For some psychologists, treating clients who identify as gay, lesbian, bisexual or transgendered may present a challenge. Fortunately, a growing body of research, training and educational opportunities exist to help mental health providers offer effective therapy for this population.
Bonnie Strickland, Ph.D., president of APA Division 44, The Society for the Psychological Study of Lesbian, Gay, Bisexual and Transgender Issues, cites growing interest in this area based on membership numbers. “We started in 1985 with 458 members,” she says. “Now we are at 910. We’ve almost doubled in 26 years.” She attributes the boost to the increase in LGBT concerns, but also because more psychologists are identifying themselves as LGBT.
According to Strickland, Division 44 continually strives to raise awareness, promote the development and delivery of affirmative psychological services to the LGBT community and inform the general public about research, education and training, practice and advocacy on LGBT issues.
Fenway Health in Boston, a leader in the physical and behavioral health of the LGBT community since 1971, presents an open and welcoming environment for all individuals, according to Rhonda Linde, Ph.D., coordinator of behavioral health training/chief psychologist. She applauds the changes that have taken place in the last 40 years and notes that the younger generation has been more accepting of differences.
Judith Bradford, Ph.D., director, Center for Population Research in LGBT Health and co-chair of The Fenway Institute (TFI), indicates that as the institution’s research division, TFI has been studying evidence-based interventions for the LGBT population and has garnered worldwide attention for its work in this area.
Bradford and Linde emphasize that treating someone in the LGBT population is no different than treating any minority individual. According to Linde “you need to know not to make assumptions when working with minority populations.” Linde adds “LGBT clients present with problems that may have little or nothing to do with being LGBT. For instance, they may have substance abuse or mental health concerns, but these are affected by others’ reaction to their sexual minority status. You have to be open and view these issues in the context of society.” Bradford adds that non-supportive families and anti-gay sentiment affect self-esteem, exacerbating internalized homophobia and transphobia, and in turn, lead to increased behavioral health risks.
Bradford and Linde add that the passage of transgender legislation, although positive, may initially prove to be a double-edged sword. While laws are needed to protect the rights of transgender individuals, this type of visibility “may put some at greater risk for societal mistreatment and discrimination,” Linde says. “Until you are really counted, however, access to services and government funding are limited and less available than for other populations,” Bradford says.
In 2007, Children’s Hospital in Boston opened the Gender Management Services Clinic (GeMS Clinic), which serves individuals with disorders of sexual differentiations (DSDs), including the transgendered population. Laura Edwards-Leeper, Ph.D., staff psychologist who recently moved to Seattle to fill a similar position there notes that this internationally known clinic focuses on puberty-blocking medication for adolescents, a controversial, but increasingly popular therapy. “Our patient load has at least doubled in the four years we’ve been open. There is a waiting list six months out,” she says, adding that insurance does not cover this therapy. The benefit of puberty-blocking medication is that it “halts puberty at the cusp,” according to Edwards-Leeper. “It prevents the development of secondary sex characteristics and buys time to sort things out,” she says. Out of 75 clients she has evaluated, only one changed her mind after starting the medication therapy.
Edwards-Leeper explains that clients must follow a strict protocol to be accepted into the program, including referrals, prior therapy and multiple lengthy evaluations and questionnaires regarding psychological function and gender identity. She notes that the clinic does not perform gender reassignment surgery and works only with clients who are 18 or younger.
William B. Nash, Ph.D., forensic psychologist in Essex Junction, Vt., worked with transgender individuals for the past 15 years and was a staff member of the now defunct Green Mountain Gender Clinic. “When someone comes to me and wants to change gender, I slow them down first. In the slowing down process, underlying issues surface,” he says. Although one in eight clients actually are transgender, according to Nash, this process uncovers “fundamentally who we are.” He says, “This work is the express lane to the soul.”
Ellen Schecter, Ph.D., clinical psychologist in private practice in Hanover, N.H., indicates that psychologists who work with the LGBT population should be culturally competent in order to effectively treat this community. She says that the practice of “reparative” or “conversion” therapy, which emerged some 20 years ago, has been condemned in recent years by health and mental health professional associations. “In 2007, the APA established the Task Force on Appropriate Therapeutic Responses to Sexual Orientation to conduct a systematic review of research related to Sexual Orientation Change Efforts (SOCE). Their conclusion goes beyond the possibly harmful concern cited in their 1997 statement to ‘efforts to change sexual orientation are unlikely to be successful and involve some risk of harm, contrary to the claims of SOCE practitioners and advocates’,” she says. Rather, the task force advocates acceptance and support, identity exploration and development, active coping skills and connecting clients with core values and virtues.
Douglas C. Kimmel, Ph.D., a psychologist from Hancock, Maine and author of “Psychological Perspectives on Lesbian, Gay and Bisexual Experiences,” believes attempts to change sexual orientation are akin to a con game, designed to take advantage of parents. “There is no empirical evidence to support this therapy,” he says.
Nash explains that healthy development is predicated on knowing our gender and that everyone goes through a process of discovery beginning at birth. “The worst thing is to become too rigid when kids are discovering the rules,” he says. “If we say, ‘You must be this way,’ we are inhibiting full exploration. We have to try on different roles.”
Bradford says, “Inherently, the LGBT population as a whole has no greater mental health problems than the general population. LGBT individuals make up a slice of American society, a subpopulation that also has its own unique culture. Its face is as diverse as the American population taken as a whole. When a new cultural group comes to public attention, it takes time for general understanding to increase. Psychologists can take the lead in this issue.”
By Phyllis Hanlon