Psychotherapy for Gay, Bi, Questioning Clients, and People with Gender Issues

Last week, I was contacted by a sincere, heartful, intelligent man who wanted to hire me for EMDR consultation. After a 45 minute conversation, I turned him away because he doing “reparative therapy”, seeking to "help" gay people become straight. He uses EMDR and other methods to target the attachment issues of gay men, so that they heal their same-sex attraction and are able to function in heterosexual relationships. (Here's a link to wikipedia)  This man uses EMDR, and uses one of my EMDR techniques, the Two-Hand Interweave in some of his work, which I find appalling.

Why am I appalled? This man is using an outdated, disproven Freudian lens through which to see his clients. According to him, gay men got that way by having overbearing mothers and distant fathers. He thinks if he clears up the relational issues with EMDR and nurturing, and he'll get a straight man. I think his skill and empathy and the therapeutic relationship push people into the boxes that his religious beliefs say they should fit in. That Freudian paradigm has been soundly disproven. Every year brings more evidence for uterine influences of androgens and other hormones, in the etiology of gender identification and sexual orientation.(Wikepedia post w/ references) (Psych Today: Finger Length) Like Lady Gaga says, we’re all Born That Way: Gay, Straight, Bi, feminine, studly, androgynous (having both high female and male characteristics) and feeling male or female.

I have worked with sexual minority clients for my entire career. I have read extensively about, taken classes on, taught classes on, and written about these clients. In 1981-83, I ran one of the world's first day treatment programs for seriously mentally ill sexual minority clients. Several of our sickest clients (bipolar, borderline, schizoid, etc.) graduated from the program into jobs, school, and weekly individual therapy. Many had thought they couldn't be sane if they were gay, bi, or had gender issues. When they were able to accept themselves, and to know that their sexual or gender feelings weren't crazy, they were able to do the trauma work, attachment work, or medication regimens that allowed them to heal and function in the world.

When I work with someone who is uncomfortable with his or her orientation or gender, we explore it, and look at the contexts in which the discomfort has arisen: family, religious belief, social expectations at work, with friends, etc. We discuss orientation. I never tell someone what they are. I do explain the oft-replicated Kinsey Scale: 0=absolutely no homosexual thoughts, dreams, activity. 6=only homosexual fantasies, dreams, activities. 3=bisexual, can go either way or both ways.  People might move a bit up and down the scale during their lives. But 0's don't become gay. 6's don't become straight. I tell them about the newest research.  I ask clients where they think they fit today on the scale. And I ask them how they feel about it. 

 That feeling may become the focus of therapy. I often see people go through all the stages of grief: NO! ; Oh shit!; Sadness; Growing Acceptance; Joy.  Some people skip quickly through the stages, coming quickly to joy that they don’t have to try anymore to be other than they are. I never tell clients what or who they should be or love. They realize it and tell me.

When people come in with gender issues (Am I a man or a woman? Can I be man and be effeminate, a woman and "butch"?) we discuss the 3 different scales:

1. Orientation: Who attracts you? 
2. Gender: What gender feels right? I've found very few people, including transgender people, to be confused about this question.
3. Society's Gender Expectations: Are you more traditionally "male" or "female". Are you androgynous, with both traditional male and female attributes? Are you "man's man", a "girly girl", a man with traditionally female pursuits and temperament, or a woman who is doesn't fit her traditional gender role? 

Examples across the 3 spectrums:

• My husband is a Kinsey 0. He says that he doesn't understand why anyone would sleep with men, though he's glad that women do. He's happy with his male body. As a slight, sensitive, emotional, artistic, introvert, he has had mostly female friends, was happy playing with dolls and girls as kid, has no interest in team sports (playing or watching), and is uncomfortable with displays of machismo. He’s very male in his single-mindedness, tenacity, and sense of stewardship and responsibility.    
•  
• When I read the new research on prenatal influences of androgen I realized that my male twin that died in utero may have provided me with the androgens that made me how I am: Kinsey 2 ½, in a tall mannish body, with highly androgynous interests:.  In grade school, I had crushes on girls and boys. When the hormones hit, I thought everyone was cute, and still do. I've been in relationships with women and men. I've had this female body a long time, but I'm not that attached to it, or to being male. I think I could be happy either way. Only on camping trips, did I wish I had different plumbing. I'm tall, broad-shouldered, thin-hipped. Because I don't dye my hair, nor wear make-up very often, and can dress androgynously, I get "sirred" often. (Can I help you, sir?) I never had girly interests. I brought home snakes and frogs. I'm bossy, can be aggressive, can be soft and nurturing, can act like a guy around guys,. I've learned to "pass" as more female than I feel, using the gay male idea of "drag": any thing you wear, any way you look is a chosen persona. So I can do girly drag, professional drag, or wear what’s most physically comfortable. I was lucky to have parents who let me be as nerdy and idiosyncratic as I turned out to be, so that I never needed psychotherapy to reconcile my gender, sexuality, and cultural issues.
•  
• A male friend is a Kinsey 6. He says that he has always known he was gay. He thinks women are beautiful, and could not imagine having sex with one. He falls in love with men. He loves his male body. He loves to play through the gender roles, going from black leather macho "drag" to pretty-boy soft fabrics. He goes from nurturing sweet artist to macho man in five seconds. Thirty years ago, he and I did "high drag" together, wearing hyper-feminine drag queen apparel and make-up. We looked like twins of indeterminate gender. 
• A female friend was a sexually abused by nearly every male in her extended family. She thought she was gay by default: women weren’t frightening to her, men were. When she cleared her sexual abuse in years of EMDR therapy, she found out that she was really was a lesbian. Her friends, including me, thought her predilection for highly feminine partners (lipstick lesbians), tomboy sports, and a construction jobs made her an absolutely stereotypical dyke. It turns out she is.
• Her lover is highly feminine, in the arts, loves her femaleness, and as a Kinsey 6, defies all stereotypes.
• A coworker from years ago, was a very feminine boy, who as soon as he left home, took on a female persona when not at work. He hated everything male about his body. It was “not me”. After going to a support group for transgender people and years of therapy, he decided to transition to a female body. Now, she feels at home in her body and is searching for Mr. Right.
• In the early 1980’s, another acquaintance, after decades living as a very butch lesbian, transitioned to a male body, finally coming home to himself. His lover of 25 years, a tiny feminine woman, stayed with her partner throughout the transition. After partner #1 became legally male, they were legally married and shortly thereafter, left the gay community to “pass” out in the suburbs.

