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Counselor Competence for Treating LGBT Clients

The Coming Out Process for Lesbians and Gay Men

1. The coming out process for many gay and lesbian people is a way of transforming a negative self-identity into a positive identity.

A. True

B. False


2. Bisexual, transgender, gay, and lesbian coming out processes are parallel.

A. True

B. False


3. Most identity stage models suggest that the first stage involves:

A. Considerable anxiety as people deal with their denial about their sexuality.

B. Denial and confusion regarding one’s feelings of attraction and sense of self.

C. An increased sense of alienation and isolation.

D. Identifying themselves as bisexual before identifying themselves as gay or lesbian.


4. At which stage of treatment should the counselor suggest attendance at gay- or lesbian-affiliated AA or Narcotics Anonymous (NA) meetings?

A. Identity Confusion

B. Identity Comparison

C. Identity Tolerance

D. Any of the above


5. The length of time that a person considers themselves gay or lesbian predicts whether they have worked through the process of claiming a positive gay or lesbian identity and of feeling good about themselves as gay men or lesbians.

A. True

B. False


Families of Origin and Families of Choice

6. Counselors need to review the client’s role in his or her family of origin, because unresolved issues with the family of origin can act as emotional triggers to a relapse.

A. True

B. False


7. In order to work effectively with LGBT clients, substance abuse treatment counselors need to have awareness of:

A. The internal and external problems of same-sex couples.

B. The diversity and variety of relationships in the LGBT community.

C. The lack of universal terminology with regard to significant others in the LGBT community.

D. All of the above.


Clinical Issues With Lesbians

8. Most lesbians:

A. Hate men.

B. Are afraid of men.

C. Want to be men.

D. None of the above.


9. Lesbians form committed relationships instantly and stay together as long as they possibly can.

A. True

B. False


10. Lesbians can change their sexual behavior.

A. True

B. False


11. Which of the following patterns is true?

A. Drinking, heavy drinking, and problem drinking among lesbians show less decline with age than among heterosexual women.

B. More lesbians than heterosexual women abstain from alcohol.

C. Rates of reported alcohol problems are lower for lesbians than for heterosexual women.

D. All of the above are true.


12. Which of the following should be the primary goal of treatment?

A. Empowering the client

B. Honoring diversity

C. Using nonjudgemental language

D. Avoiding labeling


Clinical Issues With Gay Male Clients

13. The role models for many young gay people just coming out are often gay people using alcohol and drugs at bars or parties.

A. True

B. False


14. The “symptom-relieving” aspects of alcohol and drugs do which of the following for gay men?

A. Help fight the effects of homophobia.

B. Allow “forbidden behavior.”

C. Alleviate somewhat the familiar experiences of disconnection and isolation.

D. All of the above.


15. Providers need to know that _____ may be crucial to recovery from substance abuse.

A. No longer feeling alone, misunderstood, or unique

B. Self-acceptance of one’s sexual orientation

C. Overcoming self-deception and the development of a false self

D. All of the above


16. Which of the following are the best advertised and most identifiable elements of gay social life?

A. Gay bars

B. Gay coffee shops

C. Gay bookstores

D. All of the above


17. Experimentation with drugs and sex is likely to be part of the development of gay youth even if they are accepted by family and self-accepting.

A. True

B. False


18. Which of the following is true?

A. It is a false assumption that almost every gay man has lost friends or lovers to AIDS.

B. An incorrect belief is that almost every gay man knows someone who is HIV infected.

C. Gay men who have risky sex and know about precautions for safer sex report that they are much more likely to have risky sex after alcohol or drug use.

D. All of the above are true.


Clinical Issues With Bisexuals

19. Numerous studies have found that self-identified bisexuals have been found to possess low self-esteem, low self-confidence, and a negative self-concept dependent on social norms.

A. True

B. False


20. Recovery from substance abuse and addiction for bisexuals will be facilitated by empathetic, nonjudgmental counselors who support clients in:

A. Becoming more self-accepting.

B. Healing from the shame caused by heterosexism and internalized biphobia.

C. Referring bisexual clients to either straight or gay / lesbian 12-step fellowships, or both, depending on what is more appropriate to their recovery needs.

D. All of the above.


Clinical Issues with Transgender Individuals

21. The substance abuse counselor has an opportunity while helping transgender individuals with their substance abuse issues to refer them to resources to help them cope with their transgender issues.

