Category: LGBT

Queer Couch for the Straight Girl

Posted on by Psychotherapy.net Team

The Prescription

I prescribed Gone Girl for my client. Yes, the best-selling psychosexual thriller about a woman who rewrites her life—and perhaps a queer suggestion for a psychotherapist to make. But I am queer, and that is why Amelie chose me.

By queer I mean gay, but I also mean non-normative and unconventional. My approach to therapy is not informed by one school of thought but rather draws from various theories and experiences—as an actor, a writer, and a gay man. Because when we are queer or do not fit in, survival demands that we adapt and often, in the process, become our most awakened, alive, and creative selves.

Amelie’s wish to be those versions of herself may explain her choosing me as a therapist. But she put it to me more simply: as a straight woman she wanted to work with a gay man.

“Much has been written about how working with gay therapists benefits LGBT clients. But little, if anything, has been written about the benefits to straight clients in working with queer therapists.”

The Glass Box

Enter Amelie.

With a graduate degree in journalism, Amelie was a master of writing other people’s stories. Yet she found herself trapped in a story of her own and unable to write her way out. As her classmates landed jobs at major publications, she was still unemployed and struggling to get by. “I graduated from the top program in my field and I can’t get a job," she said. “It’s official. I’m a loser.”

Amelie had always been told who she was. When she was six she wanted to be an actor, but after seeing her in a school play her father chided, “That’s not you. Try something else." At ten, as her parents were divorcing, her mother tearfully told her, “You’re a good listener,” while Amelie kept her own grief to herself. In high school she was surrounded by frenemies who daily reminded her, “You’re the fat one,” though she was always thin. And in college, after repeated criticism of her creative writing, a professor told her, “You should really be a journalist.” The rest was history.

But this his-story wasn’t working out as she imagined—she couldn’t get a job—and it was finally time to try and write her story. Hence Amelie’s decision to start therapy. When we first met, she felt she was not up to the task, powerless and hopeless to author the next phase of her life. And after a few months, I too felt inadequate. When I empathized with her pain, she felt weak. When I emphasized her strengths, she disowned them.

“I can’t be helped,” she said. “It’s like I’m cursed to watch myself forever the way other people watch me, scrutinizing every move. And every move is always wrong. I see it. But I can’t change it.”

“That makes two of us,” I replied. “I see you locked in a glass box without a key. Every attempt I make to free you fails. Which only makes you feel worse, and makes me feel like a lousy therapist.” This made her feel understood for the moment. But what was next for us? We couldn't sit re-reading this hopeless story forever.

The story in which Amelie was trapped was that of a narcissistic father and a self-deprecating mother. Nothing was ever good enough for her father, including her mother (hence the divorce), and Amelie (so it would seem). He would boast about his own achievements but leave no room for Amelie’s. Her mother, on the other hand, would tell her, “It’s too late for me, but you, you can do anything.” While this would momentarily inspire Amelie to dream of success, where her father might finally see her, it also induced the fear of leaving her mother behind—sad, broken, and alone.

How could Amelie ever be good enough for her father without abandoning her mother, the only reliable source of comfort in her life? This was the glass box in which she was trapped. Every move Amelie made, like attending a fancy graduate school, was intended to strike a delicate balance: win her father’s approval, or at least avoid his critical eye, while at the same time not hurting her mother. She felt frozen, like a gymnast on a balance beam, always at risk of falling. Good reviews or accomplishments kept her safely in a spotlight, but only for a moment, and never enough to sustain her. In this hollow, frozen pose she was arguably safe, but ineffectual. Now, out of grad school and without a job, Amelie had finally fallen, at last revealed herself as a fraud, and let her public down.

I needed to shatter the glass box of this hopeless narrative, and to help her use the broken shards to build a new story of her own making. Yet my own feelings of inadequacy as a practitioner crept into the room, as did my fear that she would leave me behind (like her mother). I began comparing myself to better therapists—peers, mentors, renowned experts—asking myself, “What would they do?”

I looked to Freud and Oedipal theories. I would help her resolve the classic fear of destroying her mother so as to win the love of her father. I sat in our sessions, serenely allowing her to project feelings about her father onto me. I hoped that my subtle insinuating interpretations would lead her to a catharsis, the way a successful psychotherapy treatment is “supposed” to go. But it didn’t, because I couldn’t explain anything she didn’t already know. She was keenly aware of the Oedipal inferences in her dilemma, which made her all the more despondent that she couldn’t resolve it. My interpretations only tightened the lock on the glass box and magnified her feeling that she was not enough—even for her therapist.
 
Together we failed to tell the story the way it was “supposed” to go. I began to watch my every move, seeing myself the way I imagined she saw me: caught in the spotlight, wide-eyed, locked in my own box, stuck on my own beam. “I became an empty replica of a therapist, going through the motions, safe but ineffectual. Just like her.”

I did not usually try to play this role of the orthodox expert with my other clients, and I wondered why I was doing it with her. Could it be that her fear of disappointing her father induced similar fears in me? Was I afraid to un-closet myself to her? To reveal myself as a crap therapist, unintelligent, also a fraud?

“I thought of my closeted days in high school, how I would walk the halls watching my every move, hoping to camouflage myself from scrutiny and derision, hoping to pass, to be anything but gay.” I thought of my own days in therapy, and how the Oedipal story never really helped me to understand myself either. How being a boy attracted to boys in a hostile world had made my journey of self-discovery queer, outside of the box, and creative. How I had to write a new story of my own to make room for myself in the world.

Show Your True Colors

And then I realized it. By trying to pass as an “expert” therapist for Amelie—to be her Wizard of Oz—I had denied myself access to queer insights from behind the curtain that could be of use to her. Cut to me running late to work one day. Windblown hair, shirt untucked, coffee spilling—and Amelie watching it all as I approach the elevator bank. “Busted,” I think. Of course I don’t want her catching me backstage, disrupting the character I had tried to play for her: the serene, wise, powerful therapist. “You caught me in Bruce Wayne mode,” I say to her. And she laughs. In our session I share my embarrassment at being caught fumbling. I wonder if this resembles the feelings she has described in her own life.

Amelie seems relieved that I’m human. She says that none of the men in her life—including her boyfriend and her father—understand how much pressure she feels, as a woman, to hide her inadequacies and pain.

In the past I might have said something flat and clinical, like her father, or over-validating, like her mother. But this time I do something queer. I take a page not from a psychotherapy book but from one I read for fun—Gone Girl. I feel a momentary rush of humiliation as I take off my superhero mask and recommend a beach read—and not just to any client, but to one who is extremely well-educated and has read everything. Unsurprisingly, she has not read Gone Girl. But her eyes abruptly brighten, and I start to relax. I’ve made a crack in the glass box. Suddenly there is more possibility in the room.

