Should LGBTQ clients be treated special?
Kurt LaRose MSW LCSW CHT CSW Supervisor & LICSW
LGBTQ populations deal with aspects of life impacted by the heteronormative and heterocentric paradigms. Centrism may be a bigger factor in care than what biology says about being gay, lesbian, bisexual, transgender, questioning or queer. Mental health experts have to treat people, increasingly like medical doctors do – based on science – not bias. Treating via a biased lens CAN harm clients; having bias, knowing what it is, disclosing it when care is potentially affected (positively or negatively) – these matter in all kinds of healthcare. You have to decide who to see and what works best, regardless. LaRose sees eclectic mental healthcare as one way to impact biases and “over-specialization” risks to talk therapy (in a number of professional categories).
Licensing boards are increasingly making mental health licensure dependent upon LGBTQ continuing education (as recently as 2017 and some still do not require this training in 2019). Universities and colleges who train mental health experts (most of them anyway) have been offering courses in LGBTQ curricula; more and more educational programs are requiring LGBTQ coursework. The mental health “experts” are being required to get educated about LGBTQ populations to increase understanding in what is normal sex, normal sexual behavior, what deviations there are that occur outside of hetero-sex, and to bring awareness to professionals who have not otherwise been trained. One day LGBTQ training will be streamlined such that LGBTQ treatment can be as well.
Does that mean that a therapist is fully trained and able to treat the unique factors that are evident in the LGBTQ population? Well, no and yes. Again, this is up to you in who you decide to see, what the mental health training and experiences are, and whether the expert can speak to LGBTQ in a professional way at least, and maybe from a personal vantage point too (if that matters). Some biological science information increasingly may guide improved practice.
Why would specialization and specialty education be needed for LGBTQ paradigms? One reason is that there are still mental health professionals in the United States (in 2019) treating people for sexuality – as if sexuality is an illness, an addiction or some other indicator for mental health disorders. Hyper sexuality can indeed be an indicator of a mental health condition however this can be seen in the context of “hyper sex” not sexuality. The point is, special treatment is not needed, even as training for the experts is needed.
The science related to brain variations in transgender populations suggests there is a biological factor at play for transgender. This can explain how it is that gender is not always evident in the XY chromosome as some trans people attempt to test. Instead brain variations appear to play out in what defines gender. The grey matter is different by gender, the development of genitalia and brains occur at different times in gestation, the hormonal processes are varied and the sizes of the hypothalamus are varied too (more can be viewed here looking at a documentary published by National Geographic). The biology of the brain for LGBTQ folks is like that of S.T.R.A.I.G.H.T people (notice there really is not an acronym of specialty based services for this group of folks). The memory center (hippocampus) of peoples brains and the emotional centers of brains (the amygdala is a player with negative feeling where positive is believed to center in three other areas of the brain) are largely universal. So where gender has a brain based biological distinction to consider, otherwise who you sleep with and what you have in the way of genitalia can be looked at as a factor of being human – not necessarily unique – not gay, lesbian or even trans. Why not trans? If the hypothalamus similarities and the grey matter or white matter variations are the same by male and female aligning with gender identification – then all brains (and gender) are equal! The point is this: brains among people are largely the same in structure and in function. Yes there are variations related to trauma and genetics to be sure – with some variations evident between what is male and female but LGBTQ brains and straight brains operate the same.
Do the minds of people operate the same? Hardly. Brain is the organ, if you will, where mind is about thoughts. Changing brains is not nearly as easy as it is to change a mind!
“Random Thoughts From A Therapist” is a podcast with one episode talking about pride as an evolutionary process from vilification to mainstream. “Pride” can help not only the individual but also the global psyche. A bit of history, a bit of snark, a bit of contemporary psychobabble to bring some perspective to pride.
