Whether we're talking the extreme of "conversion therapy" or the microagressions of a well-intentioned psychotherapist, there is a lot that can go wrong when working with folks with marginalized gender and sexual identities - and it's impact MATTERS. (TW: mention of LGBTQ+ suicidality and anti-LGBTQ+ discrimination).
Let's break it down:
It is not a given that if a therapist (or other care provider) does not personally feel prejudiced towards LGBTQIA+ people that this will translate into treating us in safe and affirming ways.
There is a long history of heterosexism and cissexism in the field of mental health (think, Freud [although he was more down with us than a lot of his contemporaries at a certain point in his career - anyone else nerd out about this stuff?]). In fact only 20 years ago, a 1991 study found that only 5% of psychologists surveyed held a "gay affirmative" stance in therapy. The DSM (Diagnostic and Statistical Manual of Mental Disorders) only removed gender identity disorder in 2013 - meaning that before 2013 it was officially encoded in our field that being TGNC was a mental disorder. All a psychotherapist has to do is nothing to be likely to inflict harm. There is much work to be done.
It can be traumatizing to be treated in non-competent ways and missteps in care can exacerbate other experiences of discrimination, contributing to "minority stress".
Numerous studies on "minority stress" (the particular stress and trauma that folks endure related to their marginalized identity) show that oppression has a cumulative negative effect on mental and physical health. The impact of this intensifies when people are impacted by multiple forms of oppression such as racism, classism, ableism in addition to heterosexism and cissexism. We know trauma and stress impact the nervous system which when routinely dysregulated can contribute to long term health issues.
DISCRIMINATION IS VERY COSTLY: Studies show each act of anti-LGBTQ+ discrimination elevates risk of death by suicide.
LGBTQ+ folks are already disproportionately affected by suicidality - studies found that 41% of trans adults have attempted suicide (trans folks were recorded to be 4.6 percent of the U.S. at the time of the study), whereas it was found that 10-20 percent of cisgender LGB adults have attempted suicide. Whether a therapist's misstep is intentional or not, there is no evidence that intent changes the outcomes for LGBTQIA+ people. Our lives are at stake.
Are you a service provider who has NOT been trained in LGBTQ+ Competent Care? I encourage you to take my training (or another)!
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Sources:
Berke, D. et al. (2016). LGBTQ perceptions of psychotherapy: A consensual qualitative analysis. Professional Psychology: Research and Practice. 47(6). 373-382.
Bowleg, L., Huang, J., Brooks, K., Black, A., & Burkholder, G. (2003). Triple Jeopardy and Beyond: Multiple Minority Stress and Resilience Among Black Lesbians. Journal of Lesbian Studies, 7(4), 87-108.
Garnets, L., et al. (1991). Issues in psychotherapy with lesbians and gay men: A survey of psychologists. American Psychologist, 46, 964-972.
Haas, A.P., Rodgers, P.L., & Herman, J.L. (2014). Suicide Attempts Among Transgender and Gender Non-Conforming Adults: Findings of the National Transgender Discrimination Survey. UCLA School of Law.
Israel, T. et al. (2008). Therapists' Helpful and Unhelpful Situations With LGBT Clients: An Exploratory Study. Professional Psychology: Research and Practice. 39. 361-368.
Lick, D., Durso, L., & Johnson, K. (2013). Minority Stress and Physical Health Among Sexual Minorities. Perspectives on Psychological Science, 8(5), 521-548.
Mereish, E., O’cleirigh, C., & Bradford, J. (2014). Interrelationships between LGBT-based victimization, suicide, and substance use problems in a diverse sample of sexual and gender minorities. Psychology, Health & Medicine, 19(1), 1-13.
Meyer, I.H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological bulletin, 129(5), 674–697.
National Center for Transgender Equality. (2015). US Transgender Survey.
Shelton, K., & Delgado-Romero, E. A. (2013). Sexual orientation microaggressions: The experience of lesbian, gay, bisexual, and queer clients in psychotherapy. Psychology of Sexual Orientation and Gender Diversity, 1(S), 59–70.