Nicole, 25, originally sought out a therapist because she thought she was in a toxic relationship. But during her initial appointment, the therapist only wanted to focus on one thing — whether or not she was actually bisexual, or if it was “just a phase.”
“She thought that because I was bisexual, I was in an experimentation phase and was I gay or was I not,” she tells Bustle. “I was and am perfectly comfortable with being bisexual. So that was difficult — the idea that the only problem I could be dealing with was self-discovery.”
Nicole's story is unfortunately common among young LGBTQ people, who often find the discrimination and lack of understanding they experience in the culture at large replicated in the offices of professionals who are supposed to help them care for their mental health.
People 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 four times greater than it is for straight youth — and, as Jeremy Goldbach, assistant professor the University of Southern California’s Master of Social Work program, tells Bustle, research shows that queer and trans people’s mental health struggles are likely the result of a culture that rejects their sexuality and gender.
“It's becoming clear that it isn't by nature of being gay or lesbian that places you at risk,” says Goldbach. “It’s the environment's response to you as young LGBTQ person or as an adult because we grow up in this environment that tells us that the core identity we have is wrong.”
Due to this lack of support, many younger LGBTQ people are turning away from traditional therapy or exploring alternatives models, instead of waiting for people in the mental health profession to catch up.
Therapists Who Think LGBTQ Sexuality & Gender Are "Trendy"
Although acceptance of the LGBTQ community appears to be increasing overall, there is still a learning curve for older generations who didn’t grow up with the same awareness of gender fluidity or the spectrum of sexual orientations. Even therapists, who are often on the forefront of progressive understandings of the human experience, can still have dated views about gender and sexuality. Many millennials who spoke to Bustle say older therapists tended to be less accepting, partly because they considered their sexuality or gender to be a phase. Some of the millennials interviewed say their therapists even seemed to think their gender identity was a choice they made in order to be “trendy.”
“I think part of it has to do with being young and not having people respect young adults’ choices for themselves.”
Jordan, 29, who identifies as queer and trans and lives in Queens, New York, tells Bustle that therapists they’ve seen sometimes struggle to use they/them pronouns instead of he/she. “It’s important to me to find someone who would listen in a non-judgmental way to the language I use to describe myself and what my own individual wants or needs are to get out of therapy, and not bring their own feelings about gender or transition into the session,” Jordan says. They say it’s difficult for trans people to experience a lack of acceptance from society at large and then walk into a therapist’s room and encounter the same judgment.
“A lot of people were more polite, but you could tell that when you asked about pronouns they would act like you were being a snowflake, essentially,” Alicia, a 27 year-old who identifies as bisexual and nonbinary, tells Bustle. “I think part of it has to do with being young and not having people respect young adults’ choices for themselves and thinking that when you’re older you won’t be bi and you won’t be nonbinary.”
Among the other complaints about lack of acceptance around nonbinary identities and bisexuality, queer and trans millennials interviewed for this piece say that there was a tendency for therapists to focus so much on their sexuality or gender that they didn’t examine anything else in their lives. Nicole says bisexuality was just one of the reasons she had a complicated relationship with her parents, but for that one therapist, it was the focus of every session.
“A lot of therapists get really hung up on thinking that I have internalized homophobia or that my issues all have to do with coming out."
“I’ve seen a lot of therapists who say they’re LGBTQ-friendly and I’ve never actually been able to work on the issues I want to work on,” Nicole said. “A lot of therapists get really hung up on thinking that I have internalized homophobia or that my issues all have to do with coming out. Nothing else in my life gets any attention from therapists who say they’re 'LGBTQ-friendly.'”
Jordan said they felt some of their sessions with therapists were “consumed by” the issue of gender.
“It was a thing where we couldn't really get past it because they weren't really on same page, so it was struggle to feel like could relate to or trust them,” Jordan said.
“This is just another facet of human diversity."
“A lot of the gap is terminology and cultural understanding,” Chanach (their middle name), a 26 year-old, queer and gender-nonconforming person tells Bustle. “Especially for people like me there are added complications. I'm a dyke, and that's easy enough for a straight person to swallow. But being [nonbinary] means that even within the queer community there's not a lot of knowledge and awareness unless you're very in the community.”
Thomas Coughlin, a licensed psychotherapist in practice in Washington, DC, and an educator who does trainings on issues relating to transgender people’s health, tells Bustle that therapists need to understand this is just one part of who is someone is.
“This is just another facet of human diversity. They’re still a student struggling in school or dealing with family issues or addiction issues but people get focused and see everything through the lens of someone’s transgender identity,” Coughlin says.
"'It Goes Against Everything I’ve Known And Practiced For 20 Years.'"
Many of the therapists who spoke with Bustle admitted the schools and programs that are training future therapists and social workers have a lot of catching up to do when it comes to working with LGBTQ community. Goldbach says that he thinks therapists could improve their approach toward all minority populations, but that therapists struggle to address the LGBTQ community in particular. Many therapists who lack training for working with LGBTQ clients, Goldbach notes, tend to either ignore sexuality and gender or focus so much on sexuality and gender that they didn’t see the whole person.