Brains change? Sure. Neuroplasticity is a thing and improved telomeres is too (humor is believed to cause declining telomeres to grow). Brain change in trauma and in growth occurs where negative and positive MAY progress differently. The HPA axis is altered during extreme trauma, particularly in childhood and post traumatic growth is a thing too as discussed by the co-authors of Option B and The Survivor Personality. How the HPA process improves in recovery is NOT well studied, if at all. DNA and epi-genes make clear that the environment can alter those “jumping genes” (to read more about the jumping genes reference as published by American Scientific give the eclectic and references pages a look here at TalkifUwant). A changed brain IS possible – and often brains are studied in their harm as opposed to brain restoration (my thinking is that there is much more money to be made in broken brains than working ones). Sleep research suggests even more about curative brains! As science continues to discover how it all works however, the processes will give rise to a “normal brain” paradigm in mental health.
I’m not an expert in brains or brain science. That would be a neurologist. Over time I have acquired information about how the brain is changed in negative and positive ways and this has increasingly directed my eclectic work in helping people change. Seeing people tackle how it is that their thinking has been shaped, so as to also change it when that is “needed” – well, this can literally impact the brain and make life so much better! —K. LaRose
Read more here about eclectic mental healthcare ….
And changing minds? Ahh yes, this is easier than changing a brain. What is required to change ones mind is intentional awareness such that what helps and what harms can be first of all viewed by the holder of thoughts. Speaking about your thoughts in a third person can help in creating some distance in viewing your own biases. Changing perspectives is what changing a mind is all about. To know what needs to change and what needs to stay the same is based on beneficence – yours and theirs. If a bias helps keep it, use it, and own it. Owned biases are easier to embrace anyway – especially when they are known to help (that is they create mutual beneficence). Even a harmful bias, once owned, can be realistically worked with – but “owning it first” is needed. President Obama as he was talking about biases in his second term of presidency, I believe during his change of mind announcement about endorsing LGBTQ and marriage equality – indicated that his own biases were something that even he might not want to share and that all of us are affected by them. Biases are beliefs and beliefs are the way you might look at mind. Mind is thought. If a bias (a strongly held thought – usually deemed as “the truth”) hurts you or others, then check for the root belief and see what parts of the thought are false. Parts? Sure. Beliefs are made up of three parts – thoughts, feelings and history. Maybe one part of a truth is discard-able even as some other part is not and here is the emergence of change. Beliefs that have hurting parts have to be tweaked in order for a bias to move to beneficence and in order to remove injury. Making a shift in the thought is a changed mind — and there you have it!
Does a changing mind, change a brain? I postulate – ABSOLUTELY! Are there brain studies to suggest this? Yes, my earlier reference to the jumping genes article is a place to begin. Here I’m looking at LGBTQ treatment, specialization and inherent benefits to looking more closely at how brains work in guiding LGBTQ (and all client) care in mental health, by and for mental healthcare providers. LGBTQ persons have been treated special, long enough. Just because a heterocentric culture, even a mental health helping one, is behind what science and evidence says about LGBTQ, doesn’t make special treatment – the best treatment. One day a treatment center will emerge for the care of prejudice and bigotry and biases – those that harm others – where an ‘onus’ on what needs treatment makes more sense.
Coming out is a thing. The variations in couple interactions, family roles and family composition, kinship networks and community support, the impact of religion and conservative views on mental health practitioners are factors – as well as matters involving the law and equality, issues of safety in general, domestic violence, substance use, suicide rates and what happens in the bedrooms in open and closed relationships plus knowing what life is about in transgender communities, understanding fluidity, pronouns and more indeed matter. Sexual behaviors, sexual language, erotic mapping, age disparities, coming out in your 40’s and 50’s from heterosexuality to a more congruent identity – and on and on the list goes as to what makes LGBTQ treatment “informed” – or not.
Random Thoughts podcast is now airing on RadioPublic! It’s a controversial view about everything I suppose. In my view of things, it gives topics of controversy a bit of alternative perspective asking listeners to consider third options. Random Thoughts is a precursor to an upcoming book approaching stage two of publishing – and it looks at shifting biases, just a bit, sufficient so you and I can find a way to talk! TalkifUwant would of course WANT to do that!
