Out On The Couch

Mono-Poly Relationships in Therapy

Posted: 4-1-21 | Stephanie Sullivan

Ask Us Anything: How does a therapist deal with a couple where one partner prefers monogamy and the other wants to be polyamorous?

 First, we can consider the many ways in which one might ask this question, which can change its meaning. There are several situations when this will come up in the therapy room, and [...]

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Decolonizing Your Practice with Trans Clients: Actions Steps and Resources

Posted: 3-17-21 | addyson tucker, Psy.D.

As a reminder, my goal in writing this two-part series is to reflect on the ways in which TGNB-affirming* clinicians contribute to colonization (Part 1), while also offering, in this article, actionable ways of moving toward decolonization and gender liberation.

You may be familiar with what is now called the Multicultural & Social Justice [...]

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Misgendering a Client in Therapy

Posted: 3-4-21 | The Affirmative Couch

Ask Us Anything: How to navigate moments of rupture and repair in the therapeutic relationship when a therapist missteps re: a client’s gender identity or expression? Important to acknowledge and apologize to the client and strive to do better – other things to keep in mind if/when this happens?

Wonderful question! You are definitely on [...]

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Why LGBTQIA+-Affirmative Primary Care Matters

With the global COVID-19 pandemic continuing into its second year, the conversation around access to healthcare has never been more relevant. For many people, going to a doctor for an annual physical was not feasible before the pandemic, whether due to lack of insurance coverage, financial cost, taking time off from work, transportation issues, or [...]

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Affirmative Therapy: Crystal Meth in the Black Gay Community

Posted: 2-10-21 | Jerry St. Louis, LGSW

Crystal Meth & the Gay Community

Crystal meth has had a devastating effect on the gay community. Over the last 20 years, meth has grown into a catastrophic force, contributing to about 15% of all drug death overdoses (NIDA, 2019). Gay and bisexual men use methamphetamines at a higher rate than heterosexual men (Lea et [...]

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Therapists Facing Internalized Transphobia

Posted: 1-20-21 | Mikey Anderson

Moving Towards Trans and Nonbinary-Affirmative Therapy Practice

As psychotherapists, we know that transphobia’s pervasive social impact affects our clients and our own internal worlds. This results in transgender and gender nonbinary (TGNB) folx internalizing society’s gender-normative attitudes and lays the groundwork for them to develop negative attitudes about themselves and their communities, which can ultimately [...]

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13 Signs You Need to Decolonize Your Practice with Trans Clients:  Paying Attention to Your Colonization-Connected Behaviors

Posted: 1-7-21 | addyson tucker, Psy.D.

This two-part series is intended to first reflect on the ways in which transgender and gender nonbinary (TGNB)-affirming clinicians perpetuate harm connected to colonization, then to present actionable ways of moving toward decolonization and gender liberation. I am a queer, white, able-bodied, and “cis-ish” person (i.e., I do not feel discomfort in my [...]

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Kink-Aware Therapy: Consent and Negotiation

Posted: 12-16-20 | Rachel Gombos

By Rachel Gombos MSW, LISW

Please note that this article contains content related to sexual trauma.

In this article, the first in a three-part series about kink-aware therapy, I will lay the groundwork for practitioners to gain an understanding of BDSM and key concepts such as consent and negotiation. Many may believe that BDSM represents [...]

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Psychotherapy with Unsupportive Parents of Transgender and Gender Nonbinary Clients

Posted: 12-9-20 | The Affirmative Couch

Ask Us Anything: How should I handle the pronouns of and name for adolescent trans clients when their parents refuse to use the correct ones? Obviously I want to support my client by using their pronouns and name, but I also feel like it is a fine line between that and making parents angry so [...]

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Why LGBTQIA+ Affirmative Therapy is Critical During the Pandemic

Posted: 11-25-20 | The Affirmative Couch

LGBTQIA+ Affirmative Mental Health During the Pandemic

The stress and anxiety wrought by the COVID-19 pandemic may be universal–so many of us face fears of the virus itself, not to mention job loss, illness striking our loved ones, and myriad missed social, professional, and financial opportunities–but all of us experience these differently. Just as everyone’s [...]

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Substance Abuse Treatment Needs to Affirm LGBTQIA+ Clients

Posted: 11-18-20 | Madeline Hodgman-Korth, LISW

“Grant me the serenity to accept the things I cannot change, the courage to change the things that I can, and the wisdom to know the difference.”

In 12-step treatment settings, the Serenity Prayer often makes an appearance at the beginning or end of a group session in substance abuse treatment. Drawn from the Christian [...]

