Psychotherapy Articles

Affirmative Psychotherapy

Many LGBT people choose to go into psychotherapy in order to find ways to deal with personal issues and improve their relationships. Regardless of why you are going into counseling, as a consumer, it is important to know that in spite of ethical guidelines, many mental health professionals do not provide affirmative psychotherapy.

First, I’d like to define what affirmative psychotherapy is. Don Clark sums it up the best, by saying that affirmative counselors may not be lesbian or gay, but they believe that that their clients’ sexual orientation should not just be accepted but appreciated—a gift that has a cost in terms of living a homophobic society. Gay-affirmative counselors know that while there is no need to address the question of whether or not to be gay or lesbian, clients may need help to find ways to live up to their potential.

Many mental health clinicians do not adhere to these principles. It may be from lack of education and training, or perhaps be due to homophobia. The following excerpt is from my book, “Affirmative Psychotherapy and Counseling for Lesbians and Gay Men:"

We (my co-author Dr. Melissa Johnson and I) have heard clinicians tell us that there is no difference between providing psychotherapy for gay/lesbian clients and heterosexual clients. Although the message these practitioners were trying to send was that they are not homophobic, they didn’t realize that they were also conveying to us that they did not understand the complexities involved in working with issues unique to lesbians and gay men.

For clinicians who experience discomfort working with lesbian and gay clients, two studies point to a need for more education. Avery, Hellman, and Sudderth (2001) found that the rate of dissatisfaction among LGBT respondents was twice as high as that of a heterosexual control group. Among the LGBT respondents who were women or members of ethnic minority groups, dissatisfaction rates were four times higher than for the respective control groups.

In a second study, Eliason (2000) surveyed 242 substance abuse counselors. She found that substance abuse counselors had little formal education on lesbian and gay issues, as evidenced by misunderstanding the concepts of domestic partnership and internalized homophobia. More troubling, nearly half the respondents had negative attitudes toward lesbians and gay men.

Be Aware of the Type of Psychotherapist you'd Like to See

There is a chance that you could start therapy with a therapist who is not comfortable with who you are. Also, people make the assumption that because a therapist is LGB, he or she will have a better understanding of what you are going through and therefore can provide better therapy. However, LGB therapists can have internalized homophobia as easily as straight therapists. For example, LGB therapists who live in the closet are more likely to work out their own issues in therapy (by that, I mean, they would suggest what’s best for themselves and not you) than those who are out.

That is why it is important to do some homework to find out if a potential therapist will see your sexuality as a gift. So, what can you do to try to limit the possibility of finding a homophobic therapist?

Some Trusted Resources for Psychotherapy Referrals

One of the most reliable sources of information is trusted friends. Ask them who they are seeing, what they like about him or her, what they don’t like, what s/he charges, etc.

If it’s not possible to ask friends, consider the following: Call a few clinicians to ask for a 15 to 20 minute interview, during which time you will ask a few questions before starting therapy. During the interview, ask them about their credentials and if they have experience working with LGBT people. Get a sense of how they react to your questions, both verbally and nonverbally. If you ask about their sexual orientation, be prepared that some therapists have a legitimate reason to not answer that question. It may relate to do his or her way of approaching therapy, so don't assume that s/he is in the closet, straight, or closed off if s/he doesn't answer.

Fewer therapists are likely to answer the question "Are you in a relationship?" (but some will). If the therapist doesn't wish to answer a question, you can ask why s/he doesn't want to talk about it and you should expect an answer to that question.

In the office, look around for signs of gay-friendliness. In the waiting room, are there any magazines or other signs? In the office, are there LGBT books on the bookshelf? Does the intake form ignore you by asking if you’re “married,” or does it ask if you have a “spouse/significant other”?

Once You've Begun Psychotherapy

When in therapy, the focus should be on you most of the time and not be on the therapist or on his/her problems. If, after two or three sessions, you’re not comfortable about opening up, mention this to your therapist. If you’re still not comfortable after another session or two, consider finding another therapist. If the therapist reacts non-defensively and you start feeling more comfortable, consider that a good sign.

You will naturally have feelings for your therapist, both good and bad. If they turn sexual (which is not uncommon), and you mention this to the therapist, his or her response is important; if he or she admits an attraction to you, you should stop seeing this person. And of course therapy never includes sex (ever! The reason for this is because of the "power differential" in the therapy room: Your therapist knows a lot about you, but you know very little about your therapist's life. Therefore, the therapist has more power).

That's why we are bound by laws and ethics - to prevent mental health practitioners from exploiting this power. If you have been asked to take off your clothes or have been kissed, fondled, or in any other way sexually touched by your therapist, please click contact the by going to the Board of Behavioral Sciences.

On the other hand, if your therapist explores your attraction and asks if it gets in the way of therapy, it’s a good first step to moving past your attraction. If you can't get past it after several weeks, consider asking to be referred to another therapist where this isn’t a problem.

In general, is the therapist supportive of your relationship status? Is he or she nonjudgmental about any arrangements you have with your other half regarding sex or with your choice of monogamy vs. nonmonogamy? Is s/he nonjudgmental in general about of your life decisions? If so, these are other good signs. Psychotherapy is a process that can take a few months or years, and it is a worthwhile journey.