MDPH Podcast 1: That’s So Gay: Preventing and Addressing ...



Webinar: LGBT Bereavement: Is There a Difference?

Webinar Description: The LGBT Bereavement: Is There a Difference? webinar was presented by Lisa Krinsky, LICSW, Director of the LGBT Aging Project & Beth Prullage, MSW, LICSW, and Adjunct Instructor at Smith College School of Social Work. Using clinical models and vignettes webinar participants will be provided with an overview of risk factors, experiences, challenges, and needs of lesbian, gay, bisexual, and transgender (LGBT) elders as they grieve the loss of a loved one (family members, friend, partner/spouse, etc.).

Webinar Duration: Approximately 85 minutes

Brandy Brooks: Good afternoon and welcome to the LGBT Bereavement: Is there a Difference? webinar. My name is Brandy Brooks and, aside from being the moderator this afternoon, I am a Contract Manager for the Massachusetts Department of Public Health Suicide Prevention Program, the sponsors of this webinar.

Before I introduce our presenters, Lisa Krinsky and Beth Prullage, I would like to go over a few housekeeping issues. First, should anyone experience any technical difficulties with either the audio or video for this webinar, please dial 1-800-843-9166. Again, that’s 1-800-843-9166 and a ReadyTalk representative will be more than happy to help.

Second, all telephone lines are muted except mine, Lisa’s, and Beth’s. So, please use the chat function located in the left corner to type in any questions you may have. Lisa, myself, and Beth will do our very best to answer as many questions as we go along and at the end of the webinar during the answer and question period.

Also, ladies and gentlemen, please be mindful. If you want to see the slides for this webinar this afternoon, you have to and type in, where it says ‘Join a Meeting’ in the upper-left corner, you type in this following passcode: 6245494. Again, that is 6245494 and it will send you to actually join this meeting so that you can see the slides. If you have any questions, again, please use the chat function.

Now that I’ve gotten that out of the way, let me introduce our presenters, Lisa Krinsky and Beth Prullage. Lisa Krinsky is a licensed independent clinical social worker and the Director of the LGBT Aging Project. The LGBT Aging Project was founded in 2001 by a group of advocates from both the Aging Service Network and the LGBT community, who recognized that lesbian, gay, bisexual, and transgender elders were invisible to mainstream elder service providers and that elder LGBT’s are invisible within the LGBT community as well.

Our second presenter this afternoon is Beth Prullage. Beth has a Master’s degree in social work, is licensed independent clinical social worker, and an adjunct instructor at Smith College School of Social Work.

So, without further ado, I will now turn it over to Beth and Lisa. Beth and Lisa are you there?

Beth Prullage: I am here. Can you hear me? This is Beth Prullage.

Brandy Brooks: I can hear you, Beth. Let me see if I can get Lisa on.

Beth Prullage: She is using her work line.

Brandy Brooks: Okay, let me see if that is -- Lisa, are you there? Well, Beth, let’s get started and then, hopefully, Lisa can join us.

Beth Prullage: Okay. I just wanted to say I’ve logged off and on multiple times and I’m still having difficulty seeing the slides. I have a ‘please wait for the next meeting to begin’ screen.

Brandy Brooks: I’m sorry. You said you see a ‘please wait for the next screen’?

Beth Prullage: ‘meeting to begin’. It says ‘please contact the conference organizer if your conference hasn’t started but please wait for the next meeting to begin’ and a scrolling circle. I have logged on as a participant.

Brandy Brooks: Give me one second. I think we’re having some technical difficulties here. Give me one second before we start.

Beth Prullage: Sure. Sorry for anyone else who’s waiting.

Brandy Brooks: Beth, now did it generate anything for you on your end?

Beth Prullage: No. Actually I just reset it. It says ‘join the meeting’ and I’m going to put in my thing. Great. Thank you very much.

Brandy Brooks: No problem. Okay so we’ll get started in a few seconds. I see Lisa’s joined us as well so we’re now ready to get started. It looks like we were having a bit of technical difficulties this afternoon but now we are all set and ready to begin here. Beth, you can take it away at any point.

Beth Prullage: Okay. I’m still waiting for data to transfer but I can give a brief overview of our presentation for today.

One of the things that we’ll do is we’ll begin the conference today by first -- there’s a brief survey that we ask the people who are participating to tell us a bit who you are so we have a sense of how we might give the information to you in a way that would be most helpful.

Then, Lisa will begin and speak about the LGBT Aging Project of Massachusetts, a bit about what that agency does -- there are my slides -- also the history of doing this grant.

I’ll talk about risk factors in relation to bereavement for the LGBT community, focusing initially on elders, as they're a population who are most likely to experience loss, but also talking about other folks within the LGBT community. Then, specifically, how we’ve come to, over the years of doing this grant, bereavement curriculum and different kinds of interventions and ways of working with this community that we find to be most helpful.

I guess, as Lisa begins, there’s a place that you can input information here on what field that you represent. That would be useful for us to have a sense of who our audience is today. It’s here on slide 3.

Thank you. I see that folks are inputting now as we speak. As that data comes in, I wonder if I could this over to Lisa Krinsky to talk a bit about the Aging Project.

Brandy Brooks: Lisa, are you on?

Lisa Krinsky: I am on. Can you hear me?

Brandy Brooks: We can hear you.

