Considering Spiritual Care for Religiously Involved LGBTQI Migrants and Refugees: A Tentative Map

Abstract

This paper describes research relevant to spiritual care for LGBTQI refugees and migrants. The literature indicates some distinct challenges faced by religiously involved LGBTQI migrants and refugees. LGBTQI migrants and refugees may not be able to experience family and religion as supportive compared to migrants and refugees who do not identify as LGBTQI. Such migrants and refugees thus face elevated levels of mental health challenges compared to non-LGBTQI refugees and they also face additional mental health risks compared to non-refugee LGBTQI adults and youth. Such risks include suicidality, depression, substance abuse, social isolation, internalised religious homonegativity, shame and risks to sexual health and a breakdown in the ability to trust others and caregivers. The paper identifies five seminal areas for extending care in the light of the research. These include building trust and properly assessing risk, working towards relational health, helping clients move to new ways of constructing and conceiving of family, easing the influence of internalised homonegativity and shame, and finding written and human resources that will be helpful to clients. These areas of care only present a tentative map as this issue requires more research and reflection.

1. Introduction

Family and kinship ties as well as religion and religious communities often provide strong supports for migrants, refugees, and asylum seekers as they negotiate the difficulties of finding a home in a new context. Refugees are people who fled their country due to human rights violations and persecution. Asylum seekers are people who are awaiting legal recognition of refugee status. Migrants are not legally defined, but Amnesty International describes migrants as people who are staying outside their country of origin who are not refugees or asylum seekers. Despite this more general category, migrants may also have fled their countries of origin for reasons of persecution and discrimination.1 In the United States the term “undocumented persons” can also be used for people who are migrants who do not have government recognition of legal status. In this paper, I will use the phrase “migrants and refugees” as inclusive of all four of these concepts. In Section 3.1 below, the author describes encountering a gay refugee who moved to Canada due to homonegative discrimination and persecution in his country of origin. This encounter highlighted the additional stressors that family and religion caused in the experience of this unfortunate person. The objective of the paper is to review more evidence of the additional impacts that religiously involved LGBTQI migrants and refugees might experience and to provide a tentative map for spiritual caregivers who encounter such people. I argue that family, kinship, as well as religion and religious communities, do not necessarily offer the same source of support for religiously involved LGBTQI migrants and refugees. In fact, in some situations, family, kinship, religion and religious communities may contribute to further distress and elevated mental health risks for LGBTQI migrants and refugees. The paper specifically reviews some of the research on the experience of religiously involved LGBTQI migrants and refugees as well as research on the elevated health risks of LGBTQI people in general. In response to this research, and for the benefit of spiritual care assessment five areas of spiritual care are identified as a tentative map for extending care to religiously involved LGBTQI migrants and refugees. These areas include developing trust and doing a proper risk assessment, working towards relational health, helping clients move to new ways of conceiving family, easing the influence of internalised homonegativity and shame, and finding community and human resources as well as written and online resources that will be helpful to clients.

2. Method and Literature

One of the methodological challenges of the proposed topic of this paper is that it covers a wide variety of experiences and intersecting fields of study. LGBTQI experience is not uniform. Different forms of sexual identity lead to a diversity of experiences. Gender diversity leads to profoundly different experiences in societies and cultures, and where all these categories intersect, a new set of potential experiences arise. To make the matter more complex, sexual identity and gender diversity are also differently constructed in different cultural contexts.

Religion and “being religiously involved” pose many complexities as well. Religions are by no means uniform; they always include people with a diversity of perspectives and experiences and multiple traditions. The same religion may also differ significantly within different geographic and cultural contexts. When all these complexities intersect, the diversities outlined above dictate caution in drawing final and definitive conclusions. The first methodological assumption of this paper is thus that it can only provide a tentative map that requires more detailed research on intersecting experiences and identities.