I describe the character of Amy from the novel. How as a child her therapist parents had written books based on idealized versions of her that she could never live up to. How oppressively scrutinized she feels, and how her sudden disappearance gives her the freedom to write a new life. (Albeit one that involves murder and framing her husband for crimes he didn’t commit.) I suggest that the book asks whether the only way to make a straight man understand a woman is to rewrite his life, against his will.

“She laughs and says, playfully, “This is why I wanted to work with a gay man.””

Amelie wanted to be seen by someone who understood her experience of not fitting in. Someone who existed outside of tradition, who knew personally the need to adapt in an unwelcoming world, and who could help her to reclaim a lost sense of self. She wanted the man behind the curtain all along, not the Wizard of Oz.

I suggested that Amelie write a story about herself. Not a journalistic piece, but something more creative, outside of the box (without killing anyone). And she did. The following week she told me how rewarding it was to transform her pain and hopelessness into art. She radiated with the glow of achievement, and though she did not imagine the story would impress her father or get her a job, it represented something better: her capacity to make use of her own truth.

Ironically, the story was published in a prestigious journal. It was then spotted by the owner of a popular blog, who eventually hired Amelie as a staff writer. Ecstatic as I was for her, and for myself—didn’t this imply that I was, in fact, a wizardly therapist?—I had concerns. I asked her if this too-good-to-be-true outcome might validate her, and me, in all the wrong ways. Launching us back up onto the balance beam, for instance, or down into that suffocating glass box, with that old familiar fear of failing?

But then Amelie shattered my suggested narrative and pieced together one of her own.

 “No,” she said. “The reward in writing that story was in writing it. I discovered how valuable it is to make meaning out of my own experience, no matter what the response. This job symbolizes a new self-narrative for me. I used to think I needed to contort myself to get anything in life—a friend, boyfriend, a job. But now I know that I can be truthful, vulnerable, and creative, and the opportunities available to me as a result will fit much better. I used to chop off my toes to fit into glass slippers. Now my slippers are custom-made.”

This is my version of Amelie's story. After she reads it, I’ll look forward to hearing her own.

Psychotherapy with Transgender and Gender Nonconforming Clients

Posted on by rezendevknowfully.com

The Unbearable Otherness of Being

Imagine making your way in a world where your physical appearance makes others uncomfortable, anxious, confused, or uncertain about themselves. Your very presence may be perceived as a threat to another individual’s sense of self or sexual orientation. Everywhere you go, people stare at you—sometimes discreetly, often blatantly—leaving you very little room to walk unselfconsciously through life. The reactions you experience from others, while the result of ignorance and sometimes mere “curiosity,” do nonetheless harm you, for you are perceived as “Other.” At times, people’s reactions are more hostile, the result of conscious and unconscious fears about what it means to deviate from gender norms, and you may be verbally or physically assaulted just for being you.

This is what it’s like to be a gender nonconforming or transgender individual in today’s world. Though there is increasing awareness and tolerance around gender issues in certain small segments of American culture, the truth is, the level of misunderstanding, ignorance and prejudice that surrounds gender nonconforming people as they go about their lives has created a mental health crisis in our society. To illustrate the epidemic nature of this crisis, here are a few statistics from the American Foundation for Suicide Prevention’s 2014 Report, “Suicide Attempts among Transgender and Gender Non-Conforming Adults.”

In a pool of 6,000 self-identified transgender respondents:

  • 41% had attempted suicide
  • 60% were denied health care and/or refused treatment by their doctors.
  • 57% had been rejected by their families and were not in contact with them.
  • 69% had experienced homelessness.
  • 60-70% had experienced physical or sexual harassment by law enforcement officers.
  • 65% had experienced physical or sexual harassment at work.
  • 78% had experienced physical or sexual harassment in school.

For gender nonconforming individuals, the very nature of their sense of “self” lies in marked conflict to society’s gender identity “ideals” and social scripts. The resulting prejudice (transphobia and homophobia), whether explicit or covert, often manifests in forms of denial, invisibility, harassment, bullying or, in more extreme cases, assault and murder. As if this weren't enough, gender nonconforming and transgender persons may be further marginalized by their ethnic and racial identity, economic status, physical abilities, and age.

More subtle forms of discrimination exist, many occurring within the helping professions, including mental and medical health, nonprofit support services, legal and government institutions and public schools. Overpathologizing, misdiagnosing, maltreatment (including refusal of services), neglect and demonization are just some of the ways transgender individuals are routinely discriminated against within systems whose mission is to support and serve. These discriminatory practices are carried out by providers who fail to become educated and respect, protect, or provide treatment that is appropriate, impartial, and equal to the care given to other clients. Following, I will attempt to provide the nuts and bolts necessary for aspiring clinicians who wish to work in a culturally competent manner with their gender nonconforming and transgender clients.

Gender and Language

I often remind my colleagues, students and clients that we all have a gender identity and diverse manners in which we choose to engage in self-expression. As a cisgender female (i.e., I identify with the gender I was assigned at birth—female), I am conscious of the great extent to which I can embrace the everyday conveniences of being privileged. I am not ostracized for my gendered self, and no one questions my choice in using a public restroom. For gender nonconforming and transgender clients, this problem is known as the “bathroom issue.”

We practitioners need to become fluent and speak the same language as our gender nonconforming and transgender clients. In doing so, we demonstrate the intention of promoting respectful communication that expresses an intricate set of thoughts, ideas, and feelings associated with sex, gender, sexuality and identity. The language used among this diverse community is multifaceted because finding words to articulate complex notions of identity is arduous. In fact, the youth in my office frequently inform me, a gender specialist, how some of the language and concepts I use are now outdated. Nonetheless, staying current with the language being used within the gender nonconforming community is an important part of being not only a culturally competent therapist, but an empathically attuned therapist. Such language literacy also enables mental health professionals to understand concepts, organize thoughts, foster discussion, exchange ideas, and support the community in the least confusing, shameful, and harmful way. Familiarity with the community’s positive expressions of self and identity not only helps clients feel understood, but ensures that therapists don’t rely on clients to educate them—an all-too-familiar experience for cultural minorities.

The following list presents a very general overview of how we come to understand the meaning of sex, gender/gender identity, gender roles, and sexuality for our gender diverse clients and ourselves. It’s important to remember that these terms are constantly evolving within the gender nonconforming, transgender, queer or transsexual communities, as well as by the practitioners who intend to help them. Gender nonconforming and transgender identities include but are not limited to: Transgender (TG), female-to-male (FTM), male-to-female (MTF), transgirl or transboy, girl/woman (natal boy), boy/man (natal girl), they/them, bigender, gender fluid, agender, drag king or queen, gender queer, transqueer, queer, two-spirit, cross-dresser, androgynous. The terms FTM (female-to-male) and MTF (male-to-female) encompass a spectrum or continuum from those who identify as primarily female or male, to those who identify somewhere in the middle or both (e.g., queer). Between these two posts or “extremes” (female and male) lie most gender nonconforming individuals.

