Understanding the Mental and Emotional Health Needs of LGBTQ Individuals

In the last fifteen years, Gallup polling shows that the LGBTQ (lesbian, gay, bisexual, transgender, queer) community has found new levels of acceptance and support in the United States. In Washington D.C., for example, there are week-long LGBTQ pride events every year in support and celebration of the sexual orientation and gender identity diversity within the community.

However, as an LGBTQ individual, you’ve probably, unfortunately, experienced your fair share of difficulty and abuse. It takes many forms, from the subtle to the outright homophobic. Inaccurate assumptions, name-calling, dirty looks, and lectures from perfect strangers can be profoundly troubling and are a stark reminder of the stressors of being a member of the LGBTQ community.

As a result, you likely have unique emotional and mental health needs requiring dedicated mental health providers. Dr. Doug Sadownick, a founder of Antioch University’s LGBT affirmative therapy specialization program, says that the needs of LGBTQ individuals should be addressed by therapists with expertise and specialized LGBTQ training. As reported by the New York Times, he stated, “…the difference between gay and straight is great and ingrained, permeating every level of being, from the biological to the psychological.”

We at Therapy Group of DC take a similar approach as advocated by Dr. Sadownick and recognize that there are unique LGBTQ therapy needs for each of you. We believe in talking frankly, compassionately, and non-judgmentally about some of our community’s challenges that make us a vibrant, diverse group.  

Mental and Physical Health Concerns for the LGBTQ Community

LGBTQ people deal with mental health concerns at a higher rate than the general public. According to the Anxiety and Depression Association of America, between 30 and 60 percent of those in the LGBTQ community deal with anxiety, depression, and similar mental disorders regularly. This rate is 1.2 to 2.5 times higher than your heterosexual and cisgender counterparts.

Alarmingly, suicide rates among LGBTQ individuals, particularly among teenagers, are two to seven times greater than heterosexual and cisgender youth. About 38-65 percent of transgender individuals engage in suicidal ideation, according to Mental Health America (MHA) research. These numbers point to exceedingly high levels of pain and distress that put you as a member of the LGBTQ community at increased risk.

Unfortunately, MHA research also shows that about 30 percent of LGBTQ people postpone or avoid medical care because of the discrimination and disrespect they’ve experienced from healthcare providers. About 8 percent report being denied health care outright, making it even more challenging to maintain mental and physical health.

For various reasons, risky behaviors with mental health-related consequences are higher among the LGBTQ youth as well. MHA surveys revealed that 20-30 percent of LGBTQ individuals abuse substances, which is two to three times higher than 9 percent of the general population. Only about 5-10 percent of the public struggle with alcoholism, but 25 percent of the LGBTQ community abuse alcohol, increasing the need for addiction recovery services.

To be clear, the root cause of these risky and unhealthful physical and behaviors is complex, but they directly correlate with the stressors and discrimination faced by the LGBTQ community. Healing and thriving as LGBTQ persons means being aware of some of these challenges and finding therapists who understand where you’re coming from.

It’s Difficult to Translate Your Experiences Constantly

Talking with people outside of the LGBTQ community can present significant challenges and can lead you to stay silent when responses to you are negative. It isn’t easy to both come out and communicate your needs when you’re surrounded by those without first-hand knowledge of what it’s like to walk in your shoes.  

There’s also a common misconception that if you’re experiencing mental health problems, you should “tough it out” and not talk about it. This sentiment is often expressed mostly by people who feel uncomfortable with feelings and emotions that they don’t understand or aren’t familiar with just how effective therapy is. So, taken together, it can be doubly difficult to talk about your emotional concerns and struggles when you’re a member of the LGBTQ community.  

Communication is as important for mental health as it is for physical health. Mental Health America research reveals that about one in every five LGBTQ individuals withholds information about their sexual orientation from their primary care physicians or healthcare providers. These communication barriers can lead to poorer health outcomes and treatment options that are not based on a full understanding of what may be impacting your health.