Lisa Krinsky: Excellent. Good afternoon. Glad to be connected technologically to everyone. I’ll just give a little bit of history and background to how we got here to provide these LGBT bereavement groups. The LGBT Aging Project was founded about ten years ago and our mission really is to make sure that lesbian, gay, bisexual, and transgender older adults get equal access to all the services and programs and resources that are out there and that are available to them.

We do that in a couple of ways. We do that through doing LGBT Cultural Competency Training for elder service providers and anyone who comes in contact with older adults and caregivers. We also do some community engagement and one of the things that we like to do, in addition to our training, is to try and create some ways to bring LGBT folks together.

We do that with partnering with organizations that run community meal programs. There are now seven LGBT-friendly community meal programs across the state. We run healthy-aging programs for LGBT folks and we have, for over a decade, run an LGBT caregiver support group. Those have been important ways to connect with LGBT older adults, with caregivers, with folks who are either growing older themselves or are in the lives of those who are doing so.

One of the things that we found was that when we were doing these groups we were always paying attention to what needs are not being met yet and what issues are out there for folks. Particularly in relation to our caregiver support groups, we were seeing that folks who had been caregivers were moving on to becoming bereaved and were losing their care recipients and then in a position where they really needed some support as they dealt with those losses. Many of those folks also have not only been older adults themselves but they’ve also been folks at mid-life who may have been caring for a parent or for an older adult in their lives.

We connected with the folks at Department of Public Health with their Suicide Prevention Program because we were quite mindful that, for many people who’ve had losses, having a disenfranchised loss and not having an opportunity to relieve that can, in many ways, lead them to a suicidal position.

As we were thinking about these bereavement groups, I did a presentation and was talking about the issues and someone got up and spoke and said, “You know, I was looking for a bereavement group for a man who had lost his partner of 35 years and when I called to make the referral, the bereavement group leader sort of hemmed and hawed and then she said, ‘Well, as long as he doesn’t talk about the nature of his relationship, I guess he would be welcome in our bereavement group’” and that absolutely shocked me. For an individual to be dealing the significant loss of a long-term partner and a long-term relationship and then be told, “you can’t talk about the nature of this relationship”; A, defeated the purpose and B, was not going to be a safe and welcoming place for somebody who was dealing with that level of grief in his life.

On the one hand I was really relieved that it was his social worker who had the door sort of shut in her face rather than this gentleman at this tremendously difficult time in his life. That prompted us to really pursue being able to offer LGBT bereavement groups for folks of all ages across the state so that there are safe places where people can talk about these losses. That was really a very powerful motivator and we have found tremendous response in the bereavement groups that we offer.

One of the other things that is sort of related to this and people’s sense of loss and concern is that just about a year ago, when there was a lot of public attention given to the rise in LGBT youth suicide and the issues around bullying and young people not feeling safe, there was a tremendous growth of an ‘It gets better’ video campaign where people who were adults were giving messages to youth and saying, “It does get better. Hang in there and go forward in your lives.”

One of the things that we noticed at the Aging Project was that everyone who was delivering these ‘It gets better’ videos, celebrities and run-of-the-mill folks, were adults but nobody was over the age of in their fifties. We thought that we had tremendous wisdom from the older adults that we work with that could really inspire young people. So, we created an ‘It gets better’ video entitled “Wisdom from our Gay Elders” that was a tremendous hit on YouTube and got lots of viral play and reached the ‘most frequently viewed’ list.

What we thought that we would do is just take this quick chance to have folks watch this and to see the ‘It gets better’ video and to also see some of the faces and hear the stories of LGBT older adults who have survived lots of many difficulties in their lives and wanting to share this sort of inspiration with younger folks.

Brandy Brooks: As we watch this video, please, please, please be mindful that you need to use your computer speakers because I’m going to put the phone on mute so there’s no feedback. You need to turn up the speakers on your computers, okay? So, here we go, “It gets better. Wisdom from our LGBT Elders.”

(Video playing)

Lisa Krinsky: I hope everybody enjoyed that and got to see sort of the spirited energy of so many of our folks really trying to inspire younger folks and older folks alike about what life is like as an LGBT older person.

Now I think we’re going to move on to Beth.

Beth Prullage: I just always enjoy seeing that video. One of the things I like about it is that one of the many things that I’ll talk about today is how folks -- as we all know, elders are rendered invisible, to some degree, in our culture but I think particularly sub groups of elders and LGBT elders in particular. When I’ve had conversations with people about this is a group that I work with, LGBT elders, even for people within the LGBT community, they don’t necessarily always think about the generation or two that have come ahead of them, maybe the younger that they are.

One thing that I have found helpful, and I saw that a number of people work in senior centers or other places, is that this population can be among their age cohort and be quite invisible. You think of, “I don’t know of anyone personally” The numbers based on initially some estimates with Kinsey data or other things that talk about the frequency of people who identify as LGBT across all people the numbers for elders currently would be between about 2 million and 2.8 million elders are what is expected in what I think is 65 and older in this country.

