Interview with Teresa Theophano, LMSW on LGBT Social Work
By Jeremy Divinity
Currently Teresa serves as the Assistant Director of Care Management at Services and Advocacy for GLBT Elders (SAGE), where she supervises several staff members and a social work intern; facilitates support groups for LGBT family caregivers; and works individually with clients, several of whom are homebound or in long-term care settings. Teresa is a board member of Trinity Place Shelter, an LGBT homeless youth shelter, and she co-founded the NYC Queer Mental Health Initiative, a peer support network that offers free biweekly support groups at the Brooklyn Community Pride Center. Last but not least, she is currently co-editing an anthology on LGBT mental health that is under consideration with an academic publisher.
[OnlineMSWPrograms.com] Could you please elaborate on the mental, emotional, behavioral, and social effects that discrimination has on members of a marginalized community, such as the LGBT community? How do you address these effects in individual and group therapeutic sessions?
[Teresa Theophano] The history of LGBT communities — and there are many, all of which can differ greatly from each other — includes marginalization and trauma, but also tremendous resilience. While we can’t overlook the fact that homosexuality was considered a mental illness that warranted mention in the DSM until 1973, and that the DSM diagnosis of “gender dysphoria” — formerly gender identity disorder —remains controversial, we must acknowledge the many strengths of community members. I believe that the best approach to clients who are experiencing negative mental, emotional, behavioral, and social effects of discrimination is always a strengths-based one. I focus on the resilience and survival of the amazing individuals with whom I am privileged enough to work.
As social workers know, stress as an outgrowth of discrimination against any cultural group is a very real phenomenon and can lead to poor health outcomes. LGBT folks of all ages can be at increased risk for depression, anxiety, substance abuse, and suicide alongside higher rates of cancer, heart disease, and STIs including HIV. Ensuring better mental health outcomes is a top reason that social support is vital at all stages of life, but especially as we age. The formation of social bonds and chosen family relationships among LGBT folks who were ostracized by their families of origin — or abandoned by their families when they came out later in life — serves as a lifeline. Exploring forms of social support available to our clients, and helping them to strengthen those, is a crucial role for social workers. I encourage peer communication and support among my clients, and also help make connections between isolated clients and service providers that I know to be LGBT affirmative.
Another important aspect of my client work in both individual and group settings entails explorations of self-care — a necessary act, as social workers well know. Self-care can even be considered a radical act for anyone who is part of a historically undervalued community or population. We value ourselves by showing ourselves the love and respect that we deserve. When we take the time to care for ourselves and nurture our strengths and passions, as well as clarify the boundaries we need to establish with others to keep our relationships healthy, we can drastically improve the quality of our lives.
[OnlineMSWPrograms.com] What socioeconomic and health disparities do members of the LGBT community face, and how can social workers and other people in the helping professions help to address these inequalities?
[Teresa Theophano] Socioeconomic status is strongly predicated upon factors related to privilege and power, and per the APA, research shows LGBT folks are consistently at a disadvantage. LGBT people make up a disproportionate part of the roughly 6 percent of the population that is considered very low-income (earning under $10,000 a year). And again, this tends to hit trans and gender nonconforming individuals the hardest, considering the high rates of workplace discrimination affecting these folks.
Health issues vary from population to population. For instance, women who have sex with women (WSW) face increased rates of breast cancer while men who have sex with men (MSM) are at a higher risk for contracting hepatitis and HIV, as are trans women, particularly trans women of color.
I cannot overstate the importance of avoiding further pathologizing of trans folks at the same time that I would be remiss in neglecting to mention that the suicide rate among trans populations is astronomical, far higher than that among cisgender populations. We need to be particularly attentive to the needs of our trans community members of all sexual orientations. That means educating ourselves extensively about not only respectful terminology and best practices, but about the unique health needs —encompassing both body and mind — of trans people alongside cisgender lesbians, gay men, and bisexual folks.
As social workers, we must keep the “big picture” approach to LGBT social work in mind. This means that while the individual work we do is crucial, and I by no means discount the importance of competent clinical work, organizing and advocacy are another piece of the puzzle that we can’t leave out. Further, our data collection methods and reporting are crucial: We need to capture SOGI (sexual orientation and gender identity) information so that our funding sources know why LGBT-competent services need to be funded.
I am lucky to work within an organization that provides case management and congregate services and includes extensive policy and advocacy work as part of its mission. I encourage aspiring social workers to connect the dots between policy and advocacy (macro) and individual or group work (micro), especially if community organizing (mezzo) is not a central tenet of their social work education, as it was in mine.
[OnlineMSWPrograms.com] How do the needs of members of the LGBT community change based on age, demographic, and geography? For example, how do the challenges and needs of LGBT teens differ from those of middle aged and older adults? Or across different ethnic groups or geographic areas?
[Teresa Theophano] Having worked with LGBT youth as well as adults of all ages, I can assure you that some basic needs remain the same: safe housing, access to solid education, steady employment at a living wage, and social support. It is particularly important to view LGBT populations with an intersectional lens. What are the strengths and stressors of clients who navigate the world with multiple marginalized identities? For instance, consider a client who is LGBT-identified and a person of color and living with a dis/ability. I’m going to refer again to resilience: the coping strategies people are capable of developing can be astoundingly effective, even if they are not always viewed as the most adaptive or healthy. This is why harm reduction is an important tool for our most at-risk clients.
