The mental health needs of LGBTQI+ persons (Reading)

One of the principles of affirmative therapy is to see the client as a whole person instead of either focusing mainly on their sexuality and gender, or tracing back their mental health problems exclusively to their sexual and/or gender identity.

It can happen that a client’s biggest challenge is not connected to their LGBTQI+ identity, as there are non-conforming persons who live in very accepting and supportive communities. In their case internalised homophobia might not be as robust, or they might already have the tools and support to deal with minority stress in their lives. Also LGBTQI+ persons deal with a lot of other things: anxiety, depression, parenting issues, death of loved ones, having a bad boss, or existential threats like climate change. Thus LGBTQI+ clients come to treatment for the same reasons as other clients, they share the same human experiences as others, thus the focus of the therapeutic process should be flexible and follow the clients’ wishes.

This can be tricky to balance, as sometimes a psychologist can sense that the client is in the state of denial or is trying to emotionally suppress the lived experiences and emotions of their own oppressed state. However, unless the client arrives with the intention to work on these specific topics, sexuality and gender should not be the main topic of therapy, rather the therapist should use their LGBTQI+ knowledge and systemic perspective as one lens of a multifocal glasses: sometimes this lens can add to the discussion about the client’s life and to to their self-understanding, thus seeing the narratives and stories of the client through this lens serves the client and the process; but sometimes this lens is almost or fully  irrelevant to the current therapeutic conversation, thus the therapist should use another lens of the multifocal glasses to look through.

The experiences of being and/or considered to be different, the feeling of risk that is attached to being open with others, the ways in which one’s identity is not mirrored and validated in culture and everyday life – amongst other similar ones these are important interpersonal and intrapersonal experiences LGBTQI+ persons potentially face. As a therapist, these experiences are all important to think about and bear in mind. However, these experiences are not simply due to sexuality and gender, there are many other aspects and factors that contribute to forming these experiences, and they are in a complex relationship with the LGBTQI+ identity. Experiences that form the identity of “being different” can for example be adverse experiences with family and school relationships and social difficulties with other parts of their identities, e.g. being a “geek. These experiences and the way they are connected to LGBTQI+ identity are worth exploring with the client.

All in all, LGBTQI+ clients have many similar problems and challenges to other clients, so as a therapist  it is suggested you use LGBTQI+ knowledge and topics  not as a focus, but more as a lens that can be put on. Also, there are some challenges that are more commonly faced with by sexually and gender diverse clients. These challenges are mostly posed by the nature of these clients’ relationships: LGBTQI+ persons’ relationship with their family of origin, spouses and partners, children and friends can be at odds with cultural norms, the patterns or arrangements of their relationships can be hard to navigate as their relationships are often not adherent to heterormative scripts. For example, ethical non-monogamy is present in more than half of gay male relationships (Nichols, 2020), or many diverse clients are estranged from their family of origin and create their own chosen families with friends and allies. Thus, being an LGBTQI+ affirmative therapist requires special knowledge and demonstrating the acceptive attitude in therapy should include the acceptance of alternative relationship forms and sexual desires (for example kink, BDSM) too.

The Introductory Activity 5. – “99 problems of an LGBTQI+ person” can be a good way to explore the assumptions you have about the mental health needs of LGBTQI+ persons.

Building trust

Rapport and the client-psychologist relationship are essential in any type of therapy setting, but building trust is especially important when working with LGBTQI+ persons as they might have experienced damaging “helping” relationships. Thus at the first contact clients may have some – sometimes quite personal – questions for the therapist, or they try to assess the attitude of the psychologist with a different method.

The psychologist should be open to answering questions about their professional stance, and be able to show their affirmative attitude and willingness to work with the client. This might be harder for those who have been trained not to answer questions, but rather than staying as a blank page for the client, by respecting and accepting the desires and choices of the client, the therapist can create a non-judgmental environment, which provides the feeling of safety for the client.

Therapists can also encourage LGBTQI+ clients to express their concerns openly about the therapeutic process, for example, if the therapist unwittingly uses an expression that is not comfortable for the client. This can deepen the therapeutic relationship and the client can learn how to give feedback in a safe environment.