Finding a therapist who can work and speak competently in the areas of mental healthcare will take some time – at least for now. Deciding who to see based upon credentialing and specialty is necessary and for those who are not competent in some area they are likely going to suggest alternative providers. Referrals though, based on not wanting to treat – this would be a non-scientific approach. Doctors do not make referrals because they disagree with a person’s bedroom habits or drinking habits or cursing habits or church habits. They find the problem, match it to the solution – and they treat. A primitive view of the universal brain (variations are noted, just as might be noted in finger prints, DNA and retinas too) is one path to universal applications in all kinds of mental healthcare.
Still, buyer beware (and consumers of mental health, are indeed buyers). My view in saying that LGBTQ folks have been treated special long enough, is not a minimization of what a culture does to impact mental health. Instead it is to say that mental health experts have to get up to speed with brain science, if nothing else, to the degree possible. The burden of mental healthcare should not really be on LGBTQ folks to accommodate the system. The system must accommodate the client. Besides buyer beware – providers are to be aware.
Straight people are not referred to mental health services because they are coming out. Straight people are not being excluded from their families and churches and communities and schools for who they sleep with. Straight people are not being attacked for being who they are – in subtle and aggressive ways. The LGBTQ community is. This, frankly, doesn’t make the LGBTQ person ill; it does suggest that the larger society might be.
Higher suicide rates, higher incidence of substance use disorders, higher incidence of depression, anxiety and trauma, higher unemployment, higher discrimination – these are indicative of a culture that misses a scientific reality. Brains are equal. Treatment should be as well.
Asking if a therapist is LGBTQ friendly is an okay question (and one I recommend). Asking a therapist to talk about what they know in relationship to LGBTQ mental health is okay too (and one I recommend). Having a therapist who can focus on care and symptomology along with and contrasted to environment and biological aspects will be key in overall improved outcomes, at least in my eclectic summary of things.
Moving from specialty care to competent care is what this article suggests.
When I attended the Pride Parade in DC the professionals from Gilead were passing out Healthysexual bracelets. This concept, “healthy sexual” helps move the discussions of “homosexual” and “heterosexual” sex to that of healthy sex. If I knew I would not violate some branding of theirs I would post a pic here of their healthysexual bracelet. Maybe we could all wear one, huh?
When the mental health profession is not up to speed as a majority in treating LGBTQ, it could be that the industry contributes to its abnormalization. Implicit bias affects us all – it is the very nature of “implicit bias.” Again, buyer beware. And too, providers be aware.
Specialization and specialties matter. One day LGBTQ will be treated as people with the same challenges in mental health as all others are treated. Maybe too those folks of harming biases, prejudices and “truths that hurt” (meaning beneficence is absent) can be referred for mental health and behavioral healthcare instead.
NOTE ABOUT SPECIALIZATION: LaRose is not a neuro-biology or brain trained expert. Neuro-experts are all usually doctors of varying kinds (PhD’s, MD’s) where LaRose is a master’s level professional. In fact the formal university training LaRose received did not include neuro-science training, hormonal or genetic training. It is still common in the university systems for disciplines like LaRose (clinical social work at the masters level) to omit neuro/hormonal/hard science coursework for the upcoming treatment providers. The training LaRose does have in these regards is in various post graduate continuing education classes, increased and informed reading of various authors who are experts. Here LaRose attempts to formulate what he has learned about the hard sciences and apply them more succinctly to the softer social sciences – where the merging of them might change the trajectory of mental healthcare. In summary, this “note about specialization” is similar to listening to a commercial about a pharmaceutical: please be aware that the information you are reading is provided by a masters level professional and not by a neurologically trained expert who specializes in neurobiology. For the most accurate information you should consult your neurobiological expert prior to deeming any of this information factually valid. It is provided here for informational purposes only. LaRose, the author of this article, is a clinical social worker who specializes in the expertise of clinical social work where the person in environment perspective largely guides care, and as such LaRose is an eclectic provider.
And just for a bit of fun, to lighten things up a bit and to talk about specialization indeed — here’s a little feed about one of my own specialties – hypnosis: