Finding a good therapist has always been a risky business. If you're queer, it's even riskier.
Chances are that the therapist you find has never been trained in lesbian, gay, bisexual, or transgendered ( LGBT ) identity development. His or her training may have included inaccuracies and misrepresentations about LGBT behavior or, even more likely, just silence about the whole issue. Your therapist may be an excellent clinician in other wayseven be a lesbian or a gay manand still misunderstand the culture you are immersed in and the unique challenges you face just because you're queer.
A group of experienced LGBT therapists in Chicago is trying to change all that. Three licensed clinical social workersBruce Koff, Theo Pintzuk, and Jeff Levyand two clinical psychologistsMargo Jacquot and Barbara Kellyare in the process of creating what they hope will be a certificate program for clinicians who work with lesbian, gay, bisexual, and transgendered clients and their families. The therapists are collaborating on the project with two community agencies, Horizons and Howard Brown Health Center, and with the Chicago Center for Family Health, an affiliate of the University of Chicago.
Barbara Kelly, Psy.D., says that her involvement with the project grew out of "the deficits, absences, and gross distortions I observed in the training of master's and doctoral level counselors and psychologists around LGBT issues." She and Bruce Koff, LCSW, started the ball rolling two years ago when they presented a talk at Horizons about "training needs for LGBT competence."
Their dream, Kelly says, was to "put together a whole program around training culturally and clinically competent LGBT-sensitive clinicians." They introduced the first pilot training sessions in October 2000 and expect to roll out the full certificate program in the fall.
So, why a certificate program? In the current situation, says Koff, "the potential risk to the well-being of LGBT individuals and their families cannot be overestimated. The history of the relationship of American psychiatry to homosexuality is a troubled one in which the notion of homosexuality as a mental illness is deeply rooted."
He points out that, although the "illness model" was formally rejected in 1974, elements of it persist in such mental illness categories as Gender Identity Disorder in Childhood and Sexual Disorder Not Otherwise Specified, and in "the views and clinical practices of countless mental health professionals."
"Anecdotal reports from LGBT clients," according to Koff, "are replete with stories of insensitive and destructive approaches, hostility, humiliation, and even unnecessary hospitalizations. Equally important, families with LGBT children, spouses, or parents are often confused or misled by mental health professionals untrained in dealing with these issues."
Some facts: A survey of psychologists conducted last year by the American Psychological Association demonstrated that, while most therapists are likely to see at least one client they know to be LGBT, they have "little or no information" regarding homosexuality. Indeed, a survey conducted only a few years ago showed that 50 percent of psychoanalysts believe that homosexuality is an illness and that they can change sexual orientation.
Over the past 40 years, Koff explains, alternatives to the illness model have evolved that "recognize the emergence of same-sex orientation or gender nonconformity as extra-developmental events," which basically means that LGBT individuals may have to work twice as hard as heterosexuals to get half as far. Without awareness of these alternative models, a clinician might see pathology where none exists.
These affirmative models of development also view "stigma" as the central problem faced by LGBT individuals and their families. Our developmental challenge then becomes the healthy integration of these stigmatized elements into our personal identity.
In other words, the central issue for LGBT clients is dealing with other people's intolerance. Most of us know that already. But the impact of stigma can be deeply damaging in terms of self-esteem and ability to function well in the world. And even the most well-intentioned and otherwise competent clinicians may not see stigma as the core issue if they don't understand these newer models of LGBT development.
Theo Pintzuk, LCSW, adds that many clinicians may miss not only "the impact of homophobia and transphobia on developmental pathways," but also misunderstand how to assess the health of unfamiliar "relational structures." One example, she says, is the "pathologizing notion of 'lesbian merger,' which comes out of a lack of awareness that interpersonal boundaries in lesbian relationships are often different than in heterosexuals."
A therapist doesn't automatically know all this information just because they're lesbian, gay, bisexual, or transgendered themselves. It helps, but it's no guarantee. Margo Jacquot, Psy.D., says that, "despite the fact that I have worked in the LGBT communities for 15 years, I am discovering how much we can't assume we know just because we are LGBT ourselves." Jeff Levy, LCSW, agrees that "being a gay male doesn't mean that I am inherently competent in LGBT issues." He says, "My own conceptions of sexual orientation and gender identity have been challenged, and ... I believe I've become a better therapist in the process."
Plans are to begin the 30-week certificate program in the fall. It will expand on the elements that were addressed in the pilot seminars, and cover such topics as historical and anthropological perspectives, identity development across the lifespan, the emergence of affirmative models of clinical practice, racial/ ethnic and cultural differences, relational counseling, parenting, trauma and recovery for LGBT individuals ( including hate violence, domestic violence, sexual assault, childhood sexual abuse, and profound social ostracism ) , HIV, gender issues, finding and using community resources, addictions, variations in sexual behavior, and providing therapy for specialized populations such as LGBT adolescents, seniors, the chronically mentally ill, and individuals with disabilities.
Later steps that the group plans to pursue include the development of a distance-learning version of the program, in-service training sessions for social service agencies, a national advisory board, and a national conference.
Contact the Chicago Center for Family Health at 312-372-4731, or ccfh@uchicago.edu .