How to Queer Therapy

by | Nov 21, 2023 | Therapy, Queer, Mental Health

As a word, queer has been used in many different contexts throughout history and to define many different concepts. Currently, queer is employed as an umbrella term for all gender and sexual minorities. Due to oppression and the struggle to find identity in a cisgender-heteronormative society, queer people and their families have been plagued with mental health issues for centuries. Some therapeutic modalities are attempting to help queer people in today’s mental health field, but not without their downfalls. One in particular, though, has changed the game for the queer population and strives to exercise a completely anti-normative approach to therapy. Based in queer theory and sprinkled with tenets of more well-known therapeutic approaches, queer therapy opposes cisgender-heteronormative interventions and techniques in mental health treatment.

Queer is a term that has evolved immensely over time and has been ascribed both positive and negative meanings. According to Sullivan (2003):

The word queer has historically been used in a number of different ways: to signify something strange…; to refer to negative characteristics (such as madness or worthlessness) that one associates with others and not with the self…; and…to denote one’s difference, one’s ‘strangeness’, positively. Similarly, queer has been used, sometimes abusively, and other times endearingly, as a colloquial term for homosexuality. (p. v)

Today, queer has become an umbrella term for a community consisting of people who identify as anything besides cisgender (biological sex aligning with gender identity) and/or heterosexual/straight. This queer community can be broken down into two subcategories of gender identities and sexual identities. Examples of queer gender identities include transgender, non-binary, genderqueer, genderfluid, and intersex whereas examples of queer sexual identities include lesbian, gay, bisexual, pansexual, and asexual. By no means is this an exhaustive list of the ways in which people identify, and the language of queer identities is constantly evolving.

Unfortunately, societal and cultural norms have placed queer people and their families outside the box for hundreds of years. Even in psychology, the cisgender and heteronormative (values and principles based on heterosexuality as the gold standard) confines have depicted the queer community as pathological on the basis of individualistic and normative understandings of gender and sexuality (Riggs, 2011). Riggs (2011) goes on to say that “within this framework of pathology, mental health practitioners could authorize the incarceration of non-heterosexual and non-gender-normative people, could engage in extreme behavior-modification techniques, and in some cases could authorize psychosurgery” (p. 89). Although this has certainly changed for the better in recent years, the fact remains that many current evidence-based practices of psychotherapy are rooted in cisgender, heterosexual norms and the application of these practices in working with the queer population can result in negative outcomes because queer people do not fit in with those norms.

Arising above other therapeutic modalities in working with queer people and their families, queer therapy is a newfound practice wherein the cisgender-heteronormative underpinnings are cast off to accommodate queer identities and experiences. In addition to queer theory, queer therapy draws upon tenets from psychodynamic theory, the person-centered approach, and the postmodernism of narrative therapy.

A major part of queer theory is the overarching system of knowledge, power, and resistance. As Sullivan (2003) points out: Resistance is inseparable from power rather than being opposed to it. And since resistance is not, and cannot be external to systems of power/knowledge, then an oppositional politics that attempts to replace supposedly false ideologies with non-normative truths is inherently contradictory. There can be no universally applicable political goals or strategies, only a plurality of heterogeneous and localized practices, the effects of which will never be entirely predictable in advance. (p. 42)

Queer theory has emerged through this line of thinking about the constructed, contingent, unstable, and heterogeneous character of subjectivity, social relations, power, and knowledge. Under this, the term queer carries a meaning of whatever is outside the “normal”, “legitimate”, or “dominant”. In fact, queer does not refer to anything in particular and denotes only a positionality through the lens of the normative (Halperin, 1995). Halperin (1995) posits that queer “describes a horizon of possibility whose precise extent and heterogeneous scope cannot in principle be delimited in advance” (p. 62).

As such, in working with queer people and their families, practitioners of queer therapy must constantly question the intricacies of power as it functions upon and through individuals via normative categories of gender and sexuality. Additionally, these therapists must take into account how the categories of gender and sexuality may be treated as variables that can be discarded rather than seen as representative of certain subjectivities in the larger social context (Hegarty, 2001). Looking at the power held by the therapists is an important focus in the practice of queer therapy. “One suggestion for doing this…is to consider how practitioners manage our own sexual and gender identities within the counselling space” (Riggs, 2011, p. 91). This signifies that therapists may need to divulge their own identity locations so as to balance the unequal power in the room and reduce the clients’ shame in regard to their identity locations. The democratization of power between therapist and client in this case can aide in the therapeutic process by showing the client that the therapist can also be vulnerable.
Another theory that can contribute to queer therapy is psychodynamic theory, and specifically Freudian psychoanalysis. Hodges (2010) explains that:

The history of psychoanalytic theory and practice as these relate in various ways to the experiences of sexual minority persons is not only complex, multifaceted and fraught with disagreements but also evidences the deep anxieties and ambivalences that human beings experience with regard to their own and others’ sexuality (p. 31).

