For many years now, speech-language pathologists and audiologists in a variety of settings—including hospitals, public schools, private practice, and universities—have been working to create more sensitive environments for and provide appropriate services to clients, family members, colleagues, and students of diverse backgrounds. We have made great strides in becoming more culturally competent in terms of race, gender, ethnicity, culture, religion, language, and mental and physical abilities.
But there is more to be done. We need to continue to challenge ourselves and our colleagues to be fully inclusive and improve our cultural competence regarding sexual minorities as well. To accomplish this, we need to know who these individuals are. Sexual minorities include individuals who identify as gay, lesbian, bisexual, transgendered, or questioning (GLBT). They may also include children of GLBT parents, siblings of GLBT individuals, and even individuals perceived to be GLBT.
It may be helpful to define some terms so that SLPs and audiologists have a level of comfort and understanding that will facilitate cultural competence.
- Bisexual—an individual who is physically, emotionally, cognitively, romantically, and spiritually drawn to members of both sexes
- Coming out—the process of claiming an identity as a sexual minority to oneself and others
- Drag queen/drag king—an individual who dresses in opposite-sex clothes for entertainment
- Gay—a colloquial term for homosexuals of either sex, though more commonly used to refer to men
- Homosexual—an individual who is physically, emotionally, cognitively, romantically, and spiritually drawn to members of the same sex
- Heterosexual—an individual who is physically, emotionally, cognitively, romantically, and spiritually drawn to members of the opposite sex
- Lesbian—female homosexual
- Queer—a controversial term for a homosexual. In the 1950s, a particularly derogatory term. In the 1990s, commonly adopted by academicians and young people. Young people prefer the term because it is less confining.
- Questioning—a term describing a person unsure of and exploring his or her sexual orientation
- Transgendered—an individual whose psychological gender identity is in conflict with the anatomical body into which he or she was born
- Transsexual—another term for transgender; sometimes used for an individual who has undergone hormonal and surgical correction
- Transvestite—an individual who dresses in opposite-sex clothing to derive sexual gratification. Most often these individuals are married men who identify as heterosexual.
Expressions of homophobia—"fear, disgust, anger, discomfort, and aversion that people experience in dealing with gay people" (Hudson and Ricketts; see resources box on page 10)—can include unspoken negative thoughts regarding sexual minorities; the use of anti-gay slurs and jokes; and violence against gay, lesbian, bisexual, and transgendered people.
Other possible targets of these expressions of homophobia include straight people perceived to be a sexual minority as well as the children of gay, lesbian, bisexual, or transgendered parents.
Homophobia is prominent among adolescent males in our society. However, homophobia can be experienced/exhibited by anyone regardless of gender, age, or sexual orientation.
This "belief system that values heterosexuality as superior to and/or more ‘natural' than homosexuality" (Morin; see resources) is a more subtle and pervasive form of homophobia. It includes the assumption that all people are heterosexual and that the possibility of being other than straight is denied or rejected. It is the idea that everyone is or should be heterosexual/straight.
Heterosexism works to make sexual minorities invisible in subtle—but no less harmful—ways than homophobia. Heterosexism operates on the societal level, and homophobia operates at the individual level.
Strategies for Clinicians
Implementing strategies for improving service provision to sexual minorities should begin with an assessment of the environment. Based on that assessment, it will be important to employ strategies to create a clinical or academic environment that is open, affirming, and inclusive. This can be accomplished through policy changes and training of employees and students.
In order to assess the environment, it may be helpful to conduct a climate study. The study should include an examination of forms, materials, curriculum, and policies for any heterosexist or homophobic language. For example, in the early 1990s the Gallaudet Hearing and Speech Clinic removed the terms "Mother" and "Father" from the questionnaire for children coming for assessments. These terms were replaced with "Parent/Guardian 1" and "Parent/Guardian 2." These terms were determined to be more inclusive for a variety of family configurations, including same-sex parents, foster parents, guardians, and single parents.
Another important step of the climate study is evaluating perceptions, attitudes, beliefs, and biases. This should be conducted at the institutional, departmental, and personal levels. A plan should be in place to provide training to encourage staff to challenge their beliefs and to create a more gender/orientation-neutral environment. It is essential for the administration to give sexual minorities the same status as other minority groups in policy and practice. This also helps to create an environment that is more amenable to students, staff, clients, and family members who are GLBT.
The institution should provide the same support to GLBT clients, staff, and students as they do to other minorities. Although a top-down approach is often helpful, sometimes the grassroots efforts of GLBT people and their allies make these important changes happen.
Strategies and action steps are essential as follow-ups to self-studies. Strategies and action steps can take on a variety of forms. For example, it is often helpful to form gay-straight alliances and to establish safe zones. Alliances allow people to come together and support one another regardless of their orientation, creating an atmosphere of acceptance and fostering dialogue. Safe zones are appearing at schools, elementary-level through university, throughout the country. A safe zone is designated with a sticker or poster that indicates that the person who has posted it is understanding, supportive, and trustworthy regarding GLBT issues.
Inclusion of GLBT topics in multicultural education initiatives benefits everyone by creating greater understanding and providing institutional support. It is important to determine developmentally appropriate ways of including GLBT topics in the curriculum. A wonderful example and resource is It's Elementary. This is a program for including GLBT topics in elementary school curricula—although, interestingly, often young children do not need as much teaching as older learners. For this reason, it is important to challenge teachers and faculty at all levels of education. Providing in-service training to faculty, staff, and employees can help to educate the educators and the educated.
Another strategy for improving cultural competence is recognizing and addressing any impact that being GLBT may have on communication, employment, or the pursuit of education. For some GLBT individuals there may be—or may appear to be—little impact; for others, particularly where local governments offer no protection, this may be very significant.
Even where being GLBT may have no apparent effect on any of these areas, it would be neglectful and insensitive to ignore the possibility of an effect. For example, an undergraduate or graduate student may struggle financially because she has been cut off from her family for coming out. An employee in a public school system may fear for his job if the community becomes aware of his sexual orientation. Or a transgendered client may be reluctant to pursue voice treatment because of concerns about how the clinic will respond to her needs.
A final strategy is developing your library and resource materials to ensure a GLBT-friendly environment and provide necessary and helpful information. If brochures, books, and resource materials are present, a message is sent to everyone who uses the space that GLBT people are valued there and that any discrimination will not be tolerated. In addition, it can provide important and life-saving information to individuals who need it.
The above are simply some of the practical steps we can take as professionals to increase our cultural competence and to make the environments in which we work and provide services that are more GLBT-friendly. The most important steps, however, are recognizing the need to do this and making the commitment to achieving it. So, remember to educate yourself, increase your comfort level and cultural competence, learn and use the appropriate vocabulary, and employ a variety of strategies to enhance service delivery.