Dr. Hannah Roberts

Dr. Hannah Roberts · April 4, 2024 ·

Accessing Therapy Beyond Crisis Situations

“When we are no longer able to change a situation,

we are challenged to change ourselves.”

~Viktor E. Frankl

by Gavin Hannegan, Cal Poly, San Luis Obispo undergraduate intern, supervised by Dr. Hannah Roberts

There’s a misconception that therapy should be complete once you start “feeling better.” It’s important to recognize your progress, but there shouldn’t be a deadline to feel your best. Mental health is complex, and oftentimes, your progress doesn’t follow a linear fashion. One week, you might feel stable and secure, and then the next week, you might feel like you fell a few steps back. Don’t worry, these ups and downs are perfectly normal. But what if you’ve been “feeling better” for months, or even years? Or, what if you’ve never had a mental health crisis? Therapy can still be a valuable resource! No matter your background or previous experiences, you are deserving of this kind of care.

Here are 3 reasons for considering therapy beyond the context of a crisis:

#1: The Brain Doesn’t Function Properly While Under Distress

Chronic stress can make your body feel like it is in a never-ending fight-or-flight state. This is because of how chronic stress delays two important parts of the brain: the prefrontal cortex and the neurotransmitter GABA. The prefrontal cortex is responsible for processes such as cognitive planning and self-regulation, while GABA produces a calming effect meant to counteract stress. Because of these delays, traumas or other ongoing adversities can impair daily functioning. For example, those who experience such stressors have significant declines in working memory, a component of short-term memory that allows you to actively process information. As we age, our working memory skills decrease naturally, but chronic stress accelerates this process (Gandy et al., 2024). COVID-19 has contributed to global increases in chronic stress, which has subsequently produced similar accelerated aging effects in adolescents (Gotlib et al., 2022). Our bodies are not equipped to handle such extreme amounts of stress in small amounts of time, which can increase the risk of cognitive and health-related deficits.

Therapy can help us navigate these stressors by providing coping strategies. However, deficits in working memory impair the learning of these strategies, and delays in the prefrontal cortex and the firing of GABA impair the proper use of these strategies. This is not to say that therapy wouldn’t be helpful to someone actively experiencing a crisis. Rather, you don’t need a crisis to justify therapy. In fact, you might be more receptive to these strategies if they are learned before a crisis emerges.

#2: Therapy Can Be a Protective Measure Against Future Mental Health Crises

It’s never too early to consider therapy. We may not be able to predict when we will encounter another crisis, but we can take action to better prepare ourselves for one. This doesn’t mean that you need to be in therapy for the rest of your life. But attending therapy even when you feel stable can help you maintain that stability over time. One way that therapy operates as a maintenance tool is by teaching skills such as mindfulness, which can help reduce symptoms of anxiety and depression (Eilert et al., 2021). Your therapist can work with you to develop mindfulness strategies that fit best for you. These can include daily affirmations, breathing exercises, or meditations. Additionally, compared to brief forms of therapy (~6 months), long-term therapy, which we often prefer at Thrive SLO (~3 years), is slightly more effective in reducing depressive symptoms and improving daily functioning (Knekt et al., 2016). For some individuals, short-term therapy may not be enough time to implement maintenance strategies and measure their effects, especially for those who are only focused on overcoming a chronic stressor. There isn’t necessarily an ideal length of therapy; it depends on the goals that you set with your therapist. You might have multiple short-term goals (e.g., wanting to be social at an upcoming party) or one overarching goal (e.g., adjusting to daily life after an unexpected loss). Each step you take towards reaching these goals can have a strong positive impact on your well-being, and the lessons you learn can be applied to new goals or concerns.

#3: Long-term Therapy Gives You More Time to Build an Alliance With Your Therapist

Another valuable aspect of therapy is that you have someone to talk to who knows you well. Someone who is unbiased, who recognizes your potential, and who encourages your personal growth. In one meta-analysis that reviewed over 30,000 therapy clients, the relationships those clients had with their therapists were consistently associated with positive outcomes such as symptom reduction (Flückiger et al., 2018). Your therapist can be a consistent form of support. Even having one such person in your life can make a difference.