Recent data -- it’s only been the last two years that in statewide or national survey data people are asked about sexual orientation and, initially, those numbers have risen. I think still that’s sort of an abstract number to me in thinking about between 2 million and 3 million people roughly. In 2004, there were 1.6 million elders in nursing homes. I feel like that’s a helpful number for me because when I think about an elder population I can clearly envision a segment of population that’s a familiar type of idea for me to have. That can maybe be in an assisted care or assisted living facility. I think that, out of all the people nationwide, there are even far more than that who identify as LGBT and who are elders so it was sort of a helpful thing to for me to begin to get a benchmark or idea of how many people, or who it was, or just the sheer numbers in this population.

I want to talk specifically about -- we’re talking about whether or not the bereavement experience might be different for people who identify as LGBT; lesbian, gay, bisexual, or transgender. The truth is, in working with a number of bereaved individuals over the years, I really believe that the grief process is an individual journey for each person who is experiencing a loss or losses.

In putting together this presentation, it’s really to talk about different themes that have come up in working with this particular population. How things might be different or what we, as providers or individuals who are in elders’ lives and people also across the age spectrum, may want to consider when sitting with people who identify as LGBT who have lost someone. I’m thinking about an elder population because that was initially who -- Lisa’s example when she talked about the man who had a long-term partnership and was unable to talk about his partner experience within the bereavement group, wasn’t going to talk about the nature of the relationship. We initially, I think, when first talking about this grant, were thinking about people coming to talk about partner loss or spousal loss and thinking of an elder population, although our groups are open to people of all ages. We’ll be talking about other age cohorts that fit as well but mostly focusing on elders.

When we think about who are -- we actually gave a numeric example but when you think who are LGBT elders, in general, or what might be some of the things that differentiate this population from their heterosexual counterparts. I think that there are a few things that have come up repeatedly across the research.

First of all, LGBT elders are more likely to be caregivers to friends and partners than their heterosexual counterparts. Part of what I’ll talk about is looking this population’s social support networks and how friends, same-age peers, there’s often the chosen family becomes a significant part of social support in individual’s lives because, particularly the older your population, there may be increased chance of cut off from family. Certainly, over time, homosexuality in general has been much more widely accepted in broader society but that doesn’t mean that the older segment of our society has experienced that kind of change within their age cohort.

In one survey, it shows on the slide -- and I draw from this survey a lot. There’s a reference on the next slide to the study -- Of 2560 LGBT elders that were selected nationwide in both rural and urban settings, 31% of participants had household incomes at or below the poverty level. Another thing that’s of interest to people that are working for various institutions, LGBT elders are more likely than their heterosexual counterparts to have contact with formal care system and more likely to live alone or also to be involved in care at some level.

One other thing -- I’m just going to go back to the previous slide for one second -- besides the poverty, slightly more than half of participants have been told by a doctor that they have had depression and nearly one-quarter were told by a doctor that have anxiety. There can be sequential mental health risks that seem to be higher in comparison studies than heterosexual populations.

This is, I think, largely due to the presence of homophobia in society. Experience of perceived discrimination and actual discrimination has had profound long-term effects on all different kinds of health indicators and one of them has a mental health impact. In that same study many people talked about having had the experience of having experienced physical assault, had definitely bias in a range of social service, health, and other kinds of settings.

Or groups are funded on a suicide prevention grant and in that same study -- which we used a lot because it’s really the best benchmark, the best research that’s been done that looked at a range of domains and also was able to get nationwide sampling and a very large sample size -- Of those 2560 participants, 39% talked about having seriously thought of suicide at some point. Of that 39%, about 40% directly related that to their sexual orientation or gender identity.

More than half also talked about loneliness. One of the things that the LGBT Aging Project does, and perhaps at the end Lisa can talk about it a little bit more, is that they have a congregate meal program where they’ve been able to get funding to have community-based meals for LGBT seniors and how, for many people, this might be the foundation of their social experiences for the week or it’s where they’ve been able to develop a different kind of social support network.

Many people, and I know from my bereavement groups over the years, may have found a partner and lived behind the picket fence or lived a private life within a long-term partnership and, although the LGBT aspect of their identity was always significant in a private way, that might not have been something that has been previously --

We’re just going to take it back to one slide and just briefly talk about the context of the work that we’ve been doing that has been funded through the Massachusetts Department of Public Health and that we have been, since 2009, offering six eight-week groups held all across the Commonwealth of Massachusetts that is free to LGBT-identified participants of any age. There is someone who specifically does outreach and I think sometimes its finding participants can be difficult. I’ll talk about that little bit with some of the internalized homophobia.

We’ve also met at a different range of locations over time; in a church, senior centers, public libraries, so that people would feel comfortable coming into our groups.

Please type in -- this is new technology to me I feel like I’m just adjusting to the point that I can’t see all of you who are listening. If there are questions that come up which I see or if you have any concerns or anything else that you guys -- please feel free to use your chat box in the lower left-hand corner of your screen and to just direct it to the Chairperson. I will see your question as it comes up.

In thinking about this group specifically and with a historical context, which I’ll talk about a little bit more in a bit, really as we entered into doing this type with others I really wanted to try to take away from approaching doing a therapeutic intervention in a way that would think heavily on pathology.

I’ll talk about it a bit more later but, for example, within the mental health field the Diagnostic and Statistical Manual that is used to come up with range of diagnoses which often will help people get access to services, get some mental health care, as I sure many of you know. What I had found remarkable is that the diagnosis of homosexuality, as being enough to determine someone’s level of mental unfitness, wasn’t removed until 1974. Which is one of the reasons why we thought a lot about giving this and thinking particularly about elders as we put together these groups.