Besides the complexity of categories, making suggestions for spiritual care poses the additional challenge of the limited literature on intercultural spiritual care for LGBTQI people. Most resources in this area are based in North America and do not necessarily provide much help for the challenges of intercultural care for LGBTQI people. The paper aims to provide a starting point to help spiritual caregivers better understand the diversity of experience of LGBTQI migrants and refugees and to assess risk as they provide care. The conclusions are tentative and indicate a need for more research. Nevertheless, the central concern of the paper is to provide enough information for spiritual caregivers who encounter migrants and refugees for whom their religious involvement has had a negative impact on their mental and spiritual well-being to responsibly assess and provide care.

The research methodology for the paper is to examine the literature on LGBTQI experience as well as the specific material on LGBTQI migrant and refugee experience in relation to religion. The literature review is limited to LGBTQI refugee and migrant experience and LGBTQI mental health risks in the general populations with most of the available research coming from Europe and North America. Data was gathered from the ATLA religion database, the Gender Studies Database, the LGBT Life with Full Text database, the Applied Social Science Index and Abstracts, and the International Bibliography of Social Sciences. As the study of the migration of LGBTQI people and their refugee experience is an emerging field, some of the arguments are of necessity more anecdotal than proven and deserve further study.

The objective of reviewing the literature is to establish areas of concern that spiritual caregivers may encounter when providing care to religiously involved migrants and refugees. The research on elevated mental health risks for LGBTQI people, in general, informs how the added impacts of homonegativity in family, religious experience, and political reality place LGBTQI migrants and refugees at a greater risk than other migrants and refugees. This is not to deny that many migrants and refugees might also face similar stressors. The author’s location is a white Canadian cisgender middle-class male who identifies as gay. The author is also a migrant. The author has personally encountered people who are LGBTQI refugees and migrants whose stories have encouraged research on the topic which in turn shaped the direction of this paper.

Whereas religion and family ties can serve as additional supports during the upheaval of moving to a new country for migrants and refugees, these supports do not necessarily work in the same way for LGBTQI (SOGI) migrants and refugees.2 Because religion and family relationships are often deeply intertwined and socio-culturally enforced for religiously involved people, it is critical to consider the role of both family relationships and religion in the experience of LGBTQI refugees and migrants. Although many negative experiences are shared among all people who are refugees and migrants, the literature points to some areas of significant difference in experience among LGBTQI refugees and migrants. It must also be noted that the LGBTQI acronym covers a very large range of experiences. There is a temptation to extend care to LGBTQI people as if spiritual care needs are universally the same. However, there are fundamental differences between people who identify in terms of cisgender gay, lesbian, or bisexual, and those who are intersex, or identify as transgender or gender non-binary. The difference between sexual orientation and gender identity is key to appreciating how to vary approaches and to properly assess care depending on the person’s self-identification. Although this paper will use the LGBTQI acronym, the complexity of needs among people who are categorized this way must thus not be ignored. It must be noted that transgender people have faced increased public and legal aggression and the threat of physical violence should be taken very seriously. Some transgender people may also face the combination of transphobia and homophobia (Weir and Piquette 2018, p. 253).

The negative role and influence of religion in relation to homonegativity is complex yet well established. A global survey of 34 countries by the Pew Foundation in 2019 found a higher level of homonegativity among religiously affiliated people (Pew Foundation 2020a). In another global study, following up on its survey in 2013, the Pew Foundation found that homonegativity is slowly declining with strongly homonegative attitudes persisting in Eastern Europe, the Middle East, and sub-Saharan Africa due to economic conditions and political and religious attitudes (Pew Foundation 2020b). An article based on the Mexican National Survey, conducted in 2008, of Political, Cultural and Citizenship Practices also indicated that those with no religion reported less homonegativity than those who identify as religious (Moral de la Rubia 2013). Christianity has a long history of rejection, abuse, torture, and violent killing of people who engage in homoerotic behaviour and relationships (Fensham 2019, pp. 66–130). In some countries such as Iran and Brunei, the combination of political power and Islam has supported laws that mandate the death penalty for homosexual activity (DW 2019a, 2019b). In contrast, there is evidence that recent gains in changing homonegative attitudes included LGBTI rights advocates finding allies within religious communities. One such example is the cooperation between rights advocates and religious communities that changed marriage and gender legislation in Argentina (Vaggione and Jones 2015). Nevertheless, homonegative religious traditions and attitudes are still impacting contemporary religiously involved migrants and refugees who identify as LGBTQI. The range of impacts goes from facing the death penalty in some countries to the threat of long prison sentences for those accused of homoerotic relationships. In other places, the social conditions are dangerous, such as the practice of “corrective rape” of lesbian women in South Africa which is a form of violent homophobia practised by those who hold the harmful belief that they will thus “cure” lesbianism (Naidoo 2021).

