Why choose LGBT supportive psychotherapy? (Rene Vazquez, DSW)

Why Choose LGBT Supportive Psychotherapy?
By René G. Vázquez del Valle, DSW

People often ask the question does a LGBT person really need a specific kind of therapy?   Standard psychotherapy is performed by mental health professionals who are trained in the helping process, but this does not mean that all therapist function similarly or that they perform gay supportive treatment just because they are mental health professionals.  If you are questioning the type of therapy offered and whether or not it is relevant to your lifestyle as a homosexual person, a few areas of concern need to be addressed   It would be of consequence to question if the treatment you are choosing is gay supportive in nature, and whether or not the therapist seen has knowledge regarding the bio-psycho-social issues related to treatment with the LGBT population.

Traditional psychotherapy was developed and historically focused on the mental health needs of the heterosexual client and how the heterosexual person functions in the world and in his or her emotional and sexual relationships. Historically, psychoanalysis described the bisexual nature of all human beings, as espoused by Sigmund Freud himself, but a conservative group among the psychoanalytic movement quickly overshadowed this.  With the homosexual client, traditional therapy had often focused on attempting to get the person to change their sexual orientation to heterosexual. This was the optimal goal, whether overt or covert, in many forms of traditional therapy.   Many traditional therapists, who are not aware of the specific focus of gay supportive psychotherapy, lack a framework other than the one provided by traditional therapy from which to work with.

Homophobia, the so called fear experienced by heterosexual persons towards anything homosexual in nature, was not examined by psychoanalyst until the early 1970’s when it was first coined. Social psychologists defined homophobia as the irrational dread, fear of homosexuality and homosexual people.   Unfortunately, the term homophobia does not accurately describe what the condition really is. Most homophobic individuals do not experience actually fear, but rather hate, dread and or loath homosexuality.  The misleading notion that heterosexuals only fear, not actually loath homosexuals, has caused confusion for therapist who are not familiar with the reality of the experience. Mistakenly, traditional therapists have focused on the fear that a heterosexual person may have of his own homosexuality, failing to see the pathology inherent in contempt of homosexuality.

Alternatively, gay supportive psychotherapy starts from the premise that homosexuality, bisexuality, transgender do not represent emotional disturbance in and of itself, but what is conflictual and problematic is the loathing and society’s bias against them. That societal bias or opprobrium towards homosexuality is what often causes emotional pain for the LGBT individual.  Gay supportive psychotherapy understands homophobia to be a dread and hate of homosexuals, which has traditionally existed in society.  This fear, dread and hate of homosexuality have existed since Biblical times and permeates all of our society and our societal beliefs and norms. Homosexuals raised in heterosexual society and who are socialized to be heterosexual in nature, are also raised with and subjected to these cultural beliefs about homosexuality.   Homosexuals who have experienced heterosexual socialization are keenly aware of the bias that society has against them and of the social pressure to conform to heterosexuality.    It is fairly easy to imagine the effect that societal contempt can have on a person’s sense of self and on the emotional development of a young adolescent homosexual who is struggling with a budding sense of self, especially if that sense of what it is he is, is so loathed by society. In gay supportive psychotherapy homophobia and society’s opprobrium is viewed as the major cause of the psychological distress experienced by the homosexual.   For most individuals, conformity to heterosexual standards results in societal acceptance, while differences, especially shame based or stigmatized divergences, cause alienation.  When a young homosexual wishes to fit in and be part of society he has to agree with the beliefs of the peer group and identify himself with them.  Identifying with peer group homophobic attitudes causes the homosexual to also believe and take in the belief as part of his being.  When this occurs it is referred to as internalized homophobia.  The homosexual who identifies with this bias is caught in an emotional dilemma when he /she attempts to counter those beliefs in him/herself and will struggle with attempting to overcome the societal beliefs, and or norms which were ingrained in him/her.  The homosexual, for example, who hates himself or who cannot accept their homosexuality is often suffering from internalized homophobia.

