Generations of Resilience: Counseling LGBTQ+ Older Adults

8:19PM May 23, 2024

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Hello, welcome to the thoughtful counselor. This is Mickey white, and I am here today with Dr. Jordan Westcott. Jordan is an excellent researcher, clinician and scholar and has published numerous research articles and given numerous presentations around the topic of working with LGBTQ plus older adults. And I'm really excited today for you all to hear from her. Welcome, Jordan. Hi, thanks

so much for having me.

So let's start off Tell me a little bit. How do you come into the field of professional counseling, and especially your work focusing on older LGBTQ plus adults?

Yeah, so my journey to counseling I think is pretty distinct from my journey to working specifically with queer and trans older people. I think this is a story common to many counselors. But when I was a little undergrad, I knew I wanted to help people. And I think the way I originally thought I was going to do it was I'd be a doctor, I'd go into the medical field. And, you know, I've talked to so many other counselors who have the same story. And somewhere along the way, when I was doing my undergrad, I had my own experiences with counseling, and it was suddenly like this whole world opened up. And I realized there are so many other ways that you can show up and help people and help people make their lives different. And I realized that the skills I had and the way I thought about the world was pretty well equipped to do that kind of work. So I really kind of shifted my career goal and started working as a tech at a crisis stabilization unit and then went to grad school to become a counselor, which was, I think, probably the best choice I could have made for myself.

Because that is such a relatable pathway, like you said this, I really want to help people and then I'm gonna look at, you know, psychology or medicine and then moving into counseling. And so you said your experience, getting into working with older queer and trans folks is a little bit different. So tell me about that.

So my first opportunity or opportunity to work with older people generally was when I was doing an internship at Cancer Treatment Centers of America. And just by virtue of working with people who had cancer on a holistic wellness team, I worked with a lot of older people. And that was really my first opportunity to work with older adults and to conceptualize that as a population where, where you maybe could specialize or do some work. From there, I was working in the community, and I found that several of the clients on my caseload were kind of aged 50 to 60. Before that Medicare eligibility where I couldn't see them anymore. As a counselor, this was pre Medicare. And I really found that like the education I had about how to work with adults was really focused on emerging adulthood and middle adulthood, and that transition to later life. I at least hadn't gotten nearly as much education on how to do that work well. And then as a queer person, myself, I'm often thinking about, like, what are the unique experiences that we have as LGBTQ folks. And so then, when I went to my doc program at Virginia Tech, I started doing research with my adviser and his research was all focused on older adulthood. So I kind of got a crash course and like, Oh, this is what I was missing. When I was trying to do this work like, man, it would have been great to know this stuff a year and a half ago. And in some of that work, one of the things there was this moment that stood out to me we were we were doing research on suicide prevention with home delivered meal volunteers delivering services to older adults in the community. And one of our research participants shared that she was a lesbian, but she never disclosed that to her volunteer because her volunteer made biblical references quite frequently. And she was so afraid her volunteer wouldn't want to call her anymore, or would judge her that she never disclosed who she was to this person who's supposed to be helping really navigate mental health concerns potentially prevent suicide. And so it just like clicked for me in that moment that this is where my stuff For him, all of my interests and my experiences could really intersect is this kind of unseen and underserved population where we don't get great education about how to work with older people, as counselors, I don't think we get great education on how to work with queer and trans people as counselors. And then when you look at that intersection, there's almost nothing there. But this is a population that still needs services. So that kind of brought me to where I am today. That's,

I think, such an incredible journey of marrying these two kind of unknown passions in a way. And you mentioned this woman not feeling comfortable to be able to disclose a very crucial part of who she is. Yeah.

Yeah, it's, we were having them do these weekly phone calls for, you know, 30 minutes to an hour every week. And the intention was, these are folks who might be at risk of suicide. These are people who are homebound, they can't leave their home due to disability or other concerns that they might be experiencing. There are financial cut offs for, for meeting the requirements of being in a home delivered meals type of program. And so we're thinking about someone who has maybe fewer social supports, who is has been flagged as potentially in need of these kinds of services, and then she's having to hide part of who she is, and these weekly phone calls. And what we know about identity concealment is it exacerbates mental health distress, and so this person who may or may not be actively experiencing distress is having this additional stressor put on her, because it was more important to her to maintain safety in that relationship than it was to be able to be authentic, and just what a challenge that must have been.

