Understanding the Needs of Lesbian, Gay, Bisexual, and Transgender People Living With Mental Illness

Christian Huygen, PhD

In This Article

Shielding or Supporting?

As mental health professionals, we often hope to shield our patients from risk and harm. But this may not be what some of our patients need most. I have worked with a number of patients who choose to publicly display a highly gender-discordant self-presentation even though this frequently makes them targets of verbal and even physical abuse. These individuals insist that they much prefer to be true to themselves and accept the consequences, rather than hide the person they understand themselves to be. As care providers, our protective instincts might lead us to encourage patients to make their appearances more normative so that they can "blend in" and avoid becoming targets for further abuse. Ultimately, however, this choice is not for us to make.

We can certainly express concern for our patients' safety, inquire about social support, raise issues of self-protection and self-defense, and help them build affirming, accepting friendships and relationships. Ultimately, our patients will find the balance between safety and careful self-expression that works best for them. Realizing that they have the freedom to choose how they express themselves in different situations and contexts can be an important step in the therapeutic process. Failing to respect our patients' choices can needlessly disrupt the treatment alliance, or even cause a patient to leave treatment altogether. Conversely, by honoring our patients' choices, we may find ourselves deeply impressed by their creativity, courage, and conviction.

LGBT people living with mental illness are a vulnerable, underserved, and sometimes invisible population. Sexuality and gender identity are issues that provoke anxiety and uncertainty in nearly all of us. Awareness of the particular challenges they face can markedly improve the effectiveness of treatment.


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