As with many other kinds of relationships, though, it can take some time for you and your therapist to form a close bond. You may be hesitant to be vulnerable to a new person in your life, while your therapist has to adapt to your level of comfort with certain topics or situations. If you’re experiencing a crisis, then your typical responses to these topics may be exaggerated or distorted. You could be more on edge, less willing to disclose personal information, or you could be more likely to think irrationally. As a result, there could be misinterpretations between the two of you that can threaten the therapeutic alliance. By spending more time with your therapist, they will have more opportunities to learn about who you are outside the context of a crisis situation. Remember that crises are temporary, and the skills you develop with your therapist can help protect you not just against the crisis you’re currently facing, but also against many other future challenges. There is no concern too small for therapy.

Have more questions or feel like you need supportive therapy? Schedule a session with one of our therapists today! You can schedule online here!

We hope you enjoyed this blog post! Have more topics you’d like us to blog about? Contact us and we’ll be sure to include your topic in a future post!

References

Eilert, N., Wogan, R., Adegoke, A., Earley, C., Duffy, D., Enrique, A., Palacios, J., Timulak, L., & Richards, D. (2023). The relationship between posttherapeutic cognitive behavior therapy skills usage and follow-up outcomes of internet-delivered cognitive behavior therapy. Journal of Clinical Psychology, 79(1), 55-67. https://doi.org/10.1002/jclp.23403

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316-340. https://doi.org/10.1037/pst0000172

Gandy, H. M., Holis, F., Hernandez, C. M., & McQuail, J. (2024). Aging or chronic stress impairs working memory and modules GABA and glutamate gene expression in prelimbic cortex. Frontiers in Aging Neuroscience, 15. https://doi.org/10.3389/fnagi.2023.1306496

Gotlib, I. H., Miller, J. G., Borchers, L. R., Coury, S. M., Costello, L. A., Garcia, J. M., & Ho, T. C. (2023). Effects of the COVID-19 pandemic on mental health and brain maturation in adolescents: Implications for analyzing longitudinal data. Biological Psychiatry Global Open Science, 3(4), 912-918. https://doi.org/10.1016/j.bpsgos.2022.11.002

Knekt, P., Virtala, E., Härkänen, T., Vaarama, M., Lehtonen, J., & Lindfors, O. (2016). The outcome of short- and long-term psychotherapy 10 years after start of treatment. Psychological Medicine, 46(6), 1175-1188. https://doi.org/10.1017/S0033291715002718

Dr. Hannah Roberts · March 28, 2024 ·

Why Therapy Is Important for College Students

“Anything that’s human is mentionable, and anything that is mentionable can be more manageable.

When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary.”

~Fred Rogers

by Gavin Hannegan, Cal Poly, San Luis Obispo undergraduate intern, supervised by Dr. Hannah Roberts

College life is exhilarating! You’re able to explore your passions and fine-tune what you want your career to look like. It’s a chance for new connections, new experiences, and newfound freedom. Sometimes, all of these new opportunities can feel overwhelming. They may create struggles or exacerbate those that were already present. Juggling everything that college life has to offer can be challenging, but you can always ask for help when you need it! Therapy can be a great resource to help you navigate this chapter of your life. For those who might be unfamiliar with therapy for college students, we wanted to address a few common concerns about therapy to help you feel more comfortable.

Why Would I Need Therapy?

The responsibilities of a college student can feel demanding. On top of academic obligations, you also may have to adjust to living away from home and paying for your own needs. Each of these factors have been linked to increases in depression, anxiety, and stress among college students. Certain types of college students are more likely to experience these increases, such as juniors who are not provided with as much school-based support as first-years or seniors (Beiter et al., 2015). Current students also had to transition from high school to college during the COVID-19 pandemic, a time period that substantially worsened students’ mental health concerns (Lee et al., 2021). Having such high levels of stress or anxiety can impair your ability to fulfill your duties as a college student. One study found that students with ongoing mental health problems saw a decrease in their GPA compared to those without these problems (Bruffaerts et al., 2018). When left untreated, mental health concerns can amplify the already stressful roles that college students have to fulfill. Therapy can provide you with tools to manage these responsibilities, while also offering self-care strategies to address the stress in life. For those of you who feel like they don’t need therapy yet, consider that therapy can also be a way to help you prepare against future stressful events.

Does therapy really work?