Yeah, I am even thinking of Justin in some of the work that I've done here with this podcast, and just in general, and some of the work you've done and already mentioned, that identity concealment feels so hard, just even for me, in a in a daily connected environment, right. And I imagine for you as well, that not being able to disclose and having to conceal are feeling, feeling that pressure to conceal when you're already experiencing the isolation. And I want to take us back a second, when you mentioned we we don't get a lot of training about working with older adults. And we also don't necessarily get a lot of training working with queer and trans folks. And a lot of the training that we do get or how we tend to frame it is primarily around emerging adulthood for LGBTQ folks or working with if you're lucky children and adolescents. And I think that's getting a lot more traction. Now, especially with a lot of the particularly egregious anti trans anti LGBTQ pro conversion therapy laws that are being proposed and passed in multiple states at this point. I'm also thinking a little bit about how older, queer and trans adults are so invisible. Yep. And I'm curious some of your thoughts about that invisibility, where that comes from, where that stems from, and then what you've noticed and some of the work that you've done.

Yeah, I, I think that the invisibility comes in part from stereotypes we have about older people generally. I think ageism really informs the way that we make assumptions about who older adults are and what their needs are. And so part of the invisibility comes from we kind of assume older people are a monolith in the United States, we tend to assume they have all the cultural capital tend to be white tend to be conservative tend to be wealthier. And we just know that that's really not the case. Those may be the most visible public facing older people that we see like members of Congress, but that's not what your everyday older person that you're encountering in this work is going to look like. And so I think when we assume that either no older people are queer, or trans, or that so few of them are, that it doesn't even matter, we don't need to think about it. That's where a lot of the invisibility comes from. We know that between two and 5% of older people openly identify as LGBTQ. Given what we see with increasing proportions of the population identifying as queer or trans in younger generations, I think we can safely assume that a lot of that is people who haven't come out or who maybe didn't come out and then have made peace with whatever version of their life that they build, and so maybe would never identify as LGBTQ. Even if they've had those experiences at different times in their life, and then we've got folks who are closeted, who maybe would identify as queer, trans but can't do so publicly. All that to say, I think that a huge part of it just comes from ageist stereotypes generally, we also have hetero sexist and sis sexist stereotypes about what does it look like to be queer or trans, we kind of don't have a template for what it looks like to age as a queer, trans person. I think the HIV AIDS epidemic really impacted our understanding of whether or not queer and trans people get to grow old, there's kind of an assumption that we die young. When you look at media to like that barrier Gays trope, like the only way to show queer trans people in media for a long time was if they died at the end, and then the surviving partner went back to being straight. And it was a little aberration on their journey, right. So I think when you combine these things were all the narratives we have about queer and trans people are focused on youth, often they die or go back to a straight lifestyle, quote, unquote. And then we have these narratives about what it is to be an older person, how you get to be an older person, those kind of combined to make it where we just don't exist in later life in a lot of people's consciousness, but it's not true.

Yeah, and that really, kind of took me into thinking even particularly about trans pneus and older adulthood, and the use of language, yes, that we have this language change that's occurred over the past few decades, that really a lot of I know, at least older folks that I've worked with have struggled with some of the language like the emergence of things like bisexuality or reclamation of the word queer, and pansexuality. And even the experience of being trans, of so many trans folks forcibly transitioning when really inhabiting a more non binary identity.

Yeah, and I think that tied with that is that there are a lot of terms now that younger, queer and trans people are like, that's outdated. Don't say that. But that's how older LGBTQ people still describe themselves. So I think about like the term trans is kind of a broad umbrella term, as we know, generally, it stands for transgender. But a lot of older trans people would use the term transsexual to describe their gender identity would use that as an an identifier. And I would say, yeah, don't use that to identify whole communities, it can be considered a slur. But also, I think that that creates some of the disconnect between older and younger generations of queer people, that younger queer people are essentially saying, the way you identify as bad, the language you use to describe yourself is harmful. And so it kind of pushes older, queer and trans folks even further into the shadows even further out of the spotlight, we kind of act like, well, that's outdated, kind of the way that actually all younger people seem to act about older generations, like you're outdated, you don't know what you're talking about. And we're really like dismissing the wisdom and the experiences that they bring, just because we don't like the language that they use to describe their own identities. They're not asking for anybody to use that language to describe themselves. And we see the same thing in sexual minority populations to where you were talking about, like the much more nuanced labels we have available today. Those simply just weren't available at the time that many of our current cohort of LGBT older adults was coming up and learning the language. I think just a final point that this is bringing up for me, is also that this is tying in with one of the narratives we have about LGBT older adults, which is that like, the only LGBT older adults that exist are people who came out in their 20s and are now living their life. But there are so many people because of greater social acceptability, who actually are coming out later in life, especially trans folks. And that's really cool to see. But we kind of dismissed those narratives as if they don't exist.

