Wednesday, May 7, 2014


Prayer for Facing Tough Choices

 

Holy One, Nurturing Creator, Ever-loving God:

You designed me with a purpose;

Guide me as I strive to understand what it is.

You endowed me with talents and abilities;

Help me recognize opportunities to use them wisely.

You provide for my every need;

Remind me to share what I have.

When I am faced with daunting complications...

When I am overwhelmed by tasks...

When I am uncertain of the way...

Send your Holy Spirit to deliver your calm

Strengthen my fortitude

Boost my confidence

And above all

Restore my faith in you, my God.

With your wisdom,

I will make sound decisions.

With your encouragement,

I will bring order to chaos.

With your support,

I will learn and grow.

We will work together to continue unfolding your perfect Creation in the world.

Easy Now
Shush mi corazón
No need for tears
Compose yourself, little me
Because how you are today
Isn’t how you’re always going to be
You feel disintegrated
And the sharpness of your fears
The acidity of consequences
Both ephemeral and fleeting
You are not undone
Rather, only just begun
You are just now learning
Strengths and limitations
Your heart’s desire and heart’s lament
Sophomorically proclaiming what you know
And don’t know yet
You’ll get there one day, but for now
Just wait.
Slow down; no hurry
The dreams you dream up are to be enjoyed
It’s sweet to dream
But dreams are rightfully forgotten
And achieved in their own time
Sounds contrary, yet both are true
Try not to worry
It doesn’t serve you well
Put aside insecurities for now
They are like weeds blocking out your sun
Let me take care of that for you
Little one
Easy now
Take it easy on yourself
Baby steps and life in small chunks
You get there soon enough
But for now, try to just rest
Easy now

Tuesday, April 30, 2013

Counseling Implications for working with LGBTs with SUDs


I created a presentation that introduces counselors to the basics of working with Lesbian Gay Bisexual and Transgender individuals with Substance Use Disorders. To view the slide show, click here. 
Counseling Implications for working with
LGBTs with SUDs
David Johnson, PCCT


Why this population is different
A. Legal issues
1. Legacy of discrimination - homophobia and heterosexism
a. Disparate treatment before the law
b. Transgender barriers
c. Military acceptance
d. Complex trauma
2. Marriage equality
B. Cultural issues
1. Coming out is part of minority identity development
2. Building community for safety and mentoring
3. Diverse community, hence the rainbow
C. Health Issues
1. Hate crimes and violence
2. IPV – Intimate Partner Violence
3. Body image
4. HIV/AIDS

What the research says (and doesn't)
A. Substance use in the LGBT Community
1. Historical ties between bars and Gay community
2. Current drugs of choice for MSM: Alcohol, marijuana, psychedelics,
hallucinogens, stimulants, sedatives, cocaine, barbiturates, MDMA,
"poppers."
3. Party drugs and the party circuit associated with
methamphetamine, aka "Tina"
B. Epidemiology research
1. Late 1980s: gay men and lesbians have 70%-80% higher incidence
of moderate/heavy/problem drinking than heterosexuals.
2. 1990s: gay men and lesbians also use greater quantities of illicit
drugs than the general population.
3. Same sex couples use substances together more than opposite sex
couples
4. Being a lesbian is included in list of risk factors for women
developing alcohol dependence
C. Holes in the research
1. Precise incidence of use and abuse rates for LGBT populations
cannot be done because we do not have reliable estimates of
the LGBT population (how to define, self-reports, rapidly changing social acceptance of LGBT people)
2. Most epidemiological studies have not asked for sexual orientation
data from participants.
3. Studies cannot be compared in meta analysis because of
inconsistencies in methodologies.

General LGBT cultural competency
DO:
  • Create safety for LGBT clients; protect them from others' homophobia/heterosexism.
  • Get to know the LGBT population and current issues.
  • Create an atmosphere that is supportive; for example, review documents for inclusive language.
  • Acknowledge their significant others in the same manner as heterosexual partners.
  • Let LGBT clients determine what is comfortable for them to disclose and support their decisions.
  • Get training to become less heterosexist and increase your understanding of LGBT issues.



