiving therapy. Another alternative to in person treatment include virtual visits.

Telehealth includes phone, texts, mobile applications, and video conference platforms. A study by Blonigen and colleagues (2021) evaluating the role of peers in facilitating the participation of veterans' use of a mobile app 'Stand Down' to help prevent alcohol use found that accountability and support enhanced patient access to care and progress towards less drinking. It is important to note that each modality has its pros and cons. However, the goal is to engage the individual in a treatment modality that will be most suitable for them.
In addition, there is a need for health providers to be sufficiently trained to meet the unique needs of veterans and their families. Clinical practice guidelines from the Department of Defense can help clinicians with suicide risk assessments, determination of appropriate care settings, therapeutic interventions for co-occurring health challenges, and continuity of care such as follow-up visits (Institute of Medicine, 2014).

Support for veteran families is another important consideration, as deployment can be a predictor of negative outcomes such as intimate partner violence and marital conflict, especially when service members show poor psychological symptoms (Institute of Medicine, 2014). Another factor that can impact overall well-being include grief/loss. Death of service members increases the likelihood that families experience negative psychological symptoms themselves.

Additionally, children of service members can become susceptible to internalizing and
externalizing problems as a result of frequent relocation and child maltreatment (Institute of Medicine, 2014). Therefore, families of service members can benefit from resources to help them better understand ways to help veterans and use these resources for themselves to navigate their own unique challenges and experiences.

The following is a list of resources that can be useful to loved ones of veterans and possibly
veterans as well:

• Military Pathways: free psychological health assessments for family members and veteran personnel
• Battle mind (Resilience training): focuses on teaching mental toughness with regard to deployment and transitioning to home life 
• Yellow Ribbon Reintegration Program: helps reserve component service members and their families with obtaining employment and health services
• Wounded Warrior Programs: helps those injured receive appropriate care
• Family-Centered Resiliency: helps military families cope with increased
challenges related to deployment
  • https://focusproject.org
  • https://deploymentpsych.org/content/building-military-family-resilience
  • https://www.militaryonesource.mil/family-relationships/family-life/keeping-your-family-strong/keeping-your-family-strong-essentials/

By Rumbidzai Mushunje

References:
Blonigen, D. M., Harris-Olenak, B., Kuhn, E., Timko, C., Humphreys, K., Smith, J. S., & Dulin,
P. (2021). Using peers to increase veterans’ engagement in a smartphone application for
unhealthy alcohol use: A pilot study of acceptability and utility. Psychology of Addictive
Behaviors, 35(7), 829–839. https://doi.org/10.1037/adb0000598

Institute of Medicine. (2014). Understanding psychological health in the military. In L. A.
Denning, M. Meisnere, & K. E. Warner (Eds.), Preventing psychological disorders in
service members and their families: An assessment of programs. The National Academies
Press. https:// doi.org/10.17226/18597
2 Comments

#CSJSpotlight - Dr. Rachael D. Goodman

10/19/2022

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Check out our next #CSJSpotlight - Dr. Rachael D. Goodman!

Dr. Rachael D. Goodman is an LPC based in the Washington DC area and has a PhD in counseling. She is the CSJ Representative to the ACA Governing Council as well as a Past President of CSJ. Dr. Goodman says she is a member of CSJ because “I believe social justice is at the core of what we do as counselors. We cannot separate our experiences and the experiences of our clients from the contexts in which we are situated. In particular, I study trauma and resilience, and these experiences have to be understood within the social context. Social injustices, like racism and oppression,
can create or exacerbate harms. ​We have to do all we 
Photo of Dr. Rachael D. Goodman smiling with dark brown hair and brown eyes. She is wearing a blue shirt and a silver circular chain necklace and standing in front of a marble sculpture. Text reads
we can to not only ameliorate these harms, but also prevent them. We can do that by taking a collaborative approach that infuses the principles of social justice, liberation, decolonization, intersectionality, trauma-informed care, and culture-centered healing. I am passionate about helping push our field in this direction -- particularly for folks with privilege, like myself, who may not have awareness or understanding of these issues. CSJ is a way to build a community of counselors who can support each other in doing this work; having a professional “home” like CSJ is incredibly important both to be effective and also to sustain ourselves as we try to effect change in our profession, our communities, and our world.
​
Regarding her role on the Governing council, Dr. Goodman states “The Governing Council has the fiduciary duty to protect the organization's [ACA’s] resources and ensure that it is well positioned to meet its strategic goals and address issues that face the counseling profession.”  While the professional staff and CEO of ACA are responsible for the operations of the organization, members of GC help oversee these efforts, with a particular focus on developing a strategic plan and identifying areas of concerns to address for our members and our profession, as well as attending the use of resources. 

