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Section 24
Supervision and Gender Questioning Teens

Question 24 | Test | Table of Contents

Blues Times Two
Harry says he has not always managed his bipolar disorder effectively. Back when his problems began, a half century ago, treatment of serious psychiatric disorders seemed much less scientific. Sometimes they also seemed more punishing than helpful.

"It took years of me struggling with myself and the system before things started to get better," he remembers. Growing up gay in the 1930s was another part of the struggle. He has vivid, painful recollections. "Back then, there wasn't really even a word for what we were," he mused, "and we sure as hell didn't talk about it with our families."

Harry prefers not to chronicle his struggles in detail. "Let's just say that it wasn't all that much fun." He does admit that early on, he spent a good deal of time in psychiatric facilities, trying the "treatment du jour"-everything from cold water baths to insulin injections and major tranquilizers. It wasn't until 1975 that he was even finally diagnosed with bipolar disorder. Before that, he says, he had collected diagnoses that ranged from schizophrenia to psychotic depression. These labels were "semi-educated guesses" that, he believes, prevented him from getting effective treatment. Though his episodes of mania only occurred once or twice a year, they were severe enough to disrupt his life. He would be hospitalized for weeks, even months. Finally the mania would subside and he would start picking up the pieces of his life.

His doctors subscribed to the theory, prevalent at the time, that his mood swings were caused by "homosexual desires."

"Not all of my life was horrible," he says. The "smooth sailing" times included peaceful intervals with "the love of my life." Harry met Alan, an actor, at a party in 1953. Alan was both "worldly and charming." And when he called Harry "sweet and handsome ... well that was it. My heart just melted."

Over the course of their forty-three years together, they had almost as many "ups and downs" as Harry had mood swings. But the up times were enough to carry them through the bad ones. Harry credits Alan's unwavering support with getting him through the hospitalizations and the bouts of despair, guilt, and suicidal thinking. They were both relieved when a combination of new medications, individual psychotherapy, and a support group for people living with bipolar disorder kept Harry out of the hospital for longer periods. He eventually managed his condition so successfully that he has now gone over fifteen years without a single inpatient psychiatric stay.

Worse than the most horrible treatment back in the "old days," Harry says, was the day that he lost Alan to emphysema in 1996. The heartache is completely different from the depression he has experienced for so long. Losing Alan was like losing his lover, his father, and his soul mate all at once, he says somberly. Tears well up in his eyes. He clears his throat and turns his head. "The last few years have been especially hard."
About a year after Alan's death, Harry fell and broke his hip. After surgery to correct the fracture, Harry spent a few weeks in a skilled nursing facility. While he was there, learning to walk again, his friends suggested that he consider more supportive living arrangements.

At the continued urging of his friends, Harry sold the home that he and Alan had shared and moved into an assisted living facility. While he finds the center clean and the staff nice, he bemoans the fact that "they don't know squat about gay people." He misses his friends and thinks about Alan every day. When he feels particularly isolated and alone, he questions whether "life is worth it."

Gender Blues
In fifth grade, Kris's Catholic school changed their policy. They split the playground into two parts. Thereafter, the nun who supervised recess announced that the boys would play on the right side and the girls would play on the left. The boys' new space was twice as big as that of the girls. It was also level. The newly designated female zone, as well as sloping, was pitted at its lowest end with mud puddles. Kris knew where she belonged, and she refused to budge. She was sent to the principal's office.

Word of the episode spread like wild fire among her classmates. Soon they began to taunt her. "You think you're a boy. Eewww, gross. You are so ugly. You are just like a boy. You must be a boy." When the taunts became unbearable, Kris would grab or punch whichever tormentor was close at hand. Back to the office she would go, for a time-out and another lecture and a warning. The worst incident occurred right before summer break. Egged on by his pals, a sixth-grader grabbed her breast and crowed, "Hey, she's a girl! She's got titties." Then in a singsong voice: "I felt your titties. I fit your titties." Before he could dodge her, she got him in a hammerlock. She half-choked, half-dragged him to a giant puddle on the girls' side of the playground, and heaved him in. By then a crowd of other kids had gathered. When she saw the supervising nun striding in her direction, Kris fled into the principal's office. There, defiant and ashamed simultaneously, she blurted out her "crime."

The nuns called her parents in and told them it would be better if she stayed home for the few weeks remaining in the school year. They also told them that she would not be welcomed back the following year. During the summer, Kris didn't go outside very often. Her brain felt fuzzy. She had trouble sitting in one place for very long. Whenever she ate, she felt sick. Often, after meals, she would lock herself in the bathroom, and stick her finger down her throat until she threw up. When she was sure she would be alone in the house, she used her Swiss Army knife to scratch her chest and her thighs. Watching the blood ooze out of the cuts gave her some momentary clarity and relief from the other, awful feelings. She made sure her clothes always covered the scabs.

Queer children's gender nonconformity makes them easy targets. Lonely, often desperate for attention, their depressions can easily be misconstrued as acting out. The problematic behavior further marks them as "different." Ever more alienated, they become more seriously depressed. Most ominous is that the depression, because it remains invisible, is never treated... Gay/lesbian/bisexual students with depression often go undiagnosed, because they are already seen as "different", their depressions can eas­ily be misconstrued as acting out.
- Hardin, Kimeron and Marny Hall, Queer Blues, New Harbinger Publications, Inc.: California, 2001

Personal Reflection Exercise #10
The preceding section contained information about counseling clients with alternative sexual or gender identities. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Clinical supervision approach predicts evidence-based trauma
treatment delivery in children’s mental health

- Meza, R. D., AlRasheed, R., Pullmann, M. D., & Dorsey, S. (2023). Clinical supervision approach predicts evidence-based trauma treatment delivery in children's mental health. Frontiers in psychiatry, 13, 1072844. https://doi.org/10.3389/fpsyt.2022.1072844


Peer-Reviewed Journal Article References:
Borgogna, N. C., McDermott, R. C., Aita, S. L., & Kridel, M. M. (2019). Anxiety and depression across gender and sexual minorities: Implications for transgender, gender nonconforming, pansexual, demisexual, asexual, queer, and questioning individuals. Psychology of Sexual Orientation and Gender Diversity, 6(1), 54–63.

Ellis, A. E. (2020). Providing trauma-informed affirmative care: Introduction to special issue on evidence-based relationship variables in working with affectional and gender minorities. Practice Innovations, 5(3), 179–188.

Falender, C. A. (2018). Clinical supervision—the missing ingredient. American Psychologist, 73(9), 1240–1250. 

Graham, K. A., Dust, S. B., & Ziegert, J. C. (2018). Supervisor-employee power distance incompatibility, gender similarity, and relationship conflict: A test of interpersonal interaction theory. Journal of Applied Psychology, 103(3), 334–346. 

QUESTION 24
Why do gay/lesbian/bisexual students with depression often go undiagnosed? To select and enter your answer go to Test.

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