Yes, but it depends on the type of therapy you’re participating in and the strength of your relationship with your therapist. When thinking about scheduling an appointment with a new therapist, it is important to make sure that their practices are evidence-based. Examples of evidence-based therapy for college students at Thrive San Luis Obispo include:

Interpersonal Therapy
Dialectical Behavior Therapy (DBT)
Gestalt Therapy
Cognitive Behavioral Therapy (CBT)
Mindfulness-Based Interventions
Behavioral Activation

Therapies that are supported through research tend to be more reliable than other types of clinical treatment. When participating in these treatments, many college students experience at least moderate reductions in symptoms of trauma, depression, or anxiety (Huang et al., 2018; McIndoo et al., 2016). Each of the Thrive SLO Therapists gives you a sense of the types of treatment they use on their profile in the Meet Us section. You can also email or talk to a therapist directly if you’re still unsure.

Successful therapy also requires active participation from both you and the therapist. This means that a therapist won’t necessarily tell you what to do, but will rather work with you to develop strategies that best fit your individual needs and level of comfort. Forming this relationship may take some time, and your ideal relationship may not be with the first therapist you meet with. Once this relationship is established, your therapist can help you feel satisfied with your treatment (McIndoo et al., 2016). Instead of asking, “What’s wrong with me?”, therapy often helps you answer the question of “How can I become my best self?”

I’m Nervous About Starting Therapy

That’s okay! You are not alone in your feelings. If you have some reservations about seeing a therapist, it could be helpful to reflect on where these feelings are coming from. Globally, college students underutilize forms of mental health treatment, with one study reporting that nearly 75% of college students would not use these resources even if they were experiencing clinical symptoms of depression or anxiety. Some of the most common reasons for not wanting to go to therapy include the desire to fix problems on one’s own and feeling embarrassed about therapy (Ebert et al., 2019). The stigma surrounding therapy for college students can feel intimidating, but know that you are still deserving of this care. You can address these feelings in the following ways:

Take a screening test to more accurately identify the next steps towards treatment.
Feel free to keep your relationship with therapy private for as long as you need.
Be honest with your therapist about your fears regarding therapy.

Allow yourself to feel what you need to feel at first. Know that your therapist is here to help you, and here at Thrive SLO, we specialize in working with college students. All of our therapists they have worked with hundreds of other college students who have experienced similar concerns. These nerves are healthy. Even considering therapy shows that you care about your well-being. Therapy doesn’t define your college experience; it helps you enjoy it.

Have more questions or feel like you need supportive therapy as a college or university student? Schedule a session with one of our therapists today! You can schedule online here!

We hope you enjoyed this blog post! Have more topics you’d like us to blog about? Contact us and we’ll be sure to include your topic in a future post!

References

Beiter, R., Nash, R., McCrady, M., Rhoades, D., Linscomb, M., Clarahan, M., & Sammut, S. (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of Affective Disorders, 173, 90-96. http://dx.doi.org/10.1016/j.jad.2014.10.054

Bruffaerts, R., Mortier, P., Kiekens, G., Auerback, R. P., Cuijpers, P., Demyttenaere, K., Green, J. G., Nock, M. K., & Kessler, R. C. (2018). Mental health problems in college freshmen: Prevalence and academic functioning. Journal of Affective Disorders, 225, 97-103. http://dx.doi.org/10.1016/j.jad.2017.07.044

Ebert, D. D., Mortier, P., Kaehlke, F., Bruffaerts, R., Baumeister, H., Auerback, R. P., Alonso, J., Vilagut, G., Martínez, K. U., Lochner, C., Cuijpers, P., Kuechler, A. M., Green, J., Hasking, P., Lapsley, C., Sampson, N. A., & Kessler, R. C. (2019). Barriers of mental health treatment utilization among first-year college students: First cross-national results from the WHO World Mental Health International College Student Initiative. International Journal of Methods in Psychiatric Research, 28(2), 1-14. https://doi.org/10.1002/mpr.1782

Huang, J., Nigatu, Y. T., Smail-Crevier, R., Zhang, X., & Wang, J. (2018). Interventions for common mental health problems among university and college students: A systematic review and meta-analysis of randomized controlled trials. Journal of Psychiatric Research, 107, 1-10. https://doi.org/10.1016/j.jpsychires.2018.09.018

Lee, J., Jeong, H. J., & Kim, S. (2021). Stress, anxiety, and depression among undergraduate students during the COVID-19 pandemic and their use of mental health services. Innovative Higher Education, 46, 519-538. https://doi.org/10.1007/s10755-021-09552-y

McIndoo, C. C., File, A. A., Preddy, T., Clark, C. G., Hopko, D. R. (2016). Mindfulness-based therapy and behavioral activation: A randomized controlled trial with depressed college students. Behaviour Research and Therapy, 77, 118-128. http://dx.doi.org/10.1016/j.brat.2015.12.012

Dr. Hannah Roberts · March 14, 2024 ·

Creating a Safe Space for LGBTQ+ People in Therapy

“It takes no compromise to give people their rights…

it takes no money to respect the individual.

