LGBTQ+ Therapy

Things Therapists Need to Know 

As mental health providers, we’re taught that all of our biases or personal beliefs are not to be brought into the session, as if they are a favored hat or scarf that we’ll need to hang on the coat rack prior to meeting with the client. Relegating implicit biases to something that can be brought or left behind is fundamentally flawed and mitigates any responsibility we have as healers and humans to intentionally acknowledge and actively work against them during a session. It’s in direct conflict with what we know about countertransference. Teaching that we can leave our biases at the door is not only disingenuous, but also dangerous. 

The cultural discourse around the 2SLGBTQIA+ experience and existence is changing, but we are all currently the product of a cisgendered and heteronormative social conditioning that directly informs our perceptions and beliefs about LGBTQ+ clients. As a result, we must consciously acknowledge what we’re bringing into the session and how it impacts our ability to guide our clients in their own self-discovery, creation, and healing. Many therapist will feel confident in treating LGBTQ+ clients, say they specialize in gay issues, or go so far as to label themselves an ally without recognition of their implicit or explicit biases. 

Let’s start by taking a look at how our language in a session can reflect these biases:

Using antiquated and charged terminology like the word “lifestyle” or “preference” when discussing sexual identity.

A lifestyle is a way of life that has been chosen. A sexual identity is not a chosen way of life. This view of sexuality immediately disrupts the therapeutic relationship.  

Conflating “gender” and “sex.”

Gender is an ever-changing social construct that is historically determined by the majority in power at any given time. Biological sex is defined by “male,” “female,” and “intersex.” Conflating the two or attempting to correct our client’s identity expression induces shame, confusion, and, many times, anger. 

“Same-sex attraction”

This term has its roots in western Christianity and is oftentimes a trigger for a client that has experienced spiritual trauma. 

Not using person-first language.

Using technical or charged language like “homosexual” and using an identity as a stand-in for the person (such as saying “transgenders” instead of a transgender person) disconnects us from any common ground by creating a barrier of technicalities and discomfort. Reflecting our client’s language around their identity or sexuality is an easy way to meet them where they’re at. 

Now let’s take a look at how our biases can inform treatment plans:

“You may need to choose between your sexuality and your faith.”

Belief systems are a chosen aspect of our identity while sexuality is not. This bias reinforces the notion that Christianity and LGBTQ+ clients are on opposing sides as well as the bias that Christianity is as integral to human existence as sexuality. 

“If they are struggling with their sexuality, I would ask about childhood sexual trauma.”

The belief that non-heterosexual identities have a cause is a direct result of heteronormative bias. It supports and perpetuates a worldview that centers and upholds heterosexuality as the default sexuality despite an overwhelming amount of research that disproves it. 

Additionally, this is an important example of the research differences in correlation vs causation. You may find a correlation between clients who are LGBTQ+ and those that had childhood sexual trauma, however, the numbers do not indicate a causational relationship. One might also keep in mind the ethical concerns found in resolving trauma through “correcting” sexual orientation or gender expression.

“You might be rebelling with bisexuality because of your previous abusive relationship.” 

This is another bias that upholds the notion of sexuality as a choice, as well as heterosexuality as the default. It is also a dismissal of bisexuality as an orientation. 

“If I can treat their depression/anxiety/trauma, that will address their LGBTQ issues as well.”

This decenters the very real issues the LGBTQ community faces as the result of heteronormativity and cisgenderism, as well as any intersectional issues. This minimization or dismissal of our client’s lived experiences will not address their mental health concerns, and may, in fact, exacerbate them.  

Confidently addressing depression, anxiety, trauma, and other issues that a member of the LGBTQ community may have is not the same as specializing in or being able to treat LGBTQ issues.  

Recognizing and understanding your biases will help you recognize and understand the barriers your clients are facing in treatment and the ones they face in finding a therapist in the first place. 

How do we ensure that we are competent and confident in treating our LGBTQIA+ clients?

There are a few key areas that demand intentionality and ongoing attention if we are to serve this community:

Representation

Our allyship should be apparent on our website and marketing pages. “Gay issues” should not just be a badge on our profile under “specialties.” If we have a resource page, there should be links to reputable resources for the community. If we have media on your website, there should be diverse representation of couples and individuals. It’s not enough to say that we are allies, because an “ally” is defined by their actions and not just their words.

Inclusion

How many therapists that identify as 2SLGBTQIA+ are we in close contact with? Are we including them in the conversation? Are we looking to their expertise and the content they are producing on this topic? Are we moving past saving a seat at the table and ensuring that we’re removing the barriers that may prevent them from filling the seat?

Education 

I’m sure many of us know statistics and facts about other populations we serve, such as the mortality rate of domestic violence victims or the statistics around leaving an abuser. I’m sure most of us know the primary and secondary symptoms of diagnoses we specialize in treating, and many probably even know the tertiary ones. How many of us knew what the “2S” stood for in the 2SLGBTQIA+ acronym prior to reading this article and looking it up? How many of us know the history of the Queer Liberation Movement? Do we know the status of conversion therapy legislature or the statistics of suicidality in the LGBTQ community? If we don’t know the granular details of an issue, how can we consider ourselves competent in addressing it? 

There are many educational resources available for continuing, or initial, education on the LGBTQ community and the unique challenges they have and are currently facing. The Human Rights Campaign, GLAAD, PFLAG, LGBTQHistory, and even the APA have free courses and resources available. EdX and Coursera offer certified courses in relevant arenas. Follow LGBTQ identified therapists on social media, and ask proclaimed allied ones questions. Don’t be afraid to ask your clients questions when they mention a term you’re unfamiliar with.  

Recognition

We cannot accept a client that is a member of the LGBTQ community if we have not done the work of recognizing and addressing our biases. If we cannot recognize that we are a product of a heteronormative and cisgender-centered society that has indoctrinated us with biases and beliefs, than we cannot treat a client effectively.  

If we are not actively educating ourselves on LGBTQ issues and do not have LGBTQ representation in our personal or professional lives, then we must recognize that serving an LGBTQ client is outside of our scope of practice. However, it’s also important to recognize that there are many ethical debates about referring a potential client based on their sexual orientation or gender identity alone. 

In conclusion 

Our understanding of ourselves and of one another is constantly evolving. There is room for uncertainty and there is room for imperfection, but only within spaces of intentional growth and development. Understanding lived experience, intersectionalities, and the historical components of our client’s identities are critical aspects of our ability to not only treat them, but to also continue moving the needle towards a more inclusive and healthy society. 

We encourage everyone to look into the aforementioned resources to begin or continue the journey in treating the LGBTQ community, as well as identify new resources that you can add to your resource list and share with others. Write down the questions you have and the answers you’ve found. Have conversations with others about your journey and ask about theirs. Be curious, and be intentional. 

Are you looking for a therapist in Dallas, TX to explore issues related to sexual or affectional identity? We have specialitsts who work with the LGBTQAI+ community that offer various niches within this community. Check out our specialty page to learn more about what we offer and to see if one of our therapists might be a good fit for you!