Substance abuse in the LGBT community has been exacerbated by internalized homophobia (Ghindia & Kola, 1996) so that many LGBT individuals feel isolated and victimized. The isolation may be intensified further by mistrust of treatment providers and a lack of civil rights protection. Seeking professional or legal help for interpersonal violence is equivalent to coming out (Elliot, 1996). These barriers may make it more difficult to identify LGBT victims or perpetrators of interpersonal violence. Consequently, LGBT clients in substance abuse treatment should be screened to identify both batterers and survivors of interpersonal violence (CSAT, 1997c). Indicators of interpersonal violence include the presence of physical injuries, especially in visible areas, inconsistent or evasive answers regarding injuries when questioned, a history of relapse or noncompliance with substance abuse treatment goals, and stress-related conditions and illnesses (CSAT, 1997c).
As with all clients, practitioners should gather information about the partner’s treatment of the client. Interpersonal violence may be a factor if the client states that the partner tries to isolate him or her socially, tries to prevent him or her from attending treatment or self-help programs, threatens to abandon him or her, or damages property.
The practitioner should ask questions in an affirming and culturally sensitive manner. Establishing rapport and trust is critical in accurately gathering sensitive information. Care in selecting words and phrases that reflect sensitivity to LGBT issues is imperative. Potentially difficult questions should not be raised too quickly or the client may feel overwhelmed or threatened and refuse to cooperate.
Clients should always be interviewed about interpersonal violence in private, even if the client requests the presence of another individual who is not the batterer (CSAT, 1997c). Putting the client at risk by interviewing him or her in the presence of others should be avoided because batterers may manipulate family members and others.
Practitioners should include questions about sexual abuse that reflect their sensitivity to LGBT concerns. Questions about the client’s family of origin should be posed in a way that helps the client speak openly. When working with LGBT individuals, the service provider should help clients feel safe and assure them that confidentiality is respected. These issues frequently provoke great discomfort in all clients, and LGBT clients may feel additional discomfort because of some apprehension about mental health practitioners in the LGBT community.
Screening of possible batterers should be conducted with the same emphasis on confidentiality, safety, and cultural sensitivity. The practitioner should ask clients about abusive behavior using the technique of circumstantial violence (Kantor & Strauss, 1987). Simply put, this involves using a third person example so as not to personalize the question, thereby making the client defensive. For example, “Some people think that under the right circumstances, it’s okay to hit your partner. Under what conditions do you think violence might be justified?” (CSAT,1997c). Then the practitioner could begin personalizing the questions assessing self-control. For example, “If you were confronted with overwhelming stress, do you think you could keep your cool? Faced with that, what do you think you would do?” (CSAT, 1997c).
Questions should be supportive and affirming, thereby encouraging genuine responses. Gradually, the practitioner should ask specific questions about the relationship, e.g., “Have you ever hurt your partner?” It is critical to recognize that denial, rationalization, and minimization are strong mechanisms used for both interpersonal violence and substance abuse. Thus, it is critical that the practitioner guard against being manipulated or misled by excuses and that batterers be held responsible for their actions (CSAT, 1997c).
Finally, the treatment provider should avoid colluding with clients in denying the implication that substance abuse causes interpersonal violence. Practitioners should watch for clients who blame others for their battering or substance abuse. For successful treatment outcomes, clients must take full responsibility for their behavior.