It’s 20 years since the first book about LGBT-affirmative psychotherapy, Pink
Therapy, was published. Jane Czyzselska asked therapist Leah Davidson
what has changed in that time.
Jane Czyzselska: It’s been 20 years since Pink Therapy’s first book on LGB
mental health issues, a time when in many respects we were far less visible
than we are today in mainstream society. How have things changed in the
therapy room in that time for lesbians and bi women?
Leah Davidson: Well for a start there are many more openly queer, lesbian
and bi therapists around so lesbians and bi women can choose to see us,
meaning they start the process without fear of therapist ignorance or
prejudice and the exhaustion of having to explain everything about gay life to
Lesbian and bi women living in cities feel much more part of the mainstream
than they did 20 years ago, see themselves represented on television (albeit
still ending up dead on a pretty regular basis), we have marriage, and lesbian
parents are pretty commonplace. So where previously women were bringing
issues to therapy around coming out, starting to think about parenting,
external and internalised homophobia, today sexuality in itself is less of an
issue. Most of the women I work with happen to be lesbian, bi or queer, but
they are bringing the same issues as everyone else. Of course I say this from
the standpoint of living and working in London, where we have privileges that
our sisters and brothers in other parts of the world don’t have. And sexuality
may still be a big issue for LGBTQI women from different cultures.
Around 50% of my clients identify as gender fluid or trans, many of them are
in kink and poly communities. A number of them work in the sex industry. In
the past I would refer to somebody’s partner as “he or she” in wanting to
make explicit that I was not assuming my client was in a heterosexual
relationship – whereas now I would never use he or she, I would only use the
pronoun they. It is important that therapists think about the nuances and
meanings of our language and how this will be received by clients who
frequently experience being misgendered.
I work with many “couples” who have also changed over the years. The
majority of the relationship counselling I do now is with people in poly/kink
constellations who come to therapy wanting to really think together about
ethical and transparent ways of being polyamorous. Previously we had non-monogamy;
we developed a set of lesbian feminist ethics and principles
whereby our friends were as important in our lives as our lovers. Today I work
with young queer women calling themselves “relationship anarchists” who
eschew very similar priniciples. I find it wonderfully affirming to watch a new
generation of lesbians and bi women with strong political principles navigating
ethical ways of “doing relationships”.
Jane C: A report last year by the London School of Hygiene and Tropical Medicine
found that mental health issues among lesbians had improved in the last 10
years, however this was not the case for bi women who were 6x more likely
than straight women to develop eating disorders and even more likely to self
harm and attempt suicide. Lesbians were 4x more likely than straight women
to suffer from eating disorders. Can you say something about this and
whether this reflects the experiences of lesbian and bi clients you have
worked with over this time?
Leah: In an environment that’s not always supportive and accepting,
gender and sexual diversities often face additional pressures and challenges
that lead to increased self doubt, shame and depression. Younger lesbian
and bi women are especially at risk as they often struggle with accepting their
identity, coming out and fitting in with peers who can be cruel and
stigmatising. Minority stress and accumulative micro-aggressions can lead to
depression and anxiety.
Bi women encounter double negative attitudes so it isn’t surprising to
find that their mental health is concomitantly at greater risk. They are less
likely to be out, frequently feel that their identity is invisible, and can
experience prejudice from their partner and community as well as from the
outside world. This can lead to bi women concealing their sexuality. Bi women
have been found to have a higher incidence of depression and mental health
challenges than straight or lesbian women, and this is certainly reflected
amongst my clients.
In general lesbians are under less “body perfect” pressure to conform, there
are wider standards of beauty out there – and I have not found lesbian clients
to have more eating disorders than straight women.
For gender fluid or trans clients there may be a greater experience of bodily
shame and dysmorphia. Trans people may be at far greater risk of developing
an eating disorder due to the need to alter their body. Striving for weight loss
may be a way for trans women to conform to what they see as feminine
ideals of slimness and attractiveness, while drastically restricting food intake
may lead to loss of curves and periods that a trans man may wish to
Jane C: PACE completed it’s five year RaRE study last year (before it closed)
and found that lesbians and bi women are no more likely than our straight
counterparts to suffer alcohol dependency or mis-use. What do you make of
Leah: The gay scene has always leaned towards clubs and pubs so it is
largely alcohol based. I think the study found that young lesbian and bi
women and those with lower levels of general wellbeing were more likely to
suffer with excessive drinking, but that they are no more likely to develop
severe problems with alcohol than anyone else. In my experience queer
women are more likely to binge on drugs especially around party scenes and
their substance use has proved to be more problematic than alcohol.
Jane C: What are some of the key issues lesbian and bi women are bringing
to therapy and how do they differ from those typically affecting the gay men
Leah: As I said before, although some queer women still bring issues of
discrimination, micro- aggression and fear of rejection, they are just as likely
to discuss mainstream issues – such as sustaining relationships, divorce and
separation, custody battles with partners or donors, ageing parents, work/life
balance, depression and anxiety, existential crises, and the reality of multiple
minority identities. Many LGBTQI women now call themselves queer, and it is
more common for today’s young LGBT people to express and accept fluid
gender and sexual identities. The “boxes” of gay/straight, butch/femme have
broken open and there is much more of a spectrum that people play with.
Jane C: What are some of the more recent issues you’re hearing from clients
Leah: One of the issues people bring to therapy is the axis of gender and
sexuality – where changing gender might imply a different sexuality. So for
example a lesbian couple where one partner transitions may look like a
straight couple. This can be very challenging for the partner who saw herself
as a strongly identified lesbian.
Jane C: A new book on gay mental health – Straight Jacket – claims that
LGBT people are more likely to introject negative social messages about their
sexuality or about feeling wrongly assigned at birth which causes anxiety, a
propensity to developing a “false self” and hyper vigilance. Would you agree
Leah: I haven’t read the book yet – and it is about men whose experience is
frequently very different from women. But lack of support from family,
negative social messages and micro-aggressions can lead to an internalised
sense of shame which in turn leads to poor mental health, anxiety and
depression. A sense of hiding who we truly are or feeling unseen is a
common response to all of this, and hyper vigilance is a “normal”, though
exhausting response, to micro-aggression and wounding.
Jane C: Can you say something about how clients learn to transform these
habitual responses and ways of being?
Leah: Well, this is where therapy comes in. The therapeutic relationship is
unique in that for many clients it is the first intimate relationship they have had
with another person where profound feelings beliefs and thoughts are shared
without the need to censor or conform. Feeling truly seen, understood and
met by another, without judgement, is an immensely profound and healing
experience, especially for women who may have spent many years feeling
unseen or hiding parts of ourselves.
Given the right environment where the client feels prized and valued, she will
start to recognise how much she may have introjected negative social
messages, and how in a need for love and acceptance, may have developed
a self concept that is at odds with the person she is. This allows one to start
to move forward in a more positive direction, to be more fully true to ones self.
Jane C: What would you say to readers who might be struggling and thinking
about what therapy could do for them?
Leah: Therapy isn’t just for people who are in crisis – it can be an immensely
helpful and healing space for people who are feeling stuck or that things are
not “quite right”. And particularly for queer people navigating a straight
heteronormative world with all the careless and casual acts of hostility
experienced along the way.
I think that this email I received from my client the
week following the Orlando massacre, shared here with her permission, says
“Thank you for doing what you do. It is very important and special. I am so
grateful to have you in my life to help me heal from personal wounds and
collective wounds inflicted on our community by society, as well as provide a
space to process the general violence of the world (shown today again).”