It wasn’t so long ago that being gay, bisexual, lesbian, non-binary, or transgender was deemed a mental illness. In fact, Homosexuality and Gender Identity Disorder were still diagnosable under the Diagnostic and Statistical Manual (DSM) in most of our lifetimes. Thankfully, the world of mental health is changing. The DSM has finally removed their archaic diagnoses for queer people, and conversion therapy is being banned in more areas of the world.

We need to educate therapists

Why is this necessary? Do sexuality and gender identity really make a difference in a therapeutic setting? Yes, they do. Being queer impacts how likely someone is to need mental health support as the LGBTQ2S+ community experiences mental health issues at higher rates than the general public. This increase is often brought on by the stigma, prejudice, and violence that queer folks face throughout their lives. These particular kinds of social stressors are known to increase anxiety, depression, and other mental health conditions. 

In Canada, gay and lesbian people are three to four times more likely to report having suicidal thoughts during their lifetime than heterosexuals. A survey  of bisexual youth found that 30% of them reported having suicidal thoughts over the past 12 months. Sixty per cent of trans people reported having depression, with 36% saying they had suicidal thoughts in the past 12 months and 10% indicating that they had attempted suicide.

When queer folks reach out for mental health support, they are often met with varying levels of incompetent or unaffirming services offered by well-intentioned providers. If they face prejudice or worse in that space as well, they may never return. The same survey showed that 10% of queer folks postponed therapy or did not access it at all due to disrespect or discrimination from health care providers.

Seeking out mental health support is vital

It comes down to the reasons a person needs that help.

• Struggling with addiction. Untreated addictions can and often do lead to death from an overdose or through a deterioration of general health.
• Dealing with suicidal thoughts. According to a 2016 study, over 41% of trans folks reported attempting suicide in their lifetime.
• Living with domestic violence. A person that experiences domestic violence is at a higher risk of acquiring a traumatic brain injury, is more likely to have depression and suicidal ideation and is at risk of being murdered by their partner or relative.
• Not having a strong, if any, support network. Sometimes a therapist is someone’s only emotional support as they begin to gain confidence and connect with other members of their community. When met with inadequate support, a client’s feeling of being alone, unwanted, or not good enough can be reinforced, potentially leading to heightened experiences of depression, anxiety, and suicidality.
• Facing stigma and judgement for their sexuality and sexual preferences. Sex has been taboo for so long that all too often therapists don’t know how to confidently and competently create a sex-positive environment. Pair this with navigating a generally sex-negative society, and queer and polyamorous folks can often find themselves feeling increased shame and internalized homophobia, further impacting their mental health.
• General mental health support not related to their gender or sexuality. Far too often queer folks are assumed to struggle with their mental health only because of their gender or sexuality, and while that may often be true, assuming that someone is struggling with their identity can cause mental health professionals to overlook a client’s actual needs, unintentionally creating a barrier to service.
• Living with a variety of marginalizing factors. Many LGBTQ2S+ folks experience multiple intersections of marginalization, including racialization, socioeconomic difficulties, ableism, ageism, and other forms of oppression that many of your cisgender-heterosexual clients face. Pigeonholing queer folks into just one underrepresented group eradicates other identities and struggles through which they navigate the world and can leave them feeling unheard or, perhaps worse, inevitably create gaps in treatment that can lead to more serious outcomes. 

These are not exaggerated examples. People are experiencing these circumstances right now and, for many, their lives are in peril. As a queer mental health professional and the founder of Our Landing Place Therapy Collective (a sex-positive and LGBTQ2S+ affirming clinic), I hear stories like these all too often, and I have personally experienced the negative consequences of unsupportive therapy.

What can mental health professionals do

Avoid assumptions 

Don’t make assumptions, regardless of your experience and level of knowledge in this area. Take your client’s lead on the use of language (most importantly their pronouns and the words they use to describe their identity). If you’re unsure, it’s OK to ask. You can be curious about your client’s lived experiences without asking intrusive questions. Be aware that you may make mistakes, and a simple apology without an excuse goes a long way. When in doubt, listen and validate their feelings with authenticity and care.

Educate yourself

This could mean taking a gender and sexuality studies course or volunteering for an LGBTQ2S+ organisation. You can participate in pride events and look for online seminars and conferences dedicated to creating more queer allies. One continuing education opportunity coming up on April 21st on this subject is a full-day online conference entitled Queering Mental Health: A Canadian Perspective. The conference offers attendees an incredibly deep level of insight through the intersectional lived experiences and professional expertise of LGBTQ2S+ Canadians, allowing mental health professionals to increase their competency and allyship, therefore working towards a more affirming practice. The conference is open to professionals and the general public across Canada, and international attendees are also welcome. The workshops will all be recorded and available to watch either live or at a more convenient time. 

If you don’t think you can help, refer out

If someone comes to you with complex problems related to their LGBTQ2S+ experience and you don’t feel you can adequately give support, refer them to someone who can. No therapist is the right fit for all demographics, and most clients would rather have a referral than receive uninformed care. It’s okay to know your limits as a therapist, and, when explained with care and compassion, can be an affirming and supportive interaction for queer clients. 

Alice Curitz is the founder and clinical director of Our Landing Place, a collective of LGBTQ2S+ identified counsellors working with LGBTQ2S+, polyamorous and neurodiverse communities across Canada.