The LGBTQ+ community (individuals who identify as lesbian, gay, bisexual, transgender, queer, or as another nontraditional gender identity or sexual orientation) has made many great strides in recent years. In 2015, the U.S. Supreme Court made same-sex marriage legal in all states, and earlier this month, it ruled to protect gay, lesbian and transgender people from employment discrimination. Despite these recent achievements, however, many people who identify as LGBTQ+ or are questioning their gender identity or sexual orientation still face serious challenges to their overall well-being.
For example, at least 1 in 4 LGBTQ+ people report experiencing some form of discrimination in their daily lives. Discrimination or fear of discrimination can be especially harmful for youth in this population. According to a 2019 survey conducted by The Trevor Project, 71% of LGBTQ+ youth reported feeling sad or hopeless for at least two weeks in the past year, and 39% of LGBTQ+ youth seriously considered attempting suicide, with more than half of transgender and non-binary youth having seriously considered suicide.
Proper behavioral health care can help LGBTQ+ individuals deal with the challenges of discovering and living out their gender identity and sexual orientation. Unfortunately, this care isn’t always readily available. This is partly because not all behavioral health professionals have access to the training and resources they need to treat this population. “In my experience providing therapy over the last four years, one barrier is a lack of LGBTQ-specific resources for mental health professionals,” says Julie Campbell-Miller, an Intake Specialist and Outpatient Therapist at Cummins Behavioral Health. “Even as a self-identified queer person, treating someone from the other side is much more difficult than I ever imagined.”
This begs the question: what does respectful, effective behavioral health care look like for LGBTQ+ individuals? How can mental health professionals help their clients discover and feel comfortable in identities that other people might not understand or agree with? In this post, Julie Campbell-Miller explains what behavioral health care should look like for people struggling with issues related to their gender identity or sexual orientation.
Placing Control in Clients’ Hands
When a consumer of behavioral health care is seeking help for problems like depression, anxiety or substance use disorder, it is sometimes appropriate for their therapist or counselor to take close control of their treatment. Mental disorders and illnesses can be very complex, but there are typically clear guidelines for treating them as well as clear goals to work toward. However, this is not the case for someone who is questioning or struggling with their gender identity or sexual orientation.
In many cases, LGBTQ+ individuals may not have a specific behavioral disorder that they are seeking treatment for. Rather, they might simply be looking for someone to talk to. “Most people who are seeking services because of their sexual orientation or gender identity just want somebody who’s empathetic and willing to ask questions and learn more,” Julie says. Instead of assuming they know the solutions to their clients’ problems, providers should strive to learn more about their situation, ask what they would like to get out of therapy or counseling, and then work with them toward that goal.
If a person is seeking help to make sense of their gender identity or sexual orientation, it’s also important that professionals resist the urge to come to a conclusion for them. Questioning one’s gender identity or sexual orientation is a deeply personal and sometimes confusing experience, and the person going through this process must ultimately make their own decisions about who they are. Therapists and counselors should act only as guides and sounding boards for this process, as Julie explains:
“It’s different than your traditional talk therapy. You don’t want to tell them what they are because it’s very specific to an identity, as opposed to something like trauma where you can simply point out the cognitive distortion they might be having. For someone who’s trying to explore their own identity, you want to support them in a way that they can come to it on their own. For example, I might give them some resources to read through as homework, and then the next time they come in, we discuss what they thought about it. This helps them to self-identify as opposed to me saying, ‘Oh, I think you might be pansexual,’ or something like that.”
Building Up the Whole Person
As we’ve suggested, there are many educational resources that can be helpful for someone who is questioning their gender identity or sexual orientation. Part of a care provider’s job should be directing consumers toward these resources when appropriate. “One way providers can help is by exposing consumers to resources such as the Human Rights Campaign, The Trevor Project, and Indiana Youth Group,” Julie explains. “For example, I use HRC a lot because they have a glossary with definitions for various sexual orientations and gender identities.”
Beyond simple education about the many gender identities and sexual orientations a person might have, some tools can even help walk them through the process of questioning their identity. “There’s one workbook I like called The Gender Quest Workbook, and it utilizes cognitive-behavioral therapy techniques specific to LGBTQ+ youth who are on the journey of figuring out how they want to identify,” Julie says.
However, behavioral health professionals should also emphasize that their clients are more than their gender identity and sexual orientation. A person-centered, strengths-based approach to therapy should be used to remind clients that they are worthwhile and valuable regardless of what gender they identify as and who they are attracted to. “Counseling is the perfect opportunity for them to identify all of their great qualities as opposed to the one facet they’re trying to make sense of,” Julie says.
Finally, it’s possible that a person might not fully understand or come to terms with their gender identity and sexual orientation by the end of their treatment. This process often takes many years to complete, and it might not be the primary goal of someone’s therapy or counseling. Care providers should reassure their clients that there is nothing wrong with this, and that they can still live fulfilling lives as they continue to work toward this long-term goal.
“I think it’s important for providers to be upfront that they are not necessarily there to help someone identify who they are. They’re there to address what the person is struggling with,” Julie explains. “If you are questioning, and you happen to come to that conclusion by the time you’re done with therapy, that’s awesome. But my goal is for you to feel confident that even if you don’t have that specific identity, you can still live and be happy while you’re figuring it out, and that it will be OK.”