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The Clinical Implications of 'Internalized Queerphobia'

How mental health professionals can help.

Key points

  • It’s impossible to be socialized in a dominant heteronormative culture and not internalize anti-LGBTQ+ bias to a certain degree.
  • Removing the stigma associated with internalized queerphobia is one of the ways to help heal it.
  • Empathy is the antidote to shame and is necessary to build a strong therapeutic alliance.

Something not openly talked about or widely addressed in the LGBTQ+ community is how "internalized queerphobia" continues to cause challenges in the lives of LGBTQ+ people. We cannot talk about societal "queerphobia"—explicit or implicit hostile beliefs about LGBTQ+ people—without addressing "internalized queerphobia."

Betzy Arosemena/Unsplash
Source: Betzy Arosemena/Unsplash

No matter our gender or sexuality, each person in the LGBTQ+ community internalizes queerphobia (both homo- and transphobia) to a certain degree due to being socialized in a dominant heteronormative world. In her book, Theory and Treatment Planning in Counseling and Psychotherapy (2nd ed.), mental health expert and author Diane Gehart writes, “Through the processes of identification and introjection, virtually all persons—gay or straight—in a heterosexist society develop homophobia.”

While pursuing a Master of Arts in Clinical Psychology with a specialization in LGBT affirmative psychology, I did my clinical training at one of the largest LGBTQ+ community mental health agencies in the United States. Although my clients varied in age, race, gender identity, background, class, and sexual orientation, what I discovered is that they all received similar messages from their families and communities about what it means to be LGBTQ+.

Much of my clinical work involved helping my clients externalize the shameful messages they internalized about being queer. While most of my clients could consciously recognize that the anti-LGBTQ messages they heard growing up were misguided, many of them weren’t fully aware of the extent to which they had unconsciously internalized external queerphobia.

Whenever I did an intake with a new client, it wasn’t a matter of assessing whether or not they had internalized queerphobia at all. It was a matter of the extent to which internalized queerphobia caused clinically significant challenges in their life.

So, what exactly is “internalized queerphobia,” and why is it something that mental health professionals need to continue to be aware of?

Internalized queerphobia is when an LGBTQ+ person unconsciously absorbs shameful messages they learn as children about what it means to be queer. It’s queerphobia from the outside that they take inside. Once internalized, it often becomes shame an LGBTQ+ person carries inside about themselves, others, or the LGBTQ+ community as a whole—conscious or unconscious.

Internalized queerphobia can be challenging to address because it’s often misunderstood. There’s a perception in the community that if an LGBTQ+ person acknowledges having internalized queerphobia, they’re somehow weak, a victim, or self-hating. I’ve often heard among gay men, “But it’s 2022—how is internalized homophobia still a thing?”

As a result, internalized queerphobia is not engaged openly enough within the LGBTQ+ community or in our relationships. The less we acknowledge shame in our lives, the more it continues to thrive. Other common terms for internalized queerphobia include: gay shame, toxic shame, internalized oppression, internalized bias, internalized homonegativity, internalized homophobia, internalized transphobia, internalized stigma—or what I like to call “messages from the playground.”

“Messages from the playground” is an analogy I use to describe the unconscious beliefs we all pick up from our childhood. Messages are the dominant societal worldview, and the playground is our mind or, rather, our consciousness. We can use these terms to describe anything, really, but for the purposes of exploring internalized queerphobia, we can use them as a metaphor to better understand how external oppression operates in individual psyches.

Using an analogy like “messages from the playground” to describe something that addresses, and therefore evokes, shame can help clinicians take their clients' to places they might otherwise fear going.

Brené Brown, one of the world’s leading experts on shame, says, “When we have conversations about shame we either shut down, change the subject, or deny that we have it.” She says that if we have “shame conversations,” we’ll lose the people we’re speaking to in 10 minutes.

In my experience, bringing up internalized queerphobia with LGBTQ+ clients, or using the term in the room, often causes them to deflect, deny, or downplay.

It’s important to note that the only reason internalized queerphobia exists is because external queerphobia exists. That said, internalized queerphobia continues to be directly connected to poor mental health outcomes, increased rates of substance abuse, low self-esteem, and intimate partner violence (IPV) among LGBTQ+ people.

In research from Rendina et al., the authors show the connection between internalized homonegativity and adverse mental health outcomes. The authors write, “… internalized stigma is closer to the self. That is, whereas rejection sensitivity may represent a functional adaptation to hostile social climates, internalized homonegativity is the personal acceptance of societal stigma as applied to the self and similar others.”

Just like any mental health condition, we have to identify the problem in order to develop an effective intervention. Internalized queerphobia is no different. In her groundbreaking book on trauma, Judith Herman says, “Traumatic syndromes cannot be properly treated if they are not diagnosed.” Similarly, internalized queerphobia cannot be properly treated unless it is named.

How mental health professionals can help

While an LGBTQ+ person can be openly gay, bi, or trans, they can also have high levels of unrecognized internalized queerphobia. Through no fault of their own, many LGBTQ+ people’s identities were formed in secrecy, silence, and shame. As an LGBTQ+ affirmative therapist working primarily with the LGBTQ+ population, it’s not uncommon to hear unconscious negative schemas behind the words my clients use to talk about themselves and the LGBTQ+ community at large.

The most important thing we can do to help our clients heal internalized queerphobia is by removing the stigma associated with internalized queerphobia and reframing what it means “to have” it. In the 12-Step model of recovery, a person is sometimes invited to consider their “defects of character,” or maladaptive coping mechanisms, as “assets gone astray.” For example, a person’s hypervigilance from growing up around a parent’s alcoholism could be seen as something that kept them out of harm's way as a child.

Similarly, holding space for a client to uncover unresolved internalized queerphobia and having empathy for why it exists can be one of the most empowering and healing interventions a clinician can use. According to Carl Rogers, empathy isn’t only needed to help a person grow. It’s a necessary quality of an effective therapist. The ability to insert ourselves into another person’s experience to understand what they’re going through makes us both better clinicians and allies. Empathy creates space for the entirety of our clients’ stories. It allows them to feel truly heard and seen and to process the parts of their past that continue to affect the present.

By understanding more about the clinical implications of internalized queerphobia and helping LGBTQ+ clients identify, name, and heal shame, mental health professionals can support their LGBTQ+ clients in living more actualized lives.

References

Boeree, C. George (1998). “Personality Theories—Carl Rogers.” Psychology Department, Shippensburg University. https://webspace.ship.edu/cgboer/rogers.html.

Brown, B., PhD. (n.d.). The Power of Vulnerability. Sounds True. https://www.soundstrue.com/store/the-power-of-vulnerability-2917.html.

Gehart, D. R. (2015, March 12). Theory and Treatment Planning in Counseling and Psychotherapy (2nd ed.). Cengage Learning.

Herman, J. L. (2015, July 7). Trauma and Recovery (1R ed.). Basic Books.

Rendina HJ, Gamarel KE, Pachankis JE, Ventuneac A, Grov C, Parsons JT. Extending the Minority Stress Model to Incorporate HIV-Positive Gay and Bisexual Men's Experiences: a Longitudinal Examination of Mental Health and Sexual Risk Behavior. Ann Behav Med. 2017 Apr;51(2):147-158. doi: 10.1007/s12160-016-9822-8. PMID: 27502073; PMCID: PMC5299076.

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