Another complicating factor in assessing the relationship between religion and LGBTQ people is that experiences of sexual orientation and gender identity are differently constructed in different historical, cultural, and religious contexts. So, for example, Javed Saunja Jaghai has shown that attempts at LGBTQI advocacy from outside Jamaica significantly increased the risk for people who are identified with homegrown concepts of sexuality such as “sadamyt,” “batiman,” “chichi,” and “fish.” These local terms indicate hybrid gender identities that are considered to develop out of children who are described as “he-she,” “boy-girl,” “taam-bwai,” and “girl-boy” (Jaghai 2019). This is one example of a culturally specific perspective on what would be taken as LGBTQI in other contexts. Contemporary experience, language, and identity do not necessarily map well on older religious terms due to an evolving insight into sexual experience and changing possibilities in relationships. It is often assumed, both socio-culturally and by religious leaders, that what is described and understood as LGBTQI in the contemporary world is the same as religious concepts of ancient times. This is specifically true within homonegative Christian traditions. Mark Jordan has persuasively demonstrated that the Christian concept of “sodomy” is a medieval artefact which has had a range of meanings over time (Jordan 1997). Despite this complex history of meaning, it is often simplistically assumed to be the same thing as the 19th-century medical concept of “homosexuality” or the 20th-century framing of LGBTQI experience. These simplistic assumptions impacted the legal traditions in Christian Europe that were exported to many other countries through the colonial process.

Another complicating factor, highlighted by the example of different constructions of sexual experience in Jamaica and the North Atlantic, is that LGBTQI migrants and refugees may arrive in their new countries with significantly different expectations of what is “appropriate” LGBTQI behaviour. Research in Canada has shown that the LGBTQI refugee reception system and the expectations of demonstrating LGBTQI status can force LGBTQI people from other cultural settings to invent experiences and behaviours that will satisfy the prejudice of the refugee hearing boards. In addition, in Canada, research has also identified political pressure on refugees to adopt migration-to-liberation-nation narratives, anticipated by the refugee determination system (Murray 2014a, pp. 133–49; 2014b, pp. 21–32). Different cultural framings of experience and pressure to adopt the language and behaviour of the host country can further contribute to alienation and a breakdown of trust among LGBTQI refugees in their receiving country which, in turn, may complicate spiritual care. Although I could not find any recent research study on the topic, I am also anecdotally aware of another risk faced by LGBTQI migrants and refugees to countries with marriage equality such as Canada. Sometimes such refugees or migrants receive offers of marriage to validate their immigration status in the new country. When they arrive, they may find themselves in abusive marriage relationships which they feel unable to leave due to the impact on their immigration status. The risk of being a vulnerable racialized LGBTQI person can also be life threatening as in the example of the serial killer Bruce McArthur, in the city of Toronto, who preyed on racialized LGBTQI migrants, some of whom remained closeted for family and cultural reasons and therefore were even more vulnerable (Wahab 2021).

Organised religion and its teachings sometimes play a key role in the abuse and danger that LGBTQI people face in their home countries and is part of the reason for them to flee to safety. As religion also plays an important role in the way that families socialize and behave in different countries, homonegative religious assumptions and behaviours can isolate LGBTQI people from their families as well as other refugees originating from their native contexts. A study of non-refugee gay men found stronger internalised homonegativity among those who had an intrinsically orientated religion (Meladze and Brown 2015, pp. 1955–58). This experience could also be part of the LGBTQI migrant and refugee experience. Extrinsically oriented religion is often associated with a functional or even pragmatic experience of religion, whereas intrinsically oriented religion, which is sometimes an indicator of better mental health outcomes, is associated with a more deeply internalised relational experience of religion and reliance on a “higher power” (Laurencelle et al. 2002, p. 111). For LGBTQI people, however, an intrinsically oriented religious experience may combine with internalised religious homophobia creating an internal dissonance which may lead to mental health vulnerability. On the positive side, some research indicates that LGBTQI religiously involved people with an intrinsically oriented religion who find affirming religious communities have a significantly lower risk of depression (Puckett et al. 2018, p. 156).

