At 23, Keegan Campbell finally decided to give therapy a try. He was tired of feeling helpless and alone, and he wanted to get his life back on track. At first, his weekly sessions had a positive impact on his life and psychological well-being. Then he revealed his sexual orientation to his therapist, and the experience went downhill. “She specialized in marriage and couples counseling,” Campbell says, “and when I told her I was in a same-sex relationship, she seemed distant. This was in New York City, of all places.”
Finding a therapist you like and trust can be challenging for anyone. But members of the queer and trans communities — a population with a threefold risk for anxiety disorders and major depression, as well as a disproportionate rate of suicidal behavior — face an outsized battle when it comes to obtaining mental healthcare. Not only are LGBTQI folks more likely than their straight, cisgender counterparts to deal with mental illness, they’re also less likely to get clinical help for it. When they do enter treatment, they report low levels of satisfaction and high dropout rates.
That’s not to say LGBTQI patients should write off head-shrinking and talking it out. Experts in the field, as well as patients who’ve found therapists they like and trust, say it’s worth holding out for a high-quality professional. But even in 2018, in places as LGBTQI-friendly as New York City, finding the right therapist can take patience and perseverance.
In 15 years of on-and-off therapy, Mikki Coleman, 22, who’s trans and nonbinary, has switched therapists more times than they can keep track of. “I can find therapists that are informed on sexual trauma and PTSD,” Coleman says, “but not on queer or trans identities and experiences. If a therapist can’t even get my pronouns right, how am I supposed to trust them with the most vulnerable pieces of myself?”
The research on LGBTQI therapy experiences is limited, but Coleman’s complaint jibes with the small number of published studies. In one survey on LGBTQI mental healthcare in Ireland, for instance, half of respondents said their therapists lacked knowledge of LGBTQI issues, and nearly as many reported feeling as though practitioners were unresponsive to their needs.
There just aren’t enough therapists with a strong grasp of intersectionality, according to Jor-El Caraballo, a licensed mental health counselor in Brooklyn. “When clinicians don’t understand how someone might experience being gay and an immigrant, or trans and black,” Caraballo says, “I think that this can cause misunderstanding or miscommunication in the therapeutic relationship, leading to early dropout in therapy.
“Even working at a hospital that advertises itself as LGBTQ-friendly, there is some homophobia and transphobia expressed by providers,” says social worker Amanda Frey, a bisexual woman who’s been both patient and therapist.
Otherwise competent therapists can still be under-informed about issues of sexuality and gender. In a recent session, Frey’s own therapist confessed that, while she’s worked with lesbian, gay and bisexual patients Frey has referred to her, she wouldn’t feel equipped to furnish therapy to a transgender or gender-nonconforming person.
Barriers aside, Frey and Caraballo insist that LGBTQI-friendly therapists are out there. Frey recommends forging on past each awkward encounter and unfulfilling introductory session — kind of like dating: “I kissed many frogs before finding my current therapist.”
To expedite the search, Frey suggests throwing all your cards on the table right away. “Be straightforward about the things you need from the therapy relationship by stating, ‘I am a queer woman and I need someone who is LGBTQ-experienced and competent to work through some relationship stuff with me’ or ‘I’m a trans dude and I need someone who understands poly relationships.’”
Sometimes the therapist an LGBTQI patient needs isn’t merely someone who’s worked with the community — it’s someone who’s also part of it. “When you’re trans or queer, the most basic and intrinsic parts of yourself are often what you have to explain in the most depth before you can even get to the actual therapy,” says Coleman. “To have a therapist concerned about my well-being as it relates to my identity was absolutely revolutionary for me.”
Coleman didn’t connect with any therapist until they found a queer woman with a decade of specialized experience in trans healthcare. “I never had to explain my identity at any point,” says Coleman of the therapist they finally clicked with.
Hannah Rimm, a 25-year-old queer woman, similarly endured years of trial and error before finding her match, a “perfect, helpful, very queer therapist.”
“My biggest struggle in all of my previous therapists and psychiatrists was feeling completely comfortable to talk about my sexuality and gender expression with somebody who not only was accepting, but who also had experienced questioning sexuality themselves,” says Rimm.
Rimm and her therapist are still going strong after three years, and she’s referred six of her queer friends to them as well.
“In the case of some marginalized identities, because you see this with people of color seeking out therapists too, it is often important for the patient or client to know that this person really understands,” Frey says. “Most people with marginalized identities have been burnt at least once before in regards to being a mental health service consumer.”
Frey tells patients right away that she’s LGBTQI-friendly. She also makes sure to “talk the talk”: “I use inclusive language,” she says. “I respect pronouns, and I try my best not to assume.”
She doesn’t go out of her way to advertise her own LGBTQI identity, but she is open to sharing that information. “If a patient asked me in the context of private practice what I identified as, I wouldn’t have a problem disclosing to them that I’m a bisexual cisgender woman.”
Beyond that, Frey says, she’s careful about the personal details she divulges. “It can distract from the reason we’re both there: to treat the patient.”