Out On The Couch
A key aspect for therapists practicing affirmative psychotherapy is deconstructing heteronormativity. Defined by the American Psychological Association as “the assumption that heterosexuality is the standard for defining normal sexual behavior,” heteronormativity stems from a long-standing, embedded cultural belief that traditional gender roles are unchanging and omnipotent. (2022) Taken a step further, heteronormativity becomes compulsory heterosexuality – the belief that every person must be straight, even if they have attraction to people of the same gender. Angeli Luz writes in the “Lesbian Masterdoc,” “compulsory heterosexuality easily ties in with the misogyny that causes women’s sexualit[y] and…identities to be defined by our relationships with men.” (2021) Sometimes abbreviated as comphet, compulsory heterosexuality pervades even benign interactions between therapists and clients.
As affirmative therapists, our work with LGBTQIA+ clients must break down the immutable belief in compulsory heterosexuality both for their clients and themselves. It impacts every stage of psychotherapy, from engagement to termination. In this article, we will explore the ways in which comphet erodes the therapeutic alliance, the challenges this poses to treatment, and how to begin deconstruction in your therapy practice.
Defining Compulsory Heterosexuality
The concept of compulsory heterosexuality was introduced in 1980 by the lesbian feminist writer Adrienne Rich in her groundbreaking essay, “Compulsory Heterosexuality and Lesbian Existence.” Her article describes compulsory heterosexuality as a “bias,” an automatic assumption that all women are heterosexual, and that “lesbian experience is perceived on a scale from deviant to abhorrent, or simply rendered invisible” (Rich, 1980, p. 1).
Queer theorist Michael Warner expanded on Rich’s work in his 1991 publication “Introduction: Fear of a Queer Planet,” in which the author introduces the concept of heteronormativity. Warner writes, “the task of queer social theory…must be to confront the default heteronormativity of modern culture with its worst nightmare, a queer planet” (1991, p. 17). Theoretically speaking, heteronormativity represents the status quo: a culture where everyone is presumed straight, enacted by compulsory heterosexuality.
In the decades since these words were published, our understanding of gender and sexuality has changed a lot. We can pay homage to the radical nature of Rich and Warner’s work in context while also acknowledging that they are further reaching than originally thought. For example, comphet does not only affect lesbians – bisexual, pansexual, and omnisexual people often experience a combination of erasure and stigmatization. With increasing visibility and representation of queer people in our modern era, we are closer to Warner’s idea of a “queer planet” than ever before, but still with further to go.
Armed with an understanding of the etiology and meaning of compulsory heterosexuality, it is easy to see how this mindset persists in psychotherapy. Although this article will focus on heterosexism, it is important to note that endosexism, cissexism, racism, and other biases also impact treatment. To begin the work of unlearning this unconscious bias, we must first learn to identify it.
How Compulsory Heterosexuality Erodes Psychotherapy
1. The therapist assumes that their clients are straight.
Many therapists might even believe that to suggest a client is LGBTQIA+ is impolite or inappropriate, and avoid addressing the topic in therapy sessions. Others might simply assume that a client is straight because they are themselves, because they don’t “look gay,” or they are unfamiliar or uncomfortable with queer identity. But the root of this issue is just as Rich wrote back in 1980 — that there is something “deviant” about queerness, or that someone would not want to be thought of in this way (p. 1).
Instead of allowing our clients to be “straight until proven otherwise,” therapists can invite conversation about sexuality and identity early in treatment. We become better therapists by treating our clients as the experts on their own experience, and letting them teach us about their sexual identities. It is well-established that a person-centered approach and strong alliance between therapist and client are reliable predictors for positive outcomes in psychotherapy, especially when paired with an affirmative approach for LGBTQIA+ clients (Davis et al, 2021). We can build the therapeutic alliance with our clients by creating a safe space for discussion of sexuality and identity. And overall, we can challenge our assumptions about sexuality and gender presentation through education, consultation, and rigorous self-reflection.
2. The client believes that they “should” be straight.
Similar to how a therapist might assume a client is straight based on their own internalized comphet, a client may have been socialized the same way. Our culture sends strong messages about what sexuality looks and feels like, which can be hard to parse through alone. Clients may have been taught to view their experiences with sexuality and identity through a lens of straightness.
In 2005, the New York Times published a piece by Stephanie Rosenbloom describing the phenomenon of a “girl crush.” Rosenbloom posited that “women, especially young women, have always had…feelings of adoration for each other,” differentiating a girl crush as “romantic but not sexual” (2005). Critics pointed out that many people experience romantic and sexual attraction separately, including those who are queer-identified. Another example would be straight women using the term “girlfriend” to describe their friends and peers – while this refers to the close and intimate nature of their relationship, it also dilutes the meaning of “girlfriend” as a romantic identifier. This is comphet in action: erasing the experiences of queer women by creating a new term to reassure straight women of their heterosexuality. As affirmative therapists, we can reframe this experience with our clients, and encourage them to adopt a more complex view. We can explore the meaning of sexual identity with our clients, and start to construct a new lens through which to view attraction.