It takes no political deal to give people freedom.

It takes no survey to remove repression.”

~Harvey Milk

by Gavin Hannegan, Cal Poly, San Luis Obispo undergraduate intern, supervised by Dr. Hannah Roberts

Therapy can be an incredibly rewarding experience, so it is important to create a comfortable environment for your clients. For LGBTQ+ folk, it is even more important. The therapist-client relationship can offer a safe space for LGBTQ+ individuals to be able to freely express themselves without judgment. But this community may feel overwhelmed trying to find a therapist that affirms them. You might explicitly state that you welcome people of all backgrounds, which is a great start, but how can you follow this statement up with action?

Here, we will be offering a few tips to help you better affirm your LGBTQ+ clients. As you read, keep in mind that the process of building that trust with your client may take time. Some clients may be more receptive to you than others. But with enough time, the relationship you build with your LGBTQ+ clients can become a valuable resource for that community.

Be Open to Learn

A common misconception is that to be an LGBTQ-affirming therapist, you have to also identify as a member of the LGBTQ community, but practicing empathy with your clients can help bridge any gaps. One theme that emerged in interviews with SLO County residents who attended therapy is that positive experiences with therapists occurred when the therapist were willing to learn more about LGBTQ identities, regardless of if the therapist identified as LGBTQ or not (Bettergarcia et al., 2021). You might ask your clients some questions about their identities to better understand your perspective. Here are some examples:

“Tell me more about this.”
“I’m not sure I fully understand where you’re coming from. Could you help me understand?”
“What makes you feel most affirmed?”

Allow your clients to educate you too. They should feel comfortable enough to correct you and explain how that made them feel. However, it is not their job to teach you everything about how to effectively work with the LGBTQ+ population; you may need to do some homework and develop your knowledge outside of the session.

Actively Validate Their Identities

An active effort with your LGBTQ+ clients is key. In their research, Anzani et al. (2019) distinguish between passive forms of affirmation towards trans people (i.e., not using microaggressions) and active forms of affirmation (i.e., encouraging gender exploration). While both forms can be helpful, Anzani et al. (2019) recommend that therapists strive to be actively affirming in order to help their clients navigate the cisnormativity that exists within society. Active validation looks like:

Connecting your clients to local groups and resources
Using your client’s correct name and pronouns before, during, and after transitioning
Treating your client’s identities as normal and authentic

In other words, an affirming therapist should do more than the bare minimum. The work that you do with the LGBTQ+ population can create positive change both in and out of a session. Take some time to reflect on how you approach LGBTQ+ issues with your clients. Do you simply acknowledge homophobia or transphobia or do you work with your clients to develop tactics to combat these prejudices?

Treat Your Clients as Individuals, Rather Than as Representatives of A Group

The ways in which one client experiences their identities might not be the same ways that other queer folk experience their identities. If you generalize these experiences by saying something like, “All gay people experience…,” then that could harm your connection with your clients. Remember that the label of LGBTQ+ encompasses many different identities. In one survey, mental health clinicians reported that even though they might be affirming of lesbian, gay, and bisexual clients equally, they actually perceive themselves to be more competent when treating lesbian and gay clients compared to bisexual clients (Ebersole et al., 2018). Each of these distinct identities can bring unique experiences–on top of the unique experiences that each individual already has! If you feel unfamiliar with some of the identities within the LGBTQ+ label, it may be best to do some research on your own time. You can also ask your clients for clarification, but do this sparingly. You might also need to adopt a multicultural approach and to consider the interplay of multiple identities. Keefe et al. (2023) found that racial and ethnic minorities who also identified as LGBQ responded best to mental health programs that emphasized the minority stress model, compared to those that did not implement this model. In other words, racial and ethnic minorities may be subject to discrimination based on race and discrimination based on LGBTQ+ status, so you should account for each of these influences when they apply.