Yeah, I've got a few friends that have kind of joined and CO created together. They call it an FTM over 50 group. And so trans mask or trans men that are over the age of 50. Because their experiences, even if they're new to taking testosterone or having top surgery or things like that, that there are still such differential cohort experiences based on age that there's a community level need there. Yeah,

yeah, there's I mean, we know that I think because of some of the beauty standards and queer and trans communities, youth, as in the broader community, but I think it can be exaggerated in queer and trans communities at times this like prioritization of youth, in a way where I think older LGBT people often don't feel Welcome in LGBTQ community spaces, but they also don't feel welcome in ageing service spaces. So there's kind of not a clear home for them where they're not encountering bias of some sort or more often the intersection of what it is to occupy the intersection of ageism and heterosexism. are six sexism, the way that those things kind of intersect with one another. And there's not a community space to go to in many places where you're not going to be encountering those together.

Yeah, and that, that takes me to this question of, you've talked about some of the unique challenges for older LGBTQ plus folks in terms of beauty standards, in terms of self concealment versus self disclosure, that language changes, community level pieces as well. Are there other unique challenges that you see for older LGBTQ plus folks, particularly in accessing mental health services?

Yeah. Oh, my gosh, so many, I think the first thing that comes to mind is, again, if we think about, Well, broadly, what's happening for older adults generally, and how might that also be additionally challenging for LGBTQ older adults. But older people in general are less likely to have access to mental health services than younger people are? We know some of that is mental health stigma, where just as folks were socialized to what kinds of services are acceptable mental health care was still pretty stigmatized for the current cohort of older adults. It's really become d stigmatized, I would say in the last two decades, there's still stigma, but it's better than it was. And so we know that when we look at the general population, queer and trans people are more likely to at least seek mental health services than sis straight people. It doesn't mean that like, we all have mental health diagnoses, but it's really just about the impacts of minority stress, increasing the likelihood that somebody will have a mental health diagnosis and need services. But we don't know if that holds for LGBTQ older adults, because there is so little research for this population. What we do know is that there are different mechanisms and mechanisms of accessing services for older people than for younger people. So generally, older adults get access to mental health services through referrals from medical sources, that could be you go to your PCP, they give you the universal screener for depression, the PHQ nine for those in the know. And, and you flag to a certain level in there, like, Hey, you might want to think about talking to someone, let me make a referral. And you know, up until this year, that referral would have been to a psychologist or a social worker now that Medicare policy has finally been updated to include more master's level providers that could also include a licensed professional counselor or a licensed Marriage and Family Therapist. But we know that queer and trans older adults are more likely to avoid medical care than sis straight older adults, because they're afraid of encountering heterosexism or sis sexism. So already, we can see where that general mechanism of access for older people might be more challenging to access for a queer or trans older person. We also know that queer and trans people who are older when they go to the doctor, they're less likely to disclose information that might lead to the doctor or medical provider, seeing them more negatively. So if they're concerned about encountering heterosexism, or sexism, they might not disclose their gender identity or sexual orientation, like the woman who shared about before. But they might also not disclose mental health symptoms, because they don't want to confirm negative stereotypes about LGBT people for that medical provider. And so we also see where they might get missed in screening processes, because they're doing some impression management to keep themselves safe. So there's some structural pieces that I think inhibit access for this population. When

you mentioned, not disclosing mental health symptoms, because I don't want to give this provider a negative view of me in the context of my identity. And I'm also curious how that shows up in terms of some of our ageist assumptions of, well, these things happen, right? Like if you lose a spouse or something like that these things happen as you get older, and then become dismissed as irrelevant mental health issues. Could you say a little bit more about that experience and how that plays in? Yeah,

so we know generally that some of the ageist assumptions we have in the US is that older adulthood is just a depressing time, and that it is normal to feel depressed and it is normal to feel depressed, but it is not a normal part of aging. What I mean by that is we want to de stigmatize the idea of depression. We don't want to say there's something wrong with you or that you're abnormal. And we don't want to say it's just the cuz you're getting older, we want to say like this is an experience lots of people have, regardless of your age and eight, like older adulthood is not an inherently depressing time of life, even as you're encountering greater experiences with loss, with grief with some physical health related changes, that you may have some grief around or you might be okay with those things can be challenging, but it does not have to be inherently depressing. When we think though, about what it might be like for a queer person, or a trans person who is experiencing symptoms, one of the messages that often people in this cohort of LGBT older adults heard is that being queer or trans was a mental illness. So there may be a greater drive to not confirm the negative stereotype and therefore, to mask mental health symptoms that they really are experiencing, so that that person doesn't say, See, you're a queer, older person, that is just a depressing time of life. And so folks may mask symptoms, or may internalize that as well. This is just how it is everything I've ever seen about what it is to be a queer adult involves tragedy, we talked a little bit about the media portrayals earlier. So people may also not disclose their symptoms simply because they think that this is how it's supposed to be, and that it can't get better.