First of all most people who experience loss tend to be over the age of 60 in this country because of that’s really when people’s peer networks are getting more -- these are the folks who experience the greatest amounts of loss. Secondly, in thinking about elders, I think that we could look at a lot of ideas around the concept of disenfranchised grief in a careful way and then design a group that would be empowering and supportive to all members of the LGBT community as well as, certainly, the heterosexual community as well around issues of loss.

With that DSM removal of diagnosis of homosexuality in 1974, I think looking at key dates can be something that’s really important as we think about the impact of homosexuality in people’s lives. For example, I identify as lesbian and was born in 1970. So, I really haven’t had a lot of experience or understand homophobia, internalized homophobia, in a certain kind of cultural context. It’s very different for me than for someone who was born in 1930 or even 1950. For the person who was born in 1930, homosexuality wasn’t removed until they were 44 years of age. If it was 1950; 24 years of age.

I often tell the story of how I’ve had arguments over the years with my stepfather who happened to be born in 1930. He’s a highly-educated man, was a university president, but still, on occasion, will conflate the two words ‘homosexuality’ and ‘pedophilia’ which are two words with very different meanings. It was helpful for me to learn that homosexuality and pedophilia were right there together in the DSM; that those ideas weren’t separate. They weren’t formally separated, in the manual that guides my field’s way of thinking, until 1974. So, my stepfather, who’s heterosexual, as well many of the elders that I work with sometimes do put those two ideas together because that was what was a broader cultural idea.

I’ve talked to gay male elders who say that, while they’ve never had, for example, any attraction to young males, it was an idea that they had to fight off internally or a bias that they had toward other same-aged gay men; just predominance of the connection of those to words in society at large.

I think that that’s kind of way of thinking in thinking about that deep level of pathology about someone’s sexual orientation is really helpful in thinking about how to do any kind of therapy, intervention, or engagement with a group of LGBT elders because what they have lived through over the arc or trajectory of history really informs us how they think about mental health, whether they would have any trust in mental health providers, how they interact or engage with institutions in other ways. When putting together these bereavement groups it was really vital for me to make sure from the initial treating conversations that I had with people that people had a sense that there wasn’t a right way to grieve; that there’s not a preferred end goal across it.

I think that for all people that I’ve worked with who are experiencing bereavement there are different moments along the way where people wonder, “Is my experience normal?” This is heterosexual people, homosexual people that, because we don’t talk about grief very well in our society at large, there’s not a lot of ways for those kinds of conversations. People are just very bereft or when people are experiencing fearfulness at different times. They can feel like, “Am I normal?” “Is this normal or not?” and for so many people within the LGBT community, who then have any less of an audience than some others to talk about their losses, I really wanted to make sure that there was just clear communication from the get go and throughout pretty much every group about how there isn’t a right way to do this or an expected timeframe. That people are on individual journey when it comes to loss.

Most of the beliefs and practices around loss are located within social or cultural discourses. Certainly, if you ask people, “What’s and expected time that someone might experience symptoms or experience high level of grief?” So often people will say something like, “About a year”. This idea of a year with the U.S. culture certainly is connected to various practices, various religious practices, cultural ideas or norms about grief.

Certainly Elizabeth Kubler-Ross’ ideas, the stages of grief, have become very embedded in how we think about loss for ideas, which some have contested over the years, about people moving through various stages or intense feelings, that they respond to a loss have become an expectation for people about, “This is the normal way. This is how people go through loss.” “I should feel the anger. I should feel denial. I should feel this that or the other. And if I’m not feeling that, if I’m just feeling this way right now, am I doing it right?”

One of the things that we talk about in the groups is that I’m not going to be the one, as the therapist or person who’s providing the service, to talk about whether or not something’s problematic in the way someone’s responding to a loss. Something’s only problematic if that individual is finding it to be problematic; that they are having trouble focusing at work, that they are feeling surges of feeling at a time that makes them feel uncomfortable or like they can’t be out it in the world in the same way. I understand grief to be a pretty disorienting process or the process of bereavement to be pretty disorienting. People have to reorganize themselves in relation to the loss. I don’t really think that, no matter how acute a person may be experiencing a particular feeling, I don’t see that often as problematic unless the person identifies it as so.

Another thing that we talk a lot about and I’ll move into disenfranchised grief in a little bit, and this is an idea that I think is connected to that, is that when the person loses someone in their life they both lose the person themselves but also hopes and dreams that were connected with that person and how they understood themselves within the context of their relationship; really that, if we’ve come to know who we are through another person’s eyes.

I often will ask people to think about a quality that they value about themselves or something that you know to be true about yourself for just a minute and then if you think about, “Well, how did I come to this conclusion that I’m a good person or that I’m kind or that I’m a smart person?”, whatever one you come up with. That has come to you through a relationship with another person. So I think so often what’s lost is the ways people uniquely view you. When people are coming to talk about the loss of the partner is what were things did that person appreciated about them or the ways that they knew them that no one else in world ever has known them. What was it that made that connection special or magical? Part of it was through that person’s eyes but part of it was how a person felt in relation to their partner or their parents or their sibling. That’s one of things then, too, but just an overview of what I do when I approach this work.