One last note: a client’s reasons for attending therapy might not even be related to their gender or sexual identity. While you should not outright ignore their identities, it may not be necessary to always attribute certain topics to their gender identity or sexual orientation. These identities are just a few aspects of who someone is. Remember that this is your journey, and you deserve to feel respected and affirmed in the ways that feel most comfortable to you.

Feel like you want your clients to have more information? Here’s a blog post that features the same tips, but directed specifically towards potential clients seeking LGBTQ-affirming therapists.

Have more questions or feel like you need supportive therapy? Schedule a session with one of our therapists today! You can schedule online here!

We hope you enjoyed this blog post! Have more topics you’d like us to blog about? Contact us and we’ll be sure to include your topic in a future post!

References

Anzani, A., Morris, E. R., & Galupo, P. (2019). From absence of microaggressions to seeing authentic gender: Transgender clients’ experiences with microaffirmations in therapy. Journal of LGBT Issues in Counseling, 13(4), 258-275. https://doi.org/10.1080/15538605.2019.1662359

Bettergarcia, J., Wedell, E., Shrewsbury, A. M., & Thomson, B. R. (2021). “There’s a stopgap in the conversation”: LGBTQ+ mental health care and community connection in a semi-rural county. Journal of Gay & Lesbian Mental Health, 26(1), 48-75. https://doi.org/10.1080/19359705.2021.1900973

Ebersole, R. C., Dillon, F. R., & Eklund, A. C. (2018). Mental health clinicians’ perceived competence for affirmative practice with bisexual clients in comparison to lesbian and gay clients. Journal of Bisexuality, 18(2), 127-144. https://doi.org/10.1080/15299716.2018.1428711

Keefe, J. R., Rodriguez-Seijas, C., Jackson, S. D., Bränström R., Harkness, A., Safren, S. A., Hatzenbuehler, M. L., & Pachankis, J. E. (2023). Moderators of LGBQ-affirmative cognitive behavioral therapy: ESTEEM is especially effective among Black and Latino sexual minority men. Journal of Consulting and Clinical Psychology, 91(3), 150-164. https://doi.org/10.1037/ccp0000799

Dr. Hannah Roberts · March 7, 2024 ·

Celebrating International Women’s Day

“Women, if the soul of the nation is to be saved,

I believe you must become its soul.”

-Coretta Scott King

by Gavin Hannegan, Cal Poly, San Luis Obispo undergraduate intern, supervised by Dr. Hannah Roberts

March 8th is International Women’s Day, an opportunity to both celebrate the contributions of women and promote efforts towards gender equity. “Inspire Inclusion” is this year’s theme, encouraging us to think about how women are represented and, also, what kinds of women receive representation. Even within the LGBTQ+ community, women are often the silent heroes. Without that representation, it can feel difficult for queer women to easily access role models who can relate to what they’re experiencing. We cannot let their voices go unheard. To inspire inclusion, I want to recognize the achievements of 4 queer women.

Sylvia Rivera

“We have to do it because we can no longer stay invisible. We have to be visible. We should not be ashamed of who we are. We have to show the world that we are numerous. There are many of us out there.”

Alongside Marsha P. Johnson, Sylvia Rivera was a founder of the Gay Liberation Front, which began following the Stonewall uprising in 1969. While some say that Rivera threw the first brick at Stonewall, others say that she may have thrown the first cocktail instead. And others still say that she may not have even been at Stonewall. Rivera and Johnson also co-founded Street Transvestite Action Revolutionaries (STAR), which provided resources such as clothing to homeless queer and trans youth. Although she advocated for the rights of all LGBT people, Rivera fought specifically to ensure that the gay liberation movement would not ignore the rights of trans women and drag queens of color, like herself.

Stormé DeLarverie

“It was a rebellion, it was an uprising, it was a civil rights disobedience – it wasn’t no damn riot.”

Stormé DeLarverie was another key player at Stonewall. Similar to the rumors that Johnson or Rivera threw the first brick, some witnesses recalled that DeLarverie threw the first punch. DeLarverie is also believed to be the person who prompted all of the bystanders to fight back against the police after she was violently thrown in the back of a police wagon. This initial confrontation ignited the gay liberation movement. DeLarverie identified as a biracial butch lesbian who presented herself androgynously. Outside of her efforts with the gay liberation movement, she performed as a drag king for the Jewel Box Revue, which was the first racially integrated drag revue, and also worked as a bouncer for lesbian bars.