Indeed, psychoanalysis has pathologized queer individuals for most of its history; however, its psychotherapeutic interventions can be tailored to alleviate the psychological impact of oppression by a cisgender-heteronormative culture. In tandem with queer theory, psychodynamic psychotherapy becomes an “important means through which individuals are not simply regulated through therapeutic discourse but where clients’ subjectivities are shaped through molding the ways in which clients choose to practice their freedom” (Hodges, 2010, p. 34). Queer people and their families can attempt to assemble and re-assemble their selves through psychoanalytic knowledge and practice, thus finding their own truths and achieving self-regulation. When separated from cisgender-heteronormative assumptions, psychodynamic psychotherapy can provide a potential source of resistance to these dominant norms, particularly in accounting for the role of the unconscious in identity development and continuity between psyche and society.

In a sense, the selves of non-gender-conforming and non-sexuality-conforming people are actually defended by Freud. His “insistence that sexuality was never simply given…but is rather molded and constrained by external forces, which, in part, operate at an unconscious level, provided a very powerful means to argue for re-thinking our current conceptions of gender and sexual identity…” (Hodges, 2010, p. 35). Psychoanalysis can help queer clients and their families uncover these pieces of their selves that have been repressed both by internal and external forces. The ploy of Oedipal relations and complexes has traditionally been to describe arrests in development or regression in homosexual clients. However, in queer therapy, they can be transformed to better understand queer clients, as Hodges (2010) clarifies:
The broad model of Oedipal relations and the complexes of desires and emotions to which it refers may not only help to make sense of the formation of gendered and sexual subjectivity through an understanding of power relations and normalization as they operate both within and without the family but may also help us to identify and understand the nature and role of the desires of parents, especially with respect to their own fears and anxieties about gender and sexuality (p. 43).

This speaks not only to helping understand dynamics within queer clients, but also dynamics within their families. The fact is, psychodynamic practice can actually be utilized to undermine the societal pressures of families to produce healthy, gender-conforming, heterosexual adults and also the clients themselves to identify with same-sex individuals and to desire the opposite sex.
Through psychodynamic psychotherapy, queer clients, their families, and the therapists can scrutinize and problematize gender and sexual binaries both in themselves and in the larger society. As a final note, Hodges (2010) offers that using psychodynamic techniques in queer therapy “allows us to recognize and understand the origins and consequences of the damage done by a culture which teaches the queer body to question and sometimes even to hate itself without re-pathologizing sexual minority experience and lifestyles” (p. 46). Clearly, psychodynamic theory, though based on cisgender-heteronormative principles, can be added to queer therapy in an adapted form and where appropriate.

A third therapeutic method that is mixed into queer therapy is the person-centered approach by Carl Rogers. Rather than treating, curing, or changing a client in therapy, Rogers believed that the job of therapists was to provide relationships through which clients may foster their own personal growth. In regard to queer clients, and in particular transgender clients, Livingstone (2008) notes that “applying [Rogers’s] wisdom unconditionally to the trans-identified population, whom society has so long sought to cure from who they are, feels to me an appropriate way to begin to mend the damage of the heterosexist dominion wrought upon them” (p. 137). The inherent deep respect that the person-centered approach offers to queer clients can be a wonderful experience after so much distressing alienation from the outside world. Certainly, “it feels well past time that the trans-identified population was deemed well worth understanding and met with the genuineness, empathy and unconditional positive regard of a facilitative phenomenological approach” (Livingstone, 2008, p. 138).