We wish that you, as members of the LGBTQ community, didn’t feel like there’s no one to talk to, but we get why you do feel that way. We encourage you to seek emotional support from LGBT counseling specialists, therapists, and medical professionals, so you don’t have to translate your experiences with them or have to risk undue judgment. LGBTQ therapists can also act as an authoritative source of support and assistance when finding ways to better live your truth with those around you.

It’s Not Easy to Trust When You’ve Been Rejected

Trusting and opening up to others can be a significant challenge as well. This largely can be linked to the discrimination and rejection you experience from acquaintances, friends, and family members. About 39 percent of LGBTQ individuals say that they have been rejected by a friend or family member, and 21 percent say an employer has mistreated them.

Think about those numbers in another way: Two out of every five of the LGBTQ community have been rejected by family and friends who have belittled their lifestyle, tried to convince them otherwise, or even suggested conversion therapy. One out of every five has faced workplace discrimination.

When you consider these statistics — and the human experience behind those numbers — it makes sense why it’s not easy to develop trust in others when you’ve been rejected so often before. Social rejection leads to ways of coping that might include being highly wary of those around you — because it was smart to be wary.

Although it may be adaptive and useful in certain circumstances or, in the past, there are many ways that being highly wary of others can cause specific struggles. It can undermine your best efforts in romantic relationships and make it hard to find love and support with friendships. It can make it difficult to let go of past hurts and find new ways of relating to family.

Significant distrust and other concerns associated with rejection can be addressed in the safe and warm environment of therapy. A skilled LGBTQ mental health professional can help you identify the causes of your trust issues and help you to cope with fears and anxiety about making connections with others with individual and couples counseling.

Unfortunately, it’s difficult to change the stigmas and ungrounded fears of those around you. However, you can find ways to cope with your environment and find hope and happiness with who you are. With dedication and the guidance of a therapist, you can begin rebuilding a foundation of trust with those who genuinely care for you.

Marriage and Having Children Pose Unique Challenges

Many people in the LGBTQ community have worked for decades to achieve marriage equality and to enjoy a historically high degree of legal protection to build a family. Even though same-sex marriage has been legalized in every state, many hurdles remain, and many still harbor negative beliefs about same-sex marriage.

According to Robert M. Kertzner, MD, the U.S. Supreme Court ruling allowing same-sex marriage in every state has helped to lessen the stress for many same-sex couples. “By underscoring the sanctity of liberty in matters of personal expression and intimacy, and asserting that lesbians and gay men must be accorded a protection of dignity that is fundamental to the US Constitution, the High Court took aim at a systemic source of discrimination and stigmatization based on sexual orientation,” Kertzner says.

That being said, it has not removed all the negative beliefs and prejudices held by others about same-sex marriage. In a society that largely recognizes heterosexual marriage as the acceptable or more typical norm, same-sex marriage is not always seen as legitimate or welcome.

Backing up to the beginning of romantic relationships, there’s also the struggle of finding someone to share the rest of your life with. You’re not alone in struggling with this, but those who identify as straight or cisgender have a significant numerical advantage when seeking a partner or spouse. As a member of the LGBTQ community, you have a significantly smaller pool to choose from.

Having someone to talk to about LGBTQ couples and relationships is often imperative to working through these feelings. If you don’t have friends or family that you can trust or, even if you do, reaching out to those in the professional mental health community can help you cope and work through your problems with families.

People Don’t Take Your Sexual Orientation or Gender Identity Seriously

Sometimes when we make ourselves vulnerable and share who we are, we are met with skepticism and statements like “you must be joking” or “it’s just a phase that you’ll grow out of.” When people don’t take you seriously, it can increase self-doubt, make you feel alien, and have you questioning the wisdom of sharing who you are with others.

Relatedly, there’s also the issue of some people refusing to acknowledge your romantic relationship. At holiday parties and family gatherings, your loved ones might refer to your new partner as your “friend” rather than the romantic partner that he/she is.

You may have also had the experience of fielding invasive questions about your sexual life. Often, when the topic of your sexual orientation or gender identity comes up, the conversation drifts to direct questions about your sexual preferences, your body, and who does what to whom.