Rachel Levine

“I hope that by being a public figure and being secretary of health during this public health crisis, that that educates people about LGBTQ individuals and transgender individuals — and if they are educated, then they fear less. Thus, they get less angry, and thus, they hate less.”

As the current assistant secretary of health for the U.S., Rachel Levine holds a historic position. She is the highest ranking public official who openly identifies as transgender, the first transgender woman to ever hold a position requiring Senate confirmation, and is among the few transgender people currently holding an official government position. One of Levine’s main goals while in office is to make healthcare more approachable for LGBTQ+ youth, especially within the context of anti-LGBTQ+ laws that target gender-affirming care. Before being confirmed to the assistant secretary of health position, Levine served in the Pennsylvania Department of Health. In this role, some of her key contributions include increasing accessibility to naloxone in response to the opioid crisis and guiding Pennsylvania through the COVID-19 pandemic.

Ella Briggs

“A lot of kids don’t feel comfortable with who they are and that makes me really sad, because I just want everyone to be happy and be themselves. I like being myself.”

At just 11 years old, Ella Briggs was elected as Connecticut’s “Kid Governor,” and was the first openly LGBTQ+ individual to serve in this position. This program gives elementary school students an opportunity to practice and learn about the state government system, but their work can have lifelong impacts. Briggs’s Pride-Hope-Love campaign consisted of three components related to LGBTQ+ care: spread awareness of the LGBTQ+ homeless population, offer schools resources on how to start LGBTQ+ clubs, and foster affirming LGBTQ+ education and treatment in schools. In just one year, Briggs hosted webinars and conferences, developed a step-by-step guide to starting a Pride-Hope-Love club, and interviewed U.S. Senator Richard Blumenthal. Briggs aspires to become the first lesbian president of the United States.

Have more questions or feel like you need supportive therapy? Schedule a session with one of our therapists today! You can schedule online here!

We hope you enjoyed this blog post! Have more topics you’d like us to blog about? Contact us and we’ll be sure to include your topic in a future post!

References

CTKG Ella’s accomplishments and term highlights (n.d.). Connecticut’s Kid Governor. https://ct.kidgovernor.org/ctkgella/ctkgellahighlights

Fitzsimons, T. (2020, June 4). Pennsylvania’s top doc is ‘calm in the eye of the COVID-19 storm’. NBC News. https://www.nbcnews.com/feature/nbc-out/pennsylvania-s-top-doc-calm-eye-covid-19-storm-n1217171

LGBTQ+ women who made history (2021, June 3). Smithsonian American Women’s History Museum. https://womenshistory.si.edu/blog/lgbtq-women-who-made-history

McShane, J. (2021, June 1). Transgender federal official Rachel Levine tells LGBTQ youths: ‘I have your back’. NBC News. https://www.nbcnews.com/feature/nbc-out/transgender-federal-official-rachel-levine-tells-lgbtq-youths-i-have-n1268795

Rothberg, E. (2021, March). Sylvia Rivera. National Women’s History Museum. https://www.womenshistory.org/education-resources/biographies/sylvia-rivera

Wong, C. M. (2019, March 22). Meet the 11-year-old who wants to be America’s first lesbian president. HuffPost. https://www.huffpost.com/entry/connecticut-ella-briggs-kid-governor-lesbian-president_n_5c950965e4b0a6329e15f504

Yardley, W. (2014, May 24). Storme DeLarverie, early leader in the gay rights movement, dies at 93. New York Times. https://www.nytimes.com/2014/05/30/nyregion/storme-delarverie-early-leader-in-the-gay-rights-movement-dies-at-93.html?_r=0

Dr. Hannah Roberts · March 1, 2024 ·

Queer-Affirming Therapy:

Finding a Safe Space

“It is absolutely imperative that every human being’s

freedom and human rights are respected,

all over the world.”

– Jóhanna Sigurðardóttir

by Gavin Hannegan, Cal Poly, San Luis Obispo undergraduate intern, supervised by Dr. Hannah Roberts

Therapy can be an incredibly rewarding experience, so it is important to find a therapist that you would feel comfortable with. For LGBTQ+ folk, it is even more important to find queer-affirming therapy. The therapist-client relationship can offer a safe space for you to be able to freely express yourself without judgment. The process of finding queer-affirming therapy can feel overwhelming. Some therapists explicitly state that they welcome people of all backgrounds, but other times, the cues can be a bit harder to read.