A 2019 study of thirty-four LGBTQI refugees in the Netherlands and Austria found that religion and religious persecution in originating countries played a complicating role in their settlement and well-being in the host countries. Religion contributed to experiences of internalised religious messaging inducing shame, self-blame, and suicidal ideation and attempts at suicide which led to a rejection of organised religion. In some cases, despite such homonegative attitudes, some individual refugees nevertheless experienced support from their own internalised experience of religion in the migration process (Alessi et al. 2019, p. 7). Combined with these negative impacts of family and religion, LGBTQI refugees also experienced additional discrimination from the native population in their receiving countries—the Netherlands and Austria (Alessi et al. 2020, pp. 13–26). Even though there does not seem to be much research on LGBTQI refugees associated with religions such as Christianity, the research on the experience of LGBTQI people within Christianity is well advanced, pointing to significant and more pronounced negative health and mental health outcomes for religiously involved youth and adults. For example, research on religious bullying of LGBTQI youth in Canada has shown greater levels of negative psychosocial and health outcomes. Negative outcomes involve depression, suicidality, self-harm, alcohol, and drug use, as well as negative academic outcomes in school. These impacts have also been found to last into adulthood (Newman et al. 2018, pp. 524–26; Newman and Fantus 2015, pp. 47–50). Given this research, it is reasonable to assess risk for Christian migrants and refugees who come from homonegative religious environments based on the findings in the studies in the Netherlands and Austria. Often such migrants and refugees from Christian environments are found in Africa and are fleeing countries where “homosexuality” is criminalized such as Uganda, Nigeria, and Ghana. In Africa, the best option for sub-Saharan migrants and refugees is to try to get to South Africa where there are legal protections. However, the experience of such refugees in South Africa is often fraught with danger, deprivation, and discrimination (Bhagat 2018).

Since Canada was one of the first countries to make LGBTQI persecution a valid refugee category in 1991, there is Canadian research on LGBTQI refugee experience (Forbear 2014, p. 52). Canada is home to a charity, the “Rainbow Railroad,” founded in 2006, which also operates in the United States and specializes in helping LGBTQI refugees move to Canada and the United States as well as other receiving host countries.3 The Rainbow Railroad publishes annual reports on their activities which include public stories of the struggle of some of their clients. Some of these stories offer further insight into the challenges faced by LGBTQI refugees. In the 2016 annual report of Rainbow Railroad, Haran Vijayjanathan describes the challenges faced by LGBTQI refugees from South-Central Asia. He observes that some countries in that region have prohibitive laws against homosexuality which draw on the British legal tradition (Rainbow Railroad Annual Report 2016, p. 15). In that same report a lesbian refugee, Toni, from Jamaica tells the story of being shot and becoming disabled and having to flee Jamaica with no support from the local legal system. The 2017 report outlines the persecution of LGBTQI people in Chechnya. Particularly relevant to this discussion are reports that Chechnyan police urge families of LGBTQI people to kill them (Rainbow Railroad Annual Report 2017, p. 10). In this way, family and the migration of Chechen LGBTQI refugees take on a sinister relationship where such refugees are forced to flee their family as well as their country. Alternatively, they are placed in a position of feeling obligated to flee to protect their families from being forced to attack them. Although the Chechnyan government attacks on LGBTQI people have complex origins the religious influence of Islam plays a role as well.

