Lesbian, Gay, Bisexual and Trans Clients
As a gay man working in the Castro district of San Francisco, roughly half of my clients have been lesbian, gay, bisexual or transgendered (LGBT). LGBT’s have unique experiences of discrimination and culture that are not often understood by heterosexual clinicians, no matter how well-meaning they might be.
One such experience is growing up. Most of us feel different from a very early age, long before our feelings are sexualized. Some of us feel alienated from our peers and are even ridiculed in childhood. This may even be compounded with the rejection from our families and friends upon disclosing our sexual orientation, and “coming out.” All this may leave emotional scars which may stay with us well into adulthood. This in itself is enough for many gay people to seek out therapy, and for many gay people, choosing to work with a gay therapist who has gone through a similar process is integral to their healing.
Coming Out has two connotations: one is coming to terms with one’s own sexual orientation, and the other is self disclosure to others. Some people come out early in life, when they are teenagers or young adults, while others wait until later in life. For queer youth today in metropolitan areas like San Francisco, “coming out” has become somewhat easier, but it is still a soul-searching and scary endeavor for those early in the process. “Am I gay?” and “What does it mean if I am gay?” are important questions for those questioning their sexuality. Some statistics say that nearly 50% of teen suicides are queer teenagers. Queer youth are especially vulnerable and need positive role models, support, and often psychotherapy. I am experienced working with queer youth, and I’m adept at assisting them as they go through the coming out process, as they navigate towards a more positive queer identity.
Coming out later in life has its own challenges. Friends and family who had no idea may have a difficult time adjusting to the new identity, and may be less accepting than expected. If the person is married to an opposite-sexed person, the spouse can feel betrayed, which creates additional stress. Psychotherapy can be helpful for both parties. The heterosexual spouse is going through a profound loss of the person they thought they were married. The gay person is also going through major changes and needs support adjusting to a new identity and a new life.
Relationships are difficult for everybody, but often queer folks lack relationship skills, especially those who have never had much experience in relationships or positive models for healthy relationships. After all, most of us didn’t go through the high school rituals of dating the same gender and exploring our sexuality. If we even begin dating the same sex in high school, it is rare for us to have our parents supporting us. More likely, we try as hard as possible to hide our sexuality from our parents to avoid rejection. As a result queer people often have a delayed adolescence, waiting until college years to explore our sexuality and have our first relationships.
Let me help you strengthen your relationship skills and help you improve communication with your partner. I am also adept at helping same-sex couples in couples therapy.
Substance Use and Addiction in the Gay Community
Traditionally, the gay bar was the one place that we, as LGBT people could go, meet people, and “be ourselves” in a relatively safe environment. For those of us lucky enough to live in San Francisco, this fortunately is not the only place to go to feel free. But gay bars and clubs still serve as the center for gay life for many of us. This and other factors have led to LGBT’s having a disproportionally high rate of alcoholism and substance abuse. The good news is that if you think you have a problem, this is also a great place to recover. There is an incredible gay recovery community in San Francisco, from 12-step groups to Life-ring, both of which have gay meetings. Therapy can also help support you as you learn new coping skills and develop a new way of life.
“Party ‘n Play” or “PnP” has become an epidemic amongst gay and bisexual men. PnP is the activity where men party on crystal meth (and other substances like GHB) and have sex for extended periods of time. The meth makes the sex incredibly intense and last a long time. Sessions can go on for hours and even days. Crystal is especially attractive for gay men because it makes us feel sexy, uninhibited, energetic, and in the short term it can help us lose weight.
This activity has become almost normalized, as evidenced by the M4M ads on Craigslist. If this sounds fun, be warned: Coming down can be extremely difficult, and guys can end up feeling extremely depressed and even suicidal. What starts out as a fun weekend activity can turn into an addiction overnight. Also most of the new HIV cases in San Francisco are reportedly from PnP sessions, because good judgment is lost due to the influence of the drug. Therapy can help you determine if you have a problem and want to stop. If you think you might have a problem, take a look at the questions from Crystal Meth Anonymous:
HIV / AIDS
HIV remains the greatest tragedy affecting gay men. Many of us have lost partners, best friends, and some gay men lost all of their friends in the late 1980’s and 1990’s and had to create a whole new support system. That experience of loss is profound, and most people fail to appreciate the impact it has had on individuals and the community at large.
Although HIV is no longer the death sentence it once was, many of those who had if for more than a decade, whether or not they got sick, were often told to prepare to die. Even if they are healthy now, the experience was enough to give the individuals Post-Traumatic Stress Disorder.
Many physicians now see HIV as a treatable, chronic condition rather than a life-threatening disease, due to advances in medicine. This does not mean that the epidemic is over. People still die from the disease, as evidenced in the BAR obituaries every week. For the most part, however, today HIV/AIDS patients have problems with fatigue, neuropathy, and digestive problems rather than life- threatening conditions as long as their medications remain effective.
People with HIV, whether newly diagnosed or long-term survivors, can benefit from psychotherapy to get support and make sense of their situation.
Sadly, some gay clients come into therapy after having spiritual abuse by a trusted cleric or therapist, who convinced them they could help them become heterosexual. This kind of psychotherapy is unethical, and is a good reason to report them to the appropriate licensing authority. First, this kind of therapy is rarely if ever effective. Second, homosexuality is not a disorder! The American Psychiatric Association removed homosexuality from the Diagnostic and Statistical Manual list of psychological disorders in 1973. This kind of therapy increases guilt and shame in the person, as they are made to feel responsible for their own lack of progress in becoming heterosexual. People who are already bisexual may be able to sexually function with the opposite sex, but they could have done this with or without this kind of therapy, and this kind of therapy will not make the same-sex attraction go away, only make one feel guilty for feeling it.
Gay-affirming psychotherapy, on the other hand, can help people create a positive identity, and Michael can help you get past any spiritual abuse you have had in the past.