Let’s start with the screening but also -- I do an initial call before anyone comes into the group which is something that someone would do in a casual conversation with someone, discussing a loss or in an individual type of treatment setting, to try to assess and come up to the ways that that loss is unique for that person. Again, this is a conversation that you would have with anybody, regardless of their sexual orientation but I do feel like, when I know that someone is LGBT, I also think about some of these pieces of information in a different kind of way. Just while I’m thinking about what is someone’s relationship to the deceased.

Another thing that I have learned and heard repeatedly over the years is how this relationship has often been influenced by -- how sexual orientation might play into that would be these people probably have an understanding of partner loss. Not everyone might see it as equivalent to heterosexual partner loss or others but I think that that’s changing tremendously in broader society as gay marriage is legalized in more places.

I think that also within the LGBT community, friendships might also be considered to be like family relationships in a different kind of way than in some heterosexual friendships. So often people talk about them, and I see this happening with elders, there might be some differences about; your friends are families. So, I’ve had participants in the bereavement groups who’ve said, “Well, you know it’s not like I would be talking about that I’m a gay man or that I’m a lesbian woman in a regular bereavement group when I’m talking about friend loss but people just don’t understand that that person was far more than my friend. They were a family member to me and then that relationship wasn’t as acknowledged.” So often you hear of the idea of a chosen family being made up of friends or other people in your life has come out from a history of someone perhaps having a cutoff from their family when they came out, so that friends then become the replacement family for some people.

That connects a bit to social support but also I think the broader recognition or acknowledgement of the relationship. Even if people are talking about a partnership where their partner has died after 35 years of them being together I’ve come to find as I’ve worked with older LGBT individuals -- whereas I, at 40, it might be out to my tax preparer or dental hygienist that many people who grew up in different years won’t have that degree of being out. They may have also worked at the same place for 30 years but no one at work knows them to have a partner, which it makes it complicated when you're going in and you have just lost the love of your life and can’t talk about it, or that it’s rendered invisible in a setting where you're spending the majority of the time.

The same thing might be true with neighbors or with other contexts. There is someone who just talked about this. I’ve heard so many stories that have been heartbreaking for me to listen to, in terms of people in long-term partnerships who were so careful never to touch each other in public, to never go to gay pride because they didn’t want to be seen or photographed there, even if they recognized that times were changing, just feeling at high risk with it. They had lived through different time periods so they knew that things could also change back, to not have different kinds of trust in institutions.

I’m going back to the idea of that more LGBT elders are caregivers. So many people talk about not wanting to have care providers into their homes, not necessarily bringing their partners with them to doctors’ appointments, not even acknowledging that they’re in a relationship, in a number of settings, because of the fear of being seen in relationship to another person.

Dramatic stories like someone talked to be about two women, who were together for about 40 years, and one of them fell and broke a hip and needed to spend time in rehab and she told her partner, from whom she had not spent a night apart in four decades, “Please don’t come in and see me every day. You can call one time a day and you can come in one time per week but bring a friend with you because, if anyone here knows that I’m a lesbian, I’m completely dependent on others, in terms of taking me to the bathroom, in terms of helping me physically move around and if people discover I’m a lesbian I might not be taken care of as well or might be at risk in some way.” Many elders may re-closet themselves as they, in this case with institutions, due to a long history in their lived life of formalized institutional discrimination. I gave the example of the DSM but people could be hospitalized long term against their will simply for being homosexual, so one can understand how there could be fear relating to any kind of health institution.

Other factors; age, gender, a history of relationships to formal institutions and services. A lot of elders or others who may not want to come out and now with ‘Don’t ask, don’t tell’ changing, culturally there’s change, but there are a lot LGBT elders who have served in the military and they feel that their benefits would be at risk if they were to come out. We may not be connected to other settings or churches or religious institutions of any kind because of having received messages of non-acceptance from such places at other times. So, there may be a different degree of isolation to broader social supports, institutional supports, as well as to friendships or other types of more informal conditions.

All this connects with an idea that was originally put forward by the bereavement theorist, Kenneth Doka, on disenfranchised grief. This definition is sort of what it stated in terms of; any grief that’s unacknowledged or unrecognized by members of society can be described as disenfranchised. If you think that it’s hard enough for anyone who has experienced a loss, we realize that your circle becomes much smaller to whom you might have a true conversation about emotional experiences in relation to loss. I think there are a range of losses, such as by suicide or homicide or other kinds of ways that people have died for example, that make it harder to have socially sanctioned conversations. If people in general are unsure to say to someone who’s gone through a loss it becomes that much harder for someone to say anything, both to talk about what someone’s experience or to have a response by others when it’s a loss that there’s less social sanction to talk about those kinds of conversations.

Many folks who participate in these groups talk about how speaking about same-sex partner relationships would fit into this category even though, again, that socially things are changing and, as a result, people who are younger might find an audience that would recognize the significance of a loss of a same-sex partner perceived the same as a heterosexual spouse or partner loss. But that isn’t true in all communities or among all age cohorts. Often the older people are, the less likely they are to find that kind of support within their age cohort simply because of when that era of what homosexuality has been over time.

Coming to these rash conclusions based on conversations with people. Disenfranchised grievers might suffer from feelings of alienation or shame in addition to their grief; that sense of internalized homophobia. They also might experience amplified physical and emotional symptoms of grief. If there’s not a place to talk about your feelings, if there’s not an audience for you to bring you experience to, often times then they might be expressed somatically. Someone might begin to have more health symptoms or other kinds of problems.

