a group of young people at a pride event

LGBTQIA+ Mental Health Treatment: What Inclusive Care Really Looks Like 

Est. reading time: 8 mins
Posted Under: Insights, Interviews, Treatment Insights

Clinically Reviewed by: Amanda Fialk, PhD, LCSW, LICSW

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LGBTQIA+ youth are an incredibly resilient, diverse, and dynamic community. And at a time when more young adults than ever identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, or another gender or sexual orientation, they also face unprecedented societal stress, discrimination, and barriers to basic human rights and healthcare. As an organization, we have covered the extensive and unique challenges facing this group, but the question that comes up most often is: How can we ensure we are providing affirming and inclusive LGBTQIA+ mental health treatment when it’s needed most? 

As a leader in young adult mental healthcare with locations in NYC and DC, we’ve served a diverse array of multi-diagnostic young adults for over a decade, a large percentage of whom are in the process of exploring their identity and sexuality. Close to 40% of our population at The Dorm identify as LGBTQIA+  –  a statistic high above the national average. Serving LGBTQIA+ mental health intentionally, and with an affirming approach, has been a priority of ours from the beginning.

Below we outline the many actions our team takes to create an inclusive community, with the help of our Assistant Director Amie DiTomasso, LICSW (she/her) and Senior Therapist Jacqueline Lord, LMSW (she/her).

 

At The Dorm, we are intentional about inclusive LGBTQIA+ mental health treatment, especially within a group therapy setting. 

Community and clinically-led group therapy foster a sense of support that LGBTQIA+ young adults so often miss in school, work, or other environments.  A few we host at The Dorm include:

Identity & Sexuality Group

A combination of process and psycho-education, this group explores topics of gender or identity each week with topics related to stressors at school, friendships, and family relationships. Clients begin with a personal check-in that may end up directing the group’s clinically-led discussion for the day. “Talking about gender, sex or sexuality brings up a lot,” explains group leader & Clinical Supervisor Amie DiTomasso, LICSW.

“In this group we really lean into conversations, never shying away from sensitive topics like bringing your authentic self to dating, pleasure for all genders, and even the process of grieving an old part of your identity, which is not often talked about. These conversations shape how clients think about themselves and project themselves into the future.”

In addition to weekly processing themes, clinicians support LGBTQIA+ mental health by building community within the group, which helps them increase resilience, improve self-esteem and reduce the mental health impacts of stigma and bias. 

Transgender/Nonbinary Process Group

Transgender/Nonbinary Process Group (TGNB) is specifically for people whose gender expression or identity does not conform to a binary system. It is a “very special, intimate, safe community of folks who are all in different places on the journey of their gender identity,” explains group leader Jackie Lord, LMSW.

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“The group is a safe place to ask questions that a client may have never even said out loud before. Having the group peer support has an incredible impact on clients and is something they would not have if they were walking their journey alone.” 

Clinicians who lead TGNB help clients approach a new process topic each week, and guide activities rooted within the greater community. For example, our NYC chapter recently visited a local thrift store in search of gender-affirming clothing. 

“A lot of clients had brought up not being sure how to dress to feel affirmed in their identities,” explained another clinical group leader.

“We all visited Housing Works together to browse and explore gender-affirming clothing, with the support of the other members. It was such an amazing moment of queer euphoria – a time when I could actually see clients catching their breath and feeling like, I’m exactly where I want to be right now. One client found an affirming outfit that serendipitously fit like a glove that they ended up wearing to the Dorm prom.” 

We step outside the four walls of the therapist’s office with real-world clinical coaching. 

During individual and group therapy, clients are able to explore, process, and build skills in a safe place. Sometimes though, it’s important to step outside of the therapist’s office to begin practicing new life skills in a real-world setting. Clinical coaching with a licensed therapist offers an experiential element to the therapeutic experience that is invaluable for clients exploring their identity. 

“We can make great steps in the journey towards self-acceptance in therapy,” says a Dorm clinical coache. “But when it comes to the real-world application of what we talk about, it’s invaluable to be able to encourage clients to take practical steps through coaching sessions.

The uniqueness of The Dorm is that if I have a client that needs to buy gender-affirming clothes or get an affirming haircut, we have the opportunity to use a clinical coaching session to support them in taking the steps to do that, right at the moment.

If what’s holding them back, for example, is something like not knowing the right words to explain the cut to the stylist, that’s a surmountable challenge we can walk through together. Real-world experiences like this can be life-changing, affirming, and empowering to clients who are just coming out or learning more about their identity beyond adolescence.” 

Visibility and culturally competent therapy matters for inclusive LGBTQIA+ mental health treatment. Our trained and diverse team of clinicians offers our clients a validating experience.

For young adults seeking mental health treatment, an affirming and validating relationship with their primary therapist is one of the most stabilizing and life-changing factors supporting their mental health. It’s important that LGBTQIA+ young adults can see a variety of identities represented within their healthcare team.  As one of our clinical coaches notes, 

“Representation matters. As therapists we are around a lot – in the Clubhouse and common spaces. The clients see us and understand how we identify in group settings. There’s a power in knowing how people identify, especially others who are a bit farther along in their journey because of age or circumstance.” 

Handling Self-disclosure

Depending on the nature of the relationship between the client and the treatment provider, self-disclosure can be beneficial within a responsible therapeutic setting. 

“Self-disclosure is something we want to be mindful about, and ultimately only disclose if it’s going to be beneficial to the client,” explains Amie. “If sharing will help build trust responsibly, for instance, if a client is saying you don’t understand their experience, you may share a brief disclosure with them to show your alignment in a professionally-appropriate way.”

