(Photo: Dave Rentauskas)

Should Gays and Lesbians Seek Different Therapists Than Straight Patients?

Mental health care for LGBT millennials is a hot topic, and the type of care offered varies wildly.
Sep 5, 2014· 4 MIN READ
Nicole Pasulka is a writer and reporter who lives in New York City. She has written for Mother Jones, BuzzFeed, The Believer, and the New York Observer.

Ian Bonner still doesn’t know how the scared freshman boy got his phone number. Back when he was a junior in high school in Scotch Plains, N.J., Bonner, who is now 32, had been one of a few students to start the school’s first gay-straight alliance. He was the only out gay person in the group; the rest were straight allies. It was the late 1990s, before elementary school kids got cell phones for their birthdays, but Bonner happened to have his own landline at home. The younger student was calling to make a confession: He was attracted to other boys. This wasn’t a fun-loving flirtation, however; he needed support desperately. “He was really struggling,” Bonner says.

For about six months they talked around four times a week. “He didn’t tell me his name. We didn’t make a big deal about that,” Bonner says. The boy talked about God and demons and sometimes described what he was going through as a sin. Though Bonner was only a teenager himself, he tried to argue that being attracted to men wasn’t wrong.

The boy had been suicidal, but the phone calls made him feel better. At some point during these conversations, Bonner says, “I realized the power of talking over time.”

Today, he’s a licensed clinical psychologist with IntraSpectrum, an LGBT-focused counseling center in Chicago, and sees a wide range of clients. In particular, he works with gay men, lesbians, people in relationships—whether couples or less traditional groupings—and many transgender men, who come to IntraSpectrum “looking for an LGBT-savvy, informed, and connected practice.”

Across the country gay, lesbian, bisexual, trans, and gender-nonconforming millennials need the help of supportive and accepting mental health care providers. Just like straight people, plenty of LGBT young adults suffer from depression, anxiety, and more serious forms of mental illness such as schizophrenia and bipolar disorder. The diagnosis isn’t necessarily different, but they just might need or want to see a therapist with particular sensitivity to sexual orientation or gender identity.

These therapists, who are sometimes described as LGBT-affirming, are often members of the communities they serve. Early struggles with mental illness, coming out, trauma, or social stigma that LGBT-identified therapists have either experienced or observed often inform their work.

Affirming therapy for same sex–attracted people is a relatively new phenomenon. Until the 1970s, most mental health organizations considered homosexuality to be a mental illness. It was classified this way in the Diagnostic and Statistical Manual of Mental Disorders, the thick tome of medical terminology doctors rely on for uniform diagnosis, until 1973. Abusive therapies that often tried to change or fix gay people made many advocates suspicious of mental health care, says Caitlin Ryan, a clinical social worker and the director of the Family Acceptance Project, an organization that studies and develops programming around acceptance of LGBT youth.

In 2000, the American Psychiatric Association adopted affirming guidelines for lesbian, gay, and bisexual clients, specifying that same-sex attraction isn’t a mental illness and that stigma and discrimination can have adverse effects on lesbian, gay, and bisexual people. In 2008, the organization authored guidelines for the care of transgender clients. Like the declassification in the DSM, these guidelines have had a major effect on the larger perception of gay, lesbian, and, to a lesser but still noteworthy degree, transgender people within the mental health field.

Practitioners used to say, “we don’t have LGBT patients, we don’t need to know this,” Ryan says. As gay, lesbian, and transgender issues become mainstream, that’s starting to change.

But even in 2014, LGBT people still face discrimination and harassment, especially when they live in conservative or closed communities. The resulting sense of isolation can exacerbate or contribute to mental disorders. Gay, lesbian, and bisexual people are two and a half times more likely than straight people to have some sort of mental health issue, according to one study. A 2011 survey of transgender people found that 40 percent had attempted suicide. In his influential research on “minority stress,” public policy scholar Ilan Meyer found a connection between experiences of stigma, prejudice, and internalized homophobia and distress, anxiety, and depression in lesbian, bisexual, and gay people.

As a student at a tiny college in Texas where the only thing to do was go to the mall or Walmart, Rena McDaniel watched two of her close male friends come out. It was a “super oppressive” environment, she says, and they could have been expelled for being gay—the school was that conservative.

When McDaniel, who came out as bisexual after college, saw how her friends faced rejection from peers, institutions, and family, she realized that “nobody’s given us a playbook.” McDaniel, now 25, got a master’s degree in community counseling from DePaul University in Chicago in 2013. She says she has always wanted to work with this community, and she is now a staff therapist and colleague of Ian Bonner’s at IntraSpectrum.

There’s often not much guidance for LGBT young adults on how to come out, have relationships, and thrive within institutions. That’s where supportive therapists play a big role. Most of McDaniel’s clients are between the ages of 19 and 30, and she thinks it’s important that therapists working with the community know “what it’s like to be in the world as an LGBTQ person.”

People are often looking for therapists and counselors who understand that sexual orientation and gender identity “are not checkboxes” and not everyone is gay or straight, or male or female. When clients don’t have to explain their gender or the particulars of their same-sex relationships, it can mean a lot to patients.

Some seeking mental health care understandably want a provider who shares their identity and experience, but as lesbian, gay, and transgender issues become part of mainstream conversations and politics, an affirming therapist doesn’t necessarily have to identify as LGBT.

According to Amy Reynolds, an associate professor in the department of counseling, school, and educational psychology at the University of Buffalo, research on the importance of having a counselor who shares your life experience is “varied.” Some studies show that it matters, and others suggest that it’s not particularly relevant. For someone who strongly identifies as gay, it could be more important to see a gay counselor. For other clients, a gay, lesbian, or transgender identity has little to do with why they’re seeking treatment, Reynolds says.

When people are nervous or tentative about their identity, when they’re closeted or newly out, an LGBT therapist could even make them feel more uncomfortable. They could “feel judged” seeing someone who is “more secure in their identity,” Reynolds says.

Carrie Sakai, a psychologist at San Diego State University’s counseling center, who sees LGBT students, describes herself as a “straight-identified therapist.” She has worked with LGBT people since getting her license 10 years ago and says that for some, there can be advantages to seeing a straight therapist. Sakai’s experience echoes Reynolds’ observations. “I’ve been sought out because I am straight by people early in coming out,” Sakai says. For these clients, “it somehow feels safer.”

In general, there are some easy and intuitive ways to tell if a particular therapist will be LGBT-affirming, regardless of his or her sexual orientation, says Sakai. Patients should ask about a therapist’s background and find out whether the person has experience working with the community. Good therapists will be open about what they don’t know and what they’re willing to learn. “Use your Spidey sense,” Sakai says. “Education and knowledge—your therapist can get that.” The key is to find someone who is “willing to sit with you and be with you, and not judge you.”

The article was published in connection with Please Like Me, a comedy about 27-year-old Australian comedian Josh Thomas, his quarter-life crisis, and his eccentric family and friends. Please Like Me airs Fridays at 10:30 p.m. on Pivot, our sister network.