• Monday 6th June 2022

One cannot say everything at once. (R.D. Laing, Preface, The Divided Self) 

When I was asked to write a piece on “LGBTQ+ issues in therapy”, to be honest, I bristled a bit.  Part of me wanted to welcome the opportunity to affirm sexual and gender diversity in the world of psychotherapy, another part felt critical of the whole concept.  Whilst I was mulling this over, I came across an exchange on a local social media forum which went something like this (names have been changed and content paraphrased):- 

Robin: Hi, I’m new to the area, please can anyone recommend an LGBTQ+ friendly hairdresser? 

Charlie: @Robin, hi, welcome, check out Jo’s Cuts on Acacia Avenue.  

Jan: Also Ian at Lucie’s Salon on George Street is really cool.  

Alex: FFS, what a ridiculous question! I’ve been a painter & decorator for twenty years, and my customers are all sorts of people.  There’s no need for this sort of sectarianism.  I treat them all the same and just get on with doing a good job.  

Kim: @Robin, another vote for Jo’s Cuts, also Chloe’s Hair on Bridge Street if you don’t mind travelling a bit further.  

Max: @Alex, that’s all very well for you to say, that’s your privilege. 

Jamie: I can’t stand those super-cool, LGBTQ salons.  I’m too old for all the scene and its assumptions.  

Chris: @Alex, totally agree, the world is going crazy! 

Alex: People just need to get over themselves.  A good haircut is a good haircut.  I don’t care what my hairdresser does in their personal life.  I’m fed up of snowflakes, all this identity politics stuff gets my goat. 

Jan: @Alex, no one asked for your opinion.  The post was asking for a hairdresser where they’d feel comfortable. If you don’t have something to offer in response to the question, how about you just keep quiet?  

Alex: @Jan, so now you want to cancel me because I don’t agree with you, what happened to free speech? 

Robin: I’m asking because I went to a hairdresser once who was really critical and judgemental about my lifestyle and made me feel very uncomfortable.  Then I found one who was really great, but now I’ve moved, it’s too far to travel.  Thanks for the recommendations.  

Max: @Alex, free speech is what the privileged liberals all talk about, without understanding anything about structural oppression.  Check your privilege.  


So, how about we replace haircuts (and maybe painting & decorating) with therapy….  Is a good therapist just a good therapist?  Is a good therapist one who can work with diverse clients and treat them all equally?    Would you question the validity of an LGBTQ+ client seeking a similarly identified therapist?   But on the other hand, would you assume that an LGBTQ+ client will always want an LGBTQ+ therapist?  Is therapy with an LGBTQ+ client different from therapy with any other client?  And if so, how? Are there any such things as “LGBTQ+ issues” in therapy?  Or should we just meet every client as the unique individual they are? 

Don’t explain…. 

LGBTQ+ clients don’t go to therapy necessarily because we want to talk about our gender & sexual identity.   We might go to therapy because we are anxious, depressed, have relationship problems, struggle with low self-esteem, feel stressed at work, have had a bereavement, are questioning life choices and meanings….. In short, all the reasons that might bring any client to therapy.  And actually, we might choose a self-identified LGBTQ+ therapist precisely because we don’t want to deal with the whole business of coming out to our therapist, wondering how we’ll be received, having to explain our gender/sexual identity, having to fend off therapist assumptions that our gender/sexual identity is necessarily problematic.  If all of that can be taken as given, at least to some extent, then we can get on with dealing with what brought us to therapy.  

Different therefore Equal 

If it makes any sense to talk about “LGBTQ+ issues”, it is about how the experience of being an often stigmatised minority has inflected other life experiences, and how experiences of discrimination and oppression have affected us.  All those life challenges that describe human existence, the project of becoming who you are, forming the relationships that nourish you, and finding the life project that fulfils you, are given an extra twist if you live in a world that routinely considers some aspects of your identity to be inferior and/or unacceptable.  LGBTQ+ people don’t have a monopoly on experiences of shame, rejection, low self-esteem, self-hatred, but we’re quite likely to know a good deal about them.  

Difference within Difference, or the Intersectionality Dance; & the second vignette 

LGBTQ+ people are as diverse as the population as a whole, across identities of class, “race”, culture, age, religion, as well as personal and family history and experiences, choices of life style, occupation, etc.  How we situate ourselves in relation to what is called “LGBTQ+ culture” is another individual project.  This is a semi-fictionalised dialogue from a recent supervision group:- 

Sara: My client Max was talking about Pride the other day, and I realised that I didn’t know much about it.  So I looked it up and did some reading.  I learned about the history of Stonewall and how Pride started.  It really helped our relationship when I showed that I knew what she was talking about.  

Janet: My client Danni talked about how much she hates the flamboyance of Pride, how she doesn’t identify with the gay club culture and wants nothing to with it.  She’s so angry whenever someone assumes she must be going to the Pride March.  

Hannah: My therapist is straight, married, children.  She often doesn’t get some parts of what I’m talking about.  So she’ll ask me why I don’t stand up to my parents and insist that they accept my partner, include her in family gatherings and so on.   It gets tiring explaining how that’s just not possible.  


It’s about the Pronouns, stupid; or we are not always visible 

In the first vignette, what assumptions did you make about the gender/sexual identities of the protagonists? 

In recent years, trans* and non-binary people have emphasised the importance of checking what pronouns people prefer to have used in reference to them.   For some people, the use of gender neutral pronouns, e.g. singular “they”, is a positive act of self-affirmation.  But for others, it can be used as a way of expressing a reticence to disclose a same sex relationship.  LGBTQ+ people who are unsure of their therapist’s response to their gender/sexual identity might refer to “my partner” or “they” out of self-protection.  So the therapist needs to learn to listen, notice their own assumptions, and facilitate the development of a relational space where all aspects of the client’s existence can be welcomed.  

Endings to be useful must be inconclusive. (Samuel R. Delaney) 

By Helen Hayes, (a tutor at NSPC)