The Genderbread Person: Gender, Sexuality, the DSM, and the Social Work Exam

Summer is coming to an end, and what an eventful summer it has been, both in the United States and in the social work world:

  1. With marriage equality legalized in all 50 States for just over a month, what will this mean for social workers in practice, most who are already working with LGBT individuals? In addition, how does the public reception of public figures like Caitlyn Jenner and Laverne Cox inform our culture competence, as well as the remaining gaps to fill in education and practice?
  2. The DSM V has been officially implemented into ASWB exam curriculum for all future licensing exams. Among its notable changes, and the first that will be mentioned in a series of DSM V posts, was the replacement of Gender Identity Disorder with Gender Dysphoria.
But first, a quiz.

A social worker at an outpatient mental health agency is completing a psychosocial with an adult 22 year-old client. In order to assess the client’s sexual orientation, which would the BEST way to explore this with the client?

 A. Tell me about your sexuality.
B. Skip the question and address at a later time, when the client is more comfortable.
C. Are you attracted to men, women, both, or none?
D. Do you identify as male, female, or other?

We can eliminate D right away because this question asks about a client’s gender identity (how a client identifies) versus sexual orientation (to whom a client is attracted to, or not).

If you picked A, that makes you a great social worker because yes, it is an open-ended question and appropriate, but it is not specific enough for a client to know what they may be answering.

B is inappropriate because in the interest of promoting agency cultures that are inclusive, it would get in the way of having an opportunity to normalize the client’s experience.

The answer here is C. It acknowledges the possibility for every sexual orientation and is specific to the client’s experiences.

The Genderbread Person
The Genderbread Person. From Sam Killermann's site,
The Genderbread Person. From Sam Killermann’s site, “It’s Pronounced Metrosexual.”

Sam Killermann over at It’s Pronounced Metrosexual has provided a great guide to the differences between gender identity and sexual orientation. As with most cultural competence guides, this is only an introductory start. Our best guides will always be our clients, as this may not always be terminology a client may identify themselves with (For example, a client who identifies as a female and is attracted to both sexes, may refer to herself as bisexual, or as a heterosexual or a lesbian, depending on her predominant attraction).

In practice, applicable ethical issues include social workers’ practice of self-awareness regarding their own beliefs about sexual orientation and gender identity, and being mindful and seeking supervision if those beliefs are not in congruence with client’s. This self-awareness becomes necessary by preventing negative countertransference from interfering with practice (one such example is the practice of reparative therapy, which has been banned in several states).

In the case of a social worker who identifies as LGBT, important transference and countertransference issues also apply since a social worker’s best route is to be mindful that a client’s experience may not always parallel their own, and to be able to work with client’s who approach their identity/orientation from a different cultural perspective.

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