The sexual orientation of gender nonconforming and transgender clients is a separate identity and should never be presumed or assumed. It refers to the gender one is typically romantically and sexuality attracted to (e.g., homosexual, heterosexual, bisexual/pansexual, polysexual, asexual etc).

Becoming Gendered

It’s important to think about how we become “gendered.” In part we do this by the way we organize and construct language. Most of the English language is “gendered,” constructed in a way that makes it difficult to deviate from strictly binary conceptions of male and female. We tend to acknowledge and refer to one another through pronouns, and consequently become gendered in our relational experiences. For example, when we frequent our local coffee shop, “Excuse me, Sir…Mam…May I have a large coffee?” Here is a simple example of how we have already ascribed gender to a complete stranger.

As clinicians, we need to learn to ask and address our clients appropriately. More importantly, we need to develop the capacity to become conscious of our own gendered ways. Specifically, we need to ask all our clients about their gender identity and development as well as their gender pronoun preferences. The youth that show up in my office often challenge this binary model most of us are so accustomed to, and request to be referred to as: ze, hir, one, or the plural “they” “their,” “them.” Interestingly, I often find myself arguing with my cisgender colleagues, who get caught up in grammar policing, about the importance of honoring the self-identification of these clients. The English language is constantly evolving, after all, and human and civil rights struggles play an important part in its evolution. At the same time, it’s important to not make any assumptions about people’s identification preferences. Plenty of gender nonconforming or transgender clients prefer to be referenced by conventional pronouns such as “him” or “her” because it feels congruent with their internal identity.

People tend to be preoccupied with gender long before a child is born. “Do you know your baby’s sex?” is a constant question for pregnant parents. Sex, in this case, refers strictly to the external genitalia of the child rather than their potential internal gendered self. “Gender is assigned prenatally and from that moment it determines—and severely limits—acceptable gender expressions and desires.” Our early training begins with our parents’ color selection for our nurseries, the names we are given, and the activities we are encouraged to enjoy, and because we want their love and approval, we emulate what is desired of us. We internalize the societal roles, behaviors and beliefs ascribed to us by the culture around us (including that of our family) and may not know that any other way of being is possible. Boys get blue items, are given toy trucks and guns, and are prompted to be assertive and confident. Girls wear pink, are given dolls to play with, and are encouraged to be empathic and compromising. These behaviors, beliefs and customs are socially constructed—situated in the context of historical time, social class, ethnicity, culture, power, politics, physiology, and psychology—but they are deeply entrenched in our psyches and ways of being.

Clinical Practice

As the presence and experience of transgender people has entered both public consciousness and mental health facilities, clinicians are now beginning to think about transgender/gender issues. However most clinicians are not trained to identify clinical themes prevalent for transgender and gender nonconforming individuals, and consequently misunderstand their mental health and their global treatment needs. Our traditional training fails to address gender and sexuality development for transgender persons from a nonpathological perspective. In addition, negative countertransference from providers and institutions is common and lends itself to discriminatory practices or, worse yet, thoughtless analysis of clients’ needs that may lead to irreversible medical interventions. Common feelings and attitudes for inexperienced clinicians toward these clients may include anxiety, fear, disgust, anger, confusion, morbid curiosity, and rejection, all of which can severely compromise the therapeutic relationship, our ability to help, and an individual’s identity development and transition process.

The journey of self-discovery for gender nonconforming and transgender individuals is laborious and often lonely because, simply put, the desire to become more congruent with their “True-Self” in body and mind may require a shift in physical identity. Children tend to be the most disadvantaged in this phase of life as they may be required to repress their desires to play with “cross” gendered toys and are left feeling ashamed to admit their favorite colors and activities (e.g., the boy who is prohibited from playing with dolls and having a pink bedroom).

As gender nonconforming individuals become more psychologically distressed they often feel the need to have a more congruent experience of their internal and external selves. They may need to first embrace a social transition—choosing an alternative name that reinforces their internal identified gender, dressing in a stereotypical fashion that supports their gender identification and engaging in “cross” gendered behaviors. In my clinical experience, when given the permission and support, gender nonconforming children and adults tend to become less anxious, depressed and gender dysphoric as a result.

However, some gender nonconforming and transgender individuals have a persistent need to modify or transition the physical attributes of their body to the opposite of their ascribed birth gender. This process is often too confusing for most people to comprehend, and is especially difficult because one’s gender expression and behaviors are typically the initial identifying marker for organizing one’s relational experiences among others. The clients with whom I work often desire bodily change not only to feel more congruent with their internal self, but with the hope of being experienced relationally as they truly are. For example, my transgender FTM clients use heavy-duty binders to flatten and contain their breasts so that they will not be mis-recognized as tomboys or lesbians. This experience of congruence tends to reduce gender dysphoric intrapersonal and interpersonal experiences. Our transgender clients need additional support around the use of physical and medical interventions, so it’s all the more important that we be well-educated and sensitive to these issues.

Gender Dysphoria

The new addition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), released in May of 2013, has removed the diagnosis of Gender Identity Disorder and has re-classified Gender Dysphoria as a clinical condition that gender nonconforming, transgender and transsexual clients may experience. Gender dysphoric symptoms arise when one’s self-concept and expressed gender in relation to their ascribed gender is “incongruent.” The psychological distress that results from these internal and external conflicts can lead to dysphoria, depression and a host of other conditions commonly experienced by transgender or gender nonconforming individuals. This turmoil is often created by internalizing the “gaze” of the world around them, i.e., they experience a great deal of psychological discomfort due to being publicly misgendered. Yet, it is also important to note that many gender nonconforming and transgender clients do not experience Gender Dsyphoria. They tend not to make it to our consulting rooms.

What of the clients who do end up in our offices? If a gender nonconforming or a transgender client and his or her family seek our support, are we available to console them, educate and advocate on their behalf, and offer culturally informed and sensitive treatment to the client and the family without getting caught up in our own agendas? How do we determine whether a child is an appropriate candidate for social transition, hormone blockers or even cross-hormone interventions? How do we determine whether the child is an appropriate candidate for genital reassignment surgery, which is often irreversible? How do we think about their fertility options and future family plans? How do we help a transgender child assigned female at birth who is in distress after his first menstrual period? Some of these interventions may seem radical, but if we fail to educate and train ourselves adequately around these issues, we can actively cause harm to our clients. Self-harm (body mutilation), substance abuse, homelessness, suicidal ideation or even suicide attempts can result.

