Systemic and critical lens (Reading)

Psychology and clinical psychology is a field with great traditions and with many theoretical underpinnings that go back hundreds or thousands of years. Psychology has a great heritage from philosophy and other humanistic disciplines that started to form in ancient times. Questions like what a healthy and happy life means, or what the roles of people in society are have been on big thinkers’ minds since antiquity. There are many “answers” to these questions hidden in our cultures and upbringing, and there are also many assumptions and ideas that are hidden in the literature and research of psychology.

It is useful to take a hard look at your field and your professional studies:

• What does healthy development, healthy sexuality, healthy relationships and attachment, and healthy coping mechanisms entail?
• What does being an adult mean?
• What does family mean?
• What stigmas do the unhealthy vs. healthy, mad vs. sane binaries reinforce in people’s lives?
• What social systems and systems of oppression do psychological theories uphold or leave untouched?

The focus of therapy is usually the individual, and oftentimes social systems and processes are neither addressed nor mitigated during therapy. If these systems are left unaddressed, the therapeutic relationship can end up enhancing the bias and oppressions that are the root cause of internalised phobias.

Also, to really understand the mental health needs of diverse groups, professionals need to understand the cultural and social forces that have an impact on these groups and on the perceptions of them. It is very difficult to separate the mental health challenges of LGBTQI+ persons from social systems, culture and politics. So it is important to get clinical psychologists to think about the assumptions that saturate their practices and fields, to help them expand their thinking beyond the intrapersonal and interpersonal relationships, and also to help them learn and establish a reflective process they can implement continuously.

Here you can find a few of these deeply embedded assumptions, but you can come up with other ideas:

Overcoming heterosexism and cisgenderism

Heterosexism is the value system that prioritises heterosexuality and assumes it is the default, most appropriate and morally acceptable sexual orientation, labelling all other sexual orientations as not-normal, undesired and unhealthy. Heterosexism and cisgenderism are oppressive and they have a negative impact on LGBTQI+ persons.

Many schools of psychology and traditions have underlying heterosexist beliefs, and many heterosexist concepts are considered to be the markers of mental health and flourishing, for example feminine and masculine expression, long-term relationships, marriage and the desire to have  a child can be the standards of healthy functioning in many therapeutic schools and methods.

Heterosexism can appear in a psychologist’s work even unintentionally, and could affect the therapist-client relationship and trust. Being an affirmative practitioner means being aware of one’s biases, stereotypes and taking care of them in order to create a safe place for all clients. To overcome heterosexism it is important for practitioners to be aware of their own attitudes and beliefs regarding LGBTQI+ topics.

It is an indicator of professional integrity to be aware of one’s prejudices and value systems and therefore be aware of professional limitations in competency. It is also expected that the psychologist be able to decide whether issues could be worked on in supervision or the client should be referred to another therapist.

The biopsychosocial framework: tackling the cause and effect thinking

This paragraph underlines the importance of the biopsychosocial model in providing effective help to LGBTQI+ persons. You most probably are already familiar with this model and use it in your everyday practices, but this can depend a lot on the time when your studies took place.

The diagnostic mode of clinical psychology can invite psychologists to think about human functioning along a cause and effect structure, which can be a fertile ground for biassed thinking. One of the biases is the imbalanced view of the “healthy” and “unhealthy” binary: “healthy” personality and functioning are considered to be the default, and they inevitably will be formed if the circumstances of the developmental process are average or “normal”; however, “unhealthy” personality  and functioning are a deviation from the default, and are caused by various factors.

In reality, both adaptive and maladaptive functioning are caused by many intertwined factors; all kinds of human functioning emerge from complex and intersecting biological, psychological and social mechanisms. Professionals should be aware of this bias and treat every aspect and variant of human functioning as the naturally diverse consequences of complex biopsychosocial processes.

Another bias that can form on the ground of cause and effect thinking is connecting trauma to sexual and gender identity: many psycholologist end up considering various elements of non-conformity and adverse circumstances in the client’s past to be the cause of their non-normative sexuality and gender.

In reality one can have a difficult relationship with their father figure, or can even be a sexual assault survivor, and at the same time can have non-normative sexual and gender experiences or identity independent of these expereiences. Even if some researchers can find correlation between adverse experiences and non-normative identities, professionals must be careful not to mix up correlation and causation.

Helping someone to heal after adverse experiences does not mean that their identity needs to or will become more conforming to the norm. Although trauma and the challenges emerging from having stigmatized non-conforming identities can have some overlaps (for example trauma can increase the effects of LGBTQI+ stigmatization on the person and vice versa); the two challenges are different sets of issues that need professional help. Dealing with one can alleviate the pain of the other, but healing trauma won’t and need not change someone’s core identity.