Psychotherapy for the Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning (LGBTQQ++) Communities

Being a member of the LGBTQQ++ community presents unique opportunities and challenges. A cornerstone of my work as a psychotherapist is providing safe, competent, and compassionate psychotherapy services to the Gay, Lesbian, Bisexual, Transgender, Queer, and Questioning communities, as well as to friends, family members, parents, and allies. Whether you are going to therapy to talk specifically about your sexual orientation or gender identity, or to work on something that may seem completely unrelated, you should make sure that you are working with a therapist who understands this important component of your life. Unfortunately, even here in San Francisco Bay Area, where I am based, there are many therapists who may just be “winging it,” at best, when it comes to this topic. And in certain geographical areas, it may be very difficult to find a therapist who is both knowledgeable and experienced with respect to working with the concerns of the LGBTQQ++ communities.

An experienced psychotherapist does not need to have your exact life experience to be helpful–after all, only you have your exact life experience—however, it is completely reasonable to ask your potential therapist about her or his experience with respect to working with the LGBTQQ++ communities. And while your therapist will be using his or her experience and/or training as a guide, what is most important is YOUR experience of your sexual orientation and/or gender identity, even if you are not yet able to put words to it.

Below are some of the topics that often come up when I work with the LGBTQQ+ communities. This list includes issues I typically see in my private practice, as well as some of the issues I have worked with as a group supervisor for Pacific Center and as an individual supervisor for Queer Life Space, two San Francisco Bay Area agencies that focus on services to the LGBTQQ++ communities.

(By the way, I am using the word “communities” intentionally. For political purposes and to represent inclusivity, community is the appropriate word; however, when I am thinking about individual psychological factors, there are both similarities and differences to consider. My personal preference is to use the plural, communities, to reflect that reality.)

Lesbians:

Coming out, coming out in midlife, marriage, divorce, deciding whether to enter or end a relationship, relationship difficulties, meeting someone, dating, finding community, lesbians living in San Francisco but finding more community in the East Bay, deciding to have children, being the biological mother, being the non-biological mother, parenting and step-parenting, living together, communication issues, older lesbians, work challenges, visibility and invisibility.

Gay Men:

Dating, relationship difficulties, marriage, monogamy, finding someone who is interested in a long-term relationship, divorce, coming out, dealing with family, isolation, parenting and step-parenting, being the non-biological father, aging as a gay man.

Bisexuals:

Feeling excluded from both the straight world and gay/lesbian world and dealing with the resulting bias, coming out to self, coming out to others as bisexual, finding community, meeting a partner, dealing with assumptions and bias.

Transgender and Gender Identity:

My work regarding the issue of gender is focused on the psychological implications of living in a binary world, e.g., how do we live in a world where our biology is artificially connected to societal and cultural constructs of appearance and behavior; a world that often seems desperate to put people into boxes and apply labels. Not fitting into these predetermined boxes or feeling comfortable using the available labels can be stressful and exhausting.

Queer and Questioning:

Who am I, how do I figure out who I am, how do I meet someone, how do I find community, how do I tell my family and friends, support around coming out, what do I do about my current life, e.g., if I come out, what happens to my current relationship(s), what about my job, how do I make sense of what I am feeling.

Don’t see your issue here? This is intended to be a brief summary of some of the more common issues I see in my practice and it is by no means complete. There are as many issues around the topics of sexual orientation and gender identity as there are people in the world. Ultimately, a positive experience in psychotherapy is about the connection between you and your therapist. Please let me know if I can be helpful to you on your journey.