Dr. Goodman goals for CSJ are to be an active participant in helping support ACA, its goals, and its members. From a social justice perspective, for example, she is interested in ensuring that we examine the ways in which we might be benefiting some members or communities more than others, and take steps to remedy those disparities. She wants to understand what counselors and communities need to be supported – and how we can do so in equitable and justice-orientated ways that truly embody the values of our profession.

When Dr. Goodman is not working for CSJ, she loves reading, being outside, and doing anything on the water, but these days, she is spending a lot of time running after her 4-year-old and our new rescue dog (a pandemic puppy)!

We are so grateful to have Dr. Goodman as a past CSJ president and our representative on ACA’s Governing Council!
​can to not only ameliorate these harms, but also prevent them. We can do that by taking a collaborative approach that infuses the principles of social justice, liberation, decolonization, intersectionality, trauma-informed care, and culture-centered healing. I am passionate about helping push our field in this direction -- particularly for folks with privilege, like myself, who may not have awareness or understanding of these issues. CSJ is a way to build a community of counselors who can support each other in doing this work; having a professional “home” like CSJ is incredibly important both to be effective and also to sustain ourselves as we try to effect change in our profession, our communities, and our world.

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Hispanic American Game Changers You Should Know About

10/14/2022

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September 15-October 15 is Hispanic Heritage Month! We use this month to honor and celebrate the rich culture of Hispanic-Americans as well as recognizing the contributions of notable Hispanic Americans to American history. From politicians, civil rights leaders, artists, and more, check out these Hispanic-Americans who have showcased CSJ’s mission of social justice and advocacy in the last century!
Image background: A wavy-lined grid with a navy blue background, text on a ripped strip of white paper B&W Photo of Justice Sonia Sotomayer smiling with dark, short curly hair in judge’s robe Text: Justice Sonia Sotomayor First Hispanic Supreme Court Justice Notable rulings include support of the Affordable Care Act & Obergefell v. Hodges which legalized same-sex marriage in all 50 states
Justice Sonia Sotomayor
  • First Hispanic Supreme Court Justice
  • Notable rulings include support of the Affordable Care Act & Obergefell v. Hodges which legalized same-sex marriage in all 50 states
​
Image background: A wavy-lined grid with a navy blue background, text on a ripped strip of white paper B&W photo of Dolores Huerta smiling with short, dark curly hair wearing dreamcatcher earrings and a geometric pattern shirt Text: Dolores Huerta American Labor Leader & Civil Rights Activist Co-Founder of the United Farm Workers of America Campaigned for Latina representation in legislation and women's rightsPicture
Dolores Huerta
  • American Labor Leader & Civil Rights Activist
  • Co-Founder of the United Farm Workers of America
  • Campaigned for Latina representation in legislation and women's rights
Image background: A wavy-lined grid with a navy blue background, text on a ripped strip of white paper B&W phot of Sylvia Rivera with shoulder-length medium-tone hair wearing a bandana with a white buttoned shirt open over a sweater Text: Sylvia Rivera American Gay Liberation & Trans Rights Activist One of the inciters of the Stonewall Riots Founding member of the Gay Liberation Front, the Gay Activists Alliance, & STAR to support homeless trans youthPicture
Sylvia Rivera
  • American Gay Liberation & Trans Rights Activist
  • One of the inciters of the Stonewall Riots
  • Founding member of the Gay Liberation Front, the Gay Activists Alliance, & STAR to support homeless trans youth​
​
​

