What is Culturally Competent LGBT Therapy?


Lesbian,gay, bisexual and transgender (LGBT) people seek therapy for the samereasons anyone does. In addition, they are impacted by living in ahomophobic and transphobic world. Understanding the issues presentedwithin that context is where the LGBT culturally competent therapistcomes in.

I'd like to first share the definitions I operate from when working with LGBT clients and issues.

Sex - What we are assigned at birth. Believed to be binary (male or female) and to dictate gender expression. In reality, many are born intersexed, and/or experience a gender that is different from their birth-assigned sex.

Gender - Socially constructed, learned via culture. In Western culture typically binary: men (who are masculine) and women (who are feminine). Behavior, appearance, and societal roles are differently defined for each gender. For most people, gender is their sex made visible. For transgender, gender variant or gender non-conforming people this is not the case.

Sexual Orientation - A person's sexual/romantic attraction to members of the same and/or opposite sex. Includes gay, lesbian, bisexual and heterosexual.

Gender Identity - A person's inner sense of self as male, female or other gendered. Gender identity may not corresponds to the sex you were assigned at birth.

(People often confuse sexual orientation and genderidentity. Your gender, whether it is man, woman, transgender, saysnothing about your sexual orientation.)

Gender Expression - The way people communicate their gender identity to others through behavior and appearance. Transgender people may desire to make their gender expression match their internal identity, rather than their birth-assigned gender or sex.

Transgender - An umbrella term that can be used to refer to a variety of identities that do not conform to the gender role expectations of their birth-assigned sex. It may include people who identify as transexuals, female-to-male (FTM), male-to-female (MTF),  genderqueer or other gendered. Transgender people may or may not choose to alter their bodies hormonally and/or surgically.

Why seek a therapist with awareness of/expertise in LGBT culture and issues?

LGBTculturally competent therapists get that you are more than your sexualorientation/gender identity. Certainly not everyone LGBT is seekingtherapy for issues related to their sexual orientation and/or genderidentity! At the same time, it is crucial for the therapist to "get" themany ways societal prejudice and discrimination create problems thatLGBT clients may seek to address in therapy. As a trauma therapist Iunderstand the individual within the context of multiple levels ofoppression (and privilege). Many institutions and individuals within ourculture continue to hold anti-LGBT biases such that growing up LGBToften is a stigmatized and traumatic experience. If you have feltstigmatized because of your sexual orientation or gender identity, thelast thing you want is to have to spend valuable time educating atherapist about your orientation or identity, or talking about yoursexuality/gender because your therapist considers it to be a "problem."You have a right to a therapist that is affirming and educated about theLGBT communities.

What are some issues LGBT clients might want to address in therapy?

1.Coming out issues: Coming out refers to the process of recognizing yourown sexual orientation or gender identity and deciding whom to share itwith and how to do that. Coming out is a life long process for mostLGBT people. Do you need a safe place to explore your sexualorientation? Are you struggling with internalized shame or fear aboutwhat it means to be LGBT? You may be comfortable with your identity butfear rejection by important people or discrimination on the job. Parentsof LGBT children might seek therapy to understand how to support theirchild in this process. You may also be wondering what it means aboutyour identity if your choice of partner changes, or your partnertransitions form one sex/gender to another.

2. Relationshipissues: Stigma impacts our ability to have healthy relationships andsexuality. Are you struggling with your ability to form and maintainhealthy relationships? Are you wondering if your sexual behavior iscompulsive? Too much? Too little? Are you questioning whether monogamyworks for you and thinking about exploring other options? Do youidentify as polyamorous and fear this being pathologized? Are you kinkidentified? Are you wanting to discuss the differences between BDSM andabuse? If you are bisexual, are you tired of explaining that this doesnot always equal nonmonogamous?

3. LGBT-related trauma: LGBTclients experience all the same traumatic events as heterosexualindividuals. In addition, they may also experience traumas related totheir sexual orientation or gender identity. You may have experiencedbullying as a child or teen related to your presumed sexual orientationor gender expression. You may have experienced physical or sexualassault (gay bashing). You may experience same-sex domestic violence,which carries with it additional stigma and barriers to treatment. Youmay have experienced prior therapy that focused on trying to "cure" yoursex orientation or gender variance or defined it as pathology. You mayhave been traumatized by cultural institutions that still stigmatizeLGBT individuals and identities. Where you rejected by your faithcommunity? Discharged from the military? Shunned by friends or family?Fired from a job? If you are bisexual, are you dealing withmisconceptions from straight and queer culture alike? All of these aretraumatic events that may be addressed in therapy.

4. Accessingcommunity support: We often here talk about the LGBT community, as ifthere is only one! In reality there are many sub-communities and findingyour niche can be difficult. Therapists with awareness of thecommunities locally and at large can help guide you in seeking supportand a place where you fit. LGBT affirming churches, support groups,recreational activities are all out there if you know where to look.

Kathleen Young, Psy.D.

Dr. Young is a licensed clinical psychologist with over 20 years of experience. She has been in private practice in Chicago, Illinois since 1992. Her career focus has been on treating trauma and its aftermath. She is also an EMDR trained therapist and has completed the Illinois 40-hour Domestic Violence Training.

Dr. Young received her doctorate in clinical psychology (Psy.D.) from the Illinois School of Professional Psychology in 1990.

For more information: http://www.drkathleenyoung.com

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