[Guest Column] "Not Assuming Your Sexuality Right Off the Bat is the Very Least People Can Do"

What Heteronormative Health Professionals Need to Learn

This is the Sunday Edition of Paging Dr. Lesbian. If you like this type of thing, subscribe, and share it with your friends. A paid subscription gets you more writing from me and will help me keep this newsletter afloat. (This week’s dispatch from the lesbian internet, which is only available to paid subscribers, was especially juicy.) Consider going paid!

Today, we’re going to do something a little different. Earlier this summer, Hannah Lord, a therapist who writes a newsletter about mental health called It’s Not What You Think, reached out to me about collaborating on a piece about mental health within the LGBTQ community and what mental health professionals might do to better support their LGBTQ patients. She asked me to share my own experiences with therapy and how my sexuality has (or hasn’t) factored into my mental health journey.

I normally don’t write explicitly about mental health in Paging Dr. Lesbian, though it’s certainly an issue that undergirds some of the pop culture topics I discuss. I also don’t usually write about myself in this newsletter because I think there are many more interesting subjects out there, but I do think it’s important to do things that are out of your comfort zone sometimes. So, I hope you will find Hannah’s interview with me (!) interesting, thought-provoking, or useful in some way. I would also encourage you to leave a comment below if you have any additional thoughts about how mental health professionals can create safe spaces for their LGBTQ clients. Now, here’s Hannah.

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Throughout my training as a psychotherapist I’ve learned how vital the individual attunement with each client is. Being able to really see them, allowing space for their myriad experiences and unique qualities. In theory, a therapist should ble to work with anyone, no matter their background, culture, race, sexuality or gender. Human connection does not rely exclusively on shared experience. However, in practice it’s clear that these differences can cause serious blindspots. Clients often request therapists that share certain identifiers as a way to feel safe, more comfortable, and more free to express themselves.

The field of psychotherapy is constantly evolving and (most) therapists are consistently learning how to better serve new and existing clients. I wanted to explore this further and had the great fortune of speaking with Paging Dr. Lesbian’s very own Kira Deshler to get her feedback on where she thinks the mental health industry could improve how they work with the LGBTQ+ community.

Here’s my interview with Kira.

What has your own journey with mental health been like?

I was always shy growing up, and definitely had a hard time socially in middle school in early high school, so those years were a bit difficult for me. My mom thought it might be useful for me to go to therapy so I did it for a while when I was around 13 or so. I felt a lot happier and a bit more confident my last couple of years of high school when I finally found a supportive friend group. I also came out to friends and family around this time, which was generally a positive experience. I've always been a pretty stoic person (even as a young child), so I think it can be difficult for other people to tell how I'm feeling, but trying to connect with others on a more emotional level is something I've been trying to work on as of late. 

How big a part did your relationship with your sexuality play in your mental health?

I think the way I felt when I was younger (and still do to a certain extent) definitely had a lot to do with my sexuality. As I said, I was quite shy as a kid and I always found it difficult to connect with others or relate to friends in the way they seemed to be relating to to one another. Later I realized a lot of that disconnect was because I was gay (and they were not), so I never felt totally comfortable. Although certainly part of that might just be how I am. I also found it extremely difficult to come out because, again, I'm a very quiet and private person so it felt totally against my instincts to have to reveal something so intimate like that to people. Even though I've grown a lot since high school I still have certain insecurities that I can pretty clearly point back to growing up gay (and shy) as a kid. 

How big a part did society's relationship with your sexuality play in your mental health? What have you experienced that relationship to be?

I would say most of the negative impacts of my sexuality on my mental health have been societal, rather than familial or social. I have a very supportive family and friends, so that was never an issue, but I most certainly internalized a lot of harmful things more broadly. I would say the biggest one is probably shame, which I know a lot of queer people can relate to, which can certainly affect's one confidence (and in turn mental health.) I know for me there was a lot of self-policing going on when I was younger in terms of how I would act or think, some of which I wasn't aware of at the time (but that I recognize now). It can be hard to snap out of that self-discipline sometimes, at least for me. 

Have you worked on your mental health with a therapist before and/or are you currently in therapy? 