3. The therapist interprets a client’s identity as pathology.
Affirmative psychotherapy firmly centers the belief that LGBTQIA+ identities are valid, and acknowledges their experiences of homophobia and oppression (Hinrichs & Donaldson, 2017). We acknowledge the harmful legacy of our profession’s work with the queer community, and how institutional oppression persists today. The DSM only removed homosexuality from its pages in 1973 – until this point, professionals were trained to believe that LGBTQIA+ identity was a disease state to be treated (Drescher, 2015).
Compulsory heterosexuality frames any experience of sexuality outside of straightness as “deviant,” as Adrienne Rich wrote. While the literature of the field reflects a shift in attitude in the years since this DSM update, there are still practitioners who were trained under this belief. There are may be others, too, who hold a personal bias that queerness is wrong or immoral. According to the Family Equality Council, conversion therapy is still legal in 25 states and 4 territories (2019). Affirmative psychotherapy believes that clients’ mental health symptoms may be due to such stigma and discrimination, but are not caused by their queerness.
4. The client intellectualizes their desire.
Intellectualizing is a defense mechanism in which clients create distance from their emotions through excessive overthinking (Bowins, 2021, p. 1). When clients intellectualize their problems, they are defending against the negative emotion by focusing instead on logical or rational explanations… even when their emotions are telling them otherwise. Some might argue that Rosenbloom’s description of a “girl crush” is intellectualizing by creating new terminology to describe romantic attraction between women (2005). A client who intellectualizes questioning their identity might search for an alternate explanation for their emotions that aligns with the belief that they must be heterosexual.
It is important to remember that we cannot equivocate desire or attraction with identity, and some people may identify as straight while experiencing romantic attraction to the same sex. Psychotherapists should help clients to move towards the belief that identity is far more expansive than simply “straight” or “not” – combating compulsory heterosexuality by encouraging non-judgmental exploration and expression of their sexuality.
Deconstructing Compulsory Heterosexuality in Your Practice
Once you have an understanding of compulsory heterosexuality, it can be overwhelming to think about how to implement a change to your therapy practice. As in much of affirmative psychotherapy, a good place to start is with yourself. Hinrichs and Donaldson define affirmative therapy as “a set of attitudes or approaches rather than specific techniques” (2017, p. 947). Reflect on the ways comphet shows up in your own practice. Do you default to gendered terminology for clients’ partners or dating interests? Are you comfortable sitting in ambiguity with a client who is questioning their sexuality without prematurely applying labels?
While much of the work of unpacking comphet happens at intake, you can deconstruct its influence throughout treatment. Taking an affirmative and client-centered approach, focus on what they see as the problem. Think of yourself as an advocate and collaborator with your client as you identify compulsory heterosexuality and experiences of homophobia or discrimination together. After all, meeting your client where they are at does not stop after the first session – therapists walk alongside our clients throughout the journey.
Learn more about working with LGBTQIA+ Clients
American Psychological Association. (n.d.). Compulsory Heterosexuality. American Psychological Association. Retrieved February 16, 2022, from https://dictionary.apa.org/heteronormativity.
Bowins, B. (2021). Psychological defense Mechanisms. In B. Bowins (Ed.), States and Processes for Mental Health: Advancing Psychotherapy Effectiveness (1st ed., Vol. 1, pp. 23–40). essay, Academic Press. Retrieved February 16, 2022, from https://www.sciencedirect.com/science/article/pii/B9780323850490000039?via%3Dihub#!.
Davis, A.W., Lyons, A. & Pepping, C.A. Inclusive Psychotherapy for Sexual Minority Adults: the Role of the Therapeutic Alliance. Sex Res Soc Policy (2021). https://doi.org/10.1007/s13178-021-00654-y
Drescher J. (2015). Out of DSM: Depathologizing Homosexuality. Behavioral sciences (Basel, Switzerland), 5(4), 565–575. https://doi.org/10.3390/bs5040565.
Family Equality Project. (2019, December 18). Conversion therapy laws. Movement Advancement Project. Retrieved February 18, 2022, from https://www.familyequality.org/resources/conversion-therapy-laws/.
Hinrichs, K., & Donaldson, W. (2017). Recommendations for Use of Affirmative Psychotherapy With LGBT Older Adults. Journal of clinical psychology, 73(8), 945–953. https://doi.org/10.1002/jclp.22505.
Luz, A. (2021). Copy of am I A Lesbian_ masterdoc.pdf. Am I A Lesbian_Masterdoc.pdf. Retrieved February 18, 2022, from https://www.docdroid.net/N46Ea3o/copy-of-am-i-a-lesbian-masterdoc-pdf#page=2.
Rich, A. (1980). Compulsory Heterosexuality and Lesbian Existence. Signs, 5(4), 631–660. http://www.jstor.org/stable/3173834.
Rosenbloom, S. (2005, August 11). She’s So Cool, So Smart, So Beautiful: Must Be A Girl Crush. The New York Times. Retrieved February 16, 2022, from https://www.nytimes.com/2005/08/11/fashion/thursdaystyles/shes-so-cool-so-smart-so-beautiful-must-be-a-girl-crush.html.
Warner, M. (1991). Introduction: Fear of a Queer Planet. Social Text, 29, 3–17. http://www.jstor.org/stable/466295