“They avoid it entirely and sort of don't want to touch it because they're not sure. Or they take the approach of ‘Let's make everything about your sexual identity, because clearly that is the core of what is what's going wrong for you. So there needs to be more education,” Goldbach explains.
According to a June 2015 article published in the journal Clinical Psychology: Science and Practice which examined how clinical psychology programs could improve their training to better address the needs of LGBTQ clients, many training programs only address LGBTQ populations when a trainee first treats a client who identifies as belonging to the community. The authors write that conversations about gender and sexuality should be better integrated into the curriculum "well before students start to work therapeutically with clients."
“A lot of younger people in the community are using different labels that maybe those of us who are older have never heard of, like pansexual, aromantic, asexual."
However, as the article points out, it’s tough to make the changes necessary to improve cultural competency because that requires that faculty have a baseline level of commitment and competence on these issues to begin with, and some senior faculty members may have outdated training. The authors also note that "many if not most psychology training programs will lack a faculty member with personal experience, training, or expertise in transgender issues and treatment."
Deborah Duley, MSW, LGSW, is the clinical director of Empowered Connections, LLC, a therapy practice based in Maryland. Duley, who graduated in 2012 from Howard University, tells Bustle she wasn’t aware of classes she could take or certifications she could get to be an LGBTQ-affirming therapist. Duley sought out informal classes and trainings on her own after she graduated, and she recently took a class on suicide prevention for the LGBTQ community which was hosted by her county health department.
“A lot of younger people in the community are using different labels that maybe those of us who are older have never heard of like pansexual, aromantic, asexual,” says Duley. “A lot of the people in the trainings had never heard of that before and didn’t know what they meant.”
Unfortunately, Duley didn’t see many other therapists at the training. In her estimation, only eight of the 40 people who attended were therapists. Duley says her community is fairly conservative, and that probably has something to do with it.
“There may be more of a pushback [with older groups], more of a debate instead of ‘Oh that’s interesting. Tell me more.'"
Coughlin says that he occasionally sees some resistance to his training on gender and sexuality from some of the older therapists he trains, many of whom have been in the field for two decades or more. “There may be more of a pushback [with older groups], more of a debate instead of ‘Oh that’s interesting. Tell me more,’” Coughlin says. “There is this sense that I have to debate them because, ‘It goes against everything I’ve known and practiced for 20 years as a therapist. And now you’re telling me this new thing and I have to learn this new thing and unlearn this other stuff and you’re telling me it’s not static.’”
Coughlin says that despite his expertise and years of conducting trainings, he has to remind himself to keep learning. He says he learns something new from every training he does.
“I don’t know it all and I have to remember that,” Coughlin says.
Duley says she’s always tweaking her approach and learning more about what it means to be cisgender and how to talk about gender with gender minority clients. For instance, she learned from a training that she should ask, “What pronoun would you like me to use?” instead of “What is your preferred pronoun?” The latter phrasing suggests they are claiming a pronoun that doesn’t really belong to them, Duley notes; that isn’t really their true pronoun.
“I definitely have changed that because I didn’t realize that small little tweak was important,” Duley says.
"I Think The Change Will Come"
A “small little tweak,” such as dropping the word “preferred” when asking about pronouns is, as many of the young LGBTQ people pointed out to Bustle, incredibly meaningful. Not only that, but finding an affirming therapist — one that doesn't just adjust their language, but actually sees the whole you — can be absolutely life-changing, which makes makes putting in any extra work to find the right one totally worth it. For folks like Chanach, that means narrowing down their options by asking their friends and other members of their LGBTQ communities for recommendations.
“When straight, cis people recommend their therapists to me, I tend to nod, smile, and ignore them because they have no idea what I need. Queer people, on the other hand, tend to know what I mean and why it's such a struggle,” says Chanach.
Given the hurdles that they face 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.
The flexibility of peer counseling groups or online therapy is necessary for another reason — people in the LGBTQ community, particularly LGBTQ people of color , are also more likely to be low-income. which means they don’t always have insurance or the cash to spend on an out-of-network therapist.
"I've always dreaded therapy because of the in-person component.”
Chanach says they were considering Talkspace, an online and mobile therapy company, however, because events like the shooting at the Pulse nightclub and the election were stressful and have motivated them to go back to therapy.
“It's been a rough year, and increasingly I'm looking into my finances to see if I can swing trying it,” Chanach says. “The appeal of TalkSpace for me is, among other things, it's virtual, which takes a weight off. I don't have to travel out of my way, which takes time and money, and it's also great for social anxiety — I've always dreaded therapy because of the in-person component.”
Alicia, who has depression, anxiety, and Asperger syndrome, tells Bustle they have been dealing with thoughts of suicide since they were about 10 or 11 years old. They use peer support, which means they seek support from people of similar lived experiences who are trained or have degrees in counseling.
On their own accord, Alicia has also helped create programs to train people to work as counselors for LGBTQ people. Alicia said the peer support program they work for tries to be as inclusive as possible by hiring people in the community, doing trainings on how to support LGBTQ people, and making sure to respond to feedback from queer and trans people to make sure they meet the community's needs.
“I think the change will come,” says Alicia. “A lot of people who struggle to find a therapist actually ended up being advocates. They’re creating the [therapy] they need because otherwise it wouldn’t exist.”