6 Tips for Marginalized People Looking for a Good Therapist
Originally published on The Establishment and republished here with permission.
(Content Warning: Mentions suicide attempt and sexual assault).
Embarking upon an adventure in therapy is already pretty hard work. But it can be especially hard if you’re a weirdo, like I am. As a bisexual, cis femme who’s ethically non-monogamous and kink-identified, it’s not easy to find a mental health practitioner. Add in the fact that I’m in my twelfth year of recovery from a violent sexual assault, grew up with a severely dysfunctional and disordered parent, and had my first suicide attempt when I was twelve, and things become even more complicated.
I’ve been lucky to work with so many wonderful professionals. But I’ve also walked out on therapists who have asked questions like: “What responsibility do you feel you had for your rape? Do you think your non-monogamy stems from a place of unworthiness of real love? Are you bisexual, or do you just have dysfunctional standards for who you sleep with?”
And you wouldn’t believe how popular the final question is.
And these fears aren’t unfounded.
Marginalized people are accustomed to their identities being medicalized and pathologized – and to being told that who they are, at their core, is broken, sick, or wrong.
This barrier to entry is particularly troubling when you consider how often marginalized people could benefit from professional mental-health help.
According to the National Alliance on Mental Illness (NAMI):
“LGBTQ individuals are almost three times more likely than others to experience a mental health condition such as major depression or generalized anxiety disorder. This fear of coming out and being discriminated against for sexual orientation and gender identities can lead to depression, post-traumatic stress disorder, thoughts of suicide, and substance abuse.
Young LGBTQIA+ humans are also eight times more likely to have attempted suicide than non-queer youth.
(There is less data out there for the kink and non-monogamous communities, in part because the stigma is so strong, and there are so few legal protections available for kink or polyamorous identified people, even in progressive states.)
Therapy is even more important for those of us with trauma in our history.
Trauma, especially when we’re young, has a physical impact on our bodies and brains. Adults with trauma histories in their childhood are “almost three times more likely to have an anxiety disorder, almost two and a half times more likely to have a phobia, more than ten times likely to have a panic disorder, [and] almost four times more likely to have antisocial personality disorder.”
Additionally, they’re at greater risk for self harm, suicide attempts, disordered eating, auditory hallucinations, and other disruptive conditions and sequelae.
So what’s a marginalized person in need of help to do?
As someone who’s logged more than 400 volunteer hours for the National Suicide Prevention Lifeline, and who’s learned how to manage therapy myself, I’m often asked this question. Here are some of the most common queries I hear from humans dipping their toes into the pool of professional guidance, help, and support.
Do I Need Therapy?
Spoilers: Yep. That said, I’m not sure this is always the right question to ask.
I prefer to ask questions like:
Are you flourishing?
Do you feel entitled to flourishing?
Are there people in your life who rely on you being your healthiest self?
Have you ever had the opportunity to evaluate the ways you weathered childhood and adolescence?
Have you ever experienced an emotional crisis? How did that go? Could it have gone better? Could it happen again?
What kind of support do you have?
How Do I Find the Right Therapist?
I will be 100% honest: I cheat.
My first stop is always the Psychology Today Therapist Finder, followed shortly thereafter by any local Queer Exchange on Facebook (most major metro areas have one; just do a Facebook search for “Queer Exchange” and whatever metropolitan area is closest to you).
The Psychology Today tool allows you to filter around all kinds of parameters, so ask yourself what keywords are important to you, and what you want to avoid. For example, my search for myself is “LGBTQIA, kink-friendly, trauma-literate, polyamory-open/non-monogamy literate.”
Do you have therapeutic needs that are spirituality or faith-based? Do you specifically want to avoid faith-based approaches? Do you know what tools and models of therapeutic practice are indicated for you? Google some!
For example, Cognitive Behavioral Therapy (CBT) is often highly indicated for folks who are struggling with anxiety and anxiety-based behavioral disorders. Psychodynamic therapy can be a great fit for someone with untreated childhood trauma or dysfunctional relationship patterns.
Most therapists will talk about their models and approaches, and you can do a little research to see if those approaches sound like something you want to explore. NAMI and the American Psychological Association are great places to deep dive into that information.
As you search for a therapist, remember that someone who might be great at self-promotion and marketing copy writing might not be a great therapist, and someone who’s a great therapist might be terrible at writing a profile for themselves.