So I'm hearing in that this connection between even identity as a mental illness and the way that that continues to be internalized as a view of self, and or an assumption of your care providers. Because I imagine that if they that folks either heard that message directly from a care provider, or witnessed it within context of care provision.

Yeah. Or even if you think about stereotype threat theory, right, this idea that, like we see these messages around us, so even if you haven't heard that message from a care provider since your 30s, it may be didn't go away. And so when you're seeking services, you're carrying that with you, every time and when we think about again, the context of current LGBT older adults, whether or not they were out during these developmental periods. Homosexuality wasn't removed from the DSM until the 1980s. People say it was 1973, it was actually the 1980s. Technically, we they were like, well, it's not the same diagnosis, but it was shifted to a different part of the DSM and then removed in a later iteration. So I think it wasn't until the DSM four TR, not the DSM four, that homosexuality was actually fully removed from the DSM. And as we know, we still have gender dysphoria. In the current iteration of the DSM, it's a little different. It's intended to help people access gender affirming care, you need a diagnostic code, but when it was in the DSM is gender identity disorder, that certainly implies that simply having a trans identity is a mental health condition. And so current younger generations of queer and trans people don't have that same context. It's a part of the history that we talk about, versus for current cohorts of LGBT older adults, again, whether or not they were out at the time, that was the context in which they came to understand what mental health was, these identities were in the diagnostic manual. And so you can see how that would be pretty hard to separate out even if you cognitively believe it's different. You don't know whether or not care providers have necessarily unlearned that information, you don't know whether or not you might confirm that or if you internalize the stereotypes and don't realize it, you might not even know you're doing it.

And I think there's also this piece of you and I are in the DSM because it's part of what we do on a day to day life. Right. But for a lot of folks that you're talking about, they may have known that homosexuality was seen as a mental illness and classified as a mental illness, but never knew that it was removed or that it shifted, or that it has, the understanding has changed the way that it has, right.

And even if even if those are folks who knew intrinsically that it didn't mean something was wrong with them, they might still not know whether or not providers have moved beyond that point. And so they're carrying those concerns with them when they go into these different care contexts. And when you think about the types of care that is available to older people, so aging service specific contexts, that invisibility of LGBTQ older adults is not just like a broad culture problem. It's documented as a specific aging services problem as well. There are very few formal trainings for people who work in the aging services network focused on LGBTQ identity. Folk, we see a lot of heterosexism and sis sexism in people's experiences in like senior living contexts, including assisted nursing facilities. We see folks encountering heterosexism when they try to get meal services, whether that's congregate meals or home delivered meals. We even see like adult daycares. People don't really know how to talk about LGBTQ identity and tend to avoid it out of fear of offending sis straight older adults, in a way that communicates to LGBTQ older adults, you don't belong here. So then if that's the context, where you're receiving a lot of your services, why would you think your health care providers know any better or gonna do any different when your day to day interactions with care providers kind of substantiate that you should be worried about encountering bias.

That's really interesting to me this point that you just made about lack of training around LGBTQ plus older adults, and how that also connects into ageist assumptions that all older adults are highly conservative are homophobic or heterosexism, or sis sexist, which is a broad sweeping assumption.

It really is. And to be honest, I think it's a really ageist assumption, no, you named it that way as well. But it feels infantilizing of older adults to assume that there's this monolithic way of thinking that we all naturally are more conservative, as we age, even if you just look at changing demographics in the US, there's been a shift and people aren't getting more conservative as they age. This is, I think, related enough that I can share it. We went to a production of Kinky Boots at the university here. Gosh, just a few days ago, actually. And there were so many older people there we were sandwiched between these older women who were here as a big group, and then this older couple, a man and a woman. And they're they're seeing a show about drag queens and what it is to be gay and queer. And so even even if some of those folks were LGBT, or even if they weren't, I think that example alone shows that older people really do have great variety in their thinking what they want to consume. And when we design our aging services with the idea of the monolithic older adults in mind, we're not serving the vast majority of people who actually are in the world and need these services.