Prioritizing Ongoing Diversity Training

LGBTQIA+ people are highly marginalized, and we must recognize the intersection of sexual orientation and gender identity with other social identities such as race and socioeconomic class; these intersecting identities can contribute to even more oppression.  So in addition to our team exploring  Intersectional mental health care training such as “Gender Dysphoria and Mental Health” or “Micro-aggressions through the LGBTQIA+ Lens”, we offer diversity, equity, inclusion, and belonging (DEIB) training in partnership with Choice Points Learning, a national leader in diversity training. 

“There are always opportunities to learn, and as therapists, we need to be aware of our own implicit biases and stereotypes,” shares Amie. “It is important to seek opportunities to continually educate ourselves and be open to correction when we make mistakes.” 

We always honor & protect clients’ sexual orientations, gender identities, and their right to self-determination.  

Young adults are often still very much a part of their family unit. However, our clients are on a journey towards adulthood and we are a proudly affirming community. That means that we fully accept the (sometimes shifting) sexual orientation and gender identity of each client throughout the treatment process. 

“We set a boundary with families straight from the start, explaining that we will always be affirming of the client we’re working with,” says Amie. “If someone comes into this space and they say that their pronouns are they/them, and their parents are not comfortable with that, our job is to be affirming of the client’s identity first.”

With this in mind, for clients exploring their identity, family therapy at The Dorm is a critical part of treatment:

“We work extensively with parents so that they can process and grow alongside their adult child during the treatment process. Ultimately, though, we’re an ally to, and in support of, the client, their goals, and their right to self-determination,” says Amie.

“We put in a lot of work to affirm and support our clients’ identity explorations,” says one clinician. “We take their goals seriously. If a client wants to take steps towards a legal name change, for instance, we’ll be right there beside them supporting their executive functioning skills each day to make sure they’re feeling confident and equipped to manage complex systems.

It’s really about always asking each client: who are you today? And what do you want your life to look like?” 

Our unique Clubhouse model and community experience provide a safe incubator for self-discovery and expression.

The Dorm’s Clubhouse is a dynamic community hub that centers around the therapy and group rooms, a place to convene between sessions in a casual, welcoming setting. Clients can often be found doing work together, playing ping pong, or preparing a snack. It’s where clients can meet as part of a dedicated affinity group and where they foster fellowship and mutual support. At its heart, The Clubhouse community is a supported place where clinicians can encourage clients to be their authentic selves; an incubator for self-exploration, articulation, and expression with affirming norms and safeguards in place.  It’s in this kind of setting, explains one of our clinicians, that self-discovery can truly flourish: 

“When new clients can come into the Clubhouse and see other clients who are living their truth, it’s extremely productive to the therapeutic process. They might see a reflection of who they could be that isn’t too far into the future, not just a celebrity or influencer, but a real peer who may share some similar experiences.  By creating an inclusive space, we let that process happen organically, no matter where on their journey a client might be.” 

“Clients say they feel supported and free to be and explore who they are here,” adds Jackie, noting the difference they feel at the Dorm versus other spaces, where they often get misgendered or disrespected for their preferences and identity.  “As an example, if someone is referred to with the wrong pronouns, The Dorm is a safe enough space that both clients and staff feel comfortable reminding and calling out others to refer to the client with the correct name, pronouns, and/or gender identity.”

We view allyship as an action

“Allyship is an action, not an identity in itself,” explains Amie. “Instead of asking, ‘How can I be an ally?’, we reframe the question as, ‘How can I work to be an ally to the LGBTQ community today?

Our community Clubhouse spaces are where our clients gather for group meals, activism, and ongoing education – and so it’s the perfect environment to learn about allyship. Community activities often include diverse media representations during movie screenings, thematic trivia, karaoke nights, and, of course, Pride celebrations. Clients are encouraged to get involved with their local communities through ongoing volunteer & activism opportunities such as with True Colors United, a NY-based non-profit working to end youth LGBTQ homelessness. 

Some suggestions The Dorm community members follow and recommend include:

  • Consistently educating oneself about the systemic issues LGBTQIA people face, which are changing every day. Public school regulations, healthcare restrictions, and voter suppression are all imminent issues to this community. 
  • Voting for elected officials that support LGBTQIA rights.
  • Volunteering for pro-LGBTQIA organizations, such as The Trevor Project
  • Supporting queer designers, artists, and craftspeople.
  • Showing up to rallies, parades celebrating human rights, and protests against discrimination or violence. Being there matters, and connects you face-to-face with your community. 
  • Enjoying all-gender representation in the media – there are so many great shows, movies, books, and pieces featuring trans, queer, and other minority voices. 
  • Not being afraid to ask questions and stay curious!

We’re proud to be located in some of the most diverse cities in the United States

With locations in New York City and Washington, D.C., The Dorm and other urban treatment communities have the advantage of being surrounded by a rich history of social diversity. “Being in Dupont Circle makes a huge difference,” explains Amie. “Historically this area has been a region with a large LGBTQIA population; the businesses have been affirming for a long time; the crosswalks are even painted rainbow.

I remember my first Pride month in DC and being blown away at how many were out celebrating on Dupont Circle. Being in cities that lend themselves to a diverse population can be helpful for clients.” 

Thank you to Amie and Jackie and our other team members for your thoughtful insights into how The Dorm provides LGBTQIA+ affirming, inclusive therapy and treatment for young adults.

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