In Russia, the Orthodox Church and Patriarch Kirrill have played a pivotal role in discriminatory laws against LGBTQI people creating physically dangerous situations for LGBTQI Russians (Manson 2013). The 2017 Annual Rainbow Railroad Report documents that there were 100 refugee requests from Russia, including Chechnya, in that year. The significant role of the family in creating distress for LGBTQI refugees is noted in the 2020 report of the Rainbow Railroad. Of the five most important safety concerns of LGBTQI people that contacted Rainbow Railroad during 2019–2020 (Rainbow Railroad Impact Report 2019–2020), family-based rejection was the top concern (26% of concerns) and family-based violence perpetrated against them was the second concern (12% of concerns) (Rainbow Railroad Annual Report 2020, p. 12). This data supports a sensitive approach to LGBTQI refugees in relation to family relationships which may differ from extending care to other kinds of refugees where family and religion can often be assumed to be an additional support network.

Another important concern raised by the Rainbow Railroad Annual Report of 2020 is the wide exposure to so-called conversion therapy and the role of mental health caregivers in supporting attempts at changing sexual orientation or opposing transgender people from affirming their gender identity. They report that attempts at “conversion therapy” was most often experienced by refugees from Eastern Europe, Latina America, the Middle East, and North Africa (Rainbow Railroad Annual Report 2020, p. 20). The report also notes the significantly elevated risk of suicide amongst transgender men and women.

Thus, the research points to some specific mental health and physical risks to consider when extending spiritual care to LGBTQI refugees and migrants in relation to family and religion. Health concerns include potential physical harm inflicted by family and community. There is also the elevated mental health risk of suicide, suicidal ideation, depression, alcohol and drug abuse, social isolation, alienation from family, and isolation from religious and social communities. In addition, particularly for those who have an internalised religious orientation, there is the potential impact of internalised homophobia and transphobia that can increase the risk of shame, existential despair, and suicide. There are also indications in the research that those with an internalised religious orientation who find affirming religious communities can experience significantly less mental health risk.

Religiously involved LGBTQI migrants and refugees often face situations that require the suppression of sexuality and sexual experience which results in an inability to obtain information about safe sexual practices. Such migrants and refugees may also face significant sexual health risks (Lewis 2016; Logie et al. 2016). An indication of this is found in research among gay Latino migrants in the United States that demonstrated potential risks due to decreased information about sexual health that would normally be facilitated through kinship ties (Adam and Rangel 2017).

The broader cultural and political expectations that require LGBTQI refugee claimants to adopt the cultural expectations of behaviour considered “appropriate” in the receiving culture can also contribute to further social isolation and distrust in the new country. Even though almost all categories of refugees and migrants may have some reason to distrust people and institutions in their new context, LGBTQI refugees face a particularly difficult challenge of trust. If one had to flee for your life, if your religious leaders, your government, your mental health caregivers, your legal system, and even your family violated your trust, how do you find the ability to trust people, institutions, and mental health professionals in your new context? If, in addition to these challenges, a person might have to be taught how to speak and behave to convince the refugee determination system that you really are LGBTQI, the level of trust and the loss of personal integrity can be devastating.

3. Towards a Tentative Map for Spiritual Caregiving for Religiously Involved LGBTQI Refugees and Migrants

3.1. Building Trust and Assessing Risk

In order to construct a tentative map for spiritual caregivers who care for religiously involved LGBTQI refugees and migrants, the research outlined above highlights some profound challenges. Among these challenges, building a relationship and establishing a basis for trust is paramount when caring for LGBTQI refugees and migrants. I have personally observed the struggle towards trust in a journey of an LGBTQI refugee. Even though this person had to establish, for the sake of the refugee determination system, that he was “really gay” in the way Canadian prejudice would construct being gay, he also could not trust that in finding accommodation and employment he could be living openly as a gay man. In his ongoing attempts to negotiate his own fear, uncertainty, and suspicion that there might be a secret conspiracy in which his status and reception in Canada would be undermined, he became increasingly isolated, afraid to see friends and enjoy a normal social life. At the same time, he had to hide his sexual orientation from his family in his country of origin, due to their religious and cultural homonegativity. For their benefit, he felt he needed to claim to be living a happy heterosexual life as a new immigrant in his adopted country. This experience suggests the need to be sensitive to the inter-relationship between fear and trust in the caregiving relationship.

