Post graduate school, while working towards my clinical licensure, I worked as a therapist at an outpatient clinic for individuals with substance use disorders. During my time at this clinic, I was a sponge for clinical and non-clinical knowledge. My goal was to provide the best care possible to my clients. If they were taking this difficult journey in their lives to work through substance misuse, trauma, mental illness and other life difficulties then it was my responsibility to show up as the most well-equipped therapist I could. Part of being a well-equipped therapist was discharging clients to competent care providers in their communities. This proved to be a difficult challenge due to the lack of trauma informed, individualized, post program care available.
I found it especially difficult to find LGBTQ affirming providers who provided trauma informed care with a specialty in substance use disorders. This shocked me because I was working in the heart of Manhattan, NY. One would think that this would be the place that anyone of any demographic could easily find services but that just was not the reality. We are in a current crisis of mental health care for many reasons including capitalism and institutionalized systemic oppression. This is not to say there are not LGBTQ affirming providers in Manhattan or the surrounding boroughs, in fact, there are many affirming providers available. But even with these providers offering competent care, the vast amount of people needing services out numbers the available services to individuals.
As I was thinking of next steps in my career, I decided that I wanted to start my own private practice working with LGBTQIA+ individuals who are exploring their gender, sexuality, identity, relationships, and life transitions. This was important to me as a queer genderfluid person because there have been times in my professional life when I have felt misunderstood or judged by other mental health providers because of my queerness. It is a core belief of mine that trauma informed care should be the underpinning to any therapeutic relationship and a core pillar of trauma informed care is safety. If I am feeling misunderstood or judged in a professional setting, then that does not leave much room for establishing safety in a therapeutic setting with LGBTQ clients. I have established my group practice as a gender and sexuality affirming practice where all the clinicians are well educated in the importance of LGBTQ affirming care.
According to SAMHSA (2022), LGBTQ+ populations of all ages disproportionately experience more instances of mental health and substance use disorders, suicidality, and poorer wellbeing outcomes compared to their heterosexual and cisgender peers. In addition to this, LGBTQ+ individuals are less likely to seek out medical care or mental health care due to fear of discrimination, shame or because of past experiences of mistreatment in a healthcare setting. Studies have consistently demonstrated that providing gender-affirming care that is both age-appropriate and evidence-based leads to improved mental health outcomes. Conversely, denying such care is linked to a greater incidence of anxiety, depression and self-harm (Jr, 2022).
References
Jr, J. R. (2022, August 16). Everyone deserves quality medical care delivered without bias. Retrieved from American Medical Association : https://www.ama-assn.org/about/leadership/everyone-deserves-quality-medical-care-delivered-without-bias
SAMHSA. (2022, June 2). LGBTQ+ Behavioral Health Equity Center of Excellence. Retrieved from https://www.samhsa.gov/lgbtq-plus-behavioral-health-equity
