Counselling Black Gay Men in North American

Multicultural Counselling Psychology Approaches
Jessica C. Henschel and Dr. Austin Mardon
Antarctic Institute of Canada

Counselling Black Gay Men in North American
Counselling is an interdisciplinary field that requires appropriate knowledge of cultural impacts on clients and how to select appropriate interventions. The 2SLGBTQIA+ community is a widely diverse minority group that requires special attention and counselling considerations due to historical, systemic oppression. More specifically, Black gay and bisexual men in North America have been targeted for their sexual orientation and racial identity. These men are at an increased risk for psychological disorders, sexual health concerns, and hate crimes/microaggressions (Camarena & Rutter, 2015). It is crucial that counsellors engage in psychological interventions that are culturally applicable and destigmatizing in nature. This paper will examine considerations for counselling Black gay men and how counsellors can incorporate multicultural, gay-affirmative approaches that include these men’s unique, intersectional experiences. 

Racism and Discrimination 
Societal racism and stigma of HIV have long-lasting impacts on Black gay men (Arscott et al., 2029; Saleh et al., 2016). Black gay men report a stigmatizing interaction between their gay identity and race that are perpetuated by racial stereotypes. Often, they are portrayed in media and pop culture as “thuggish” and overly masculine, suggesting that Black gay men are aggressive and engage in sexual activity more than other gay men (Arscott et al., 2019, p. 179). Furthermore, Black gay men are hypersexualized by society and associated with historical stereotypes of Black men being well-endowed. Due to the perpetuation of inaccurate labels, Black gay men are inherently associated with HIV and poor sexual health. Arscott et al. (2019) found that the majority of their sample of Black gay men had a stigmatizing interaction with another person that heightened their awareness of narratives that all Black men who have sex with men have HIV. Therefore, counsellors should work to incorporate strategies that address sexual health stigma and the negative effects of stereotypes. Including a historical context and social justice lens into practice can help build the therapeutic alliance and improve outcomes for Black gay clients. 
Since Black gay men are particularly vulnerable to racism and discrimination, it comes as no surprise that they face increased rates of police brutality and unprovoked altercations with police officers (Remsh et al., 2021). Individuals with dual minority status face increased negative downstream effects in the criminal justice system in America. In Remsh et al.’s (2020) study, about 60% of the sample of Black gay men reported police harassment characterized by homophobia and racism. Understandably, these men had increased rates of distress due to traumatizing experiences with police officers, judges, and staff in criminal courts. Police harassment and violence may contribute to adverse mental health outcomes (most prevalently is depression and anxiety) of sexual and racial minority men, as well as creating physical health risks. Being understanding of these negative experiences is essential in counselling; Black gay men seeking therapy may have altercations with the law and counsellors must remain as unbiased and culturally informed as possible to not pass judgements. 

Substance Use 
As a response to internalized and external homophobia and racism, Black gay men report higher drug and alcohol use than White gay men (Ogunbajo et al., 2018). It has been discovered that recreational drug use, alcohol consumption, and depression are strongly related to the Black gay experience. Due to homophobic experiences and racism, these men often turn to drug and alcohol as a coping strategy. Most Black gay men have had to face financial instability, housing issues, limited social support, and dangerous encounters with racist/homophobic individuals due to their minority status. Ogunbajo et al. (2018) determined that these factors lead to high rates of post-traumatic stress disorder (PTSD) in Black gay men and self-medicating with substances is common. Furthermore, substance use is frequently promoted in Black gay and bisexual communities through modelling behaviour, media, and ease of accessibility of elicit drugs (Harper et al., 2016). This result implies that substances are a distinctive theme in Black gay social groups, regardless of if an individual chooses to use them or not. With this in mind, counsellors can assist clients with navigating the discourses around drugs and alcoholic within the gay and Black communities. Ogunbajo et al. (2018) suggest that mental health workers take a holistic and comprehensive approach that establishes an environment of safety and security, as well as building healthy coping skills.