Spending my entire career in an urban environment means that I have become intimately familiar with the particular set of challenges posed to community members in a major metropolitan area. Finding an affordable, safe place to live is invariably a top need. We face a serious housing crunch in New York, and LGBT-specific housing programs for adults, including older adults, simply do not exist as of yet. It is surprising to many — I get calls all the time from folks requesting information on these hypothetical facilities who cannot believe that NYC, of all places, has no LGBT adult shelters (folks age out of youth shelters when they turn 24), NORCs (naturally occurring retirement communities that facilitate aging in place), assisted living programs, or nursing homes. A coalition of organizations that includes SAGE is working on developing housing to meet this need for older adults, and a couple of LGBT shelter programs are under private development, but the sheer number of people looking for stable, sustainable living situations is overwhelming.
Across the board, the service needs of people of color, trans and gender nonconforming folks, dis/abled individuals, and older adults are left out of the conversations when we assess service provision to LGBT folks. It’s easy for us to get a little too comfortable with the idea that since marriage equality is now a reality, and because Laverne Cox and Caitlyn Jenner are on magazine covers, homophobia and transphobia are coming to an end. It’s undeniable that significant progress has been made — and continues to be made — around LGBT rights (again, emphasis on the LGB populations), but we still have a long way to go. It’s on providers, including social workers on the macro, mezzo, and micro levels, to assess clients holistically and competently in order to advocate and serve alongside them most effectively.
[OnlineMSWPrograms.com] Currently, there is limited research focusing on LGBT families — for example, their dynamics, the social support they receive, and the issues they face. How can social workers advocate for more research in this area, and work for equal access for LGBT families to health insurance and care, employment, and adoption and visitation of a child?
[Teresa Theophano] There are some fantastic organizations doing work in these areas — the Family Equality Council, GLAD (Gay and Lesbian Advocates and Defenders), and the NCLR (National Center for Lesbian Rights), alongside local programming at, for instance, NYC’s LGBT Center, which has extensive resources and support available to LGBT parents, including foster parents.
That being said, when we talk about families in the LGBT communities, we often leave out an essential family role: that of caregiver. In the case of working with LGBT older adults, “family” may not imply a close blood relation. We can be talking about a partner or former partner, a close friend, or a distant relative. This is the “chosen family” to which I referred earlier. Per a recent AARP report, unpaid family caregivers provide services worth an estimated $470 billion. Across New York City, several organizations contracted through the Department for the Aging provide services to family caregivers, SAGE being one of them (and the only one that specializes in working with LGBT family caregivers).
Working with these courageous and giving community members, many of whom experience astronomical levels of stress as they juggle caring for a loved one while working, holding down a household, and maintaining intimate relationships as well as other familial ones, is my passion. I describe caregiving as an experience both universal and isolating. It’s universal in that everyone will be and/or need a caregiver someday, and it’s isolating in that many who give care feel like they’re in this alone. A colleague of mine — a fellow social worker who teaches at Lehman College — is currently undertaking research to better understand needs of LGBT caregivers of older adults, and thus inform funding for service provision, but right now, very little is out there. The needs of older members of LGBT communities and those who help care for them (many of whom are in the same demographic) deserve our attention.
[OnlineMSWPrograms.com] For social work students who are interested in a career in LGBT social work, how would you recommend they gain the knowledge and develop the skills to provide more effective services to LGBT people and organizations? Based off of your own experiences, what have you learned over the years?
[Teresa Theophano] There are LGBT-specific practice courses in many, if not all, schools of social work and countless trainings available on the topic of working with LGBT communities. I took a practice course when I was in social work school, although much of what we discussed regarding competent approaches to LGBT clients was not new to me, as I had been involved with queer activism for years prior to enrolling in an MSW program. After interning my first year at a small Brooklyn community-based organization at which I was doing mezzo-level projects, I requested a second-year placement at a transitional housing program and basic center (comprehensive youth emergency service program) for LGBT homeless youth in Manhattan. That internship enabled me to get up close and personal with a diverse array of young people whose service needs were clear: a safe place to live, healthy food to eat, warm clothes to wear, and emotional support from staff. This entailed sessions with an onsite psychotherapist along with residential counselors and a life skills coordinator; the staff’s approach served as my introduction to team-based client work.
Internships at LGBT-specific organizations — whether those are grassroots community-based ones; national nonprofits like the one at which I work; or ones housed within local social service agencies —can provide a wonderful opportunity to learn best practices with LGBT clients. Most major cities have their own LGBT community centers, and some even boast dedicated LGBT health centers, such as Mazzoni in Philadelphia, Callen-Lorde in NYC, Chase-Brexton in Baltimore, and Whitman-Walker in D.C. An internship during which students can function as part of an inter-professional team — working alongside medical professionals such as primary care providers and psychiatrists, for example, or alongside seasoned community organizers and legal services attorneys — will provide an invaluable holistic experience.
Agency-based internships at local LGBT and HIV nonprofits will teach you things you cannot learn in a classroom. Further, the Internet has exploded with a wealth of comprehensive information regarding cultural competency and best practices that can be a terrific supplement to course materials. For instance, the website for National Resource Center on LGBT Aging, which is spearheaded by SAGE, provides a clearinghouse of educational resources, including countless free downloadable publications for both lay people and professionals. Because geriatric mental health courses in social work schools are not necessarily a common offering — and the geriatric mental health needs of LGBT people in particular are not often touched upon — these types of resources are all the more necessary.