LGBT-Inclusive Recovery and Therapy

A Community For Everyone: What LGBTQ+-Inclusive Therapy Needs To Look Like In 2019

Est. reading time: 4 mins
Posted Under: Treatment Insights

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

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June is Pride Month, a time to honor and celebrate the LGBTQ+ (lesbian, gay, bisexual, transgender and queer) community. While much progress has been made, we still have a long way to go in order to properly serve LGBTQ+ populations and create LGBTQ+-inclusive therapy and recovery spaces.

The unique challenges facing LGBTQ+ youth

Rates of substance abuse and mental health challenges are significantly higher among LGBTQ+ individuals than their straight, cisgender counterparts. People who identify as LGBTQ+ face discrimination on both individual and systemic levels, and often lack access to life-saving resources. This can be particularly dangerous to LGBTQ+ youth who are beginning the process of coming out and facing familial rejection; over two-thirds of LGBTQ+ adolescents have reported family members making negative comments. The school environment can also remain a challenging space; in a recent survey of LGBTQ+ teenagers, half reported that they have felt unsafe at school while over 25% said they have experienced physical harassment at school.

The result is that many LGBTQ+ young people turn to drugs and alcohol as a coping mechanism, and treatment providers need to be aware of the specific challenges facing these communities; for example, crystal methamphetamine use is particularly prevalent among men who have sex with men.

Addressing labels, gender identity and sexual orientation

The language used to describe gender identity and sexual orientation are constantly evolving, and it can be hard to keep up! Many of these terms are quite nuanced, so much so that there is even argument within the community itself about what certain words mean, such as the difference between “bisexual” and “pansexual”. It is also common for the labels someone uses to change over the course of their life. Words that may feel outdated or offensive to some can be affirming to others, and it is imperative that LGBTQ+ individuals be given the opportunity to name their own experiences. It can be highly invalidating for the client and damaging to the client-therapist relationship when the therapist incorrectly labels a client’s gender identity or sexual orientation. This can certainly be confusing, but taking the time to learn about someone’s sexual and gender identities provides an important opportunity for connection.

Be careful not to refer to clients using labels or identities that they don’t use to describe themselves, and try to avoid making assumptions. For example, if someone mentions that they have dated someone of the same gender, rather than assuming that they are gay, simply ask, “How do you identify?” Another common pitfall is the assumption that everyone you encounter is seeking romantic and/or sexual relationships when in reality some people are asexual. Conscious changes to the language we use can make a big difference!

Recognizing that the LGBTQ+ community is diverse and complex

It is important to recognize and remember that the LGBTQ+ community is not a monolith and subsets of the larger population face unique issues. People who are bisexual experience different forms of discrimination than lesbian and gay people, and may feel silenced or invalidated by their fellow members of the LGBTQ+ community. Lesbian, bisexual and queer women can experience sexism in tandem with homophobia. People whose gender expressions deviate from socially accepted norms are often targeted regardless of whether or not they are transgender, and these challenges are internalized and processed differently depending on one’s gender identity.

Just last month the World Health Organization removed the diagnosis of “gender dysphoria” from its manual of mental health disorders, reclassifying the experiences of some transgender people as “gender incongruence”. This shift affects the treatment of transgender individuals; in the past, a formal diagnosis of gender dysphoria was required to obtain sexual reassignment surgery. Transgender people often experience barriers to accessing the care they need when insurance companies deny coverage to those seeking physical surgeries and are subject to “gatekeeping” by healthcare professionals.

LGBTQ+ people are highly marginalized, and we must also 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. Marginalized groups are statistically less likely to be able to afford healthcare and affordable treatment options must be made available. When considering the treatment of LGBTQ+ people it is important that we take their entire background and lived experience into account. It can be all too easy to see someone struggling with symptoms and miss the implications of the larger context of living in an oppressive and often hostile society.

What we can do

Organizations can make efforts to be as affirming as possible by being conscientious and making a few small but powerful changes. Intake forms can be altered to replace “male” and “female” checkboxes with an open space to write one’s own sex and gender, as well as asking for one’s pronouns. This gesture is accommodating to transgender or intersex people who don’t fit neatly into a binary system. Hanging posters and providing fliers and other resources makes a space more welcoming. When appropriate, forming treatment groups for LGBTQ+ clients or otherwise fostering a sense of community can be extremely useful to those who may feel they are alone and would strongly benefit from the connection with their peers.

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Depending on the nature of the relationship between the client and treatment provider, self-disclosure of the provider’s own sexual orientation or gender identity can be beneficial.

We are constantly provided with opportunities to learn and need to be aware of our own implicit biases and stereotypes we may hold. It is always important to seek opportunities to educate ourselves and be open to correction when we make mistakes. Allyship is an action, not an identity in itself. Instead of saying “I am an ally”, we can reframe the sentiment: “How can I work to be an ally to the LGBTQ community today”?

How The Dorm Is Working To Create A Safe And LGBTQ-Inclusive Therapy Community:

  • We foster a culture that understands that gender is not a binary system. Every client is given the opportunity to name their own experiences and pronouns are always respected. Intake forms do not contain a standard, binary gender checklist, but an open space to write one’s own sex and gender, as well an invitation to share one’s pronouns.
  • Our space reflects our values. When clients step into our community facilities and our Clubhouse, they will see a welcoming array of posters, fliers and resources that are specific to the LGBTQ+ community.
  • We know that learning and listening never stops. All of our staff are committed to continually educating themselves on the evolving and changing language used to describe gender identity and sexual orientation.
  • We offer treatment groups for LGBTQ+ clients to foster a sense of community and connection and we support any clients who need or want to attend LGBTQ+-specific 12 step meetings.

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