In the light of the distrust that such refugees might experience with someone who provides spiritual care, one might argue that a completely secular caregiver might be more appropriate. However, it is often through spiritual care that a liberating healing journey towards an integration of a self-affirming internalised religious conviction can be achieved with religiously involved LGBTQI refugees. If trust can be established with a spiritual caregiver, and if that caregiver can journey with a person to a place of internal peace and acceptance of their sexual and/or gender experience, and if that might lead such a person to find an affirming spiritual community, there is extraordinary potential for a flourishing new life.

The spiritual caregiver will have to work hard at being self-aware of their own cultural biases and assumptions about sexual orientation and gender identity and religious beliefs in establishing trust with a new client (Marshall 1997, p. 131; Schlager and Kundtz 2007, p. 177). As with all counselling relationships, openness to learning from the client, allowing oneself to listen, hear and test understanding, and being carefully inquisitive remain important. However, LGBTQI clients who are religiously involved will need more reassurance and clear and honest communication in the process of care. As Schlager indicates about any spiritual caregiving process with LGBTQI people in the context of religion, there is an extraordinary experience of betrayal and hurt that must be overcome (Schlager and Kundtz 2007, p. 159). Building trust will thus involve communicating a profound respect for the clients’ own understanding and narratives of explanation and their own cultural framing of their experience.

Given the risks faced by religiously involved LGBTQI refugees and migrants, a thorough risk assessment is required. Establishing trust needs to be followed by assessing risks for PTSD, suicide, depression, substance abuse, and making proper referrals where necessary. Extending care to transgender people also requires additional levels of care given the pronounced presence of post-traumatic stress due to anti-transgender bias, non-affirmation, and internalised transphobia (Barr et al. 2021). Because the new freedom around sexual practice in the receiving country may lead to sexual health risks, the caregiver will also need to assess and build trust to ensure that the client has access to sexual health information appropriate to their orientation and information about accessing sexual health care, testing, and disease prevention. In addition, the initial process of building trust and assessment should also involve assessing the vulnerability of the client to potential sexual exploitation and building some basic strategies for self-protection. Whereas sexual health may not be a high priority for other kinds of migrants, LGBTQI migrants will require both care and a careful building of trust and confidentiality in this area. Assessment and the building of trust also need to involve all the other risk factors discussed above, including self-harm, internalised religious homophobia, social isolation, and the existential experience of alienation.

3.2. Towards Building Relational Health

The research demonstrates that for LGBTQI refugees and migrants the experience of family and personal relationships can be fraught with hurt, rejection, isolation, and disappointment. Beyond building trust in the spiritual care relationship, the caregiver will need to be particularly sensitive to the struggle to trust others and new communities of relationship. Traditionally, religiously involved LGBTQI people have faced the challenge of finding alternative ways of building friendship and community and even of finding alternative definitions and understanding of the concept of family. The isolation, rejection, and judgment that LGBTQI people face within religious communities also mean that they need to find ways of living outside the heteronormative expectations of society at large. Schlager describes some of these alternative ways that LGBTQI people find meaning in both personal and communal relationships (Schlager and Kundtz 2007, p. 179). He names such alternative LGBTQI experiences in terms of friendship as primary and foundational to most relationships, a tendency to prioritise hospitality, community building, the celebration of embodiment, the sharing of sexual liberation, and the embrace of a sense of generativity in Queer love. LGBTQI migrants and refugees will encounter these alternative and sometimes subversive forms of community and relationship in their new context particularly in countries shaped by liberal Western culture. Such experiences of new forms of relationship can be both liberating and challenging for refugees and migrants as they make their way into a new way of finding community and personal and intimate relationships. For some religiously involved LGBTQI migrants and refugees, particularly those struggling with internalised homonegativity, this might be a disconcerting and distressing experience that both draws and repels them. The negotiation of the new LGBTQI sub-cultural expectations in tension with societal heteronormative expectations in contrast to the religious and cultural world out of which they come can be traumatic. Encountering people who will have different ways of bringing together sexual relationships and personal relationships may even be shocking to them. When this is combined with fear and distrust born out of experiences of judgment and pain, it could lead to elevated mental health risks. In such cases, LGBTQI refugees and migrants might find themselves in an internal double bind of being drawn to a new sexual freedom and the embrace of their own embodied experience as well as a deep struggle with internal self-loathing, shame, and religious fear.4 The spiritual caregiver will face the challenge of taking a non-judgmental stance in relation to the desire for freedom and the struggle with self-loathing. The goal will be to journey with the client to a place of inner integration of their sexuality, gender identity, values, and beliefs.