Overall, it’s not unusual. I think people in long-term partnerships, a partner’s often at a greater risk of death themselves in first year of post-loss just because of adjusting to life alone after a loss of partnership. Studies across the UK and the U.S. have shown that there’s even less of an audience to talk about loss. People who have experienced same-sex partner loss might be more likely to have greater risk of having physical, emotional, other kinds of -- both how they experience it but also health experiences that put them at risk in some ways.

I talked about the next slide a little bit about homophobia across the lifespan. This just gets to the different comparative ages of someone was born in 1946 versus 1966 of how old the person was at key markers indicating social change over time. First public elected figure; someone who’s born in 1946, the first time the president mentioned the word AIDS or HIV was not until they were 41. That would be someone also who’d have likely been losing a tremendous amount of their community, at that time, to HIV. For all of us, so often when we experience a loss, it might connect us to other histories of loss in our lives and I think, particularly when I’ve worked with gay men of a certain age, any loss that’s in the present is also connected to a very significant history of many losses they’ve experienced.

There was a participant in a group a couple years ago who came, not for a recent loss, but because when they came out as a teenager their family put them on the street and he survived through connecting with other young gay men his age. It was kind of a community of 19 men who became each other’s’ family, other people who had family disconnect or had to make it on their own at a young age. He was the only person -- he was HIV positive -- but he was the only person out of the 19 men, who were his family who helped him survive through this tremendous vulnerability and homelessness and this adjustment, as he was coming into being a gay man as he knew it -- he was the only one of the 19 who survived. All 18 others had died of HIV/AIDS.

It was something that there was both the survivor guilt but also just weathering all of that loss, even if it had happened over a decade ago, it was something that he carried with him into any relationship, any friendship that presented itself. He completely changed his relational world in terms of how to give trust or his willingness to be close to anyone else. I do feel like knowing about history, particularly maybe LGBT history or thinking about key markers, can be something that’s helpful when speaking to people over time.

The next piece is how perceptions of homophobia impact whether or not individuals access available services. As I did reference before, many people may not have trust in different kinds of institutions because of a history with these institutions. They may not be open to going to a bereavement group that’s affiliated with maybe with a hospital or hospice services. They may feel very wary of having people come into their homes to provide homecare.

Lots of people, who were caregivers, who were talking about partner loss over the years talked about how, retrospectively, they probably waited too long to get help for their beloved because of that person’s distrust in getting help from anyone else, their unwillingness as a couple to have anyone come into their lives or into their homes There’s that horrible post-loss guilt of “Maybe I should have done differently.” and people really having to reconcile with the wall of homophobia in their lives and their partnership and how it might have been impacted their going to get services in the past.

I know, for example, I do lot of different kinds of clinical work and very rarely do I come out to people that I work with, however I find that in doing these groups that so often something that people want to know right away from me is if everyone in the group identifies as LGBT. Do you? These questions tend to come up a lot more in relation to doing LGBT-specific groups.

That doesn’t mean that I don’t be careful (inaudible) group just as well. It’s not better. I think sometimes when we identify and have similarities with other people we might think that we understand more of their experiences than we do but I do feel like somehow it’s important to communicate, in doing work with others, that we have an understanding or a context or a way that we might be able to ask particular kinds of questions that would help them understand that we’ll hear or understand parts of their experience, whether that be understanding that a friendship would have a different level of significance possibly, that it may be as significant as a family member, the other different kinds of contexts. Not assuming that someone is out to everyone in their lives, for example. Just to always think about what our assumptions are in relation to others.

We can go onto the next slide, understanding the LGBT experiences of grief. What research has shown is that in different kinds of needs assessment surveys, LGBT elders have said there is a real need for more people to be doing LGBT-specific bereavement groups or to, at least, increase the level of education to understand their experiences more. This is something that’s come up in three surveys that I can think of and looking at the literature. So, how does that play out? Is it there might be a lack of assessment questions by providers to acknowledge losses in the first place? I think that, so often, the questions around how we assess the individuals that we work really then have so many broader -- if we don’t ask a question we’re not going to have information that might be useful.

Not everyone’s going to come out to us right away, In fact, it may take a lot of time but even to be able to ask a question of a little bit about someone’s -- even if we ask a question on how someone might identify to their sexual orientation or you can inquire, if you talk about a loss, whether or not that person was a partner, a friend. How they would describe -- what word they would use to describe the relationship. I think as open ended as we can leave our questions might invite people to step in and talk a bit more about who they are.

Similarly, a lack of knowledge about LGBT history or culture to understand significance or context of various losses or how people might be responding to them. How I have really realized over time that to really find out, for example, “how many people knew that you and so and so were a couple?” It’s so important because if there’s really only -- like their partner’s sister is the only other person who really knew that they were a couple, and several friends, that already reduces an audience of who can potentially about that person’s pain in losing their same-sex partner. It might bring it down to three or four people, when they're at work every day, when they can’t talk to their boss about how they're a bit distracted right now because they lost their partner of several decades. I think that, for me, follow up questions are really critical to make sure that I understand this kind of context.

I’ve spoken a lot about same-sex partnerships and particularly in thinking about LGBT elders. I also feel like, in doing these groups we’ve worked with people of all ages and it’s just been interesting to see themes that come up related to sexual orientation or identity through different other kinds of losses.