Absolutely. So speaking of services, in particular, what are some of the things that are very helpful? So start with kind of a broader service perspective? And then I want to ask to bring it down into counseling specific, but what are some of the things that are particularly helpful for LGBTQ plus older adults?

Yeah, so thinking broadly about services, this is kind of the same thing like what are the biggest barriers to care? The answer is right there. But culturally responsive services regardless of what kind of service you're delivering, acknowledging that LGBTQ older adults exist, and inviting them to have opportunities to share about those experiences. So whether it is asking about gender identity instead of sex on intake forms, or inviting people to share about their pronouns, asking about sexual orientation, using inclusive language like partner or spouse instead of husband, wife, little things like that, that can just communicate that people are welcome. And that you have thought about the fact that they might exist as they're encountering your services feels really, really important. Some of the research that I've done and that's involved, like working with sage services and advocacy for GLBT elders specifically, a lot of their recommendations are how do you make sure to show that your services either invite older people, if they're LGBT specific services, or invite LGBT people, if they're aging specific services? How do you include either of those groups in your advertising materials or make sure your paperwork is inclusive? I think if people are going to do that, you also have to commit to then being culturally responsive in the way you interact with people, right? Like it's such a punch in the gut, when you see all the right language on a form and then the first provider you interact with, says or does something that implies heterosexist heterosexism, or sexist bias or ageist bias, so if you're going to do that, you also have to like provide training to your staff to walk the walk and engage with people in a culturally responsive way. And

I really appreciate the way you said it of when you specialize, because we do most of us specialize with particular populations that have a lot of additional intersections, that intentionally being inclusive and knowledgeable and responsive to those intersections. And knowing you know, you don't have to know all of it, right but you do have to have the training that you can't find a forum, download a form and use that and say, Now I'm culturally responsive, because this person is going to be across from you or in the room with you that you're going to need to, to address. So speaking of that, what are the what are the specific things and counseling that counselors can do?

Yeah, so I think when I'm thinking specifically of what are some of the approaches that counselors could take, or ways that they can be inclusive, again, making sure that it is obvious that you are affirming and inviting people who hold these identities into the space rather than just assuming they'll be able to pick up on it? Because you're thinking about folks who are having to navigate dis affirming contexts in lots of different ways. So if they're in LGBT spaces, is their age affirmed? Is it accessible, we know that there's a greater intersection with disability and aging? Again, not all older people have disabilities. But we know that as physical health changes over time, we just tend to age into having disability experiences, or they follow us across the lifespan. So also being aware of if I'm saying I invite LGBTQ older adults into my space, is it accessible? Can they get in the door? Can they get in my office? Are they going to have to take stairs? Is there an elevator, these little things that I think we should always be conscious of, but feels especially important if you're intentionally inviting folks who are more likely to have that experience into the room? Another thing to think about? Is, is telehealth an option for you. We know that telehealth is a really great way for counselors to get around barriers to care that older adults experience and that includes LGBTQ older adults. Now, if you're going to do that you might do some additional digging around are they in an affirming environment where they could talk about their sexual orientation or gender identity without fear? We talked before about Senior Living contexts being pretty disarming for many people. So if they're in a senior living apartment building, for example, and like use the computer room downstairs, is that a safe place for them to talk about their gender or their sexual orientation? If they were to be overheard, you might need to do some exploration there that you wouldn't do with someone who didn't hold these identities, in terms of intervention, or ways that people can work well with this population. Unfortunately, there are very few evidence based interventions available even when you look outside our discipline. So social work probably has the most research on this population because of Karen Fredrickson Goldson, who does like all the research in this area, she's great, everyone should read some of that work. But so much of it is just documenting what happens for this population, rather than what can healthcare providers do to support mental health in this population? Psychology would come in second. But similarly, it's been pretty focused on just what are the mechanisms of the mental health needs that we see or of resilience and wellness. And we have less around well, what interventions work really, really well. So I tend to go to techniques or approaches that have a strong evidence base, either for older adults, or for LGBTQ folks generally, and think about what app that what adaptations might I need to make to make this work? So if I'm pulling an intervention that generally works well with older people, like Okay, where did they miss attention to sexual orientation or gender identity? Where might those pieces of culture be absent that need to be integrated here? If I'm pulling an intervention that's for younger LGBTQ folks, I'm thinking Where does age tie into this? How might ageism be impacting if I were to try to use this and make it less impactful or less helpful for this person? So some of the specific techniques narrative approaches, generally, especially narrative reminiscence, are really effective with older adults, you have an entire lifetime of experiences, a lot of the developmental tasks and older adulthood are starting to make meaning of your life story. And so these approaches that are about meaning making and tying your stories together are really effective when you've lived several like so many decades, and have all these experiences that are coming together to mean something to you, especially as you think about, well, what do I want these last decades of my life to look like? If you're doing that I think narrative approaches also tend to be recommended for LGBTQ folks, these postmodern humanistic approaches can be really helpful ways to explore culture with people in ways that are salient identities have influenced our life story. I think that you just need to be intentional about integrating that focus rather than just focusing on like the surface level stuff you here. Remember, you're working with a population who was told their whole lives not to talk about being queer or trans, right? And that doesn't mean every single person internalize those messages. But if you're working with a queer, trans older adult, and this isn't coming up, you might consider intentionally inviting it in. They just might not know that it's okay to talk about it with you.