It’s exhausting to spend your time trying to explain your sexual orientation and gender identity when you prefer to not be reduced to one facet of who you are. In a roundabout way, this trivializes your experiences and can subtly reinforce your experience as an outsider.

In our practice, we often hear how members of the LGBTQ community purposely seek us out so they can fully explore all elements of their lives and struggles. From a practical standpoint, we recognize that when all of you is accepted and understood, it’s easier to make progress on those aspects of your life and emotional health that are causing you concern.  

Adapting To People’s Negative Perceptions

When an outside world of negative perceptions surrounds you, it takes great strength to cope. Because of who you are, you quickly learn to adapt and find ways to read situations for contextual cues. Yet, this necessary and adaptive skill has its own downside.

“If you’re LGBTQ, I’d wager a bet that you’re really good at reading a situation to determine how much you can safely be yourself,” says Brad Brenner, Ph.D. “This skill, while adaptive, comes at a cost because it was developed in response to being subjected to high levels of persistent prejudice and discrimination.”

Dr. Brenner explains that the context of your surrounding world can affect how you think and feel about yourself. “In response to an outside world full of negative messages about what it means to be attracted to people of the same sex or gender nonconforming, many people come to view themselves as deeply flawed, unlovable, unworthy, and hopeless,” Dr. Brenner says.

These adaptive skills to cope with others’ negative perceptions serve you well in so many situations. Yet, over time, they take a toll. In simple terms, if you’re always scanning and reading the room, there’s minimal opportunity for you to be you.  

Minority Stress

Anxiety, depression, and other mental health concerns often stem from something called minority stress.

Let’s look at the numbers. According to Mental Health America research, in the United States, 96.6 percent of all adults over the age of 18 identify as heterosexual. That is a stark reminder of how few people in the US openly identify as members of the LGBTQ community. Even in Washington D.C., where the LGBTQ community is the highest in the nation at 8.6 percent of its residents, the overall group size is still minimal.

Several scholars have examined minority stress. Professor Ilan Meyer, a psychiatric epidemiologist at Columbia University, has extensively studied its impacts on members of the LGBTQ community.

“…The basic issue … is not whether some or many [lesbian, gay or bisexual people] can be found to be [psychologically distressed],” says Professor Meyer, author of a study published in the Psychological Bulletin journal. “In a society like ours where [LGB people] are uniformly treated with disparagement or contempt—to say nothing about outright hostility—it would be surprising indeed if substantial numbers of them did not suffer from an impaired self-image and some degree of unhappiness with their stigmatized status. … It is manifestly unwarranted and inaccurate, however, to attribute such neuroticism, when it exists, to intrinsic aspects of [LGB people] itself.”

Instead, Professor Meyers associates it with the problem of being an unaccepted numerical minority in our society. “Stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems,” he says.

Translation: many people in the LGBTQ community struggle with their mental health due to their experiences as a member of a numerical minority group that is poorly treated. Being different along dimensions of sexual orientation or gender identity isn’t the root cause. How you’re treated by others because of your differences is.

Feeling Unsafe, Bullying, and Toxic Shame

While American society has made great strides, basically half of all Americans, unfortunately still struggle with the idea of LGBTQ people. About 49 percent of non-LGBTQ adults said that they were very or somewhat uncomfortable around those in the LGBTQ community, says a study published in USA Today.

When dealing with others’ discomfort, you might also be concerned about safety. “The study validates what LGBT people feel inside,” says Sarah Kate Ellis, president of the LGBTQ advocacy group GLAAD. “I hear every day, ‘It’s not like it used to be; I am nervous; I don’t feel safe anymore.”

Sadly, at a personal level, you’ve probably encountered any number of hurtful words or slurs aimed at you as an LGBTQ individual, and you’re not alone. Virtually all LGBTQ teens — about 95 percent — report hearing negative messages and comments from those around them, according to the Human Rights Campaign (HRC) research. Add to that, about 68 percent say they’ve heard negative messages from their elected leaders. With recent movements from national politics, this should be no surprise.

