Sociopolitical Implications to Consider When Working With the LGBTQIA+ Community

Introduction

The global understanding of gender (identity and expression) and sexual orientation is deepening and evolving. More specifically, the Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual or other sexual or gender minorities (LGBTQIA+) movement is challenging long-held gender roles and expectations accumulated across a history of European colonization and enculturation. These expectations, rules, and laws were predominantly created to limit women’s access to men’s space and further limit and oppress Black and Indigenous people of color (BIPOC; Vaid-Menon, 2020). While the understanding of these concepts may seem new to some, it is important to note that sexual orientation and gender diversity have been documented across cultures throughout history (Vincent & Manzano, 2017). European colonists imposed their socially constructed gender binary onto indigenous cultures, and attempted to erase and eradicate gender designations that were not either male or female across the world (Tharp, 2016; Vaid-Menon, 2020). In the United States, numerous laws were put in place to ensure that men and women dressed differently (Sears, 2015), primarily to prevent women from accessing powerful institutions and spaces that were exclusively for men (Sears, 2015; Vaid-Menon, 2020). This imposed gender binary was further used to oppress BIPOC. Transgender BIPOC are at higher risk of physical assault compared to all other race/gender groups (Coulter, et al., 2017) and are often erased from the transgender narratives led by predominantly White researchers (Singer, 2015). As Western cultures begin to shift toward greater flexibility in gender roles, many LGBTQIA+ individuals are beginning to embrace and accept themselves and live a life of greater authenticity. However, this cultural shift is also causing a backlash from others, resulting in a groundswell of anti-trans legislation currently being passed in multiple states at the time of this chapter (American Civil Liberties Union, 2021).

Speech-Language Pathologists (SLPs) as communication experts are in a unique position to begin challenging and changing systems that oppress LGBTQIA+ people. This shift hopefully will lead to greater acceptance of people who are LGBTQIA+, allowing everyone to live authentically and openly without fear. However, currently, such a goal has not yet been achieved. Due to socially-constructed, binary gender expectations and assumptions that pervade the general culture in the U.S., LGBTQIA+ people experience numerous health disparities in both healthcare and education settings (Baams, 2018; Bränström, Hatzenbuehler & Pachankis, 2016). If SLPs do not become aware of the harmful paradigms that they are supporting, they will continue to contribute to these disparities hurting their clients, students, and colleagues. Such harms include poor outcomes in therapy, depression, suicidal ideation, and assault from others.

The first principle of The Code of Ethics of the American Speech-Language-Hearing Association (ASHA) dictates that SLPs and Audiologists should hold the welfare of their clients paramount (ASHA, 2016). The Ethics of Care (Gilligan, 1982; Noddings, 1984; and Tronto, 2013) asserts that the core of ethical practice lies in how one expresses care and concern for others. This model stipulates that ethical practice requires practitioners to: (a) pay attention to people and the surrounding cultural context, (b) recognize power differences and act responsibly in situations where they have greater power than others, (c) always continue to acquire competence in how to care for others, and (d) be responsive to the needs of others. In other words, treat others how they wish to be treated (a.k.a., the Platinum Rule).