A lot of LGBTQ / LGBTQIA individuals I know are skeptical of the mental health field. And with good reason!
Even though I am a drama therapist, I would never judge someone for not feeling comfortable seeking therapy.
But why is it so hard to find an affirming mental health provider?
There are a few different but overlapping factors involved.
Stigma within the US Healthcare System
A lot of marginalized individuals – including queer and trans folks – have medical trauma.
This is what happens when patients experience microaggressions, discrimination, or other forms of harm at the doctor’s office, in the hospital, or when seeking mental health support.
This leads to a pattern where LGBTQ individuals often don’t even attempt to seek care.
But even when they do, there are still additional barriers.
The power structure inherent within our current US healthcare system puts healthcare providers in the position of “expert” when it comes to our bodies and experiences.
This makes it easy for doctors, nurses, nursing assistants and technicians, dentists, therapists, counselors, social workers, and even medical office staff to gaslight members of marginalized communities.
When it comes to mental health, a lot of providers still hold stigmatizing beliefs about “malingering.” They might think a patient is exaggerating symptoms to get attention. Or develop unconscious bias related to certain diagnoses due to past experiences.
In the age of the Internet, some healthcare providers also feel frustrated and irritated when patients look up information online about their symptoms. They might dismiss someone who comes in asking about a particular diagnosis.
But I believe knowledge is power!
Problems with Healthcare Training Programs
Yes, healthcare professionals receive specialized education and training about diagnosis and assessment.
But A LOT of the research performed about all kinds of health issues uses upper class cis white men as subjects. Which means the resulting data is skewed.
This shows up as disparities in access to care related to disabilities and chronic illnesses across the board. Both underdiagnosis and misdiagnosis are common, as is the inability to recognize less common symptoms. Mental health is no exception!
That isn’t even to mention how racism impacts healthcare outcomes for BIPOC and BBA individuals.
When I took Abnormal Psychology, the information about trans people especially was so out of date! Mental health professionals might confuse being trans with transvestism. Or think gender dysphoria is a requirement before recommending gender affirming surgery.
Healthcare professionals are not immune from bias. Those with privilege internalize a lot of problematic messages and myths about marginalized communities.
It is important for everyone to spend time in diverse spaces and prioritize listening to those with lived experience.
Unfortunately, education about LGBTQ issues is often optional in mental health training programs, and isn’t standardized. There might be an advanced elective, or perhaps just a page or two in a textbook.
Cishet providers (and even cis queer providers) who do not seek additional training end up holding harmful and stigmatizing opinions about queer, trans, and gender expansive people.
Some healthcare providers also use religious beliefs as an excuse to discriminate. And in many states in the Southern US, this is legal!
The mental health field says that cultural competency is important. But there is often a huge gap between expectation and reality.
Requirements for Advanced Degrees
It also takes a lot of class privilege to afford a Master’s degree. It is uncommon for funding to be offered for counseling and social work programs.
Additionally, a lot of students are required to complete unpaid internship hours on top of their coursework. This makes holding a job while in school challenging.
Many mental health professionals graduate with six figures of debt.
Then, they may work in community mental health settings with high volumes and a salary of less than $40K annually.
What about the provider who opens a private practice and charge $200 a session? That might help pay down debt, but makes therapy accessible only to high income clients.
Either way, economically disadvantaged communities end up with reduced access to qualified professionals.
LGBTQ individuals are often economically disadvantaged when compared to cishet peers. Trans and gender expansive people feel the brunt of that stigma, often choosing between staying closeted or losing a job due to transphobia.
What Can We Do
None of this is an excuse.
We need to do better.
I became a drama therapist due to my own struggles to find LGBTQ affirming therapy so I could heal complex trauma from emotional abuse.
But it isn’t any easier to navigate these systems from the provider side.
That’s why I believe social justice can’t be divorced from mental healthcare.
Marginalized individuals have worse mental health outcomes because the trauma of experiencing oppression is real! It gets called minority stress, but it is trauma.
What people need is to be paid a living wage, to have access to universal healthcare, to not live in food deserts, to get six weeks paid vacation like the rest of the developed world, etc etc etc!
Rates of stress, anxiety, and depression are skyrocketing. Gen Z has lower mental health satisfaction when compared to any previous generation.
Reducing the stigma associated with going to therapy helps more people access diagnosis and treatment.
But in a world ravaged by climate change, the ongoing COVID-19 pandemic, systemic racism and other systemic -isms, anxiety and depression are also rational responses.
You Deserve Support
When you can’t find a therapist who can help you, know that it isn’t because of you.
You aren’t too broken, too difficult to deal with, or undeserving of care.
You are living in a society that wasn’t built for you.
You aren’t making it up.
You do have to work harder than people who have more privilege than you. And you deserve support.
If you are thinking about starting therapy, you can contact me for a free consultation.
If you are an ally, this glossary of common terminology might be a useful resource.