Since internalized homophobia works at both the conscious and unconscious level a skilled therapist must be able to identify the multiple manifestations of homophobia in a client’s life. When a gay person is himself homophobic, this leads to massive amounts of guilt and shame and a tendency to be punitive towards him-self and others. For example, the homosexual who experiences shame based feelings can often experience difficulties in his relationships, due to the projection of these unresolved feelings onto friends, partners and /or significant others.

For the homosexual, therapy should focus on developing a healthy identity by coming to terms with any denied, shame based or punishing aspects of the self; a therapy, which is self-loving, and which helps to reject and externalize any homophobic belief which the client may have accepted as part of his identity.

The ultimate objective of gay supportive psychotherapy is to provide the client with corrective emotional experiences that are geared towards ameliorating the emotionally negative effects of biased socialization, and overcoming internalized homophobia.

If you are attempting to decide what type of therapy or therapist you need it would be especially important to know if your treatment is gay supportive in nature, and if the therapist is trained in issues related to homophobia. If the therapist should try to convince you that the issues in therapy with gay people are no different than therapy with straight people, question how is that so and why aren’t they different?  The response may guide you in determining if that therapist is the right one for you.




What is psychotherapy? and do I really need it? (Rene Vazquez, DSW)

Rene Vazquez (small)

What Is Psychotherapy? And Do I Really Need It?
By René Vázquez del Valle, DSW, LCSW

People often ask the question, what is psychotherapy all about?  Many are confused and unable to distinguish between psychotherapy, counseling, psychiatric treatment, psychoanalysis and or mental health services, in general.  Psychotherapy is a form of treatment performed by mental health professionals who are trained in the helping process. Psychotherapy is but one form of mental health service, and which has been described as both an art and a science. The practice of psychotherapy involves the skill of an artist, who is able to draw with the client an emotional picture of his problem, combined with the knowledge base of a scientist who can explain human behavior.   Not a scientist in the sense of “hard science”, but science based in the theories derived from all of the social and behavioral sciences, specifically from psychology, sociology and anthropology.  Psychotherapy is a treatment process that helps people identify in them-selves those areas of intra-psychic functioning which are most problematic for them, as well as areas of functioning that are conflict free, in an attempt to resolve the everyday difficulties that arise in people’s lives.  In therapy, one actively looks at one’s psychological self, in an attempt to better understand the why and how questions related to how one copes with problems and how effectively one relates to other individuals.

Psychotherapist and psychoanalyst are trained to observe and study human behavior.  They are trained to understand primarily three areas of human development.  Those areas are the brain, the heart, and the sexual/sensual development of the human being. When I say the brain and heart, I am referring specifically to those mental processes such as intellect/intelligence which are associated with the brain, and the emotions and or affects which are associated with feelings, commonly referred to as the heart. Finally the trained therapist looks at the sexual world of his client to help the client understand more about whatever difficulties, fears, anxieties, taboos or inhibitions the person may be experiencing in his intimate love relations.  The brain, the heart and the sexual world of the individual are the domain of many forms of psychotherapy.

You may ask yourself why is it that psychotherapist are interested in these areas or how is it that psychology has come to understand and focus in on these areas of human functioning. The answer may be found more in looking at Greek Ancient society and the writings of the scholars, who believed that the fully developed human being was the one who developed not just one area of his being, but who nurtured and developed his mind, his body and his soul.  This was viewed as the perfected person, the individual who had worked on and came to terms with these areas of their humanity.  This coupled with the writings of moral philosophy, referring to the question of what is good and bad in society and in human beings are the cornerstones of modern day psychology.