DON’T:
  •  Label clients; allow them to apply labels for themselves.
  • Pressure clients to come out or pursue relationships; respect where they are at.
  • Ignore their significant relationships or make assumptions about the importance of a particular relationship.
  •  Interpret on behalf of the client or make judgments about what/who is "good" or "bad;" rather, follow the client's lead. A comment that is empathetic in one context may be invasive in another.
  • Categorize clients by gender, gender identity, partner preference or history without asking them how they identify.


Clinical recommendations and best practice
  • LGBT individuals seeking treatment for SUDs have many of the same issues as heterosexual populations, but in addition, they may be having difficulty with coming out, sexual orientation, gender identity, stigma, HIV/AIDS, discrimination, same sex relationships, lack of social/family/spiritual support.
  • Counselors need to understand the primacy of accepting oneself as LGBT and finding a way to feel comfortable in society.
  • Two approaches have been shown effective in promoting effective recovery with LGBT clients: abstinence and stage-specific treatment
  • Counselors need to assess the client's overall ability to cope with stressors when selecting treatment. One example is that methamphetamine reached epidemic levels among gay men in the past decade; abuse of this drug was linked to strong cravings and more frequent relapse.
  • Discrimination and systemic historical marginalization may present real and/or perceived barriers for LGBT clients who seek treatment. This is sometimes mistaken by program staff as "resistance" in treatment.
  • LGBT clients may feel more comfortable with either same or opposite sex roommates, staff, and/or counselors. For example, programs that require an observer to collect urine samples might consider asking an LGBT client which gender observer they prefer.
  • Programs might consider designating a unisex toilet or shower to be responsive to transgender or gender queer clients
  • Heterosexual staff should not assume LGBT clients will be more or less likely to flirt, push personal boundaries, or act out with others simply because they are LGBT.
  • Get to know the Levels of LGBT Sensitivity in Treatment Model
  • Be aware of a number of health related issues that affect this population such as HIV/AIDS and other STIs, sexual assault/trauma history, prostitution, (particularly with Lesbians and Transwomen), and barriers related to access to medical care.
Resources and References
Association of Lesbian Gay Bisexual Transgender Issues in Counseling, a division of ACA. www.algbtic.org. This is the leading professional association for counselors focused on LGBT topics. Their website has an extensive list of research articles. Also they have a recent document that outlines the “gold standard” of LGBT competencies for counselors.

Family Health Centers of San Diego, Gay Men's Health Services www.gaymenshealth.org. This is a leading local agency that offers a complete range of health services including HIV prevention and education, counseling, case management, AOD outpatient (including court ordered) recovery groups primarily in Hillcrest and North Park. The larger agency, www.fhcsd.org, offers free and low-cost medical, vision, and dental care for women, men, and children with over 25 locations across metro San Diego.

Josue Homes Sober Living Communities. (pronounced like “Joshua”) www.nationalaidsfoundation.org. This is a network of sober living communities that offers counseling, education, and case management with a special focus on serving women and men who are HIV+ and/or have AIDS. Since safe affordable housing is a critical need for this population

The Live and Let Live Alano Club of San Diego. www.lllac.org. Is a large recovery organization offering a variety of member-supported 12-Step programs, mutual support groups, and meetings at their location in University Heights. Their mission has a special focus on serving the LGBT community, although all are welcome, regardless of affectional preference.

National Association of Lesbian Gay Bisexual Transgender Addiction Professionals and Their Allies. www.nalgap.org. Similar to ALGBTIC, but with a special focus on addiction. Their website has loads of references and resources, plus they have rich offering of training and curriculum on the topic of LGBT issues in addiction treatment.

Substance Abuse and Mental Health Services Administration (SAMSHA) A Provider's Introduction to Substance Abuse Treatment for Lesbian Gay Bisexual and Transgendered Individuals. www.kap.samhsa.gov/products/manuals/pdfs/lgbt.pdf. It’s basically starting point for standards of practice, curricula, latest research, and practical “how to” of mental health practice. We should all have SAMSHA bookmarked on our browsers.