A number of other conditions emerge in gender nonconforming children, particularly when their families aren’t able to provide the support and unconditional love that is necessary for them to thrive. These include adjustment issues, depression and anxiety disorders, trauma, substance dependency, and characterological pathology. Clinicians must be aware that families, too, must be educated about transgender issues, learn skills for coping with the child’s gender change, and be able to mourn and seek social and emotional support for themselves. And, of course, many clients may have co-occurring conditions, such as Autism spectrum disorders, that are beyond the scope of this article.

When treating a client with a gender nonconforming or transgender identity, clinicians may find themselves involved in a few situations unique to these clients. They may be asked to assess and substantiate a client’s preparedness for various biomedical interventions—usually involving the Real-Life Test/ Real Life Experience or a Gender Readiness Assessment—which involves encouraging a gender nonconforming client to begin living in their self-determined gender role and then assessing the impact of that experience. For example, some clients might experience a reduction in gender dysphoric distress, while others—say those whose family or community context is hostile to their nonconformity—may experience an increase in symptoms. Though this assessment is no longer required by the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People published by The World Professional Association for Transgender Health, many medical providers and insurance agencies require it for coverage.

Bridging the Gap

A transgender or gender nonconforming individual’s psyche and the issues they face are very complex—and at times, convoluted—with complications in the psychological, medical, legal, and social realms. Because of this complexity, and the severity of their suffering, it should not be left solely in the hands of clients to educate their clinicians, nor should these clients be put in the vulnerable position of relying on their clinician’s empathy to determine whether they will receive the care they require. An ignorant clinician who responds negatively to such clients—even if only at an unconscious level—can cause untold harm and make it that much more difficult for clients to seek the help they so desperately need. We need to take responsibility for becoming educated and seek guidance from gender specialists—trained providers who can inform clinicians about transgender history and integrate traditional psychoanalytic and psychodynamic perspectives with queer theory.

Diane Ehrensaft, PhD, director of Mental Health at the Child and Adolescent Gender Center in San Francisco, and her colleagues are doing groundbreaking work in this area, bridging the gap between developmental, biological, queer and psychoanalytic theory using what she calls a “Gender Affirmative Model.” She draws upon Winnicott’s ideas of “true gender self” and “false gender self” in formulating her notion of gender creativity to better understand gender nonconforming and transgender children and adults. Turning prevailing wisdom on its head, she argues against labeling gender nonconforming invidividuals as dysphoric and instead views their varied gender expressions as fluid, dynamically intertwined between biology, development, socialization, and cultural context in time. Gender is not binary and may change over lifespan.

Understanding the issues that gender nonconforming clients face creates the possibility of an authentic and empathically attuned treatment that can be a true corrective emotional experience. Having the competence and confidence to administer a Real-Life/Gender Readiness Assessment can make all the difference in our patients’ lives, allowing them to socially transition and integrate their gender identity with other aspects of themselves. Thinking of the client as whole is instrumental to their overall well-being.

Not until we as clinicians grapple with our own gender identity, behaviors, and attitudes can we begin to utilize our assessment skills in developing diagnostic impressions, identify and observe our countertransference feelings, and implement treatment interventions that will lead to a balanced internal and external sense of self that improves a client’s overall quality of life. I encourage all my fellow colleagues to become more cognizant of the their own identities, values, and beliefs, and particularly to confront their fears and prejudices when working with transgender individuals. We must become mindful of what we ask—and do not ask—in our clinical interviews.

We also mustn’t assume that gender nonconforming clients are coming to us because of their gender or sexual identity and be open in creating our hypthotheses about our clients’ needs and desires. Let us accurately reflect the true clinical condition with which our client’s struggle. As I noted at the beginning of this article: imagine making your way in the world where your very sense of being makes others anxious, confused, and uncertain of themselves. By becoming culturally competent, we will be better able to provide an empathic approach to treatment that considers a range of gender nonconforming expressions and behaviors as healthy, as an authentic gender identity and bodily presentation, albeit variant from societal expectations. Gender deviation is not pathological, and if you think it is, you’ve got some work to do. On the other hand, it’s important to not be reflexively “progressive” and mindlessly support a transition that is not first deeply understood clinically.

Reflections on the theory of gender development, diagnostic conditions, and clinical treatment implications must include the role of the clinician as a gatekeeper to another’s self-determined gendered body, heart, and mind. The exploration of the transference-countertransference relationship is paramount, regardless of whether you are a case manager, a medical doctor, or a psychotherapist. Let us play with gender, and in our journey, discover the kaleidoscope of possibilities for clients as well as for ourselves. As providers, it is our social responsibility to change the role of the clinician from a gatekeeper to one who can form a therapeutic relationship that offers a way for clients to integrate their sense of self in relationship to the other that can hopefully be emulated in the outside world. A solid sense of self is likely to build confidence and self-esteem that will foster healthier relationships and diminish uncertainty and fear, decreasing the risk of self-harm and—hopefully—violence toward gender nonconforming and transgendered individuals.

Recommendations for Clinical Practice

  • Ask your clients about their gender identity and preferred pronoun. Explore their internal experience and how it impacts them interpersonally.
  • Foster multiple and integrated identity development: race, ethnicity, gender, class, sexuality, profession etc.
  • Educate parents about the importance of not pathologizing the gender expression of their children.
  • Treatment interventions should include allowing children the space to explore their gender expression, family education and support, as well as parental support to mourn the loss of their fantasies about their birth child's ascribed gender.
  • Collaborate treatment efforts with the providers involved, e.g., social workers, endocrinologist for hormone blockers and hormone treatment, family therapist, and treatment team staff.
  • Remember: Gender nonconformity is a natural expression of human development and experience.
  • Do No Harm: Seek consultation from a gender specialist. Monitor countertransference and refer out if you are not able to act fully in the best interest of your client.

Clinical Resources

  1. Report of the APA Task Force on Gender Identity and Gender Variance.
  2. Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming People, Version 7.
  3. Achieving Optimal Gender Identity Integration For Transgender Female-to-Male Adult Patients: An Unconventional Psychoanalytic Guide For Treatment (2008), Karisa Barrow.
  4. Gender Born, Gender Made: Raising Healthy Gender-nonconforming Children (2011), Diane Ehrensaft.
  5. The Transgender Child: A Handbook for Families and Professionals (2008), Stephanie Brill & Rachel Pepper.