People have often questioned how is psychotherapy, also referred to as the “talking cure”, helpful to a person? Why would one seek therapy? Or how is it different than talking to a friend for advice?  Does seeing a therapist mean that I am “weak” or unable to help myself, or perhaps more painfully, could it imply that I may be mentally ill?  All of these are valid questions. Again the answers could be found in the training that most therapists receive.  The goal of a good therapy would be to help the individual reach his highest and healthiest emotional potential. A skilled therapist would help a client to grow and mature intellectually, emotionally, sexually, and perhaps spiritually, if the therapist is so inclined.  Intellectually a therapist could challenge a client to consider an array of learning styles and use his intellectual abilities to think differently about varying situations, focusing in on multiple coping styles and or problem solving skills.  Emotionally, the therapist by exploring defense mechanisms would help the client understand how he uses defenses adaptively or mal-adaptively.  The therapist would help with feeling and identifying emotions, thereby increasing his ability to express his feelings more accurately and verbalize his thoughts more succinctly. The therapist could help identify that which is considered “normal” from that which is “abnormal or less than normal”, perhaps even deviant, which could be causing emotional pain for an individual. In the area of the person’s sexuality and intimacy, the therapist could explore with the client what are the client’s fears, difficulties, concerns, hang-ups, inhibitions that lead to unsatisfying or difficult intimate love relationships.

How would talking to a friend be different from seeing a therapist?  The answer to this can be understood by knowing that a friend can only help you with that which is at the conscious level.  A friend cannot go deeper in his understanding of your problems. He/she cannot tell you what may be occurring at the unconscious level, which could be driving you or forcing you to behave in certain ways that may pain you emotionally. As good intentioned as he/she may be, they are often limited not only by what they may know of the problem, but also by the fact that they can not always be objective since they have feelings about you as a person, which could get in the way of perceiving reality.

Relating to the question is psychotherapy only for those individuals who may suffer with chronic mental illness or those who may be perceived as emotionally weak, I would have to say that yes these individuals may require therapy as a way of helping to organize their thoughts and function effectively in the world; but equally significant would be the help offered to the emotionally well or strong person who also faces life difficulties and could benefit greatly from the psychological help which analyses thought patterns, emotional states and cognitive processes which are integral to daily functioning and which become confused and or disturbed in relationships with other human beings.  In the hands of an ethical, qualified, concerned therapist, many of the difficulties of life can be either viewed differently and or handled more effectively, and especially to the personal satisfaction of the client being helped.

The types of problems which are often seen by therapists range from common fears, anxieties, phobias, depression, substance abuse, adjustment difficulties, work problems, family problems, child parent problems, intimacy difficulties, relationship problems, sexual dysfunctioning, eating disorders, sleep disorders as well as psychotic like disturbances; all addressed in individual, group, family and or couple therapy.  If you feel distressed in some area of your life, don’t hesitate to consider consulting with a mental health professional. Like with a medical illness, which one would not consider twice about seeing a doctor for one’s health, so too one should consider one’s mental health as equally important.  Does everyone need therapy? Clearly, the answer is no.  Could everyone benefit from it, undeniably yes!

* * * *

René Vázquez del Valle received his masters of science in social work degree from Columbia University and his doctorate in social welfare administration at the  City University of New York (CUNY) Graduate School and University Center. Dr. Vázquez del Valle has been an adjunct associate professor at the Long Island University, where he has taught courses in both clinical practice and human behavior. He has served  both as clinical director and team leader at the Baltic Street Clinic of  South Beach Psychiatric Center, an outpatient ambulatory care clinic of the New York State Office of Mental Health. Over the course of thirty years at SBPC, Dr. Vázquez del Valle has engaged in clinical treatment, policy analysis, research, administration  and developed conceptual models for program development. At the University of Rhode Island’s Latino Psychology Conference, he presented on “A Study of Program Efforts to Facilitate Access and Increase Utilization of Community Mental Health Services by Puerto Rican/Hispanic  Clients” and “The Use and Perception of Psychiatric  Medication in the Latino Community.” At the New York University School of Medicine Department of Psychiatry’s Latino Mental Health Conference, he presented a paper on “Developing   Latino Mental Health Leadership: Tested Conceptual Models for Program Design and Therapy.” He has been a consultant to CUNY Law School conducting training seminars to law professors on the management of racism, homophobic violence, prejudice and bias for university interns, as well as workshops on stress management for minority graduate MBA employees of the Continental Insurance Company. He has evaluated grant proposals for Ryan White Federal funding of NYC HIV programs. He maintains a private practice in Jackson Heights, Queens. In June 2012, Dr. Vázquez del Valle joined the staff of Queens Pride House as director of clinical programs.