Stepping Stone of San Diego. www.steppingstonesd.org. A well-known local treatment center offering inpatient, outpatient, and recovery/maintenance services. Stepping Stone has a national reputation as a leader in adapting proven AOD treatments for use with for LGBT populations. 

Monday, April 22, 2013

The Candle Who Thought He Was a Lion


A dimly lit bedtime story...

Once upon a time, there was fine beeswax candle molded into the form of a mighty lion. He had a beautiful golden mane, large powerful front paws, and a long graceful tail, the end of which supported his wick, made of sturdy braided cotton. The lion was the newest addition to a wax menagerie, and he enjoyed being displayed in a place of pride on the mantle, alongside a zebra, an elephant, and a gazelle. 

On special occasions, the woman would dim the lights and play soft jazz music. She lit each candle one by one. Then she slipped off her shoes and removed her bra, lay back on her sofa, and enjoyed a bottle of wine by herself. The lion felt no pain when his tail was lit; on the contrary, he rather liked that he was able to provide a beautiful glow against the wall. He observed that he and the other animal candles pleased the woman as she read her book or updated her Facebook status. He beamed with happiness that the glow from lion filling the room with a soothing essence which woman found remarkable and reassuring.

“How lovely we are,” said Lion to the gazelle, “to think how the woman enjoys the sight of us during her alone time. I do believe she loves us. Truly, this is the happiest place in the world.”

Gazelle said nothing in reply, and only looked at the lion with suspicion, for she could not decide if the lion were a friend or a foe. Nor could she decide if she thought herself lovely or not, since she had nothing with which to compare her visage. Nor could she decide anything for herself, because she was unaccustomed to speaking with the other animals and rarely entertained profound thoughts on her own.

The elephant, who was by far the largest and oldest of the wax beasts, spoke up in a wise deliberate voice. “I do not believe it is accurate to say the woman loves us, for we are but inanimate objects. We are designed to be a pleasing sight to the woman, nothing more. I have been here far longer than you, Lion, and I have seen smaller animals come and go. In fact, you replaced our friend the monkey who used to amuse us with his bawdy jokes and witty riddles. Believe me, when our wax has melted and our wicks grow long, our purpose on this mantle will be fulfilled.  The woman will replace us with no remorse or regret.”

The Lion was well aware that he was inanimate, but he did not like being reminded of the fact. In his own imagination, he was descended from a long line of noble rulers of the African Savannah. The lion looked at the elephant who slumped slightly to one side where her wax had melted over time; he noticed how the flicker of the elephant’s wick appeared more regular and steady than the others. The lion supposed the elephant had made a valid point.

“Elephant,” said the Lion, “is it sad when the woman throws us away?”

The elephant sighed and took sweet time to thoroughly examine her thoughts before responding. “It is neither sad nor happy. It just is.”

“Bullshit!” interjected the Zebra who had been listening all along.

All eyes turned suddenly to the zebra in a way that made him feel scrutinized and judged. “Oh come on. Really, Elephant? What are you, a philosopher? You would have the lion believe death is neutral? Dying sucks. Nobody wants to be thrown away just because their melting pool has grown too large, or maybe they accidentally dripped a little wax on the hardwood floor. That’s the worst. I don’t know about you, but I kind of like it up here and I for one don’t want to melt away.”

The elephant was silent; she only blinked a few times, allowing a tiny drop of wax to fall from her long beautiful eyelashes.

Zebra continued, “That’s why I blow out my wick when the woman isn’t looking.” And the Zebra puffed a few times until his wick flickered and his flame eventually went out, leaving for a moment, a steady stream of black smoke rising above him into thin air. “I intend to conserve my wax for as long as I can, you know, to stick around as long as possible. That’s the only way to stay alive up here, man. Anyone who says otherwise is stupid or lying to you.”

The lion looked at the Zebra and the Zebra looked at the lion. The lion then looked to the elephant who looked at the zebra and back to the lion. Then the lion looked at the gazelle who looked away.

“You can do that?” asked the lion.