Within the person-centered approach, the techniques of affirmation and prizing are also extremely important when working with queer clients and their families. Because queer people are subjected to social isolation and the resulting anxieties, proactive affirmation must be employed by the practitioner of queer therapy (Livingstone, 2008). Due to the social constructs of gender and sexuality as unchanging binaries (man/woman, homosexual/heterosexual), some therapists must take into account their own conscious or unconscious value system and refrain from imposing it upon queer clients. Livingstone (2008) states that the person-centered perspective “is about being truly open to working on the client’s terms, however fragile; holding the client’s perspective rather than regarding them as disordered” (p. 140). Valuing queer clients’ experiences and their fragile processes can let them know that they are valued in the world just the way they are. “Respecting all diversity as equally valid to the binary can restore the individual’s basic human right of self-governance” (Livingstone, 2008, p. 141). The person-centered approach offers this facet to queer therapy and shows queer clients that therapists can accept them, respect their gender and/or sexual identity, and remain flexible with treatment.

A final type of therapy that has contributed to queer therapy is that of narrative therapy, which falls under the broader school of postmodernism. Within this school of thought, it is understood that there are numerous ways to gender-identify and conduct romantic or sexual relationships, thereby getting rid of the man/woman and homosexual/heterosexual binaries. This approach is important in working with queer clients because it takes a non-heteronormative stance. In addition, narrative therapy posits that clients are the experts on their own meaning and experience, whereas the therapists are in the non-expert or not-knowing position. Butler & Byrne (2008) argue that as therapists, “by positioning ourselves as non-expert, we thus acknowledge and respect the choices and power of the client” (p. 94). Power is relational and rather than attempting to empower the client (as if the therapist has the power to give), therapists can draw on the power that queer clients use in making their own choices.

Speaking now of the discourse used in narrative therapy, queer clients, along with the rest of the population, have internalized the dominant narratives of culture and society. Narrative therapy aims “to deconstruct these narratives in ways that are in line with queer theory, in that we put the dominant narratives under the microscope for inspection” instead of the narratives of the queer population (Butler & Byrne, 2008, p. 100). The deconstructive questioning of narrative therapy fits well into queer therapy because it challenges and resists the dominant discourse that oppresses queer individuals. A final note from Butler & Byrne (2008) sums it up best:

By validating the client’s sexual and relationship choices by deconstructing norm-based messages and position the client as an expert on themselves, our clients find ways to resist oppressive narrative and continue to develop and practice their sexual and relational lives as they desire (p. 103).

This shows why narrative therapy and postmodern thought can offer so much to working with queer clients and their families.

Therefore, queer therapy can be a monumental modality to use in mental health treatment of queer individuals, couples, and families. The term queer has been used in many contexts, both positively and negatively. Now, queer is an identity, a culture, a politic, and a theory. There can be power in the word queer and helping queer clients and their families realize this is an important aspect of their therapy. The combination of queer theory, psychodynamic theory, person-centered therapy, and narrative therapy has produced this potent type of therapy to be used with queer people and/or anyone that falls outside of the “norm.”

 

References

  • Butler, C., & Byrne, A. (2008). Queer in practice: Therapy and queer theory. In L. Moon (Ed.), Feeling queer or queer feelings? Radical approaches to counselling sex, sexualities and genders (pp. 89-105). New York, NY: Routledge.
  • Halperin, D. M. (1995). Saint Foucault: Towards a gay hagiography. New York, NY: Oxford University Press.
  • Hegarty, P. (2001). ‘Real science’, laboratory phantoms and the gender of my lab coat: Toward a new laboratory manual for lesbian and gay psychology. International Journal of Critical Psychology, 1(4), 91–108. Retrieved from http://www.academia.edu/1105187/Real _science_laboratory_phantoms_and_the_gender_of_my_lab _coat_Toward_a_laboratory_manual_for_lesbian_and _gay_psychology
  • Hodges, I. (2010). Queerying Freud: On using psychoanalysis with sexual minority clients. In L. Moon (Ed.), Counselling ideologies: Queer challenges to heteronormativity (pp. 31-49). Burlington, VT: Ashgate Publishing Company.
  • Livingstone, T. (2008). The relevance of a person-centered approach to therapy with transgendered or transsexual clients. Person-Centered & Experiential Psychotherapies, 7(2), 135-144. doi:10.1080/14779757.2008.9688459
  • Riggs, D. W. (2011). Queering evidence-based practice. Psychology & Sexuality, 2(1), 87-98. doi:10.1080/19419899.2011.536319
  • Sullivan, N. (2003). A critical introduction to queer theory. New York, NY: New York University Press.

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