How Therapists Often Fail Their LGBTQ Clients

LGBTQ-friendly is not the same as LGBTQ-informed.

Posted Aug 30, 2018

 Marjan_Apostolovic/Getty Images
Source: Marjan_Apostolovic/Getty Images

While giving presentations around the country on sex- and LGBTQ-related issues, I often encounter therapists who have LGBTQ clients, think they feel no particular bias toward them, and assume they understand the issues facing these clients. But many have a gaping hole in their knowledge: The insidious role that internalized homophobia plays in many of these people’s lives. 

There are centuries of taboos at work, both subtly and overtly, in cultures around the world and in ours, despite the fact we often consider ourselves to be more progressive. The problem lies deep within our societal assumptions. Consider the situation facing LGBTQ persons when they are exposed throughout their life to the only cultural templates considered acceptable—hetero or cisgender relationships. If someone, especially a young person who is struggling with their feelings of same-sex attraction or love, experiences the disgust and vitriol of those around them toward such people, accepting their own sexual orientation becomes nearly unthinkable. 

Few parents, teachers, or other adults talk to kids about such feelings. If a child is seen to love being around someone of the opposite sex, we might tease them about having a “crush” on that person. But if a child is seen to love being around someone of the same sex we don’t acknowledge it in any positive way. Indeed, the child is more likely to be scolded or shamed for it or told that such a thing is wrong. More extremely, they may even be subjected to the horrors of “gay-conversion" therapy. Just the failure to acknowledge same-sex attraction in children leaves them without a vocabulary for what they are going through. 

With no external affirmation of their feelings from adults, children then must develop their own narrative about their non-heterosexual orientation—a daunting task. The overwhelming message they get is clear: I’m bad, I’m wrong, the world is dangerous, I’m unsafe and must keep my true feelings secret. 

When same-sex attraction is suppressed, homophobia, biphobia, or transphobia often become internalized, leading to lifelong feelings of self-loathing and shame. The less conscious or accepting someone is of their true same-sex sexual orientation the more likely they are to descend into finger-pointing and even violence toward those reflecting their own denied nature. And when they begin to experience internal hints about their true sexual orientation, it can be frightening and devastating, like when the babysitter in the movie When a Stranger Calls reports to the police that she is getting threatening phone calls, and they tell her “The call is coming from inside the house!” 

There are many clues to internalized homophobia that a therapist more widely educated about LGBTQ issues can pick up. Just a few examples: 

Looking for a “straight-acting” partner. A gay client is seeking, perhaps online or in bars, “straight-acting” friends and partners.

In other words, his assumption is that “straight-acting” means more masculine, less likely to be seen as gay than if the person was more effeminate. This is as absurd as a person of color seeking someone who is “white-acting,” or a Jewish person seeking someone who is more “gentile-acting.” This gay male has internalized the belief that masculine men are straight and feminine men are gay. There is nothing wrong with preferring someone who is overtly masculine, but calling it “straight-acting” rather than “masculine acting” is a form of internalized homophobia. Younger millennial gay men are increasingly saying they are looking for “alpha men,” which is more acceptable. Gay, bi or straight men can all be alpha. 

An LGBTQ client voices disdain for living in a neighborhood suffused with other gays, lesbians, or transgender people, often called a “gayborhood”—“I don’t know why they all want to live around each other!”

While it may seem quite normal to them for Jews or immigrants or other ethnic groups to cluster together with those who have the same backgrounds or interests, the idea of being identified with the socially marginalized LGBTQ community makes them uneasy. To combat this internalized homophobia, I will often ask my LGBTQ clients who express this if they have disdain for neighborhoods that have clustered ethnic groups, to which they often say “no,” and that they understand people wanting to be near their religious institutions, schools, restaurants and raise their kids in neighborhoods that foster a sense of belonging. Then I ask them, “Can’t LGBTQ people want and do the same?” to unpack their internalized homophobia.

A client tries to convince the therapist of all negatives of being LGBTQ, hoping the therapist will give them weapons against their real sexual orientation, and help them to be straight. In truth, there are a lot of negatives of the LGBTQ community.

For one, a sense of belonging is an important aspect of mental health, but there is not a lot of feeling of community among LGBTQ folks—especially with bisexual and transgender people who are often shunned and rejected by gays and lesbians. To challenge their homophobia, therapists need to point out some hopeful signs, such as millennials and younger LGBTQ folks in general being more accepting of other communities.

On the other hand, there are some positives about being LGBTQ: Gays often make their own rules about monogamy, and open relationships are widely accepted and appear to be quite healthy. Gays tend to be more sexually curious, and more open about their likes and dislikes in the bedroom, something that straight couples struggle with. There is even research by John Gottman showing that gay and lesbian couples do better than straight couples in recovering from fights with their partners, resolving their issues more quickly. 

It will “kill” my family member! 

Therapists will often hear from an LGBTQ person that they could never tell a family member because it would “kill” them. Of course, there is risk in revealing one’s true sexual orientation to loved ones, but I’ve never read a death certificate that says someone’s parent was killed by bad news. It isn’t going to kill a family member, but it could “kill” the relationship with that person. In other words, the relationship might end because the family member cannot handle it. Stories about parents fully accepting their child’s news, much to the surprise of the LGBTQ person, are legion, and reluctance to burdening their parents can also be a screen for the person not being accepting of themselves… again, internalized homophobia. 

The gay male community is too sexual. There is a widely held view that the gay male community is too sexual (read “oversexed” or “sex-addicts”).

But this is not a gay thing, it’s a guy thing. If it were a gay thing, lesbians would be equally as sexual as gay men, and they are not. It is true that gay men have a higher frequency of sexual contacts than straight men, but I believe it is because heterosexual men have to seek out relationships with women, who are, for good reason, more reticent than men to take risks. In general, men have far fewer restraints on sexual exploration than women, who have to worry about male-on-female violence and slut shaming.

Fortunately, there are many opportunities today for therapists to go beyond being merely LGBTQ-friendly and become LGBTQ-informed. One great organization is AASECT, the American Association of Sexuality Educators, Counselors and Therapists, which offers certification covering all aspects of healthy sexuality. I am partnering with Modern Sexuality Institutes to provide an LGBTQIA online certification program and I give talks around the country to therapists helping them become LGBTQ-informed.

Recognizing internalized homophobia requires some work, including examining one’s own buried prejudices and assumptions, but the result can mean far more effective counseling for our LGBTQ clients. If you are interested in further trainings on this topic go to my online training program at Modern Sex Therapy Institutes LGBTQIA Certification.

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