Beyond this individual journey towards integration of spirituality and sexuality, spiritual care for LGBTQI refugees and migrants will need to focus on supporting the client in finding a new community and growing to trust that community. Ideally, for the religiously involved person, this will involve finding a new life-giving and affirming religious community that they can trust. Where this is not possible, the formation of informal religious networks of affirming support might present an alternative. Besides referring those clients that seem to be struggling with PTSD for medical help, finding appropriate support groups may also be important. Processing trauma through group work, particularly groups of refugees and other LGBTQI migrants who faced comparable struggles, is one of the most effective ways to build trust, confidence, and relationships. Such groups also create potential pools of friendship and even personal relationships. Spiritual caregivers working with LGBTQI migrants and refugees will also need to be familiar with online dating apps often used among LGBTQI people to which their clients will be exposed. Processing with clients how to be safe, and to guard against further trauma in the context of such digital tools will be critical. For transgender clients, special care is needed to assess trauma due to physical violence and further risk of violence. A recent study found that 37% of transgender people faced at least one instance of physical violence after the age of 13 (Barboza et al. 2016, p. 387).

3.3. Towards a New Conception of “Family”

Many LGBTQI people have had the experience of being alienated from their families. This is an experience they might share with LGBTQI refugees and migrants. Within Western contexts, LGBTQI people have often assumed that friendship provides the most important intimate human connections in their lives (Schlager and Kundtz 2007, pp. 179–82). The challenge for the caregiver working with LGBTQI refugees and migrants from other cultures is that this might not be the assumption or expectation of their clients. When people come from cultures where family and biological relationships of extended family are expected to be the primary source of trusted friendship, the caregiver cannot assume that their clients will easily transition to be comfortable with “friends-as-new-family.” Nevertheless, given the potential isolation from their own cultural immigrant community, their faith community, and their biological family, gently helping clients find new trusted friends that can begin to take the place of the family will be an important therapeutic intervention. This would involve finding connections with groups and potential affirming faith communities where the person can find multi-generational human connections. For the LGBTQI refugee or migrant, there may be a peculiar form of culture shock to overcome. The assumed roles of elders, parents, siblings, uncles, and aunts may turn out to be different in the new culture. The work of spiritual care can thus focus on helping the refugee or migrant client process changing kinship relationships while encouraging new life-giving friendships and educating the client about different relational expectations of equality and mutuality in their new home. In his landmark work on treating trauma, Charles Figley has argued that trauma is best treated with a family as a whole rather than individually (Figley 1989). However, for LGBTQI refugees and migrants, this is often not practically possible or even therapeutically advised. Thus, encouraging fresh connections with groups of people where friendships can organically develop and creating opportunities for group therapy will also contribute to building an alternative sense of family. Schlager points out that the Hebrew and Christian Scriptures provide paradigmatic same-sex friendships that might be helpful to some LGBTQI refugee or migrant clients such as the relationship between Ruth and Naomi, David and Jonathan, and the relationship between Jesus and “the beloved disciple” (Schlager and Kundtz 2007, p. 181).