I also here in this you mentioned, being told not to talk about being queer Are you? And I'm also thinking about the contextual pieces of this, this cohort also being told not to talk about distress or not to talk about mental health in general. So I imagine because that's a barrier working with older adults, or an adaptation that needs to be taken into consideration is how much they were told not to talk about the hard stuff. Yes.

And I completely agree with you. And at the same time, a mistake I sometimes see counselors make when they're working with older people, is to push hard at trying to get people to talk about the hard stuff. So someone will disclose symptoms they're having or share a past trauma, but then they're able to contextualize it and kind of like, but you know, it's okay, I've landed here, and I sometimes see early counselors jumping in to be like, No, don't dismiss your experience. But what you might actually be doing is dismissing their effective coping and resilience, like it really might be okay. At this stage, because you have a lifetime of finding out what strategies help you survive hard stuff. And so I think it's a both and you're going to encounter I think that there really is a tendency among many older people, not all, to maybe try to put a shinier face on things because that was the messaging around mental health. And some of that might be appropriate, because they really feel the way they're feeling now. And so I think there's a balance of how do we elicit the information that's accurate, help people connect with their feelings? Without unfairly pathologizing? What might be an appropriate response? If we're quick to say, well, they're just they're avoiding their feelings, rather than maybe they've actually resolved that feeling. And I think it takes some nuance to separate out things that are from the past that are resolved, but are important context for their story, versus things that are in the present that might be being minimized. And navigating that space, I think just requires more intentionality than I think people maybe are expecting going into this work.

Absolutely. I like the way you said, you know, making it shiny. And that how, as counselors, that's a really important skill to learn of differentiating, meaning making and kind of coming to a conclusion with this experience. That's no longer enormous ly distressing, even if distress is still somewhat occurring. Versus I'm avoiding it. I'm bypassing it, it's it's not actually processed, it's not actually experienced healing. And we really would maybe benefit from digging into it a little bit more.

And even the stuff that hasn't healed, the emotional response might not look the same, because you have had 30 years of coping with that experience. And so not trying to elicit more distress. I know that many of our therapeutic approaches involve helping people feel their emotions and eliciting the emotional response. And that's not inappropriate, but maybe just being cautious not to jump in and assume that somebody is inappropriately masking their feelings, or burying their feelings when it might also just be that the feelings are less strong, because they've been living with this for a really long time. And when you're working with older people, you might be talking about things that happened 4050, even 60 years ago, versus if you're working with a younger adult, it might be 510 years, there's a difference in what the distance from the event, even if you do need to process it, how the emotions might be elicited.

And I'm hearing this piece of like how even just continues to process in the background? Yeah,

yeah, exactly. along the same vein, when we think about effective approaches, and kind of this like weirdness, not weirdness, this nuance that we need to bring to understanding people's expression of emotions and honoring where they are approaches that work really well for both older people and LGBTQ folks are group counseling approaches. And that's going to add another layer of that nuance, right, where you're going to have these differences in how people prefer to express their emotions or what emotions they need help processing. So I strongly recommend that people consider groups social connection is so important, resilient strategies are so important. I think that probably the most important external thing that we can put in a queer trans older person's life is more social supports, or higher quality, social support and group is a really great place for that to happen. And I think then we're at adding this additional piece of different people are going to express their emotions very differently. Some folks may be experiencing more distress some may not, and not judging, one person's response against another's, which I know we have to do generally in group. But I think that if we're already battling some of the light while we think you heard messages about don't talk about your mental health, don't talk about your feelings. It could be even easier to character I someone not expressing very much emotion in that space as problematic or is indication of distress that maybe isn't there. So just a piece for folks to hold? Absolutely.