Deconstructing Gender: Self-Exploration Exercise

  • What is your own gender identity?
  • How old were you when realized you were a “girl” or a “boy?”
  • Who and what made this clear to you?
  • Did you agree with your parents clothing choices for you as a child?
  • What activities did/do you enjoy?
  • Have you expressed your own gender identity differently over the course of your life?
  • How do you feel about your body? Your genitalia?
  • What messages have you received about your gender and from whom (e.g. parents, media, religion etc.)? Were you “policed” by others around your identity, gender roles and social practices or body?
  • How has your gender shaped your beliefs, social engagements and practices?
  • What have you been allowed/encouraged to do because of your gender identity and what limitations have you faced (e.g. social sanctions/promotions)?

Don Clark on Psychotherapy with Gay Clients

Posted on by rezendevknowfully.com
Ruth Wetherford: Don, thank you for letting me interview you today for Psychotherapy.net. I’m so pleased.
Don Clark: Well, I am delighted to be your interviewee.
RW: Thank you. Let's start with a brief introduction for those who don't know you, or who have not read Loving Someone Gay, You say on your website that this book is so associated with you it's practically part of your name.
DC: Yes.
RW: What would be a general outline that would orient people to your work?
DC: That would be the book Someone Gay: Memoirs that I wrote, which is about 350 pages long. But I assume what you want is a thumbnail sketch of what my life as a therapist has been like?
RW: Yes, but first give us an introduction from before you became a therapist. You describe in Memoirs being born in 1930, during the Great Depression, which influenced you strongly, because though you grew up in New Jersey in relative poverty, you still had opportunities that gave you your strong desire for education and your love of learning, which has guided you all your life.
DC: It wasn't relative poverty. It was poverty. As in, we moved frequently because we couldn't pay the rent. And my parents really were basically illiterate. My father could not read or write. My mother was able to do some reading and she was the writer. My father's writing was limited to signing his name to things, which he did very meticulously. But there were fortuitous events. Perhaps everyone has them, I don't know. Like when I was in the eighth grade, I hated school, because of course being socially at the bottom of the totem pole you get picked on by other kids. Recess was a nightmare.

But in the eighth grade, bless her heart, my teacher must have seen something, and pulled me from the back row up to the front row of the class, and started smiling at me. And I don't remember a teacher ever having done that before. So I started paying attention to her. And her passion seemed to be diagramming sentences in English. Instantly I became the best diagrammer of sentences in the class. Since that had to do with words, which I had been playing with all by myself unbeknownst to other people-trying to decipher Shakespeare, for instance, which I had decided was a secret code like the ones being used by the Allies and the Nazis. I was already enamored with words, and I had already tried writing poetry, but all of this was unknown to any teacher. So we were in this together, now, the teacher and I. We were doing words. And I became her darling and she became my darling, and when it came time to do the eighth-grade yearbook, she appointed me chairman of the committee. I ended up writing the whole yearbook, and I did it in poetry!
RW: That illustrates the power that an individual can have in a child’s life.
DC: Oh, god, teachers, absolutely.
That one teacher in eighth grade saved my life, I'm sure. I would have been working in a factory like my siblings.
That one teacher in eighth grade saved my life, I'm sure. I would have been working in a factory like my siblings.
RW: How did you come into psychology?
DC: Well, I always had to work, of course. Money was always needed in the family. And so one of the jobs I took when I was in high school was an usher in the fanciest movie theater in town. In the beginning I was only allowed to work days, but when I became sixteen I was able to work evenings. And I remember one of the first evening programs I saw was Spellbound with Gregory Peck and Ingrid Bergman. Of course, I fell in love with both of them immediately. I fell in love with a lot of movie stars during that period, male and female. And the males were silent; the females I could talk about. And I wanted to be just like her. She was a psychologist, interestingly. She was acting as a psychoanalyst in the film, but she was called a psychologist. So, duly noted, I thought I would be a psychologist, so that I can save young handsome men like Gregory Peck who have had these awful things happen to them that they can't remember, but I'll help them remember and they will be cured.

So when I got to college, at Antioch in Yellow Springs, Ohio, I started out as a business major, then I became an art major. Then, I took a couple of hospital jobs in the Antioch work-study program. The first one was hideous. The second one was wonderful, at Chestnut Lodge, which was the mental hospital in Maryland that Harry Stack Sullivan had been the control analyst in when he did his writing, and he was followed by Frieda Fromm-Reichmann, who was still there at the time. I had a chance encounter with one patient who had been mute for years. I was nineteen or twenty years old at the time. For whatever reasons, I think she fell in love with me, and I was able to get her to talk and to move and to ambulate, to the point where I was able to take her on a train trip to visit her mother in New York City, which everyone considered to be a total miracle. Frieda Fromm-Reichmann offered me an analysis at fifteen dollars an hour, which of course I could ill afford, but I understood it was a bargain, if I would stay and work with this patient, which I was delighted to do. By the way, Morrie Schwartz–the sociologist at Harvard, who became known for Tuesdays with Morrie– got fascinated by it and he recorded a meeting with me every week a about this. Everybody was trying to figure out why it was working, how this was happening. Now I know why it was working, but then I didn't.
RW: Why do you think it was working?
DC: I really cared about what she had to say, and I cared about her. She had not had that before. Even in her analysis there, her presumed analysis, which was a joke since she was totally mute, no one was giving her any warmth. So the first time we met was when she raised herself up off the floor and threw herself at me, literally, and I caught her in mid-air. Her legs were wrapped around my waist, her arms were wrapped around my neck, she was grunting and salivating, and she was kind of a mess. But I said, like a well-trained twenty-year-old on the staff, I said, “Mary, I think you’re trying to tell me something.”
RW: But you did it with kindness.
DC: I cared about her, and I came back at night on my own time when I was off duty to sit with her and draw little boxes and ask her questions and say, “If the answer to this is yes, just put a mark here. If it’s no, put a mark there.” I’m laughing and almost on the verge of tears, because it sort of reminds me of Ann Sullivan with Helen Keller. No one had taken the trouble to do this with her. And I wouldn’t have either, had it not been that she had thrown herself at me.
RW: Right.
DC: I guess that makes me a sucker for people who throw themselves at me.