Here, I will be offering a few signs to look out for to help you determine if you would feel affirmed by your therapist. As you read, keep in mind that the process of building that trust with your therapist may take time. You might also respond differently to different therapists. There is no rush to feel comfortable right away!

Your Therapist Is Open to Learn

A common misconception is that an LGBTQ-affirming therapist has to also identify as LGBTQ, but there are plenty of straight or cisgendered therapists who can empathize with your experiences. One theme that emerged in interviews with SLO County residents who attended therapy is that positive experiences with therapists occurred when the therapist were willing to learn more about LGBTQ identities, regardless of if the therapist identified as LGBTQ or not (Bettergarcia et al., 2021). A therapist might ask you some questions about your identity to better understand your perspective. It is also okay for you to educate your therapist when the opportunity arises. Here are some examples:

“I actually go by this name, and I use these pronouns.”
“No, I haven’t really felt that way. I feel more like this…”
“That term is a little outdated, it’s more appropriate to say this…”

You are well within your right to correct your therapist and explain how that made you feel. However, it is not your job to teach your therapist everything about how to effectively work with the LGBTQ+ population; the therapist may need to do some homework and develop their knowledge outside of the session.

Your Therapist Actively Validates Your Identities

An active effort on the part of the therapist is key. In their research, Anzani et al. (2019)

distinguish between passive forms of affirmation towards trans people (i.e., not using microaggressions) and active forms of affirmation (i.e., encouraging gender exploration). While both forms can be helpful, Anzani et al. (2019) recommend that therapists strive to be actively affirming in order to help their clients navigate the cisnormativity that exists within society. Active validation looks like:

Your therapist connecting you to local groups and resources
Your therapist using the correct name and pronouns before, during, and after transitioning
Your therapist treating your identities as normal and authentic

In other words, an affirming therapist should do more than the bare minimum. When meeting with your therapist, you can ask them directly how they will actively validate your LGBTQ+ identities. If this feels too forward, you can also take note of how your therapist responds to LGBTQ+ issues. Do they simply acknowledge homophobia or transphobia or do they work with you to develop tactics to combat these prejudices?

Your Therapist Treats You As An Individual, Rather Than a Representative of Your Identity

The ways in which you experience your identities might not be the same ways that other queer folk experience their identities. If a therapist generalizes these experiences as representative of the broad LGBTQ+ community (i.e., “All gay people experience…”), then they might be missing some important details. For starters, the label of LGBTQ+ encompasses many different identities. In one survey, mental health clinicians reported that even though they might be affirming of lesbian, gay, and bisexual clients equally, they actually perceive themselves to be more competent when treating lesbian and gay clients compared to bisexual clients (Ebersole et al., 2018). Each of these distinct identities can bring unique experiences–on top of the unique experiences that each individual already has! Again, you are more than welcome to correct your therapist if they make a generalization, but don’t feel responsible for teaching your therapist about the diversity of LGBTQ+ identities. You might also encourage your therapist to adopt a multicultural approach and to consider the interplay of multiple identities. Keefe et al. (2023) found that racial and ethnic minorities who also identified as LGBQ responded best to mental health programs that emphasized the minority stress model, compared to those that did not implement this model. In other words, racial and ethnic minorities may be subject to discrimination based on race and discrimination based on LGBTQ+ status, so your therapist should account for each of these influences.

One last note: your reasons for attending therapy might not even be related to your gender or sexual identity. While affirming therapists should not outright ignore your identities, it may not be necessary for your therapist to always attribute certain topics to your gender identity or sexual orientation. These identities are just a few aspects of who you are. Remember that this is your journey, and you deserve to feel respected and affirmed in the ways that feel most comfortable to you.

Feel like you want your therapist to have more information? Here’s a blog post that features the same tips, but directed specifically towards those in the helping profession.

Have more questions or feel like you need queer-affirming therapy? Schedule a session with one of our therapists today! You can schedule online here!

We hope you enjoyed this blog post! Have more topics you’d like us to blog about? Contact us and we’ll be sure to include your topic in a future post!

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