So often men, hearing about someone who’s lost a parent, feeling not only the grief in that loss but if you look at the caretaking history or the management of the estate or different kinds of things related to loss within a family context, a regular theme that comes up with people is that your siblings, when it came time to doing some caretaking, taking a leave from work or something else, your siblings assume that they could do it because maybe they just had their partner and the other heterosexual siblings were married with children so it was less of a disruption for the gay or lesbian sibling to do the parental care. That may or not be the case, but that was sort of the assumption and the pressure that a sibling experienced. It doesn’t need to just be around partner loss for different things to come up around about homosexual identity?

I’m doing a lot of talking. Please feel free, again, to come up with any questions as we go along. It’s hard not to see all of you.

You want to think, too, that if people have less of an audience to talk about their experience of loss or how they're moving through something, it’s very easy then to realize -- look at the man who’d lost 19 people. This has been over a decade. Is there something wrong with him? Why wouldn’t you talk about it? Why is he still experiencing this grief?

Well, he lost everyone in his family. He feels quite alone and he has not had a lot of trust around any kind of institutions or going to mental health services or other kinds of things because of some of the experiences that he had over the years. How that it was only because everyone else in the group was going to be identified as LGBT that he felt comfortable to begin to put words to his experience. He felt that other people in the group would understand the significance or friendships that they might understand why he didn’t have trust in talking to other people about it because of the homophobia that he had experienced in his primary relationships. He was completely cut off from his family at age 14 so why would he come forward and talk to someone who might similarly reject him?

Thinking about useful treatment concepts with the next slide, slide 14 -- I talked a bit about this disenfranchised grief idea by Kenneth Doka -- so to really think about the impact of stigma on the acknowledgement or expression of feeling from losses which is why a lot of hospice groups like Samaritans do groups around loss the way they do suicide. How important it is when there hasn’t been an audience we create an audience to diminish that sense of stigma, to create and audience that will have understanding of the particularities of experience.

I think whereas certainly many communities or places they just can’t do a LGBT-specific group or might not find enough individuals, the idea that one might be offered or it could be different has been something that has brought many people into bereavement groups that might otherwise be there. Also, it’s not uncommon in my groups that people are actively having suicidal ideations. They talk about, because of the loneliness, because of the isolation that they feel post-loss because they haven’t had anyone to talk to, it’s something that they are spending much time engaged in that kind of thinking.

I found that more post-modern therapy, which is narrative therapy or other collaborative therapies that really recognize the role of the client being the experts in the room, help in terms of an empowerment approach. Also, I think post-modern therapies tend to understand the role of identity as being shaped through other people’s eyes; that it’s something that’s relationally created and, as a result, I think that that can be a helpful understanding if you bring into a bereavement group.

Group therapy, in and of itself, after has someone has gone through some initial potential individual work or has had some initial support is a wonderful way to diminish the sense of isolation and of stigma. I just think that bereavement groups are such a common group -- many people do therapeutic work within a group context and appropriate individual context because there is so much that people can learn from each other and I think it just takes away from the isolation of experience that so many people have post-loss. Just repeatedly, people will talk about how nice it is to have a set time and place and to meet people that they might not meet in any other context or way as they went through the world and yet that there’s so much commonality of experience around loss.

I find approaching bereaved individuals whether in individual work or in a group context really challenging and paying attention to any ideas about what normal loss looks like and what might not be normal and to really think about, if I begin to think about pathology or maybe something’s not normal in someone, to make sure that I’m accounting for all the different kinds of experiences and marginalization or discrimination or life context that a person would have prior to joining the group.

Lastly, the recognition of significant (inaudible) behavior due to the history of oppression in institutions and systems which is so key. It’s hard to reach out for help under any kind of situation. I think that, for those who have recently experienced loss there’s often a particular vulnerability, and for people who have had formalized institutional discrimination, I think that coming forward and asking for help in institutions is something that should be minimized in a new way. I appreciate people reaching out and talking about what steps it might have taken to get there to have that wonderful connection in the beginning.

We have just under 15 minutes left and I’m happy to talk a little bit about some of the things that I do in group or if you have any particular questions about what you’ve heard thus far, I’d be happy to answer those. I would love to have a little bit of connection with folks who might be listening so I know what might be useful to you at this point. Brandy, if you have anything as well.

Brandy Brooks: I think we’ll just wait a bit and see if any questions come in. Again, if you have any questions, please use the chat function so that we can see your question. Beth, I guess we can just wait a minute then if you want to speak particularly about some of your experiences with some of the groups then we can do that and then end accordingly.

Beth Prullage: Okay. One of the things, Lisa, that I would be interested in hearing about a bit from you maybe, is I think so often people who work for various organizations can talk about how hard it can be to find members of the LGBT community. I know that The Aging Project has done a lot with partnerships, has done a lot with training, and I wondered if you might have any ideas that might be salient on the subject for that.

Lisa Krinsky: I think that one of the things that has been important to us and challenging is; how do we reach folks who are isolated and who are carrying this sense of grief that they need and would really benefit from these connections? We will advertise in Bay Windows, which is the local LGBT press, about groups that are taking place. Most of the groups that we’ve run, we’ve done in conjunction with mainstream elder service providers who may have participated in some of our education and training and want to be reaching out to this community or folks who are really trying to make these kinds of connections.