And kind of this last piece here, I feel like we've kind of spent some time talking about access to care. And some of the accessibility that is there, you've mentioned now, especially LPCs, and LMFT, is being able to take Medicare, so maybe not having as much of a disruption of service or increasing the availability of service as well. And from a different kind of holistic framework. We also have talked about some of the barriers just to healthy aging, or aging well, and some of the even stereotypes about aging. And so I'm curious now to kind of shift gears a little bit and ask you about what does it look like to age? Well, as an LGBTQ plus person?

I think to start, we have to talk about what does it mean to age? Well, in general, I think that in general, our conception of aging in the US is pretty stigmatized and characterized by ageism. So I would really nudge people toward Dr. Matt Fallens. Work on Aging, well, resilient aging, he's got a holistic wellness model for older adulthood, that's really great. He's also my advisor. So this is where I learned a lot of my stuff. But but really, it's about viewing aging processes holistically, instead of only through a deficit lens. So it's not to say that we don't acknowledge some of the very real challenges that come with aging, many of those are structural, and the ways that our culture isn't built for older people and doesn't value older people. And then some of those are just related to aging related changes can be hard to navigate, there's a lot of transitions. And at the same time, there are a lot of strengths associated with growing older and older adulthood can be a time of joy, as much as it's a time of anything else. So I'd encourage all of us to reflect on like, what does it mean to age? Well, and what preconceived ideas do we have about aging, that some of the work that we do with any older adult client on developmental wellness, helping people develop a more positive aging identity. I also think that when we take that more holistic understanding of wellness Fallens model is a great starting point. And we have to go beyond that when we're thinking specifically about LGBTQ folks. There are elements that are going to be relevant for every single queer and trans person. And I think that our social structures tend to look different as we age, especially for the current cohort of LGBTQ older adults. So same gender marriage wasn't passed until 2015 by the Supreme Court. So this is a cohort of people who, at least in their early and mid life didn't have access to marriage equality, they may still have built family structures, don't assume that that means no one could have had a long term partner couldn't have had kids. Like that's not what I'm saying. But this cohort of LGBTQ older folks is less likely to have children than their straight counterparts, and they're more likely to be cut off from other family members. If you think about the stories, we've all heard about folks who get disowned for coming out that was more prevalent in the 60s 70s 80s. So they may not have sibling networks, which means nieces and nephews may not be an option. At the same time we want so then I'm not saying that in a deficit Lens, I'm saying so you might want to think creatively about what does a family structure what does a social structure look like? And how are those pieces sources of resilience and strengths for the person that you're working with? It might not look like having a positive relationship with kids is a part of what aging is aging? Well, it might look more like staying connected with the family of choice that you've built and creating intergenerational connections with LGBTQ communities so that you've got queer, queer, younger generations that you're supporting, engaging with and receiving support from. Resilience is also a really key component that emerges in the literature. We know that the way we think about resilience in counseling and psychology doesn't always translate super well, for queer and trans people. It's not just about the ability to bounce back, but it's about community. It's about resistance. It's about activism. It's about trying to create a better world. And when we look at the current cohort of LGBT older adults got who better did that for us than the people who were at Stonewall and the people who fought the first three iterations of the gay civil rights movement. There's been a couple of qualitative research studies. And so much of the resilience processes that the cohort the people who were interviewed and those which are current LGBT older adults, they talk about the sense of generativity and seeing the world change and seeing that their efforts weren't in vain. It is better for someone who is like them today. That was when they were that person's age. And that's a really meaningful process that really, I think lends itself well to having a positive life meaning at the end of your life, which is part of the work we're trying to do, we also see decreases in distress and minority stress, specifically proximal minority stress. So things like internalized heterosexism or sis sexism, expectations that people will reject you that is lower among LGBTQ older adults than it is among younger LGBTQ people or midlife LGBTQ people. In part, because the coping processes that you develop across a lifetime work, you kind of stopped caring as much because you figured out how to deal with it. That also means LGBTQ people. There's some research that shows generally we adapt better to being an older person than sis street people do, because the coping strategies we had to develop to manage societal heterosexism and sis sexism translate really well to what it's like to experience ageism. And so often, we actually find that there's higher quality of life in certain subsets of this population, and that the aging identity is less negative, despite some of the ageist things we hear from other LGBTQ people. So there's a lot to love about being a queer and trans older person as well. And a lot that those of us who are younger, could really learn from these generations, we need these stronger intergenerational bridges.

