Hello Kate Johnston, thanks for joining me. This will be the first article in a series exploring today’s mental health options and ways to navigate them as a member of the LGBTIQ+ community. Today we’ll be meeting our resource, Kate, and outlining some of the obstacles particular to our community. Kate is an LCSW (Licensed Clinical Social Worker) and has been practicing for 13 Years.
Q: What are your pronouns and how do you identify?
A: I use she/her pronouns and identify as a lesbian and cis-gendered woman.
Q: What is your license, and how long have you been practicing?
A: I am a Licensed Clinical Social Worker, and have been practicing for about 13 years.
Q: Tell me about your background.
A: For the first 8 years of my career I worked in the D.C. Metro area in inpatient settings, including at a state psychiatric hospital and and crisis stabilization unit in Northern Virginia. In 2017, I moved to Colorado and worked in integrated care for the first 3 years. Currently, I work in my private practice, which I started about 2 years ago.
Q: Kate, what are some changes in therapy that have happened since covid?
A: Telehealth has been amazing for the world of therapy. [Telehealth is meeting with mental health or medical professional via online video] There were telehealth services before covid but they were much harder to gain access to mainly for insurance reasons. As far as I know, most insurance companies are still honoring telehealth visits. Tricare has been waiving co-pays for it. So many people sought out care when covid hit or shortly after that the stigma around mental health and seeking care has taken a serious blow. That, coupled with much easier access to telehealth makes it so much easier to get care.
Q: What are some obstacles or elements specific to members of the LGBTQ+ community should be aware of as they look at therapy?
A: Being part of an oppressed community, we must look for therapists that are not only queer accepting but Queer Affirming. That’s a huge distinction to look at, these terms can be used interchangeably, despite having different meanings. If you go to Psychology Today you will see tons of therapists that are queer accepting. I do want to say that just because someone uses this language doesn’t mean anything negative but it is something to take note of. If you do see queer accepting, that is a talking point to bring up with your therapist when you meet them to determine if they are actually queer affirming or not.
I like when therapists offer a little bit about them and their experiences. I think it’s a great way to build rapport. It used to be that therapists would give very little information about themselves but that isn’t the space that therapy seems to be occupying anymore. People want to connect with a human, and with someone who they feel like they have shared experiences with or someone who can understand their experiences. Don’t expect therapists to tell you every detail about their life, but something about their experience or values. It gives clients a little more insight into whether this will be a good match for them. If a therapist doesn’t say anything about themselves on their site it isn’t a red flag but it should be something that you ask about.
Gaydenver: From a therapy standpoint what is the difference between queer accepting and queer affirming?
Kate: A lot of that is the same in therapy as it is in the general community. Someone who is queer accepting might be, ‘I’m open to working with someone that identifies as queer’. This is distinctly different queer affirming which might look like: ‘I’m going to use your requested pronouns, I’ll refer to your partner as your partner not your girlfriend or boyfriend, or things like that.’ They are socially small gestures that indicate their experience with the LGBTQ community. Queer-affirming counselors are already well informed in respectful language and nuances and shouldn’t need a lot of additional education from the client. This is important for the client to consider because the education process can interfere with the time you have with your therapist. You have to consider what role you want in your sessions. Your therapy time is your time, you shouldn’t have to do additional work to create a safe/brave space. Some people, don’t care if they have a teaching role tied to their patient role. For others, especially those new to therapy or dealing with traumas, it’s enough work to get to know and trust the therapist, without feeling like you need to educate them as well.
Gaydenver: Is it ok to switch therapists? How do you even gauge something like that? It seems like the most awkward breakup.
