What to Look for in a Therapist if You are An LGBTQIAA+ person
In a previous You Tube, I gave the history of LGBTQ-Affirmative Therapy from the rise of homophobic practices in psychoanalysis, to Gay Liberation’s invitation for therapists to come out of the closets to their patients, to the American Psychological Association’s publication over the last 22 years of guidelines for the treatment of homosexual, bisexual and transgender clients. Whohoo!
Today, I want to talk to you about how these ideas can help you find a therapist if you are a queer or queer-loving person. It may not be the easiest thing in the world to find an LGBTQ-Affirmative therapist. After all, The LGBT Specialization in Clinical Psychology we formed at Antioch University in 2006 is still one of the only graduate teaching programs to teach a new approach and a new system. But this doesn’t mean that many therapists have become more informed and also that you should be a “**smart consumer”** and introduce your therapist to many of these principles. Important point: It’s okay for you to tell your therapist what you need and even to encourage them to get future training, which is a key ethical suggestion in the field of psychologists and Marriage and Family Therapists.
There is a lot that goes into being affirmative: a **HOST OF TERMS** and also ideas about how sexual identity and gender expression is fixed or fluid. There is also a lot of history and even spirituality.
FIRST OF ALL: I think it’s important that your therapist **not be dismissive** of your sexuality and gender expression and say stuff like, “oh all people are the same” or “I treat all people equally.” It’s better for the therapist to adopt a stance of what is called “**cultural humility**” and to say instead that queer people deserve their own kind of therapy and stance, and let me learn. Hopefully you are not their main teachers but they are getting knowledge from other areas.
As aspect of this new kind of opening about being an LGBTQIAA person is that the therapist, from the jump, may not be the kind of therapist who hides behind the therapist persona. The passive blank-slate therapist is, in my opinion, a thing of the past. I** have always taught my students that it is almost unethical of the therapist to hide their sexual and/or gender identity/expression while the client is sharing theirs.** That may create more stigma and more shame. I encourage my student therapists to consider “coming out” to their clients, even if it just means to say that they have been trained to be LGBTQIAA affirmative. All my clients, even my straight ones, know that I am a gay man. And while I am also careful not to impose my personal life on my patients, I like to be conversational and engaged and to try to help the client realize that **I AM NOT THE EXPERT ON THEIR LIVES, BUT RATHER THAT THEY ARE THE EXPERT. THIS IS THE MOST IMPORTANT PART OF ALL THERAPY, IT SEEMS TO ME, TO DECONSTRUCT THE EXPERT STANCE.**
You also want to be on the look out that the therapist is not “**heteronormative**,” namely that they do not assume that being “straight” is a more natural and preferred way to be. This may emerge when your therapist asks you tons of questions if “you are going home for the holidays to see mom and dad” but doesn’t ask if you will be taking your partner. Another term is “**heterosexist**,” which means the therapist may talk a lot about their opposite sex boyfriend and girlfriend without being aware that you may be feeling a certain way about this when you do not yet have a partner. This can feel subtly violating and dismissive.
It’s better if they can, instead, put on a pair of Rainbow Glasses and **get curious **when you say the word “my boyfriend” or “I had sex last night” and not assume what you mean. It’s best for them to be able to “hear” for “clues” that you are trying to drop to make to make sure they are not assuming that straight ways of being are the norm. The affirmative therapist listens to cues (or hairpins) being dropped by the client about queer life because so many of us may feel a kind of toxic shame about talking about sex, gender, romance, drugs that we may not come very forward about these things, even if we have queer therapists. **When my client drops a hint that they had sex last night, I will bookmark that crucial clue and invite further discussion if the time feels right.**
The affirmative therapist must be very careful about our conscious and unconscious biases, especially as it relates to **sexual expression**. I don’t care how queer the therapist is. We are all raised to be judgmental about queer sex, love and romance. Said another way, we as therapists can’t be telling a gay man, for example, who is having sex with multiple partners, that he is doing something wrong, other by explicit or implicit bias. Rather, that man’s sexuality should be attended to and even celebrated as an aspect of his freedom. So a therapist should be aware that they are going to project onto homosexual, bisexual and gender variant people stories that may be oppressive. **As therapists, we are allowed to be human and fallible but we must also take greater responsibility for our blindspots. **
The same for a person’s need to become “**fluid**” in their sexual orientation or “**gender varian**t.” We want to be able to “deconstruct” what is called the “**gender binary**.” The affirmative therapist needs to be aware that the categories of “masculine” and “feminine” can be understood as “social constructions” and not natural as such. Another term is “gender non-conforming” and also “gender queer.” Or said another way, we want our therapists to be aware of **“cisgender privilege”**in which all the unearned privileges people have who are aligned with the sex they were assigned at birth.
Furthermore, an affirmative therapist is someone who has thought about the differences between identities that feel **fixed**, essential and soulful versus that identities that are changeable and **“socially constructed.”**
Also it may be hard for some therapists, whether gay or straight, to check their **biphobia**, and to be careful never to suggest that one’s bisexuality is a phase or that one must chose. There is a bisexual identity that needs to be honored on its own terms. Sigmund Freud, you might be surprised to know, though that all people were constitutionally bisexual. It may be interesting to consider that bisexual people have more opportunities for sexual and romantic love than all other people.
Also an affirmative therapist is aware of how identities **intersect**: what it means to be an African American queer woman, for example, or a mixed-race bisexual transperson. There are challenges in this intersection but also place for pride and resilience.
The affirmative therapist will be on the look out for your **PERSONAL TRAUM HISTORY**, if you were bullied as kid or shunned. A lot of our queer clients may have PTSD from abuse. One symptom of this childhood PTSD may be substance abuse, to blunt the deep pain. There is also such a thing as **COMPLEX PTSD,** in which nothing bad actually happened, but the queer child as ignored and forced to act “normal.”
Another key term to be aware of is **“internalized homophobia”** or **“internalized stigma”** in which we say rather rude and crude things about our queer brothers and sisters because that is how the bullies talked about them. Also a person may have an inner attacker that beats them up for being unable to pass. **The Inner Homophobic Bully** should be identified and separated from the rest of the personality, just as you would any bully.
I think it’s also very important for the affirmative therapist to be understand the mystery of **“coming out,”** first to oneself and then to others. There are many staged models of LGBTQI identity development and it’s important for you to get help to see what stage you might be at and to understand that is normal and natural to be confused, ambivalent, angry, prideful and then integrated with the larger society.
There is more to be said about what is involved in being an affirmative therapist. But I’d like to close on how important it is for the therapist to aware of many different cultural values, such as music, art, **history**. The well-informed affirmative therapist should know about the **modern history** of LGBTQIAA Liberation, starting in the 1950s in Los Angeles and taking us to the Stonewall Rebellion in 1969. But we should also know something about **ancient history**, about Plato’s understanding that homosexual love is spiritual, that the first recorded piece of writing from Ancient Sumerian concerns a homosexual love story, and that Native American, Japanese, Chinese and African indigenous cultures have spiritual roles for the people we today would call either “gay” or “gender variant.”
That’s my quick guide to what to look out for when searching for a therapist if you are an LGBTQIAA person. Keep in mind that most therapists haven’t been trained in the above, but some will be more aware than others and you can engage a therapist you like in other ways to be more aware of the basic points named above. **We are all here to learn. And while we do not want to be our therapists main teachers, it’s also okay to point out when you want a more affirmative stance. That can itself be very empowering and therapeutic, to ask for what you need, want and deserve. **
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