The Importance of Empathy

RW: You’re talking about the role of empathy.
DC: Yes.
RW: As a key ingredient in what makes psychotherapy work.
DC: Empathy and warmth. Showing that you really care.
RW: Showing it. And feeling it.
DC: Yes.
RW: How long have you been a psychologist? Half a century? When would you say empathy emerged as something that psychologists talk about as a key ingredient?
DC: God, I don’t know. I mean, in a way, in the writings of Harry Stack Sullivan you see some of it because, as far as I know, he was the first person saying, “Look, there are two people in the room. And it’s not just this cold analytic idea about the patient, and you sit behind the patient with a pad and paper and write things down. There are two of you there. There’s an interaction going on between the two of you. Pay attention to it. Pay attention to what you’re feeling, pay attention to what the patient is feeling, and to what the interaction is between you. Be real.”
RW: Right, like Carl Rogers.
DC: Yes! Carl Rogers, absolutely.
RW: Who else has influenced your work?
DC: Well, in terms of the analytic school, that was it,Stack Sullivan, Frieda Fromm-Reichmann. Gosh, Carl Rogers played a big part. I was already very interested in what he was doing while I was an undergraduate student. I remember going to the library, I think he had one book published so far, and everybody was making fun of him…
RW: Do you want to say anything about your mixed feelings about Fritz Perls?
DC: Oh, I spent some time at Esalen in its heyday in the early '70s, when I was on a Carnegie grant mission studying the new human potential movement. I really paid attention to what the Esalen staff were doing. I was permitted into the royal presence of Fritz Perls, who was the reigning diva there at the time. And of all the people I studied on my Carnegie sabbatical from university teaching, he put more fear into me about what was being done with all these new things than anybody else. I named in my report Marion Saltman, who was a woman who did play therapy with adults on a houseboat in Sausalito, as the person guaranteed to do no harm, and often did a lot of good. I named Fritz Perls as the person who was most likely to do harm while sometimes doing a lot of good. He was very good at what he did and very smug.
He was like a surgeon who went into the operating room, did everything exactly right, laid the guts out on the table, and then smiled at the young residents and said, "Okay, you take over now," and pulled off his scrubs and left.
He was like a surgeon who went into the operating room, did everything exactly right, laid the guts out on the table, and then smiled at the young residents and said, "Okay, you take over now," and pulled off his scrubs and left. And I witnessed one, and know about another one, where following his dramatic interventions, the people went into psychotic episodes. Now, I'm sure he rationalized that as saying, "Well, that was what they needed to do." One of them was the wife of a colleague in the university where I taught. I don't think that's what she needed to do. And it brought a lot of grief into that family for both of them. So, I have mixed feelings about his diva behavior.
RW: Well, it sounds like it wasn’t compatible with the importance of empathy.
DC: Right.

Early Struggles for Gay Rights

RW: Going back to the work you're best known for, Loving Someone Gay, you talk a lot about the importance for gays of being visible and resisting discrimination in any interaction that you have energy to deal with. If you hear a slur, if there's legislation, if there's something in writing, etc. I believe this is important for a gay person to become able to do. This is something you did in your efforts toward depathologizing homosexuality within professional psychology. What were some of your activities toward that?
DC: Oh, boy. Well, the roots of this are back at Antioch when I was an undergraduate there, because it was, and apparently is going to be again, a very social activist school. I think within the first weeks that I was there as a naive eighteen-year-old freshman from New Jersey, we were picketing the barbershop in downtown Yellow Springs, Ohio, population 2,000, because the one barber in town would not cut black people's hair, saying he did not know how, because they have different hair. Well, that was just a small example. Actively advocating for disempowered people permeated the school, and during the time that I was there, people took it really, really seriously. So, going back to Mary, the woman at Chestnut Lodge, perhaps I wouldn't have been smart enough to do what I did.
RW: If you hadn’t had the Antioch experience.
DC: If I had not already been immersed in that very well.
RW: So you were primed for this struggle. Because Stonewall* was in the summer of ’69.
DC: June '69. But I was already rolling before that.

Coming Out as a Gay Psychologist

RW: Yes. So how did you address professional psychology about this?
DC: Oh, god. I think I started writing letters to the editor. I know I wrote a letter to the editor of Time magazine, when they did a big expose about gay people, and my father-in-law at the time was devoted to Time magazine. And I was beginning to get it, that if I said, "Hey, I'm the expert in this field because I am gay," that's where I was going, that's what was beginning to happen, other therapists backed off. They had no credentials. But Time magazine, lo and behold they printed my letter as the lead letter two issues later. My father-in-law called my wife and said, "Hey, Don's letter is the lead letter in Time magazine this week. I don't know what he's talking about, but isn't that great?" And I wrote letters to the APA (American Psychological Association) too. I was beginning to get in touch with other gay therapists, mostly not out yet, but it was happening. The groundswell was beginning to happen, when I moved back to California, in January, 1971.
RW: Being gay was still officially a mental illness.
DC: Oh, absolutely. Absolutely. And I could lose my license. I had a license in California, one in New York, and I could lose them in both places for “moral turpitude.”
RW: If you were homosexual…
DC: Guaranteed, if you’re homosexual, because the law describes homosexuality as criminal, the church describes it as sinful, and psychology describes it as a mental illness, you’re going to be tossed out because it’s moral turpitude.
RW: Well, when I was taking abnormal psychology in graduate school in 1971, it was still in the DSM-II as a mental illness, right between alcoholism and personality disorder. How did it get taken out of the DSM, and what was your role in that?
DC: I think the first public appearance about it, per se, was here in San Francisco at a Western States Psychology conference, and I was the new kid in town, but the word got around fast, I had come out, and I had left the university and come to San Francisco specifically because I had decided to start a full-time private practice devoted to gay people.
RW: Were you the first in San Francisco?
DC: Absolutely. Or anywhere.
I was the first one to say, "I'm gay. I'm devoting my practice to helping gay people, their families, and their friends in any way I can."
I was the first one to say, "I'm gay. I'm devoting my practice to helping gay people, their families, and their friends in any way I can."
RW: You were full of moral turpitude.
DC: I certainly was. So at the Western States meeting, there were four of us presenting on a panel on homosexuality, organized by John Neumeyer. I think all of us were gay, but I was the only one that was going to say it. I didn’t know I was going to say it actually, until I got up, and as I stood in front of the microphone, before I had said anything, I looked at the audience, and what I saw was a big room, packed with about 250 people who were very interested in what homosexual people might be like.
RW: Wow, big room.
DC: Well attended. Very well attended. I stood there, I looked, and I just opened my mouth and said what I was thinking and feeling, which is, "You know, as I look out at you people, I'm sorry to tell you, I think I see the same smug faces that I've gotten used to seeing at psychological meetings. People who either think they know all about homosexuality and have decided that it really is sick, or people who are in some way or another just beyond this. You don't even have to think about it. You can just come and be amused. Well, okay. Here's what I want you to do, for your amusement and mine. I would like every man in the audience to reach out with his right hand and put it in the crotch of the man seated nearest you."