A. True

B. False


22. The study conducted by the San Francisco Department of Public Health AIDS office found that there is a(n) _____ lifetime rate of intravenous drug use among MTF transgender individuals.

A. 18%

B. 34%

C. 48%

D. 62%


23. Substance use treatment does not influence people’s HIV risk behavior.

A. True

B. False


24. Violence and discrimination have been found to have negative effects upon gay, lesbian, and bisexual youth, encouraging:

A. Substance abuse

B. Prostitution

C. Suicide

D. All of the above


25. Because all assessments should be designed to elicit the full spectrum of relevant information, it is appropriate to ask each client about all of following, except for:

A. Their sexuality.

B. Their gender identity.

C. Their gender issues as the root cause of the addiction problem.

D. Their comfort with his or her sex role.


26. When inquiring about the client’s substance use, counselors need to recognize that:

A. Substance abuse among transgender people can involve multiple patterns of use, misuse, and abuse.

B. Multiple causal variables combine to produce problems.

C. Treatment should be multimodal to correspond to a client’s particular pattern of abuse.

D. All of the above.


27. It is important that both the clinician and the client understand that _____ therapy can affect mood, especially when taken improperly.

A. Estrogen

B. Testosterone

C. Both (A) and (B)

D. None of the above


28. All of the following should be done, except for:

A. Have transgender clients choose between hormones and treatment and recovery.

B. Use the proper pronouns based on their self-identity when talking to / about transgender individuals.

C. Find out the sexual orientation of all clients.

D. Allow transgender clients to use bathrooms and showers based on their gender self-identity and gender role.


Clinical Issues With Youth

29. Adolescents who use _____, in particular, are at high risk for HIV infection.

A. Alcohol

B. Crack cocaine

C. Heroin

D. Amphetamines


30. Initial awareness of same-sex attraction occurs, on average, at what age?

A. 10

B. 13

C. 15

D. 18


31. Reports suggest that which of the following may be at greatest risk for antigay violence?

A. Youth of color

B. Youth who are openly or stereotypically gay

C. Transgender youth

D. All of the above are at equal risk for antigay violence


32. _____ is an essential element in prevention and treatment of substance abuse in LGBT youth.

A. Providing safety

B. Giving support

C. Both (A) and (B)

D. None of the above


Related Health Issues

33. As a public health measure, all gay and bisexual male clients should be referred for vaccination for all of the following, except:

A. Hepatitis A

B. Hepatitis B

C. Hepatitis C

D. Clients should be vaccinated for all of the above


34. Which of the following is true with regard to lesbians?

A. Healthcare providers do not need to test for STDs and pregnancy because lesbians do not have sex with men.

B. Lesbians may have an increased risk for breast, colon, and ovary cancers, endometriosis, and bacterial vaginitis due to factors such as a higher fat intake, alcohol abuse, not bearing children, and inconsistent medical care.

C. Lesbians do not need pap smears as often as heterosexual women.

D. All of the above are true with regard to lesbians.


35. Which of the following is a particular concern for FTM hormone use?

A. Male hormones are injected.

B. The use of needles raises the risk of hepatitis C and ovarian cystic syndrome and may increase the risk of injectable substance relapse.

C. Hormones can damage liver function and, with the added effects of alcohol and drugs, the combinations may be even more harmful.

D. All of the above.


36. Researchers suggest that individuals who feel more comfortable about their sexuality and gender identity are more resilient, have better coping skills, and are better able to articulate their mental health needs.

A. True

B. False


37. Experts have found that interpersonal violence occurs at a higher rate in same-sex relationships compared to heterosexual relationships.

A. True

B. False


38. Clients should always be interviewed about interpersonal violence in private, unless the client requests the presence of another individual who is not the batterer.

A. True

B. False


Counselor Competence in Treating LGBT Clients

39. The most important ethical issue in counseling is:

A. The protection of clients’ well-being and safety, based on an “ethos of care.”

B. A “covenant of trust” between clients and counselors.

C. Both (A) and (B).

D. None of the above.


40. _____ is one of the most essential elements of effective counseling.

A. Recognizing the manifestations of countertransference reactions

B. Obtaining proper supervision

C. Adhering to professional and ethical standards

D. The willingness to transfer the client to someone who is better qualified for working with that client


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