“You bet your whiskers,” replied the zebra. “And it works, too. I am half the size of the elephant, but I’ve been here almost as long.”

The lion looked puzzled for a moment. “But if you blow out your flame, isn’t that contrary to your purpose? Are you not afraid the woman will become displeased with you and discard you anyway for not producing the soothing glow that she likes?”

“She hardly notices,” replied the Zebra in a matter-of-fact tone of voice. “And besides, with the rest of you lighting up the room as you do, the woman scarcely even bothers to relight me after my flame is out.”

“If we all did that,” said the elephant, “then the woman would most surely notice, and she would not be happy with us anymore. Tell me Zebra, what’s to keep her from replacing us with LED candles that never melt? Have you have forgotten your purpose.”

“What is our purpose?” asked the lion.

“We are here to bring the woman light and fill her home with happiness,” answered the elephant.

The zebra became upset because he knew the Elephant was right, and he had no other sensible response. “You know what, Elephant? Fuck you, that’s what. Don’t talk to me anymore. I don’t need you. And I’m tired of your judgmental attitude.”

Gazelle blushed and looked away.

The elephant sighed a disappointed sigh, because she knew Zebra would refuse to listen to reason. The elephant believed in her heart the zebra did need her, that in fact all the animals needed one another. But the elephant did not know how to explain that, so she remained quiet and reflected on the answer.

The lion disliked the unpleasant tone of the zebra. He felt the elephant had been unfairly dismissed, but did not feel he had authority to tell the zebra what to do. He did not know whether the elephant or the zebra was correct, so he also sat in reflection and hoped to somehow acquire Elephant’s wisdom by thinking. So the conversation ceased, and animals all sat quietly as their flames flickered and danced – except for zebra, who sat doing nothing at all.

At the end of the evening, the woman brushed her teeth and tweeted "goodnight" to her followers. She blew out the candles, first the elephant, then the gazelle, then the lion, but not the zebra, because he had blown his own flame out hours before. Finally, she went to bed.

But just then something strange happened. The lion’s flame flickered ever so slightly and slowly returned, unnoticed by the woman. Because the wick emerged from his tail behind him, the lion failed to notice. His eyes were closed, so he was completely unaware. The living room was quite dark, except for the gentle glow emanating from the lion.

Gazelle was the first to notice. “Look,” she gasped to the elephant, softly. She could say nothing further however, because the gazelle was so painfully shy.

“Oh my dear!” exclaimed the elephant.

Then the zebra opened his eyes and observed the glow coming from the lion. At first the zebra became concerned, because he knew the woman would never intentionally allow an unattended candle on her mantle as this could be a serious fire hazard. But on second thought, the zebra determined that if the lion’s flame was to burn through the night, it was the lion’s own misfortune, not his. So the zebra said nothing.

Then the lion’s eyes were opened. And he discovered he could see the other animals staring at him. “What?” he asked.

“Your tail,” Elephant indicated gently with her trunk.

The lion, still unaware his flame had never been completely extinguished, continued, “My tail? What about it?”

“You’re still lit, Idiot” chimed the zebra indignantly.

“Oh” Lion finally noticed. “So I am. Ha. That’s never happened before. Is that okay?”

The lion looked at the Zebra and the Zebra looked at the lion. The lion then looked to the elephant who looked at the zebra and back to the lion. Then the lion looked at the gazelle who looked away.

The lion repeated, “What?”

“Well?” hinted the zebra, sarcastically, “are you going to just sit there and let yourself burn like a dummy, or are you going to blow out your flame?”

The lion took notice for just a moment of his own brilliance. He seemed to bathe the entire room in a soft golden light that was quite heavenly, and he thought it beautiful. “Look! My light is powerful enough to light the entire room. Isn’t it amazing?”

Zebra surprised them all with a loaded compliment, “Sure kid, let your amazingness burn bright all night. But if you burn down the house, I will whoop your...”

But then Elephant chastened Lion, “If you allowed yourself to shine all night, your wax will melt and your shape will grow distorted and you will age before your time. Besides, the woman is asleep and she will miss your glow. And all your wick will be wasted.”