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Helping Queer Clients Become Their Own Liberators

Posted: 9-9-20 | Matthew Spector

Liberation Psychology’s Critical Contribution

Keywords: Liberation, Psychology, LGBTQIA+, Affirmative, Queer, Decolonizing, Martin-Baro, Anti-oppression

Liberation psychology strives to understand and address the oppressive sociopolitical structures affecting communities in order to promote their healing (Martín-Baró, 1994). Developed by the Spanish-born psychologist Ignacio Martín–Baró in 1970s El Salvador, liberation psychology tasks itself with examining contexts of oppression in [...]

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How to Help Clients with Queer Impostor Syndrome

Keywords: queer, LGBTQ, LGBTQIA, impostor syndrome, impostor, cognitive behavioral therapy, CBT, core beliefs

I thought I identified one way, but now I’m not sure. What if this really was just a phase?

I’m afraid I won’t like all of the changes medical transition will cause to my body. What if I’m not really trans?

Can [...]

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Long-term Survivors Living with HIV: Considerations for Practice

Posted: 8-1-20 | Jill Gover, Ph.D.

In my previous article, I explored the many challenges unique to individuals who are aging with HIV. In order to overcome these, long-term survivors (LTS) need the support and expertise of competent psychotherapists. Effective treatment to reduce symptoms from this type of sustained trauma requires interventions that focus on strengthening resiliencies and creating a [...]

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A COVID-Era Review of Five Fabulous LGBTQIA+ Adult Coloring Books

Posted: 7-11-20 | Stephanie Sullivan

Coloring Books in Therapy

Coloring books aren’t just for children anymore: adult coloring books have gained great popularity in the last few years. They have been found to reduce symptoms of anxiety and depression; increase perseverance; and provide short-term stress relief (Eaton & Tieber, 2017; Flett et al., 2017; Rajendran et al., 2020; Simmons, 2016). [...]

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Long-term Survivors Living with HIV: History and Clinical Considerations

Posted: 6-23-20 | Jill Gover, Ph.D.

This year, more than 70% of people living with HIV (PLWH) in the U.S. will be ages 50 and older–up from 50% in 2015 (Anderson, 2015). The HIV epidemic has disproportionately impacted LGBTQIA+ people and people of color since its inception (Anderson, 2015). As anti-retroviral therapy (ART) continues to improve, the number of older PLWH [...]

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Maintaining Hope & Self-Compassion for LGBTQIA+ Clients During Covid-19

Posted: 4-22-20 | addyson tucker, Psy.D.

By now, we are all experiencing the impact of the ubiquitous trauma and stress surrounding COVID-19 in some way. What might have started with a distal awareness of the problem quickly snapped to a reality that the world will forever be changed by this virus. You might have also noticed the varying “stages of

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How Psychotherapists Can Help LGBTQIA+ Clients Cope with COVID-19

Posted: 4-8-20 | Alison Picard

Alison Picard, MA, AMFT

All corners of our society are affected by the current global health crisis caused by COVID-19. Beyond the obvious risks of severe illness and mortality, many of our clients are managing the myriad mental health effects of financial insecurity, social isolation or co-quarantine, and general societal uncertainty.  LGBTQIA+ communities [...]

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Telepsychotherapy Protects Queer Communities From COVID-19

Posted: 3-15-20 | The Affirmative Couch

Telehealth offers psychotherapists a way to provide quality mental health services while still practicing and promoting extreme social distancing. This practice, instituted early, can help save lives during the COVID-19 pandemic (Pueyo, 2020; Stevens, 2020). Psychotherapists who work with queer communities should be switching to telehealth in order to decrease the risk faced [...]

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Dating Violence Among LGBTQIA+ Teens

Posted: 2-29-20 | Muria Nisbett

Muria Nisbett, LCSW

As a mental health professional, you may be familiar with some of the issues faced by teens who identify as LGBTQIA+: bullying, harassment, rejection, and physical and emotional violence. One lesser known and often undiscussed issue is teen dating violence (TDV). Violence against LGBTQIA+ teens is usually categorized as a hate [...]

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Helping Clients to Negotiate Intimate Relationship Contracts

Posted: 2-24-20 | Sharaine Conner

Sharaine Conner, LMSW, IADC

It can be difficult to find guidance on writing effective relationship contracts, largely because the therapeutic community lacks consensus on the efficacy of such documents. Many clinicians believe that contracts serve the purpose of simply negotiating sexual acts and dynamics, and that by creating a contract, clients can sacrifice creativity [...]

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