The Gay Affirmative Practice Scale (GAP): a new measure for assessing cultural competence with gay and lesbian clients.

Few studies have been conducted on homophobia, a term used to refer to the broad range of negative attitudes toward gay men and lesbians (Hudson & Ricketts, 1980), in social workers. The first such study, conducted by DeCrescenzo (1984), examined homophobia in 140 mental health professionals in Los Angeles, California, and found that social workers were more homophobic than psychologists. Wisniewski and Toomey (1987) found evidence of homophobia in their study of 77 social workers in Columbus, Ohio. Using classifications developed by Hudson and Ricketts, the authors found that 4 percent were high-grade nonhomophobics; 65 percent were low-grade nonhomophobics; 25 percent were low-grade homophobics; and 6 percent were high-grade homophobics (in total, 31 percent were homophobic). Berkman and Zinberg (1997), using a mailed survey, studied 187 heterosexual social workers randomly selected from the membership rolls of the National Association of Social Workers (NASW). In contrast to Wisniewski and Toomey, Berkman and Zinberg found that only 11 percent of social workers were homophobic, based on their responses to Hudson and Ricketts' Index of Homophobia.

Although these studies yielded helpful information about social workers' attitudes toward gay and lesbian individuals, they ten us little about their social work practice with this population. Several authors have discussed the practice implications of homophobia in social workers, and many claim that homophobia may reduce the effectiveness of services offered to gay and lesbian individuals. Homophobia may thus lead practitioners to provide inferior treatment; minimize or exaggerate the importance of sexual orientation in the gay of lesbian person's life; change the topic when clients talk about gay or lesbian issues; devalue clients' feelings and experiences; deny clients access to a broad range of experiences; view clients strictly in terms of their sexual behavior; assume celibate adults and adolescents cannot identify as gay men or lesbians; inform clients that they are not gay of lesbian because they fail to meet some arbitrarily defined criterion; assume that gay or lesbian relationships are phases clients will move through; or perpetuate self-hatred experienced by some gay and lesbian clients (Brown, 1996; McHenry & Johnson, 1993; Messing, Schoenberg, & Stephens, 1984; Peterson, 1996). At its extreme, homophobia in social workers and other practitioners can lead to the use of conversion or reparative therapies, treatments aimed at changing the sexual orientation of the gay, lesbian, of bisexual person, which are explicitly condemned by NASW, the American Psychological Association (ApA), the American Counseling Association, and the American Psychiatric Association (ApA) (American Academy of Pediatrics, n.d.; ApA, 1998; NASW National Committee on Lesbian, Gay, and Bisexual Issues, 2000).

Despite these assertions, few studies have assessed the relationship between social workers' attitudes and practice with gay and lesbian individuals empirically, although a relationship between the two is generally assumed (Wisniewski & Toomey, 1987). Oles and colleagues (1999) claimed that although attitudes are an important component of practice with gay men and lesbians, other factors also are required for culturally sensitive practice with these individuals. Given these limitations, additional research on social workers' behaviors in practice and beliefs about practice with gay and lesbian individuals is needed. The goal of this study was to develop a two-dimensional scale that would assess both these elements and to examine the relationship between this scale and social workers' attitudes in general toward gay and lesbian individuals.

GAY AFFIRMATIVE PRACTICE

Gay affirmative practice models provide guidelines for treating gay and lesbian individuals. Historically, this approach to practice has been the domain of psychologists with an emphasis on gay affirmative psychotherapy. More recently, social workers such as Appleby and Anastas (1998); Hunter, Shannon, Knox, and Martin (1998); and Hunter and Hickerson (2003) introduced the concept of gay affirmative practice into the social work literature and broadened the model to include the many venues in which social workers are employed.

As defined by Davies (1996), gay affirmative practice "affirms a lesbian, gay, or bisexual identity as an equally positive human experience and expression to heterosexual identity" (p. 25). Tozer and McClanahan (1999) said that affirmative practitioners

 
   celebrate and advocate the validity of lesbian, 
   gay, and bisexual persons and their relationships. 
   Such a therapist goes beyond a neutral or null 
   environment to counteract the life-long messages 
   of homophobia and heterosexism that 
   lesbian, gay, and bisexual individuals have experienced 
   and often internalized. (p. 736) 

Thus, an absence of homophobia is not sufficient to practice affirmatively. Rather, affirmative practice requires that practitioners celebrate and validate the identities of gay men and lesbians and actively work with these clients to confront their internalized homophobia to develop positive identities as gay and lesbian individuals.

Gay affirmative practice is well suited for the many settings in which social workers assist clients. According to Appleby and Anastas (1998), "There is no particular approach to psychotherapy or other forms of mental health treatment nor any particular modality of treatment--individual, couple, family, or group--that cannot be made useful for lesbian, gay, or bisexual people if approached affirmatively" (p. 286).

In addition to being applicable across a variety of social work settings, such as case management, substance abuse treatment, child welfare, and private practice, gay affirmative practice is consistent with approaches familiar to many social workers (see Figure 1):

* Person in environment--Gay and lesbian individuals are considered in the context of the many environments in which they interact and the many roles they play. For example, when working with gay and lesbian individuals, affirmative practitioners pay attention to gay men's and lesbians' work and family settings and the degree to which they disclose their sexual orientation to others along with the roles that gay and lesbian individuals play in these environments.

* Strengths perspective--Gay and lesbian individuals are viewed as having many strengths that can assist them in addressing their presenting issue. Where appropriate, affirmative practitioners also use other components of the strengths model, including self-determination, by supporting gay and lesbian individuals in their decisions regarding when and to whom to disclose their sexual orientation (Appleby & Anastas, 1998); a focus on health, not pathology, by viewing identities as gays or lesbians as equally healthy as heterosexual identities (Davies, 1996); and consciousness raising, by encouraging gay men and lesbians to examine the impact of homophobic forces in their lives.

* Cultural competence models--Many of these models suggest that culturally sensitive practice with diverse populations …