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LGBT Issues Column by Christian Huygen, Ph.D., Director, Rainbow Heights Club

In my last column, I talked about how important it is to let our therapists know what’s helpful for us so they can give us what we need. I also pointed out that sometimes our therapists say and do things that aren’t quite so helpful. This can be particularly true for lesbian, gay, bisexual and transgender consumers.

It can take courage to come out to your therapist, and talk about your thoughts, feelings and relationships if you’re LGBT. Some therapists have worked with dozens of LGBT consumers. But maybe you’re the first consumer who has ever come out to your therapist. Maybe you’re even the first LGBT person they think they’ve ever met. (I say they think because everyone knows LGBT people, but not everyone knows that they do.)

Sometimes your therapist can catch up if you help them a little. If they say something that makes you feel bad, maybe you can say so. “That hurts my feelings,” or “That really doesn’t help me when you say things like that,” might be something they’d be able to hear. “Homosexuality hasn’t been a mental illness for over 30 years, y’know,” might also work. The main issue is that no matter what your sexuality is—if you’re straight, gay, or just plain human—you should be allowed to decide what the problem is, and what the problem isn’t. Your therapist can give input on this decision, but ultimately the decision should be yours. One consumer might say to her therapist, “The fact that I’m a lesbian is really not a problem for me, and it isn’t something that I want to change. I’m living with schizoaffective disorder, and that’s something I need help with. And I argue with my girlfriend about money and sex sometimes. I’d love it if I could talk about that with you. Plus, frankly, living in a society that’s prejudiced against me really gets me down sometimes. So, if you can help me with those things, that would be great, and I would really appreciate it. How does that sound to you?” You have a right to say that to your therapist. And if your therapist isn’t willing to let you decide what is and isn’t the problem, you have the right to switch to a therapist who is.

Sometimes a therapist may say, “But wouldn’t your life be easier if you were straight?” Often straight people don’t realize that nearly all LGBT people, growing up, try very, very, very hard not to be LGBT. They know very well that society expects them to be straight, get married, settle down and have children. They know that most likely, their families and friends and religious communities won’t welcome the news that they’re different. It’s pretty common for someone to struggle with their sexual or gender identity but then realize that they’d be much happier if they could just accept themselves as they are. And that’s when they start thinking about how to tell other people in their lives that they’re LGBT.

You might try telling your therapist that. The best response you can get when you come out to a therapist is, “OK,” or maybe “I’m really glad you told me that, and I want to support you.” Second best would be, “Well! I have to admit, you’re the first client who’s brought up this issue, but I want to support you and work with you. Let’s give it a try.” If the response you get from your therapist is more like, “Hmph,” or a frown that won’t go away, you should probably consider changing therapists.

The single most important thing about therapy is feeling comfortable with your therapist. This is true for everybody. If you feel comfortable, your therapy will probably go well, you’ll feel safe to explore important questions in your life, and you’ll probably get better. This is a scientific fact. On the other hand, if you feel uncomfortable, or judged, or like there are limits on what your therapist is willing to hear about, your therapy probably won’t help you, and it may even make you feel worse. This is why it’s so important to have a therapist who makes you feel comfortable, and to change therapists if you don’t feel that way.

Some consumers think it’s up to them to make the therapy relationship work. They say to themselves, “Well, I’m not comfortable with my therapist, but maybe it’s my fault. Maybe I’m the one who’s doing something wrong.” Or they may say, “I’ll try it for another six months and see if things get better.” Or, “Every time I talk about my innermost thoughts and feelings my therapist looks so uncomfortable. I don’t want her to suffer. I’ll just avoid talking about that stuff.”

You should throw all of those ideas out the window. How long does it take to know if you feel comfortable with someone? Probably 30 seconds or less. You already know if your relationship with your therapist is working or not. If you’re not sure, here’s the perfect experiment to try: tell him or her, “I don’t know if you realize this, but I’ve been feeling kind of uncomfortable in our sessions and here’s why.” Give examples of situations or conversations, and anything your therapist may have done that made you feel bad, like, “When I tried to talk about my girlfriend you said that God doesn’t want me to be a lesbian,” or “When I try to talk about dating guys you only bring up the terrible things that might happen to me.” Then watch very carefully to see how your therapist responds. If he or she says, “Oh! I’m sorry. I didn’t realize I was having that effect on you. Here’s how I’m going to try to respond differently from now on,” that’s someone worth staying with—at least for a few weeks to see if things actually change. On the other hand, if the response is negative, or makes you feel blamed for the problem, or makes you feel that the therapist doesn’t actually believe a problem exists, it’s time to tell your therapist you’d like to work with somebody else instead.

Everything I’ve said in this column applies equally to non-LGBT people. Next time I’ll talk a little bit more about some of the positive and negative responses LGBT people sometimes get from their therapists.