Harmful words and verbal harassment are just the tip of the iceberg. According to HRC, LGBT youth are twice as likely as their straight peers to report being physically assaulted. Many report instances of feeling unsafe when alone or walking to their cars at night. This concern goes beyond the teenage years.

As a result of this bullying and assault, it’s not uncommon to feel what is referred to as “toxic shame.” Akin to internalized homophobia, this act of hiding behind a screen of shame for being who you are, is induced by unkind words and violent actions. It’s like a poison that can work its way through your psyche, making you feel worthless and unloved for just being who you are.

It takes time and support from loved ones, friends, and LGBTQ therapist professionals to battle against these experiences. You can thrive despite them discovering strength, humanity, and talents along the way to leading an authentic life.  

Your Career May Be Affected

Thankfully, workplaces are advancing to include greater acceptance of LGBTQ individuals like yourself. In 2010, only 69 percent of organizations had a non-discrimination policy that protected the LGBTQ community. Now, 97 percent have this policy in place.

However, this doesn’t adequately protect you from discrimination in the workplace, unfortunately. A Harvard survey of 489 LGBTQ adults showed that 57 percent had experienced offensive comments and slurs at work.

Transgender employees, in particular, experience struggle in the workplace with an unemployment rate three times higher than the national average. About 27 percent say that they have been fired, denied a promotion, or denied being hired because of their gender identity. About 75 percent of employed transgender individuals say they must take steps to avoid mistreatment while at work.

You no doubt heard (or experienced) countless stories of individuals being harassed until they quit or are fired on a questionable technicality that stemmed from their sexual orientation. Here’s one example.

Kylar Broadus, a transgender man, shared his negative work experience when he announced his gender affirmation process to his coworkers. He reported being harassed daily, including constant monitoring from his boss despite no changes in his performance. After six months of this, he was fired unceremoniously.

Broadus put this social injustice to work, appealing to the United States Commission on Civil Rights on the grounds of discrimination in the workplace. “We are people, and we are human beings, and we deserve the right to make a living,” he told the commission.

Thanks to the testimonies of those like Broadus, civil rights in the workplace have improved for you and others in the LGBTQ community, but that doesn’t prevent you from being harassed or bullied by your coworkers. If you’ve been subjected to that, you may have experienced severe emotional difficulties. Talking it out with a DC career counselor can make all the difference.

You Need An LGBTQ-Affirming Therapist

There are many well-educated and well-meaning therapists who work with people from the LGBTQ community. Yet, despite their good intentions, they don’t understand your sexual orientation or gender identity experiences. They are good people trying their best, but sometimes the lack of specialized training dramatically hinders their ability to understand you as an LGBTQ client. You need specific LGBT therapy and gay therapists to help you fully cope.

Talking to the New York Times Ian Jensen, a graduate student at Antioch University’s specialized LGBTQ reparative therapy training program, sums it up well:

“Having a gay-affirmative therapist really changed my life in a lot of ways,” he said. “I had always thought, ‘I’m just like my straight friends, only I’m attracted to men.’ But what I found out is that there’s a deeper level of experiencing what it means to be a gay person than just my sexual identity. So discovering that — and realizing there’s so much more to be discovered — I thought, I really want to do that for other people as well. I want to be an agent of change.”

At Therapy Group of DC, our goal is to help you find increased self-acceptance, navigate dating and relationships, handle messy family relationships, address anxiety, depression and other health problems, deal with career complications, and better understand your strengths and gifts.

Our Washington DC-based gay therapists, lesbian therapists, and gay-affirming therapists make it easy for you to explore your concerns with us so you can move beyond that “stuck” feeling.

We like to tell our clients, “No LGBTQ-to-Straight Dictionary is required with us.” We hear from our LGBTQ clients that they are relieved not to have to translate their experiences with us. Also, visit our guide on how to find the best therapist for further guidance. 

Our goal is to help you achieve long-lasting change. For personalized LGBTQ-affirming therapy, contact us today!