Focus on keywords rather than prose, and make sure you take note of what they charge, what insurance they take, and if they’re affiliated with a practice group.
How Do I Know I’ve Found the Right/Wrong Therapist?
Therapy is challenging.
You should feel fully heard and seen, but you should also feel challenged and sometimes uncomfortable. Having someone point out that you’ve consistently chosen romantic or sexual partners who check out emotionally when things are hard on your end – you know, just like your dad did? – isn’t meant to be comfortable. It can be done more or less gently, but ultimately, we’re in therapy to confront, reveal, heal, and correct maladaptive coping mechanisms and patterns of behavior and choice.
That’s never going to feel like a huge sparkly party, but you should definitely feel like your therapist is on your team and that you’re safe.
As time goes on, you’ll build trust and be able to lean into that discomfort with more grace and aplomb (and less defensive blustering – we all do it, friend). You should feel and experience significant gains quickly (I’d say by your fourth session), or you should reevaluate. Therapy is far too materially and emotionally expensive to waste time with someone who isn’t leveraging their expertise for you in a pretty short timeframe. If you’re a therapy first-timer, this may vary, but I’d say a four-session trial period is pretty reasonable for any human.
Also, note that there’s a difference between discomfort and boundary violation.
If the therapist you see makes you feel objectified, violated, wounded, broken, or sexualized, forget the four-session trial and get the heck out. That person is not a safe person.
You should be able to safeword at any time during a session if things become too fever-pitch, or if they become too emotional toward the close of a session and you feel unsafe or unmoored leaving on your own. You should never feel abandoned or manipulated.
How Do I Pitch to a Therapist?
This is hard to do. You’re putting a lot of yourself on the line for a human who is an unknown variable. How will they react to some of your biggest vulnerabilities and secrets? As difficult as it is, the best policy is to be clear and concise. State whatever vision you might have for the measurable outcomes of a successful therapist-client relationship.
Do you want short-term intervention? Do you need long-term care? Are there patterns in your life that you want to unwind?
It’s a lot to shoot out into the ether all at once, but I usually recommend providing a four sentence self-summary describing the most clinically significant things about you, followed by your three or four most significant goals, problems, or patterns you want to tackle with your prospective therapist.
Don’t forget to take a deep breath. This person went to school for a very long time to help someone just like you. They’ve heard everything. They’ve heard worse. It’s okay.
This is also a great opportunity to screen a therapist on logistics: How quickly do they answer e-mails? Are they open to texts/e-mail communication between sessions? Do they insist on a phone consult? What is their schedule availability like?
How Do I Tell My Therapist [Insert Sensitive Subject Here]?
I get asked this a lot. How do I tell my therapist I was violated as a child? How do I tell my therapist I’m feeling suicidal? How do I tell my therapist that I’m having an affair? How do I tell my therapist that my partner hits me (consensually or otherwise)? How do I ask if I have a drinking or drug problem?
My answer is always the same: “Probably exactly the way you just told me is good!”
Keeping secrets from your therapist is like leaving one of the shoes you fully paid for at the store. You can wear the one you brought home, but it’s a suboptimal choice. It can be hard to admit to the things that make us feel ashamed, flawed, imperfect, or bad. However, therapy offers us a unique setting in which we can talk about those things with someone whose sole objective is for us to move past those patterns and behaviors and toward greater health and well-being.
They might call us out for engaging in a self-destructive habit, but only so that we can find a way to replace those habits with better ones.
I Think I Need a New Therapist – What Do I Do?
Copy and paste this sentence into an e-mail: “Thank you so much for your time thus far. My therapeutic needs have changed, and I’ll be moving on to someone else’s services to meet my needs.” Hit send.
Move on with your life. You do not owe anyone, especially someone you pay, an explanation or ongoing conversation about your choice to get your needs met in a therapeutic context.
Toxic shame, sexism, cissexism, discrimination, bullying, blackmail, violence, abuse, rejection, homelessness, addiction, and suicide are just some of the specters haunting marginalized communities when we dare to be our truest selves.
To increase well-being and overall community health, evidence-based, high-outcome therapeutic models are one of the strongest tools at our disposal.
Finding and supporting practitioners who speak to our needs as freaks, geeks, queers, and weirdos is essential to our survival and thriving.
Please don’t be afraid to reach out, ask for help, and seize it wherever you find it.