At which point there was a standing ovation, and I think John Neumeyer nudged over close to me and said, "There are no laps out there now." But that did a lot for me. I realized if I could stand up there and call them out on their prejudice and their smugness, all I had to do was talk about what I was thinking and feeling, and people were going to listen. And they did. So from there on, I kept using my slightly false pretense in saying, "Hey, I'm the expert on this. I know about it. I'm gay." And what are you going to say to that? If a black person says, "Hey, I know about being black. I'm black," and you're white, what are you going to say?
RW: Was there any backlash against you?
DC: Yes. But I didn’t care and it truly didn’t matter. Everybody said, the friends that I interned with out here, said, “Oh my god, you’re committing professional suicide. Never mind losing your license, you’re never going to be able to have a full-time private practice. You’re going to be persona non grata.” Au contraire. I had started a little practice in Menlo Park and one here in the city, seeing which would work better. Both of them were filled immediately.
RW: Beautiful.
DC: No problem getting customers. Both of them were filled, and filled with gay people who wanted to talk to someone who would understand what they were talking about.
RW: And who would not think it was a diagnosable mental illness.
DC: Absolutely.
RW: How did it stop being that?
DC: Well, you see, as soon as a few psychologists started to be visible and probably gay, and then visible and gay, and then some more thought it might be safe to put a toe out of the closet… as soon as we started to be visible, gay psychologists’ organizations formed. All the liberation movements were happening at one time. And the time was right. People could smell it. It was going to be okay.
RW: The paradigm was changing.
DC: Yes. During that time, I joined a committee that was working with the San Francisco mental health association, or the county mental health association I think, working on this problem, trying to figure out if homosexuality might possibly be considered not a mental illness. It was amazing. From this committee, Sally Gearhart, Rick Stokes and I became the feared trio on the speaking circuit, because Sally knew the bible inside out and she would come wearing a dress or a suit and stockings and high heels. Rick was a lawyer, knew the law inside out, and he had been hospitalized for this mental illness by his parents as a youngster, and I think given shock treatment, as I recall. I was the psychologist, I was out. So all three of us were out: law, religion, psychology.
RW: It must have been around that time that the APA made the change.
DC: You know, it was actually the American Psychiatric Association.
RW: They were first.
DC: Well, because they move faster. They were just working on it at the same time. And there was actually only a thirteen-month difference between the two associations. But it looks like there’s a longer time-span because the American Psychiatric Association did it in December of 1973, and then not a month later but the following January of 1975, the American Psychological Association did it. The American Psychological Association’s change was much, much more comprehensive. The ones that lagged far behind, of course, no surprise to anybody, were the psychoanalytic people who didn’t come out for another five years, I think. But wanted to make sure they wouldn’t get shot. So then the book.
RW: Then the book. This all led up to Loving Someone Gay.
DC: I wrote it in ’75. At first, nobody would touch it with a ten-foot pole.
I got a scolding letter from the Editor in Chief of Basic Books, saying, “Doesn’t this man, he calls himself a psychologist, and doesn’t he understand these people are sick and they need help? And this is not going to help them, it’s going to help them deny their sickness.”
I got a scolding letter from the Editor in Chief of Basic Books, saying, “Doesn’t this man, he calls himself a psychologist, and doesn’t he understand these people are sick and they need help? And this is not going to help them, it’s going to help them deny their sickness.” Finally, after a year of many refusals, when Celestial Arts agreed to publish it, they sold out the initial five thousand copies before the publication date, which was January of ’77. We were really happy. But soon it collided with Anita Bryant**, so I was suddenly wanted on television and radio all over the country. Being basically an introvert, I hated the idea. But I knew… where would this kind of publicity ever come from again? So I did that. I spent about a year doing that.
RW: How many copies did the book sell?
DC: Beyond count, I mean, truly there were many printings, many different editions, in many languages. It was in two different kinds of paperbacks, mass-market editions, which was where the count got lost because nobody could figure out how many copies Bantam or New American Libraries sold. But that was why I was getting fan mail from people all over the country. Also hate mail. The ones that moved me the most were exactly, exactly the ones I wanted-the kids who had been able to sneak into a little drugstore in Podunk nowhere and get a paperback copy of this. And they suddenly knew there was another gay person somewhere out there in the world, saying, “It’s okay, it’s okay.” Now I get emails from all over the world.

Doing Psychotherapy with Gay Clients

RW: So, Don, turning now to the issue of therapy with gays, what are some of your thoughts about how psychotherapy with gay people, men and women, is different from and similar to therapy with straights?
DC: Well, we have to get into the psychodynamics of what does it mean to be gay. And, not in the interest of selling more copies of Loving Someone Gay, I really would encourage those who are interested to pick up the 5th Edition, the new one, and read it, because I can only give a few words here. The main special dynamic for a therapist to understand is that a gay person goes through a different maturational process than a straight person does. We actually go through two at the same time. We get matured through the steps as if we were straight people, and also as gay people.