 

Therapy Issues

• Don’t project that these clients are coming with issues about their orientation. They may be fine with being gay, bi, or gender variant. They may be coming in with PTSD, anxiety, depression, addiction, or grief.
• Don’t miss the milestones. When I do an intake on gay, bi, or transgender people, I often ask when they first knew, when they first told someone, and when/if they are out in their lives, and what kind of discrimination they experienced. Often there is trauma, grief, or ongoing anxiety. Imagine not knowing how each new person will respond to who you are. Or fearing firing, violence, or death, for being who you are.
• Do notice and acknowledge ongoing stress and fear about being a targeted minority.
• Coming out is differentiation:  “I’m here. I’m queer. Deal with it.”  Differentiation means accepting oneself, even when others don’t.  First coming out to self. Then others. And for many, coming out to everyone. “I’m out” means to anyone who wants to know. 
• Coming out can be dangerous. Never push clients to come out. Always acknowledge clients’ fears of coming out: rejection, judgment, loss of relationships, even violence. I’ve had friends and clients lose their families, experience shunning by their church communities, and lose jobs. I’ve known military people who lost their positions and their health care and their pensions. And this week is the 13^th anniversary of the murder of Matthew Shepard, killed by homophobes in Wyoming.
• Coming out can be exhilarating and empowering. Here’s the subtext: “I’m here. This is me. I care about you enough that I want you to know me. I’m willing to risk our relationship in order to be known.”  And it, in the best of circumstances, coming out becomes mundane: “My husband/wife/partner and I saw a great movie last night.” Or, “Yeah, I look familiar because I used to be Mary and now I’m Marvin.”
• Things are changing, but not fast enough. Don’t Ask, Don’t Tell is gone. Gay marriage is now acceptable to about 50% of Americans. Sitcoms with gay characters are normal and popular. Rosie and Ellen are icons. Chaz Bono is dancing with the Stars. And kids are still being bullied to death, thrown out of families, and fearful of growing up alone and “weird”. Gay people are vilified from many pulpits. “That’s so gay!” isn’t a nice thing to say about anything. One of my favorite referrals is to Dan Savage’s “It Gets Better” campaign. Gay, bi, and straight people giving messages of encouragement to gay kids: “Hang in there. It gets better when you grow up. You’ll find love. I made it. You can too.” There are thousands of videos, some of them musical, all testimonies to the future.
• Community can be powerful. There is no one sexual minority, gay, bi, lesbian, or trans community (except in the minds of certain right wing opposition). There are many groups. And it's a thrill for an isolated person to find "people like me". Back in my day, it was support groups. Now, online communities can be a first step for people looking for support, information, acceptance, and relationships. I warn newly exploring people to watch out for jerks and crazy people. I say, "Just because they share an attribute with you, doesn't mean they aren't out to exploit you. Pay attention! Look for smart, kind, honest people, whether online or in person."
• Steer your clients towards themselves. Be curious. Support. Use your tools towards healing in everyway. I tell my clients of whatever orientation, "When you lay me off, I want you to be as weirdly idiosyncratic as you were always meant to be, and absolutely accepting of all of it." 

Comments

[Robin Shapiro]

People are having trouble posting and I'm looking into it.

[Drkathleenyoung.wordpress.com]

Robin-

This is a fantastic, comprehensive article. I love all the examples and suggestions for therapists.

Here's to the freedom for all of us to be our "weirdly idiosyncratic" selves!

Kathe Young

[Jamie Marich]

Bravo, Robin...good for you for putting all of these fastly important issues out there!!!

[Sandy Mitchell]

Robin, I really appreciate the thoroughness with which you've addressed these issues. I'm dumbfounded that someone could think he could 'cure' homosexual people through the use of EMDR...sounds like he needs to work on his own delusional thinking!
I look forward to getting your emails - but I notice that they don't have any reference to you in the text, and a couple of times I didn't realize it was from you (the source is always listed as 'Feedblitz'). It's probably a picayune point but I would like to see your name in the subject line so that I'd immediately know it's from you...
I just counted how many emails I got this morning, from midnight to 8:30 a.m. I got 47...once in a while I overlook something good 'cuz it gets lost in the mix...
Anyway - keep 'em coming! Thanks for all your great work.

[Robin Shapiro]

Thanks, Sandy,
I don't know how to change the way the email is labeled. When you do notice you received one, you can always go to the "home" part of the blog and see if you missed anything.
I'm glad you like the material.

[Marielouise Dodson]

I love your passionate post!

MarieLouise