Getting the help you need – advice on choosing the best possible therapist – includes list of referral sources
A sane approach to choosing the best possible therapist
When Steve, a 33-year-old gay man in California, sought therapy, it wasn’t because he had a problem with his sexual orientation. He had other issues to work on. But unfortunately, the therapist provided by his health plan did have a problem with it. “I wasn’t even seeing him regarding any gay issue at all,” Steve recounts. “Yet he seemed to want to bring that up often as though it was the `root’ of all my problems.”
Jodie, a 30-year-old lesbian playwright in New York, encountered a similar obstacle a few years ago when she went to therapy to sort out her career ambitions. “Whenever I would talk about a woman I was seeing, my therapist would ask me, `Why can’t you just be friends with these girls?'”
These negative experiences are all too common among gay men and lesbians who seek mental health services, according to a recent national survey. The survey, conducted last year by Nancy Nystrom, a University of Washington doctoral candidate, found that 46% of gay men and lesbians encountered a homophobic therapist when seeking help. Fully 34% reported that the therapist refused to acknowledge their sexual orientation or dismissed it as a “fad,” and 10% saw therapists who attempted to “cure” them of their homosexuality.
So how do you avoid such nontherapeutic experiences and get the help you really need? The key is to look in the right places and ask the right questions. Although it may seem unnatural to hunt for a therapist the same way you would shop for a new car, it’s not really that different: In both cases it’s about doing the research, taking test drives, and choosing a product that’s going to help you move forward.
Here are some guidelines to help you decide whether a certain therapist will provide you with the gay-affirmative care you need:
* Ask to see a license. Many local gay newspapers contain ads for therapists who specialize in gay, lesbian, and bisexual issues. But anyone can legally advertise as a therapist–even a person with no training, no license, and no idea of how to help you. If a therapist does not have a license, he or she is not bound by laws that protect the confidentiality of your therapy records. Licensed therapists are bound by these laws and can be sued for malpractice if they reveal anything to almost anyone–including a court of law–without your consent. It is important to make sure any therapist you see is licensed, says Beverly Greene, a clinical psychologist and coeditor of Contemporary Perspectives on Lesbian and Gay Psychology. There are three main types of licensed therapists: social workers, who have at least a master’s degree in social work; psychologists, most of whom have a doctorate in psychology; and psychiatrists, who have graduated from medical school and have completed at least four years of psychiatric residency. Psychiatrists are the only therapists certified to prescribe medication.
* Cause trouble. Don’t be afraid to ask directly about a therapist’s views of homosexuality. “It’s a reasonable question to ask the therapist what he or she thinks causes people to be gay,” says Richard Isay, a gay psychoanalyst and author of Becoming Gay: The Journey to Self-Acceptance. “If a therapist says that becoming gay is caused by a poor relationship with the mother or the father, this should be a clue to a patient that this therapist views homosexuality as a pathology.” Even if the therapist says he or she knows what causes homosexuality and gives reasons that are not negative, this could still be a warning sign, Greene says: “After all, we don’t even know what causes heterosexuality. “
* Check background. Just because a therapist is, gay does not mean he or she will be a good therapist. What’s more important is whether a therapist has had any formal training in dealing with gay and lesbian clients. In addition to asking about the extent of this training, Greene suggests you ask whether the therapist has gone to seminars, taken continuing education courses, or had other exposure to gay and lesbian issues, to see if the therapist is up-to-date on these matters.
* Ask about experience treating gay men and lesbians. It is also important to inquire about how long the therapist has treated gay clients and what portion of his of her practice is gay or lesbian. Just because therapists say they work with gay and lesbian issues does not mean that they have any gay or lesbian clients. This is one of the first things Lena, a 36-year-old from New York, brings up with a potential therapist on the phone: “I say, `Tell me about your experiences working with queer women.’ “If she hears the therapist gulp on the other end, Lena knows she has not found a match.
* Prioritize your issues. Many gay and lesbian people go to therapy for other issues besides their sexual orientation. It may be difficult to find a therapist who has experience with all your issues, so it’s helpful to decide which ones are of primary importance. “Before you go into the office, list ten things that are important to you in a therapist, and then pick the top three,” advises Robert E. Penn, author of the Gay Men’s Wellness Guide. “You don’t want to set up a test that every potential therapist will fail.”
* Ask about areas of expertise. If you are dealing with issues other than your sexual orientation, you may find yourself working with a straight therapist whose expertise lies in these areas. “It’s almost like, `Who are you going to hire, a gay plumber or the plumber who is going to fix your sink?'” Jodie asks. On the other hand, when a therapist does not know about the gay community or gay-related issues, “there are a lot of blind spots which he or she may not recognize,” says Dan Hicks, a psychiatrist at PRIDE Institute, a Washington, D.C.-based chemical dependency treatment facility focusing on gay clientele. If you are having difficulty with homophobia at work or in your community and coping with these problems in self-destructive ways, “it does make a big difference to go to a therapist who knows about these issues,” Hicks says.
* Be willing to change therapists. Many therapists won’t tell you their sexual orientation when you first meet them. “Sometimes there are good reasons why a therapist doesn’t want to reveal [this] right away, until he has an opportunity to explore what the patient’s views are on what it means to have a gay or straight therapist,” Isay says. “If, after a reasonable period of time, the therapist still continues to say ‘I will not tell you’ and feels to [you] to be withholding or even mean about it, I think [you] should leave.”
* Find out if your HMO is homo-friendly. If you are seeing a therapist through your health plan, your choices may be limited to therapists in your network, and not many health plans have therapists who are identified as gay or gay-affirmative in their networks, says Armand Cerbone, a gay Chicago psychologist. Additionally, your therapy records may not be confidential if your managed care company is paying for the therapy. As many as 70 people at the managed care company can have access to your psychotherapy records, according to Cerbone. Sometimes a client’s employer can even get access to these records, depending on the relationship between the employer and the health plan. For clients who do not want sensitive information about their sexual orientation known by anyone outside the therapist’s office, this can be a major obstacle–one that might make you think about paying out-of-pocket. Many therapists are willing to accept payment on a sliding scale, and some offer free therapy to people living with HIV or AIDS.
* Trust your gut. The bottom line is to find someone you feel comfortable talking to or at least feel you can work with, experts agree.
RELATED ARTICLE: Referral services
While gay-friendly therapist often can be found through a tip from a friend, many people do not feel comfortable bringing this issue up with friends. Fortunately, there are several mental health associations that offer referrals:
* The Association of Gay and Lesbian Psychiatrists has a national directory of 600 gay-affirmative psychiatrists. Call (215) 925-5008 or E-mail email@example.com.
* The National Association of Social Workers has lesbian- and gay-friendly staff members who can cross-reference gay-affirmative therapists will ones who specialize in certain other areas. Call (800) 638-8799, Ext. 291.
* The state psychological associations of Arizona, Connecticut, California, Georgia, Iowa, Illinois, Maryland, Maine, New Jersey, New York, Ohio, Vermont, Washington State, and Washington, D.C., can make referrals for gay-affirmative therapists. Call the American Psychological Association at (202) 336-5500 for individual numbers.
* The PRIDE Institute is an excellent resource, especially for addictions-related treatment. Call (800) 54PRIDE.
* 1-800-THERAPIST, a private service that therapists pay to be listed with, tested out well in terms of going the extra mile to refer gay clients to gay therapists in a large metropolitan area. Because this referral service is not especially gay, however, you must request a gay- or lesbian-affirmative therapist to get one.
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