The different dynamics in development of the gay childhood, young person, adolescent, and so on, is that even today, let there be no mistake, most gay people are growing up invisible. They are having to learn how to become adult as straight people do. They're also having to learn at the same time what to do with being invisible, with having nobody know who they really are, with being terrified of what would happen if they were known. Black people grow up in black families, usually. Jewish people grow up in Jewish families. Gay people do not grow up in gay families. The vast majority of the time, they do not have any support around who they are.
There is nothing comparable in the human experience. It is as if the gay child is the result of having an egg from outer space planted in the uterus of the mother
There is nothing comparable in the human experience. It is as if the gay child is the result of having an egg from outer space planted in the uterus of the mother, and then appears looking just like the people who live on this planet, and grows up, develops, but all that time something different is happening inside this person; and he or she understands early not to let it show, or not to let it show enough that he or she will get into trouble because of it. And trouble, is indeed, what awaits most of them. So, you live two lives. You hide the life of your true self.
RW: As an alien.
DC: An alien, who has these strange and different feelings about other people of the same gender, which you dare not reveal; and you learn to live as if you were having all the same feelings that your parents, and the preachers, and the teachers, and the police, etc., are having.
RW: So you’re saying that when a person discovers that they are defined by the majority as being in some way deficient or sinful or ill or illegal, that that creates a secret part of themselves, that they can’t gain approval of, and so they have to hide that. And that split between what they hold inside and what they express is part of the development that therapists must understand.
DC: And that the therapist needs to go back with them and visit through every level, every age level, every stage of that development. How has it affected them as they grew up? If they knew when they were five years old, what was like that? If they still knew when they were fifteen and were maybe even experimenting with having sex and nobody knew, what was that doing to them? How did they feel? What did that tell them about themselves? Because it affects people differently.
RW: You don’t want therapists to stereotype gays.
DC: And you always have to be on their side. It doesn’t matter how it looks to you. It matters how it looks to them. The biggest mistake is for therapists to think or say: “I’ve been studying this for years, I know what you’re thinking. I know what you’re feeling.” No, you don’t.
RW: What do you see as some of the implications of this for therapists?
DC: Well, there are a few things I put into Loving Someone Gay, aimed at everybody who wants to help gay people:
  • Number one: The gay person probably has learned to feel different. Keep that in mind.
  • Two: A gay person may have learned to distrust her or his feelings. Very important for a therapist.
  • Three: A gay person may have a higher degree of self-consciousness.
  • Four: A gay person may have decreased awareness of feelings, such as anger generated in response to a punitive environment.
  • Five: A gay person, often invisible, as such to others, is assaulted frequently with attacks on character and ability.
  • Six: A gay person is more likely to fall victim to depression.
  • Seven: A gay person may be tempted to dull the pain that surfaces, by making use and misuse of alcohol and other drugs.
  • Eight: A gay person who is respected and loved, but who is hiding his or her true gay identity and facing what she or he believes would be a ruined life, if the truth were to be discovered, is at a high risk for a fatal accident, or a seemingly inexplicable suicide.
  • And, nine: A gay person usually has lived in two worlds simultaneously.
This is why
I believe it usually is much better for gays to see a gay therapist than a straight therapist, and the therapist must never, ever hold back on revealing that they're gay.
I believe it usually is much better for gays to see a gay therapist than a straight therapist, and the therapist must never, ever hold back on revealing that they're gay. Otherwise they're acting like they're ashamed of it. They have to be able to be supportive, and the first thing that I tell young trainees is you always say something positive and affirmative when the person says anything about sexual desires, sexual fantasies, sexual whatever. If it's homosexual, you're there. You're on it, you're with it, you smile, you sit forward in your chair-
RW: Say more about why you believe gays and lesbians are better off seeing a gay or lesbian therapist.
DC: If a gay person walks into your office with a seemingly small or large problem, you may make the mistake or thinking that you can deal with it just as you would for any other person. Well, that's not true. Maybe if they just want advice on whether they should contact a lawyer because they're getting a divorce, yeah, you can deal with that just as you would with a straight person. However, if you're talking about psychodynamic issues, from day one, everything is different. They are very eagerly watching you to see if you might have any idea of what their life is like. And chances are, unless you have been through it yourself, unless you, too, were born gay and had some decent therapy yourself, so that you could explore your own internalized homophobia, which comes with the course for gay people and for not gay people.

We all have internalized homophobia because we live in a homophobic culture, which is not that unusual. Most cultures on this planet are homophobic, which is a term that was created by George Weinberg, who was a statistically oriented psychologist in New York City. He hit on exactly the right word. If you're phobic about snakes or spiders–two familiar phobias that people have–it doesn't necessarily ruin your life, but you certainly don't want to go near them, and anything that hints of them is going to make you a little uncomfortable, to the extent that for many people, with snakes for instance, seeing a picture of a snake in a book makes them consciously and/or unconsciously uncomfortable. It's just, "I'm not sure I want to go there."

Okay, so now you have a homosexually inclined client in your office, and you, as far as you know, have never had any of those feelings yourself. Or maybe you did and well, you took care of it. You're all grown up now. You've had your therapy. What are you going to do? You know, how are you going to let this person know that you really understand what he or she is feeling? My opinion, I don't think you can, unless you've been down that road yourself. And even then, unless you've had some expert help from other people like you, who have been down that road before you, who can help you to see that it really is okay to be you.
Whatever the presenting problem is, you don't go anywhere with your client unless you have that magic thing called rapport.
Whatever the presenting problem is, you don't go anywhere with your client unless you have that magic thing called rapport. And you're not going to have that rapport unless you can illustrate that you have genuine, genuine empathy. And you can't have genuine empathy if you don't know anything about the world this person came from.
RW: Well, you know there is such a big range, from low to high, of empathy or experience with gay people, within a distribution of therapists, as well as a range of how much a therapist has examined his/her own homophobia, so, it is confusing to me for you to say that you feel like gay people should only see gay therapists. Is that what you mean?
DC: Well, if I had my druthers, that would be true. I don’t think it’s possible, of course, because there are not enough gay therapists to see all the gay people who need to be helped. There is another solution. I don’t think we’re anywhere near doing it yet, but if therapists who are not themselves gay, and have not confronted their own internalized homophobia, were willing to become really, really, really familiar with the experience; to immerse themselves in it. A one-day, continuing ed course, or lots of reading about it doesn’t quite do it. It doesn’t give you the feel of what it’s like to be such a person.
RW: That is true. The subjective experiences are much more enriching to one’s understanding.
DC: So, if you’re a therapist who is not gay oriented, not gay yourself, and you want to really familiarize yourself with what it’s like to be in this world, to be one of these people, go where they go. Do what they do. Have lots of them as friends. Have lots of them in your home. Have your children be familiar with them. You know, if you’re not that comfortable, you’re not there.
RW: Well, I agree with that. But doesn’t it seem like there are other things that are very alienating besides just the fact of being gay, and having that be a secret. There are so many things about the self that are denied, cause a lot of shame, and cannot be accepted in different social circles, families, communities, cultures. And that the effective therapist knows that it’s this individual person’s experience of their situation that is important to learn, and to be open to it. And to ask the questions empathically. Isn’t that your point? Do you think it’s possible for a straight therapist to be sensitive to a gay client?
DC: I think it’s possible if you are willing to learn. That when that person sits down in your office, someone is sitting there that you have to assume you don’t understand.
RW: Like what you were saying earlier about Carl Rogers, that got him laughed at.
DC: Yeah.
RW: What advice would you have for straight therapists that you already haven’t mentioned, in working with gay clients?
DC:
Get out into the community. Get to know gay people. Get to appreciate what is better about the life they are living than the one you are living.
Get out into the community. Get to know gay people. Get to appreciate what is better about the life they are living than the one you are living. Be honest. Find out something you’re envious about. If you can’t find envy in another world, you’re not open to that world. So, maybe that’s enough about that. Get out, read about it. You know, meet people, go. Eleanor Roosevelt used to immerse herself in black culture. She didn’t sit home and read a book about it, she got out there and did it.
RW: Don, you quote Horace Mann as having a philosophy that influenced you. What was the quote?
DC: The quote, which is on the one monument that exists on Antioch’s Yellow Springs campus, is Horace Mann famously saying, “Be ashamed to die until you have won some victory for humanity.”
RW: Would you say you have fulfilled that challenge, and what is that victory?
DC: Well, I’ve tried. And I think I have. Probably through the book, since it has reached so many people and obviously done a lot of good, or they wouldn’t be writing me and telling me that. It’s certainly more of a contribution than I ever thought I was capable of making. And I’m still stunned that it happened, that I was blessed with being able to do this.
RW: Yes. Well, thank you so much for spending this time with me.
DC: Any time.