Why “Tolerance” isn’t enough

We’ve got to do better, folks.


in the 21st century, we’re still hearing the following phrase from some of our clients:  “I’ve been looking for an LGBTQIA friendly therapist, and I’ve had a really hard time finding one.”

There are many layers to what this phrase means.   It does not mean a lack of “specialists”. First off, I don’t even like the term “specialist”.  It implies that we are experts.  While we should always strive for professional excellence, the minute we see ourselves as “experts”, we risk losing our humility.  We risk losing our curiosity, and our openness to take in new information.  This prevents us from actually seeing the client in front of us, with all their struggles and their strengths.

It’s easy to check the “LGBT” box on your psychotherapist profile.  Many therapists check it because they are open to working with people who identify as be being a part of that population.  They have no moral objection, so they consider themselves competent.

There is nothing special about a lack of moral objection.  While openness and non-judgement may make someone a decent human being, it doesn’t make someone a competent therapist for this population.

What does?  Well, there’s the ongoing commitment to professional education.  I’m actually not talking about education about the “how tos” of doing therapy with LGBTQIA folks.  There’s no established methodology for “queer therapy”.  Methodologies, after all, are designed to heal symptoms.  Queer is not a symptom.  It is simply part of who the client is…and there is nothing about that person that needs to be fixed.  So, when I am talking about “professional education”, I am talking about awareness of the types of healthcare that are available, and the types of resources that the community has to offer.  I am also talking about awareness of the current political situation, and how it affects our clients.

Understand that oppression is real.

This is where Cognitive Behavioral Therapy is limited.  I am not saying that it isn’t useful.  It absolutely is, and it is important to have an awareness of how and when to apply it.  I’ll tell you when NOT to apply it:  If a client from an oppressed population is coming to you with a fear that they will be rejected, harassed or subject to violence, it is NOT a cognitive distortion.

There is an old Gestalt saying that I have found very useful:  catastrophic expectations are memories.  I have found this to be true on more occasions than I can count.  Your client may be remembering something that actually has happened to them, or somebody they love.  And yes, there is a legitimate danger that it will  happen again.

Assuming that fear is a cognitive distortion helps the therapist feel safe, but it does not serve the client.   Now, therapists do not protect themselves because they are bad people, or even bad therapists.  None of us want to think that a client, who we legitimately care about, could have something horrible happen to them.  Who among us is ready for that?   Nobody, I hope.  We cannot afford to be complacent.  If the possibility of something terrible happening to our clients does not break our hearts, or make us angry, then we probably should not be working with them.

This, for me, is part of being trauma-informed:  facing the existential reality that trauma happens.  Nothing we say can erase it.  While we can help people heal themselves, we cannot form a healing relationship without acknowledging how bad it actually was.

When we can meet our clients where they are at, and acknowledge the enormity of what they face, we are able to actually see them.  When we do that, we can truly appreciate their strengths.  This turns strength-based therapy from empty platitudes into a true alliance, and that is that most important vehicle for healing.

Most clients who report being unable to find LGBTQIA-friendly therapist are not saying they can’t find someone who checked “the box”.  Often, they have seen several people who checked the box.  All of them have acted dismissive in some way, or worse, terrified.  I fully acknowledge that these therapists do not do this on purpose, but that does not make it any less harmful.  Therapists can, and must, do better.

Therapists talk a lot about being trauma-informed.  I don’t see “trauma-informed” as a methodology.  I see it as an awareness.  It’s about understanding how trauma affects someone’s life, and their ability to engage with the world around them.  This has to include an understanding of societal oppression, which can be the cause of trauma. At the very least, it can exacerbate trauma or be disruptive to healing.  So, educate yourself, be kind, and don’t be afraid to admit when you don’t know everything.

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