ABSTRACT: Given the increasing numbers of openly lesbian, gay, bisexual, transgendered, and questioning (LCBTQ) people, music therapists are more likely to be in contact with LGBTQ individuals in their daily routines. LCBTQ people are coming out at earlier ages, staying out into their senior years, participating in marriage, and raising children. Expanding media coverage has focused on civil rights, marriage equality, bullying in the schools, and respect and pride in the community. Even though the AMTA Code of Ethics and Standards of Clinical Practice define a non-biased approach to working with LCBTQ individuals, the profession is still in need of best practice guidelines that will assist music therapists with tools to ensure that they are informed and sensitized to the needs of the LGBTQ community. The purpose of this paper is to propose a set of best practice guidelines and make recommendations for its implementation.
Over the past several years, lesbian1, gay, bisexual, transgender, and questioning (LGBTQ) people and LGBTQ related issues have been visible in the popular press (www.glaad.org). With the marriage equality debate, increasing awareness of the suicide rate of LGBTQ teens and young adults as a result of bullying, hate crimes victimizing LGBTQ individuals, legal challenges to the Defense of Marriage Act, and the Don't Ask, Don't Tell Policy reversal, the lives and challenges of LGBTQ individuals have been open to public view, debate, and scrutiny (Carey, 2012; Webb, 2012). Because LGBTQ people are of all ages, cultures, and populations, and from all geographical areas, it is highly likely that therapists will find themselves working with LGBTQ clients, coworkers, students, and/or family members, whether they know it or not. Given this reality, it is therefore essential for music therapists to seek out opportunities to learn about LGBTQ concerns and community resources as well as seek supervision about working with LGBTQ individuals.
Historically, LGBTQ people have been marginalized and under served by the mainstream culture2. According to the Federal Bureau of Investigation, 1 7.8% of the total number of reported hate crimes in 2010 was attributed to homophobia (U.S. Department of Justice, 2010). In a recent survey of 6000+ transgender individuals, discrimination was identified as a factor in workplace harassment (90%), loss of employment (26%), refusal of housing (19%), denial of medical care (19%), and homelessness (19%) (Grant et al., 2011). The effects of this discrimination are detrimental. Over the past 20 years, the long-term effects of nonacceptance, discrimination, and violence in the lives of LGBTQ individuals have been studied. Researchers have noted lesbians, gay men, bisexuals, and transgender individuals have an increased risk for suicidal ideation (Clements-Nolle, Marx, & Katz, 2006; RotheramBorus, Hunter, & Rosario, 1994; Savin-Williams, 1994), high risk behavior (Heck, Flentje, & Cochran, 2011; SavinWilliams, 1994), mental health problems including substance abuse (Cochran, Sullivan & Mays, 2003; D'Augelli, 2002; DiPlacido, 1998; Heck et al., 2011; Lewis & Hugelshofer, 2004; Lewis et al., 2004; Meyer, 2003; Ross, 1990; SavinWilliams, 1994), and compromised physical health (DiPlacido, 1998; Lewis et al., 2004; Ryan, Huebner, Diaz, & Sanchez, 2007) due to heterosexism, transphobia, gender-role stereotyping, and lack of acceptance by family and society.
In a study of 245 lesbian, gay, bisexual, and transgender young adults, researchers found that "the direct effect of adolescent gender nonconformity on young adult adjustment was fully mediated by the experience of victimization" (Toomey, Ryan, Diaz, Card, & Russell, 2010, p. 1587). Ryan et al. (2007) found "family acceptance predicts greater selfesteem, social support, and general health status [while guarding against] depression, suicidal ideation, and behaviors" (p. 205). Similarly, participation in Gay Straight Alliances while in school helped to created "more favorable outcomes related to school experiences, alcohol use, and psychological distress" (Heck et al. …