Image background: A wavy-lined grid with a navy blue background, text on a ripped strip of white paper B&W phot of Lizzie Velasquez smiling with wavy medium-tone hair and a geometric pattern shirt Text: Lizzie Velasquez Motivational Speaker and Disability/Rare Disease Advocate Campaigns for anti-bullying Authored three books, has spoken at over 200 workshops, at her Tedx talk has over 12,000,000 viewsPicture
Lizzie Velasquez
  • Motivational Speaker and Disability/
    ​
    Rare Disease Advocate
  • Campaigns for anti-bullying
  • Authored three books, has spoken at over 200 workshops, at her Tedx talk has over 12,000,000 views
Image background: A wavy-lined grid with a navy blue background, text on a ripped strip of white paper B&W Photo of Cesar Chavez with short dark hair wearing a plaid shirt and peacoat, speaking into a microphone Text: Cesar Chavez American Labor Leader & Civil Rights Activist Co-Founder of the United Farm Workers of America Organized non-violent protests campaigning for livable wages & humane working conditionsPicture
Cesar Chavez
  • American Labor Leader & Civil Rights Activist
  • Co-Founder of the United Farm Workers of America
  • Organized non-violent protests campaigning for livable wages & humane working conditions
Image background: A wavy-lined grid with a navy blue background, text on a ripped strip of white paper B&W Photo of Sylvia Mendez smiling with short dark hair wearing a white blazer and dark shirt Text: Sylvia Mendez Civil Rights Activist Catalyst for Mendez v. Westminster which was monumental in ending U.S. segregation Awarded Presidential Medal of Freedom in 2011
Sylvia Mendez
  • Civil Rights Activist
  • Catalyst for Mendez v. Westminster which was monumental in ending U.S. segregation
  • Awarded Presidential Medal of Freedom in 2011
​
Image background: A wavy-lined grid with a navy blue background, text on a ripped strip of white paper B&W photo of Alexandria Ocasio-Cortez smiling with long, straight dark hair wearing a white collared button shirt with a microphone clipped on her chest Text: Alexandria Ocasio-Cortez Youngest Woman Ever Elected into the United States Congress Proposed the Green New Deal to address climate & economic inequality  Advocates for issues related to immigration, environmentalism, labor rights, & accessible healthcarePicture
Alexandria Ocasio-Cortez
  • Youngest Woman Ever Elected into the United States Congress
  • Proposed the Green New Deal to address climate & economic inequality 
  • Advocates for issues related to immigration, environmentalism, labor rights, & accessible healthcare
Image background: A wavy-lined grid with a navy blue background, text on a ripped strip of white paper Photo of Juan Felipe Herrara smiling with rectangular glasses and a grey mustache. He is wearing a fedora and a camouflage polo. Text: Juan Felipe Herrara First Latino United States Poet Laureate  & past Chancellor of the Academy of American Poets Authored 30 books for adults and children about immigration, Chicano identity, and social justicePicture
Juan Felipe Herrara
  • First Latino United States Poet Laureate  & past Chancellor of the Academy of American Poets
  • Authored 30 books for adults and children about immigration, Chicano identity, and social justice

Image background: A wavy-lined grid with a navy blue background, text on a ripped strip of white paper B&W Photo of Celia Cruz smiling with long dark hair and bangs wearing a white headband, polkadot dress, white choker necklace, and dangling earrings. She is holding a microphone at her chest level. Text: Celia Cruz Afro-Latina Salsa Singer named
Celia Cruz
  • Afro-Latina Salsa Singer named
    ​"The Queen of Salsa"
  • Sang with La Sonora Matancera to renounce Fidel Castro's regime, which resulted in the orchestra being banned from Cuba
  • Received three Grammys and four Latin Grammys
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