Therapy for the LGBTQ Community

What role can a qualified therapist play in serving and advocating for the LGBTQ community? The primary role a qualified therapist can play in serving and advocating for the LGBTQ community is to first reflect on their own sexuality and feelings about it. Therapists need to be comfortable in their own skin regarding their sexuality and to be able to embrace alternative forms of sexuality before they can help those in the LGBTQ community be comfortable in theirs. Heterosexual therapists need to recognize that they bring a level of heterosexual privilege to the table that members of the LGBTQ community don't have and to be sensitive about the privileges they take for granted because they are heterosexual. Aside from doing the things most therapists do with most clients (provide a safe emotional environment, build a therapeutic rapport and alliance, welcome clients without judgment, encourage authenticity, etc.), therapists can be very helpful in serving the LGBTQ community by becoming familiar with the culture of the community. It is essential for therapists to avoid making assumptions and to recognize that there is a lot of diversity within the LGBTQ community. Therapists should visit LGBTQ communities, talk to LBGTQ members of the community, find out what their needs are, give LGBTQ community members a voice, and then advocate on behalf of them.

Why do you specialize in treating the LGBTQ community? I've been an out and proud gay man most of my adult life, and purposefully began working with the LGBTQ community as an intern therapist decades ago. From the time I was a teenager, I was an activist for civil, human, women's rights, peace and social justice issues, and then LGBTQ and AIDS/HIV rights. Currently, about 65% of my practice is made up of gay men and transgendered individuals, and typically anywhere from half to two thirds of my practice is peopled by LGBTQ individuals and couples. I carry the scars, like muscle memory, of growing up as a gay boy to man, in a straight, white, male-dominated society hostile to me in all ways. These "scars" are now part of my personal make-up, my strength and character and my professional tool kit, enabling me to better assist LGBTQ clients no matter what their "presenting problems" may be. Even in this far more progressive day, which is so much less damaging to us than in past times, we LGBTQ persons still face systemic prejudice, exclusion, everyday assumptions, insults and violative behavior from the dominant society which tears at the very fabric of who we are as people. We have far higher rates of depression, suicide, anxiety, substance use, family and couples conflict and other concurrent disorders than the "general population." I understand how important, sometimes necessary, it can be to sit across from someone with shared, personal experience. There is nothing more vital in all therapy relationships than to feel safe, heard and understood by your therapist. We who are LGBTQ identified are not defined by our orientation but are inextricably affected by who we are and how we interact within the larger, dominant culture. As a gay man and a therapist, I know how isolating and challenging a minority identification can be. I also know, conversely, how enormously valuable it can be to work with a therapist that you feel has walked in your shoes, and enables you to feel more safe, trusting and nurtured.

How can a therapist help a transgender client who is considering transitioning? A client who is thinking about transitioning has questions and concerns. A therapist who works with transgender clients helps the client explore his/her reasons for transitioning and the obstacles that he/she sees moving forward. Has he/she told her family/friends/coworkers? Has he/she gone to a doctor to talk about hormone therapy? Is he/she interested in joining a support group? A good therapist is one who listens, encourages, supports, and educates. Transgender clients need therapists to help them explore their thoughts and feelings and help them move forward with whatever decisions they make for themselves.