3.4. Towards Easing Internalised Homonegativity and Shame

The research above highlighted the potential role of an internalised homonegativity in religiously involved LGBTQI refugees and migrants. Within psychology the parallel idea of “internalised homophobia” can be traced back to the work of Sandor Ferenczi first published in 1914 (Ferenczi [1914] 1952). Malyon has defined internalised homophobia as “the internalization of societal antihomosexual attitudes” (Malyon 1982). As noted above the risk of struggling with an internal dissonance is particularly high for LGBTQI people who have an internalised sense of religion. For many people this inner dissonance or experiential-spiritual rupture may never completely ease. Progress can be made by normalising and embracing embodied experience including sexual attraction and sexual expression. This is not just a personal journey but, in important ways, also a spiritual journey. Finding resources in the person’s own religious tradition and finding an affirming community that supports those resources is therefore important. Growing trust by the client in the care and acceptance, the experience is critical for such a spiritual journey. When affirming religious resources are combined by an affirming community around the client the sense of transcendent or Divine affirmation can grow and flourish. The physical movement of LGBTQI refugees and migrants from bondage to freedom can be connected to resources in Judaism and Christianity which tell stories of a movement to Divine acceptance and liberation that may bring an internalised sense of integration of the physical and the spiritual (Schlager and Kundtz 2007, p. 186). As mentioned above, stories within Judaism and Christianity that reframe close same-sex relationships in a positive light can help clients from Christian and Jewish traditions move towards a deeper sense of self-acceptance.

A parallel source of religious dissonance is where religion places a strong emphasis on heterosexual procreation as the basis for sexual intimacy and where such a bias becomes internalised for the LGBTQI client. This kind of homonegativity can be addressed by exploring with the client religious resources on the relationship between biological procreation and the metaphorical value of a flourishing creation. Schlager associates such a reimagined understanding of “procreation” with the concept “generativity” (Schlager and Kundtz 2007, pp. 186–87). For Schlager generativity points to the life-giving aspects of religion which is not simply limited to the production of children. Rather, generativity refers to the potential of loving relationships to bring life and hope to many people. Healthy and loving intimate sexual experiences can contribute to this potential life-giving activity of LGBTQI people. Schlager insists that such sexual expression can bring “healing, uniting, expressive, loving, and creative” results (Schlager and Kundtz 2007, p. 187). Goss argues that a more metaphorical spiritual understanding of procreation includes “the contributions made for renewal and transformation of society” (Goss 1997, p. 12).

Internalised homophobia or homonegativity are functions of shame. Shame, as the conviction that one’s very being is corrupt and unacceptable also contributes to the elevated levels of suicidal ideation and suicide amongst LGBTQI people. Kundtz names shame as a “bestowed burden” in the lives of LGBTQI people and frequently a life-long challenge in their lives (Schlager and Kundtz 2007, p. 84). Journeying with LGBTQI refugee or migrant clients who struggle with the tension between an internalised religious bias rooted in shame and focused on biological procreation towards a broader and healing understanding of the generative potential of sexual intimacy can thus help address internalised homonegativity.

3.5. Accessing Religious and Other Resources

Spiritual caregivers can find a growing repository of affirming religious resources online. Presently, the charity “Rainbow Faith and Freedom” is building an online database that will eventually include resources from many different religious contexts.5 Schlager and Kundtz name some resources in Judaism and Christianity as well as other general resources in the appendix to their book (Schlager and Kundtz 2007, p. 220ff.). They also updated those resources in the 2019 edition of their book published by Wipf and Stock. Such online and printed resources are very important but they should also be augmented by accessing local religious communities and finding affirming groups and people in those communities.

4. Conclusions

This paper has described research relevant to spiritual care for LGBTQI refugees and migrants. The literature indicates some distinct challenges faced by some religiously involved LGBTQI migrants and refugees. LGBTQI migrants and refugees may not be able to experience family and religion as supportive compared to migrants and refugees who do not identify as LGBTQI. Such migrants and refugees thus face elevated levels of mental health challenges compared to non-LGBTQI refugees and they also face additional mental health risks compared to non-refugee LGBTQI adults and youth. Such risks could include suicidality, depression, substance abuse, social isolation, internalised religious homonegativity, shame, risks to sexual health, and a breakdown in the ability to trust others and caregivers. In response, this paper identified five seminal areas for extending care in the light of the research. These include building trust and properly assessing risk, working towards relational health, helping clients move to new ways of constructing and conceiving of family, easing the influence of internalised homonegativity and shame, and finding written and human resources that will be helpful to clients. These areas of care only present a tentative map that requires more research and reflection.