Getting the word out both in -- it might be the local community newspaper. It might be the LGBT community newspaper, through elder services, through word of mouth are all the ways that we really try to make sure that we’re reaching the people who need us most.

One of the things that I have also seen that’s come up around the bereavement issues, when we’ve even advertised the group is, and you’ve been talking really nicely about all the issues around loss of relationships; the couple things that have come up that people have inquired about that sort of fall outside of the usual realm for what we think of for bereavement group is that we have had some inquiries from folks around loss of their pets. Particularly in the LGBT community, where many people and many of this generation don’t necessarily have children, that their primary relationship and the primary life companion may be an animal. Our larger culture has an issue about recognizing those relationships and I think, particularly in the LGBT community, that can be really quite significant for folks.

The other thing that we have heard around inquiries has been around grief around life experience and grief about a lifetime of missed opportunity, around having that internalized sense of homophobia and, “Look at what I missed out on” or “I lived such a closeted life” or “I wasn’t able to connect with people in an authentic way.”

We did have someone who called and said. “I really want to be in this bereavement group.” When he was asked, “Who are you grieving?” he said “Myself.” This was somebody who I think has been HIV-positive for many years and sort of lived in a sense of limbo. Those are some of the other requests that we’re hearing from folks in the community when they are interpreting what grief means to them and what loss means as well.

Brandy Brooks: Beth, I don’t see any questions. I don’t know if you have any concluding comments or thoughts as we are approaching 3:30 now.

Beth Prullage: I guess I really tried to focus some of the differences that an LGBT individual might face, tried to talk about some themes around loss. As a Social Work and Practice instructor, I really always try to give people skills or tools or different kinds of ideas and I think that, in general, one of the things that can come up that was really useful around loss, I think this would be true in any kind of bereavement group or conversations around loss is the favorite groups that people have is when they bring in photographs of the person that they’ve lost or the people that they’ve lost and how having an image that can be passed around is really a wonderful way to start as a catalyst for telling stories. Often times; why this picture as opposed to others? unlocks different kinds of things or particular memories; these kinds of tangibles of holding on to a picture.

You’re also going to also ask the questions of just this idea of how we understand ourselves is through another person’s eyes. I like to spend a lot of time really having extended conversations to people about “What was it that that person knew about you that maybe no one else did?” or “What was it that they appreciated about you that felt so special?” I think that that can also help in terms of helping people to find or to think about other relationships where there might be similar kinds of acknowledgements.

But, there is something about the photographs which also makes relationships that have so often been rendered invisible quite visible. Photographs of someone with their partner, photographs that are quite dear to people’s hearts that I think are a wonderful thing that people can do in any kind of context.

So often what people are eager for is an audience for their stories. So, whether one works at a senior center and are having more informal conversations with people or are doing some kind of explicit therapy, I think that really inviting people into the detailed specifics around loss. Even to say, “What was the person’s name?” Using the person’s name. People say “No one in my life says his name, her name anymore. How nice that is.” Anyway, I do feel like these kinds of interventions are important.

There is a question that has come in about, “Do we have a flyer or brochure about the groups. That would be helpful on many levels to place in a medical practice along with other flyers.” Lisa, do you want to answer that one?

Lisa Krinsky: Sure. Yes. We do have some materials and have sent things out through email to lots of medical practices and to hospitals and hospice and variety of resources as well. I can continue to send those out and if anyone’s interested in getting some, my contact information, I think, is up on the slide and we’re happy to send some of that out to folks as well. I think that any and all of the participants who can hold on to our materials and let us know when they have folks who might be a good referral would be great.

We schedule the groups. We don’t have a set schedule so that we can’t say, “Oh yes. Right now we have a group that is starting in this location at this time.” We try and take a look at where there’s some demand and also take a look at availability but do want to make sure that we are getting the groups out there for folks as they need them. If you know folks, please do refer them to us and, even if we don’t have a group that’s going to start up right away, we will continue to engage with folks as we are getting our time and place and location set up for them.

Beth Prullage: I just appreciate everyone’s attendance and participation today to learn more about this or to just be involved. If anyone else has a final question, one of us can answer that.

Brandy Brooks: Beth, I think I’ll just go ahead and piggyback off of what you're saying. I want to thank, Beth, you and Lisa, for presenting today. I want to thank all of the participants still remaining on our call.

I don’t know if I said this earlier but I will be emailing everyone who participated this afternoon, I’ll be emailing you the slides as well as sending you the link for the podcast for our webinar since we did record it today. After you log off, please take a few minutes and just complete the survey as we definitely value your feedback, not only for this webinar but for other webinars that you may want to have in the future.

Again, I thank you for participating and I hope you’ve gained a little bit more knowledge about some of the risk factors, experiences, challenges, and the needs of lesbian, gay, bisexual, and transgender elders as they grieve the loss of a loved one. Again, thank you, Lisa. Thank you, Beth. Thank you, everyone, for participating and have a wonderful day.

Lisa Krinsky: Thanks so much for having us and for hosting this, Brandy.

Beth Prullage: Yes, yes.

Brandy Brooks: Thank you again. Bye everyone.

Lisa Krinsky: Bye, bye.

Beth Prullage: Bye.

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