“You should feel happy your family accepts you at all,” a therapist once said to my partner Dianne after she’d poured her heart out about her family woes — things that gave her panic attacks during the day, kept her up and night and made her feel nothing but dread about the upcoming holidays. Dianne is a lesbian, and her family was accepting of her from the time she came out in her early 20’s. But despite the family embracing her sexuality, family issues were still present — things that had been a part of their dynamic for many years. Dianne was in therapy as a means of learning some healthy coping mechanisms and healing her emotional wounds. But what she got that day in her therapist’s office was a far cry from what she was seeking — she got a dose of veiled homophobia, wrapped up in the “pleasantry” of the therapist suggesting she feel happy — lucky, even — that her family accepts her being gay at all.
Unfortunately, Dianne’s experience of homophobia in the therapist’s office is not rare. Countless individuals in the LGBTQ community have stories similar to Dianne’s or even worse — blatant homophobic experiences in a place that is supposed to be a judgement-free zone. Unfortunately, the lack of understanding members of our queer community experience in our society at large is often replicated in the offices of professionals who are supposed to help us care for our mental health.
Research shows that individuals in the LGBTQ community are almost three times more likely to experience a mental health condition, according to the National Alliance on Mental Illness, and the rate of suicide attempts among LGBTQ youth is five times greater than it is for straight youth. And it isn’t the nature of being queer that places us at risk — queer and trans people’s mental health struggles are likely the result of being part of a culture that rejects our sexuality and gender. It’s the environments in which we live and work that tell us our identity is “wrong” or “weird.”
A feeling of not being understood, and the isolation that often comes with that, can exacerbate or contribute to mental illness and disorders. As someone who grew up in a small town in Central Pennsylvania where the only thing to do was go to the truck stop or Walmart, I came out in an oppressive, toxic environment. My school’s culture was conservative, my peers grew up ignorant to LGBTQ issues and my family knew little to nothing about gay people. At the time, I wished desperately for a mentor, therapist or even a handbook on how to handle the stress and anxiety that bowled me over when I was outed out as a teenager. My school counselor did not know how to handle my situation; his homophobia was repeatedly an issue and he once told me I would “meet the right boy” eventually, I stopped talking to him entirely.
Across the country, individuals in the LGBTQ community need and seek out the help of supportive and accepting mental health care providers. Our community needs therapists — the people we trust with our vulnerabilities, our secrets, and our emotional traumas — to be sensitive to our sexual orientation and gender identity. What we don’t need is to experience more homophobia in a place that is supposed to be safe. We need therapists who support us not in spite of our identity, but because of. These therapists, who are sometimes described as LGBTQ-affirming, are often members of the queer community themselves. In some cases, it is their own struggles with mental illness, coming out, trauma, or social stigma that that inform and inspire their career as therapists.
In 2000, the American Psychiatric Association developed guidelines for lesbian, gay, and bisexual clients, specifying that same-sex attraction isn’t a mental illness and that stigma and discrimination can have adverse effects on lesbian, gay, and bisexual people. And although acceptance of the LGBTQ community appears to be increasing overall, there is still a learning curve for most straight therapists. Even therapists who are progressive and open-minded can still have outdated views sexuality and gender.
So, what are you to do if you’re queer and find yourself in need of a therapist? Some tips for finding an LGBTQ-affirming therapist:
Ask friends and community for suggestions.
Asking your local LGBTQ centers for referrals or suggestions of LGBTQ-friendly healthcare and mental healthcare providers will be a great place to start! Don’t be shy about asking friends for referrals – sometimes word of mouth is the best way of finding a therapist who is a good fit. Your school’s student wellness office and/or local LGBTQ center will have resources on-site or at least be able to refer you local therapists who are LGBTQ affirming.
It’s perfectly okay to interview any potential therapist and ask them as many questions as you’d like answered. Some sample questions include:
I have been feeling (anxious, tense, depressed, etc.). What kind of experience do you have in this area?
What experience do you have working with the LGBTQ community?
What kind of treatments do you use, and have they been proven effective for dealing with my kind of problems?
Do you treat other LGBTQ clients?
What are your views about whether being LGBTQ is a problem?
Take notice of those who don’t pretend to know it all.
Good therapists will be open about what they don’t know and what they’re willing to learn for and with you. Good therapists don’t have to always be right and shouldn’t act like they do. An expert who always has to have the answer, can’t admit mistakes or change his or her mind in response to what a patient is saying, is not someone you should entrust with your care.
A good therapist will explain how their approach can help you feel better and can also periodically review their progress with you. A good therapist will be comfortable with being honest and transparent about your progress – or lack thereof – from their treatment, and will be open to trying different approaches with you if something needs to change.
Be willing to “shop around.”
Don’t be afraid to interview and question therapists before deciding on one who is the right fit for you. Many will have a preliminary phone call or visit with you as a means of getting to know one another. Think of your relationship with any potential therapist as you would with a potential friend or lover – it’s okay to ‘vet’ them – to ask them questions about themselves and make sure you’re a good fit before you invest your time, money and emotions into spending time with them. Interview as many potential therapists as you need to until you find one you feel comfortable with.
Given the hurdles we face when it comes to finding affirming therapists, many queer and trans people simply create their own options, such as peer counseling groups, or seeking help through online therapy services. Sometimes, seeking support from people with similar lived experiences and who are trained or have degrees in counseling is the preferred option. Some existing support and resources include:
The Trevor Project is a support network for LGBTQ youth providing crisis intervention and suicide prevention. You can online chat and even communicate through confidential text messaging — text “Trevor” to 202–304–1200
The GLBT National Help Center provides multiple resources and access to a hotline and a youth chat line
The Association of Gay and Lesbian Psychiatrists includes a directory of LGBT-friendly therapists
My experiences in therapy have been far more positive in the last few years than they were back when I was visiting my homophobic and ill-informed guidance counselor in high school. Over the years, I’ve seen a few therapists — some better than others, and some much better at understanding that me being a lesbian doesn’t mean all of the issues that come up in therapy are tied to my lesbianism. My current therapist is queer herself, and I feel so much more comfortable opening up to someone who has an understanding of LGBTQ issues due to her own lived experience.
Ultimately, it is important to trust your gut. Listen to what your intuition tells you about a therapist. And understand that a few sessions of therapy won’t be a ‘cure’ for what ails you, but that you should be feeling more optimistic, relatively understood by your therapist, and have an intuitive sense that you and your therapist are on the right track.