Gazelle, in a rare decisive moment, agreed with Elephant.

And so Lion puffed and attempted to blow out his flame, as the zebra had done before. He puffed and puffed and then he puffed some more, but he was unable to gather enough breath to extinguish his flame. He turned to Gazelle, who was closest to him. “Please, can you blow out my flame? I do not want to flicker the night away and end up melted by morning.” Gazelle agreed, but her tiny lungs were no match for the lion’s stubborn flame.  Then Lion beseeched Elephant who began to blow through her trunk. “I need you,” implored Lion. “Will you please help me?”

The zebra laughed a cynical laugh. “It isn’t going to work. His wick is too long and his flame is too big.” At the elephant’s suggestion, they all worked in cooperation to puff puff puff at the flame, but it was no use. Even Zebra with his experience extinguishing his own flame, had given a worthy effort, to no avail. Finally, exhausted and out of breath, Zebra spoke. “I hate to tell you, kid, you’re luck has run out. Too bad for you. You’re on your own.”

The lion dripped a clear waxy tear, and he could feel the flame’s warmth against his beautiful mane. “I don’t want to melt away,” he cried. “It’s too soon.”

Gazelle spoke softly, with sadness in her voice “What are you going to do, Lion?”

“Oh please,” scoffed Zebra.

Finally Elephant, who usually tried to remain stoical about such matters began to moan with grief, her long trunk like a trumpet being tuned for performance. “Don’t make me cry too.” And despite his best efforts, Zebra felt himself overwhelmed with sadness as well. So they all shared a moment crying together.

Well, they were all crying so loud, the woman was startled awake. She looked at the crack beneath her bedroom door and noticed dim shadows dancing in the living room.  The woman rose at once and went into the living room where the flame of the lion’s tail provided the source of the shadows. For just the slightest moment, she paused as she noticed the beauty of the golden glow of the room. And it was a beautiful sight, she thought. And in that moment, she truly loved the lion.

“Oops. Can’t have that,” said the woman out loud to no one in particular, ever mindful of the danger of an unattended candle.  And the woman licked thick little fingers and then snuffed out the lion's flame with in one swift stroke, leaving a steady stream of black smoke rising above him into thin air.

With that, the woman breathed a sigh of relief went returned to her bedroom where she fell fast asleep. And the lion breathed a sigh of relief. And the elephant breathed a sigh of relief, and the gazelle breathed a sigh of relief, and even the zebra, who usually wanted nothing to do with any of the others, joined them and breathed a sigh of relief. And then with all the lights out, they all went back to sleep for the rest of the night.

The End.

Monday, April 1, 2013

Statement of Intent (2011)


I applied for a scholarship in 2011 for which I needed to submit a statement of intent of 250 words or less. It's like asking a caffeine addict to compose a haiku on the spot. Here's what I cam up with - it was 247 words! Oh, and I did receive the scholarship (go me).

For me, counseling is more than just a job, it’s a vocation. American Theologian Frederick Buechner wrote, “The place where God calls you to is the place where your deep gladness and the world’s deep hungers meet.” I have taken that wisdom to heart in discerning my academic and career goals. I am pursuing a master’s degree in counseling with the goal of becoming a Licensed Professional Clinical Counselor (LPCC); I’ll be among the first in California to enter this emerging profession.
My deep gladness is to help people learn and grow so they may become fully who they are. I have the patience, empathy, and analytic skills to excel in the field of mental health counseling. The role of helper is expressed throughout my employment history. Some of my favorite experiences have been as an educator, counselor, and childcare giver. Pursuing a career in counseling will help me develop the specialty skills and expertise to work with combat veterans in the process of reintegrating into civilian life.
The next five to ten years will see unprecedented demand in mental health care, representing one of the world’s deep hungers. The end of major combat operations in Iraq and Afghanistan and the Health Care Reform Act of 2010 will contribute to increased demand for qualified personnel to diagnose and treat mental health conditions. LPCCs will begin to replace Psychologists in some mental health settings because they are as capable and more cost effective. Thank you for considering me.