I'm so glad you said that with intergenerational bridges, right. Like this entire conversation we've been having I've been having this feeling come up. Throughout of I wouldn't necessarily relate it to excitement, but less anxiety around aging, as a queer and trans person myself write that. I think aging is something that is terrifying for a lot of people in a lot of ways due to stereotypes, and also just changing and knowing this research as exist, and then also is coming out, which is of course representative of experience, research doesn't create that experience. But knowing that like these skills on these tools, translate. And I'm hearing this piece too, of tapping into community, and how so much of what we've talked about today is not just relevant for counselors working with this population, or for those in this population, or who part of it, but also, particularly for younger, queer and trans identified folks to engage in and create those bridges and learn that history and learn that context and have these relationships and these intergenerational relationships. And I'm also thinking of that as a as a context of something potentially, maybe for counselors to be aware of working with this population of there's some really rich history.

Yeah, there's really rich history. And it's bi directional when these intergenerational relationships happen. I think we sometimes infantilized older peoples the assumption is like, oh, it would be so good for these older folks to get to tell their stories and get help. But also there is research that shows it is so good for queer and trans kids to see that queer and trans adults exist. And I don't know about you, but I mean, my only context, I was lucky enough to have a queer person in my family who was my great uncle, so like, grandparent ish age. Without that, I think I wouldn't have realized that you could be an older adult who is queer or trans. And so I think one of the things that contributes so much to the distress that we see in queer and trans younger people beyond the horrific legislation, beyond the lack of control in their own lives, when they're in dis affirming context, is also that there is no example that you can grow up to be a happy, queer, trans adult, or queer, trans older adult. And these intergenerational bridges help us see that there is queer joy at every stage of the lifespan. And I think it's meaningful on both sides. There's some really exciting work coming out of the University of Montana where they're starting to build out some intergenerational group connections with LGBT older adults and emerging adults. And it seems like it's been really beneficial for both groups involved in that.

Absolutely. So I'm wondering if, if there's any kind of advice or any kind of takeaways that you would really want students or clinicians who are listening to this to know about aging well, as an LGBTQ plus person, from your experiences that you've seen working with folks or the research that you've seen, what is it that you want listeners to leave with?

I think one of the most important things that we can do in general, whether or not you're an LGBT person to age well is to start working on developing a positive aging identity now, thinking about and that's to speak to anyone, it doesn't matter what age you are, you could be 64, about to turn 65, you could be 75, you can be 21. whatever age you are thinking, starting to deconstruct the negative ageist stereotypes and think about examples of older people, you've seen leading full lives, what it might look like to live that way, we see that extending people's lifespans, we see that leading folks to be able to generalize their resilience strategies better. And having a positive aging identity helps you embrace what it looks like to go through aging related changes. I four years ago, when I was really starting to get deeper into the older adult research, I had, I still have a lot of death anxiety, but I had even more death anxiety, and I was terrified of growing older. And now I really believe it and mean it when I say it's such a privilege to grow old. And I really hope to get there. So I think my hope for folks is to think about what does it mean for growing older to get to be a privilege? We want to live longer? And so then what would it mean for your life to still be meaningful for you to still be capable of growth and change when you get to the stage? Because older adults are, I think we tend to think like you can't teach an old dog new tricks. And that's just not true people grow and change at every single stage of the lifespan. We should all be so privileged to reach that age group. I hope we're all so privileged to reach that age group. And when we do we deserve to have high quality, culturally responsive, accessible mental health services available to us, just like the people who are currently there deserve that same thing. So I think my two biggest takeaways is one, think about your own aging identity that will help you deconstruct ageism, that might come into the room with you. It will also help you get to grow older in a way that you can embrace and feel joy about. And then the second piece is to think about what could you do today that might make the world like this much I'm doing like a tiny little squeeze in my fingers. I know you can't see me it's audio only, but like 2% better for the LGBT older adults in your community? What are the kinds of things that would make services more accessible? What are the kinds of things that would make people feel safer being out and visible as who they are in the age group that they're in? Getting involved donate money to Sage services and advocacy for GLBT elders. For counselors and counseling students think about getting involved with the other sage society for sexual affectional intersex and gender expansive identities. And ADA, the Association for adult development and aging. These are two great organizations, they partner together sometimes who really care about making sure that counselors are prepared to work with these populations and have the resources that they need to do so. I could come up with like 18 more recommendations, but I'll pause it there rather than just keep rambling all the things that you hope people will do. Yeah,

I really appreciate it. I'm, I'm coming away from today. Knowing more than than I thought I would or learning more than I thought I would rather. So again, thank you very much. It was it was lovely to have you joined me today.

was so good to talk with you today Mickey

and thank you listeners. This has been the thoughtful counselor

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