5 Things Your LGBTQ Therapist Wants You to Know
Starting therapy and reaching out to a LGBTQ+ therapist can bring many unknowns. Here are five things as a queer therapist that I want my clients to know:
1) You deserve to have a LGBTQ-affirming or LGBTQ specialized therapist even when you don’t feel “queer enough” or “trans enough” to have one.
2) You don’t have to be publicly out to everyone in your life for your LGBTQ+ identity to be valid.
3) You can disagree or see things differently than your LGBTQ therapist does.
4) The feeling of needing to prove your transness might come up in therapy.
5) There’s no required amount of time for you to be in therapy before getting a letter of support from your therapist for gender-affirming medical or surgical care.
Let’s look at each of these in some more depth…
1) You deserve to have a LGBTQ-affirming or LGBTQ specialized therapist even when you don’t feel “queer enough” or “trans enough” to have one.
Queer imposter syndrome is that feeling of not being queer enough or trans enough. It often leaves us stuck from getting to further embrace our queer or trans identities. There is so much pressure to ‘be sure’ of your LGBTQ+ identity before speaking about it out loud or with other people. This queer imposter syndrome often leaves us full of self-doubt. Odds are, if you truly were cis-het and not LGBTQ+, you wouldn’t be sitting here thinking about it and questioning it so much. I encourage you to listen to the part of you that brought you to this page.
You don’t have to be certain on whether or not you are LGBTQ+ in order to start therapy with a LGBTQ+ therapist. In fact, if you’re feeling uncertain about your identities, you’re probably someone who would most benefit from working with a LGBTQ+ specialized therapist. Instead of having to figure this out alone, it’s something the two of you can figure out together within the privacy and confidentiality of therapy.
It’s also ok if you feel intimidated by your LGBTQ therapist or don’t feel queer enough in comparison to them. This can be a normal reaction when you are still settling into your own identity. Keep in mind that when you interact with your LGBTQ+ therapist, you might be speaking with someone who’s had years to settle into their identities. The beginning of this process for them might have looked very similar to what you are going through now. If this kind of comparison comes up for you, it can be something valuable to talk about with your therapist.
2) You don’t have to be publicly out to everyone in your life for your LGBTQ+ identity to be valid.
There are many ways to develop a healthy LGBTQ+ identity. For some people this will include being publicly out and being visible as a LGBTQ+ person. However, this is not what is healthiest for everyone. Your LGBTQ+ identity is valid regardless of how many people know about it or how openly it’s talked about.
Coming out to other people is often overemphasized as the most significant experience in a LGBTQ+ person’s life. Often we think of coming out as this experience where you make a grand announcement: “Guess what mom and dad? I’m bi.” However, verbal disclosure of your identity is often a White narrative of coming out. In reality, sharing your identity can look a lot of different ways. For instance, gay Latino men might find that tacitness is what’s best for them (Villicana, Delucio, & Biernat, 2016). This is where one’s queerness is known by others in nonverbal ways, such as bringing a significant other to family events or supporting LGBTQ+ social causes.
You don’t have to be out to everyone in your life. Your LGBTQ+ identity is a wonderful and sometimes precious part of who you are. You are allowed to be selective in who you share that with.
3) You can disagree or see things differently than your LGBTQ therapist does.
You and your queer or trans therapist can have different ways you each embrace your queerness. You and your therapist can have different perspectives or philosophies about what it means to be queer or trans. You can have different approaches to how to navigate the world as a LGBTQ+ person. As a marginalized group, there’s a lot of pressure for us to be united in our thoughts, opinions, and beliefs because straight, cis people can’t handle our complexities.
A good LGBTQ+ therapist gets this. A good LGBTQ+ therapist will understand that complexity and diversity within the LGBTQ+ community is a wonderful thing. Your queer or trans counselor shouldn’t pressure you to think and feel the same way they do. They should help you find your own voice and honor your perspectives. There have been times when a LGBTQ+ client spoke about what their queerness means to them in a way I had never thought about before, and it moved me. This moment for the client to be heard, and for me to hear and really listen, would have been lost if we didn’t allow room for us to have different perspectives.
4) The feeling of needing to prove your transness might come up in therapy.
Trans identity has historically been, and unfortunately continues to be, pathologized in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM outlines specific criteria for the diagnosis of Gender Dysphoria, such as a strong desire to be a gender other than the sex assigned to you at birth. Given Gender Dysphoria’s ongoing presence in the DSM and its format of listing specific symptoms for this diagnosis, it inappropriately creates a sort of checklist for proving you’re trans. When there is a literal checklist created by the mental health field, no wonder you end up feeling like you need to prove your trans identity to your therapist!
Mental health professionals are also gatekeepers to gender-affirming care. To receive gender-affirming medical or surgical care in most states you have to have an assessment done and a letter of support from a mental health professional. It’s unfair and it’s understandable that you would feel pressure to prove your trans identity in these scenarios. It makes sense that when you are not being empowered to make your own medical decisions, you do what you can to make this broken system work for you. You may feel pressure to present yourself as fitting into a more stereotypical trans narrative (e.g. being born in the wrong body, having known you were trans from a very young age, etc.) because you worry your therapist won’t approve you for surgery otherwise. You are forced to question whether taking the risk of talking about how you don’t fit the stereotypical trans narrative will be used against you to withhold the medical care you need.
5) There’s no required amount of time for you to be in therapy before getting a letter of support from your therapist for gender-affirming medical or surgical care.
The World Professional Association for Transgender Health (WPATH) writes the Standards of Care for the Health of Transgender and Gender Diverse People. This document includes recommended criteria for gender-affirming medical or surgical care that most insurance companies base their policies on. While laws may vary from state to state, currently there is no criteria in the WPATH Standards of Care Version 8 about needing to complete therapy for a certain amount of time.
If all you’re needing therapy for is access to gender-affirming medical or surgical care that’s perfectly ok. Current WPATH guidelines do not state a required amount of time spent in therapy before you can seek gender-affirming medical or surgical care. You don’t owe your therapist a certain amount of time in therapy before or after stating this need. There are many therapists who are qualified to assess and write a letter of support for you within 1-2 sessions.
Ready to find your next LGBTQ+ therapist? Reach out to me to start therapy. I am a bi/queer therapist in Minneapolis offering online therapy throughout the state of Minnesota.
I wish you all the best in your therapy journey!
Research cited in this blog:
Villicana, A. J., Delucio, K., & Biernat, M. (2016). “Coming out” among gay Latino and gay White men: Implications of verbal disclosure for well-being. Self and Identity, 15(4), 468-487. https://doi.org/10.1080/15298868.2016.1156568