As I said I had a therapist when I was about 13, and I've also been in therapy recently though I'm not currently doing sessions. 

If so, was your therapist part of the LGBTQ+ community?

Yes, she was a lesbian. 

Is it / Would it be important to you that your therapist be part of the LGBTQ+ community, and why?

Yes, I had specified that when I was looking for a therapist. I just think it's much easier to be able to speak about things related to queerness (which is a huge part of my life) without having to explain what you mean by something and having a therapist relate to your experience. Like what I was saying earlier about queer shame, or feeling stressed at sleepovers or the like – when I would say something like that my therapist immediately knew what I was talking about without having to ask follow-up questions. Having that common language or experience makes a difference I think. 

What would make you feel comfortable/safe when working with a therapist who had no personal experience with LGBTQ+ issues, or would this not make a difference to you?

I think I would hesitate to work with a therapist who has no experience in this arena because, like I said, I think it's useful to have that shorthand and that shared knowledge. I suppose there's a difference between someone asking you questions about your experiences from a place of ignorance or a place of wanting to learn more so you can better help that person's specific situation. It's also just nice not having to feel like "coming out" is a big deal, which I always find awkward in situations like at the doctor's office and the like where I don't know the person. 

Is there anything you think mental health practitioners overlook or get wrong when it comes to working with the LGBTQ+ community?

I think it can be hard to describe the process of internalization of homophobia or heteronormativity because for example, in my case, it wasn't necessarily coming from my close circle but rather society at large. So it's difficult to pinpoint where these kinds of self-loathing or self-disciplining behaviors actually come from, and I think that can be difficult to explain to people who are not queer themselves. I'm still unpacking these things years later. 

How often do you find you’re dealing with outdated or prejudice attitudes towards gender and sexuality?

I wouldn't say I deal with it on a personal level, more so on a societal one. Mainly the idea that everything in the world is so centered on heterosexuality, and that that is the assumed standard is still very obvious to me. I've been lucky enough not to have dealt with much face-to-face homophobia in my life, more so just basic assumptions. I get asked if I have a boyfriend on occasion, which I usually just shrug off because that's not a conversation I want to get into with, for example, my taxi driver or eye doctor or what have you. 

What are the most irritating comments/assumptions people make regarding LGBTQ+ issues?

For lesbians and queer women in particular there's still in many cases this strange polarization between either invisibility or hyper-visibility in the sense of fetishism or sexualization. I also think the assumption that you only come out once is erroneous because you're constantly coming out (or not) for your whole life in different situations and different scenarios, which can be a complex situation for people. Having to navigate other people's expectations, or in some cases, even your actual safety can be quite tiring. I think most queer people I know (including myself) have also had to deal with assumptions from doctors about one's sexual practices based on gender (assuming every patient is heterosexual unless corrected, basically) which can be frustrating. 

How can society improve, particularly mental health professionals working with clients? 

I suppose the best practice for queer clients would be to take each person's experience with their sexuality at face value but also have a background on some common queer issues and experiences, which, as I said, would help queer clients with feeling like they're constantly having to explain things in layman's terms. I think mental health professionals having a better understanding of why queer people might feel the things they do – like shame, for example – would be useful. 

Do you have any additional tips for therapists outside of the LGBTQ+ community?

I think striking a balance between having some sort of background knowledge about the most common issues that queer people often face while also not making assumptions about what their experiences have been like is the best way I can summarize that. For me I know I feel most comfortable talking about queer mental health issues with other queer people, but I think if a non-LGBTQ mental health practitioner were able to illustrate to me their support or comfort with these issues right off the bat I would feel more comfortable speaking to them. As I mentioned above, not doing the thing doctors sometimes do where they assume your sexuality right off the bat is the very least people can do, and definitely makes a difference.

As Paging Dr. Lesbian’s audience, I’d love to know your feedback or individual experiences in the comments. Or if you wish to contact me directly you can email me at hclondontherapy@gmail.com and find me on Substack at It’s Not What You Think.

And thanks again to Kira for her brilliant interview and for letting me slide into her newsletter residency! 🙌