Kate: It is always appropriate to switch therapists. I always encourage people to talk to their counselor before just ghosting them. It is possible that whatever the issue is can be remedied. As a therapist, I am constantly reminding myself to check in with my clients: how are you feeling about the process, was this skill/concept helpful, etc. All therapists should be open to feedback, it is our job to provide specialized, individual care. There is no one size fits all. Within my current caseload, there’s space for many different modalities, interventions, and cultural competencies. We’ve all been trained very thoroughly to adapt to changing situations and identify particular needs. So I always recommend to people to bring up whatever is raising doubts. An example would be, ‘Last week you said x, y and z to me and I didn’t like it for these reasons. I just wanted to be clear about what you were trying to communicate to me.’ It’s completely appropriate to have those kinds of conversations. If the therapist doesn’t correct their behavior or seems defensive/combative then that’s a definite red flag. If the therapist turns it into processing instead of addressing your relationship with them then that’s also a clear red flag. Contrary to popular belief therapists don’t have to process every little thing and assume it connects to your presenting issue. You can just be two people in a room talking.
Q: What are some questions to ask yourself before you meet with a therapist?
A: A great starting question is what are your goals. As a therapist, I advocate therapy for everyone but I recognize that not everyone needs therapy to effect positive life changes. Start with what your personal goals are and how a therapist could help with that. If you know of any types of therapy (ex: DBT) and have done research look for therapists that specialize in those therapies. Also, ask yourself what expectations you have for therapy. Not only do I want to feel better, but how much time do you have to dedicate to this? What does your insurance cover or what is your budget per month? How long are you willing to be in therapy? Some of these questions your therapist will help answer but it’s important to set up that mental framework on your own first. These can be ball-parked figures, it’s good to have a general sense of these questions before you walk in.
Gaydenver: Does therapy have to be a lifetime commitment? Can you get anything out of a shorter plan?
Kate: Brief therapy is certainly an option and can be beneficial. I would place any therapeutic plan under three months as Brief Therapy. There are therapeutic modalities that are more oriented toward Brief Therapy. Solution Focused Brief Therapy (SFBT) is available and might be something to look for as you research. Brief Therapy treatment plans are less process-oriented and more directly related to goals, tools, or more measurable interventions to reach goals. For instance, you might focus more on developing coping skills, improving sleep issues, or improving your understanding of your specific symptoms. Brief Therapy treatment plans are usually more focused and directive-driven. You can find therapists that specialize in this.
Q: What are some questions you should ask your therapist when you first meet?
A: I would ask open-ended questions, ‘How do you provide queer-affirming care/treatment?’ is an example. You can get as specific as you want though. What are some past experiences or specific training they have had to help them become queer affirming would be another question? How do they show or verbalize being queer affirming? These are all applicable questions whether or not they are part of the queer community themselves. Even therapists that identify as part of the LGBT community can carry stigmas and prejudices. It’s great if they are queer because that will give them shared experiences but doesn’t ensure that you’ll get the treatment that you want.
Q: What are some ways to communicate your inhibitions to therapy? Is it important?
A: I do think it’s important. It helps build rapport with your therapist. Time and time again when researchers look at what is most valuable in successful therapeutic sessions, the therapeutic relationship is at the top. It’s called the therapeutic alliance which sounds a little like Star Trekkie but it’s very important. It doesn’t matter how well trained or knowledgeable your therapist is, if you don’t trust them or don’t feel a connection it’ll be harder to accomplish your therapy goals. You won’t take what they say to heart.
Therapy is a massive commitment, taxing you personally, fiscally, and your time. You want to be as upfront as you can to maximize your returns on those investments. It is important to figure out how to communicate with your therapist, and that responsibility certainly does not solely fall on you. You do not need to be a master communicator, but being able to express your concerns and desires, with support from the therapist on this, will have a positive impact on your therapeutic process.
If you would like to connect with Kate, you can contact her (719)301-6162 or email her at [email protected].
Psychology Today link: https://www.psychologytoday.com/profile/809609
Accepted insurances: United, Aetna, Medicare, select Medicare Advantage plans, Anthem BCBS, Optum, Cigna, Bright HealthCare, Friday Health Plans, Apostrophe, TriWest
Soon to be credentialed with Kaiser