HIV Implications 
Another significant challenge for Black gay men in North America is the heightened risk of contracting AIDS/HIV, as well as the stigma associated with the infection. Black men who have sex with men accounted for 51% of new infections among all African Americans in 2014 (Saleh et al., 2016). Notably, there are social-psychological factors that influence HIV risk among Black gay men, including racial discrimination, homophobia, isolation, and familial rejection due to sexuality. The subsequent psychological distress can lead to risky sexual behaviours (i.e., anonymous unprotected sex with other men) that increase the probability of contracting or transmitting HIV and STIs. Based on the negative stereotype surrounding HIV and Black gay men, there are reports of sexual racism, where other gay men do not wish to engage in sexual or romantic relationships with Black men (Callander et al., 2015). 
Additional consequences of psychological distress and stigmatization of HIV are alienation and withdrawal from social networks (Saleh et al., 2016). However, social support and community connection is a protective factor against detrimental psychological and health concerns. Counsellors can work with their Black gay clients to develop skills and attitudes that allow them to connect with their communities on various levels, whether that be with Black, gay, or social location groups. The more open sexual minorities are with their healthcare providers, the better outcomes are for mental and physical health, including HIV prevention (He et al., 2016). Based on these findings, counsellors should make an effort to incorporate 2SLGBTQIA+ affirming therapies and interventions. The more open and accepting an individual is with their sexuality and racial identity, the higher their chance of attaining proper care and education about HIV safety. 

Culturally Informed Counselling Practices
When counselling individuals from a minority group, specific considerations need to be taken and included in treatment. Counselling Black sexual minority men requires knowledge and education about the interlocking systems of oppression and discrimination that affects the Black queer community in Canada and the USA (Camarena & Rutter, 2015; Mosley et al., 2021). Therefore, understanding the influence of this oppression and taking accountability is vital for successful outcomes. Various culturally informed steps can be taken in counselling to promote recovery and liberation. Counsellors can engage their Black gay clients in processes that explore collective, personal, and relational dynamics. This can be achieved by bringing these clients to a place of what Mosley et al. (2021, p. 293) calls “radical healing,” which has five anchors: collectivism, radical hope, critical consciousness, strength and resistance, and cultural authenticity/knowledge. Taken together, counsellors can guide clients through a healing journey that addresses the intersectionality of being Black, gay, and a man. Radical healing approaches have been shown to have positive outcomes, as it identifies themes of systemic oppression encountered by members of the queer Black community and unravels the stigma. Above all, counsellors should assist Black gay clients with coming to a place of self-acceptance and skills for building social support (Mosley et al., 2021). Frameworks such as the radical healing model allow counsellors to actively acknowledge oppression with their clients and use techniques geared toward regaining dignity and control. 
An overarching model that can be used in tandem with radical healing and any other kind of therapeutic intervention is Camarena and Rutter’s (2015) historically informed Multicultural and Gay Affirmative Approach. The Multicultural and Gay Affirmative method is based on dismantling “colonial mentality,” or the psychological effect historical colonization has had on ethnic and sexual minorities (Camarena & Rutter, 2015, p. 59). By understanding colonial mentality, counsellors can comprehend the marginalization and challenges of being Black and gay. The therapeutic aspect of the Multicultural and Gay Affirmative Approach comes from psychoeducation about traditional cultural practices in countries/areas that have been colonized. It helps clients to know that their behaviours and desires are mirrored in their Indigenous histories, as many of these groups engaged in same-sex behaviours. Therefore, counsellors can help clients connect to their ethnic backgrounds, which in turn can affirm their sexual orientation. Camarena and Rutter’s (2015) framework can be applied to many different treatment techniques to help build the therapeutic alliance and give the client confidence in their sexuality and/or gender identity. Due to the historical degradation of queer Black communities, the most important role of a counsellor is to affirm the client’s identity, help them take back their control, and connect to cultural support networks. 

Conclusion 
Counselling Black gay men require special attention to the culture and discrimination they face at many different levels. They face challenges for both their race/ethnicity and sexuality, as well as the stigma of HIV that is so prevalent in their communities. Intersectionality is at the forefront with these individuals and should inform counsellors on treatment and in building the therapeutic relationship. Counsellors who wish to have a well-rounded multicultural practice should also incorporate SLGBTQAIA+ affirmative therapies into their interventions. Taken together with therapies developed for Black queer individuals, counsellors can help Black gay men with healing and liberation. 

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