Out On The Couch

LGBTQIA+ youth have a higher susceptibility to developing mental health disorders than people not in this group, along with a higher rate of body dysmorphia and gender dysphoria (Huerta, 2019). Struggles with body image can complicate symptoms and treatment. These higher risks are related to discrimination and mistreatment at home and in society (Trevor Project, 2021). Evidence has shown that providing a holistic approach can improve mental health symptoms (Javier, 2021; Colpitts & Gahagan, 2016). As a clinician being able to work in conjunction with a trained yoga instructor may improve a client’s ability to experience mindfulness.

 What is a holistic approach?

 A holistic approach in the context of LGBTQIA+ youth is understanding all the possible psychological pressures a member is under due to intense discrimination (Huerta, 2018). It can be a challenge to address body dysphoria, gender dysphoria, low self-esteem, depression, or trauma symptoms of hypervigilance, anxiety, related to these pressures (Colpitts & Gahagan, 2016). Being able to recognize the social context in which LGBTQIA+ youth are under is an important part of working holistically. Societal forces that impact LGBTQIA+ youth can create unique pressures to understand themselves and defend their own gender and sexuality (Huerta, 2018).

 As a therapist, it can be difficult to support a client who experiences distress in both their body and the community daily. The body is like a memory card for traumatic events in someone’s life and the history of that person’s family origin (Welford, 2019). Our bodies store information in the form of physical pain and mental health symptoms. When stimulated memories of earlier events may be elicited (Welford, 2019). A holistic approach takes these distinct areas into consideration. While there are many approaches that work specifically on the psychological and social domains, yoga and other physical approaches have been supported in having a positive impact on the distinct challenges that LGBTQIA+ youth face.

 Gentle movement as a holistic intervention

Yoga is an ancient practice that is possibly traced back to over 10,000 years ago (Burgin, 2022). It is a physical practice with a specific focus on breath that uses mindfulness to become present in the moment. Yoga is a grounding tool that is and can be used by trained yoga instructors to help clients who are struggling with mental health challenges (Borotikar et al., 2023). Most therapy interventions focus on the cognitive distortions that a client may think. While there is considerable evidence of how Cognitive Behavioral Therapy is effective (Ólafsdóttir, 2022), there is evidence that yoga can offer relief from body dysmorphia, and potentially gender dysphoria (Borotikar et al., 2023; Brotto et al., 2009; Javier 2021).

Yoga is another approach that can be used in a highly effective way with the LGBTQIA+ community to focus on the mind-body connection (Borotikar et al., 2023). There can be resistance to trying yoga, for a variety of reasons (Burgin, 2022). A client’s experiences with heteronormativity and class privilege may affect their perspectives of yoga as a practice (Wijeyakumar & Klein, 2021). By finding an affirming space, and a client who is willing to try, they can find new opportunities to ground themselves in the moment.

 Case Example

A 16-year-old trans-female (she/her) was my client at an outpatient level. This client had a significant history of body dysphoria, sexual abuse trauma, and significant bullying at school. She expressed her dysphoria by describing how she doesn’t fit in her body, and how she had overly masculine features. She talked about the difference between how she felt about how she looked. We explored the societal expectations of femininity and masculinity, and the impact that had on her gender dysphoria. This client felt like she had been attacked at every opportunity and didn’t have support to feel safe in her body.

 Clinical Approach

In treatment, I provided this client with Emotion-Focused Therapy. My primary interventions were providing unconditional positive regard, supporting her to understand and name emotions, and providing psychoeducation and reframing unhelpful thoughts.

When I introduced the idea of yoga to her, she brushed it off as a “fad” and how “it doesn’t work.” I normalized these opinions, and talked to her about how yoga is an ancient practice. I shared with her that some people had found that a committed practice can help feel safer in their body. She was able to try yoga at the guidance of this writer. The client began taking yoga sessions and was able to use those experiences at a local studio. It was important to help the client reflect on their yoga sessions and talk about them in therapy. I used recommended interventions including speaking in a soft and calming tone and created visualizations for the client to follow (Brotto, 2009). Reminders of breath work supported her in therapy and the yoga studio. as well as reminders of how to breathe to ground herself.

Therapeutic Response

A holistic approach was created by using EFT and yoga. This approach helped her connect her emotions, thoughts, and physical body to each other. With gentle movement, focused visualizations, and emotional and physical awareness in and out of the yoga studio, the client reported a reduction in her body dysmorphia and dysphoria. She additionally reported a reduction in her nightmares and PTSD symptoms.

 Conclusions on Holistic Approaches 

 A holistic approach can tend to clients’ needs for affirmation, safe spaces, along with gender euphoria and embodied empowerment. Clinicians can also intervene in systemic ways by advocating for inclusive yoga spaces in their communities and knowing where to make safe referrals for their clients. Affirmative clinicians can add RYT certifications to their qualification and incorporate yoga practices with all their practice with all their clients. An ongoing yoga practice can support mindfulness, body awareness, distress tolerance, through gentle movement and grounding techniques (Brotto, 2009; Borotikar et al., 2023).

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 References

Borotikar, S., Tillu, G., Lavalekar, A., & Nagarkar, A. (2023). Effect of yoga on psychological well-being in men. GeroPsych, 36(2), 75–83. https://doi.org/10.1024/1662-9647/a000308

Brotto, L. A., Mehak, L., & Kit, C. (2009). Yoga and sexual functioning: A Review. Journal of Sex & Marital Therapy, 35(5), 378–390.        https://doi.org/10.1080/00926230903065955

Burgin, T. (2022, July 20). History of yoga • yoga basics. Yoga Basics. https://www.yogabasics.com/learn/history-of-yoga/

Colpitts, E., & Gahagan, J. (2016). The utility of resilience as a conceptual framework for understanding and measuring LGBTQ Health. International Journal for

Equity in Health, 15(1). https://doi.org/10.1186/s12939-016-0349-1

Huerta, T, (2018). Use of the creative arts therapies and creative interventions with LGBTQ individuals: Speaking out from silence a literature review. Expressive Therapies Capstone Theses. 83. https://digitalcommons.lesley.edu/expressive_theses/83

Javier, N. M. (2021). Palliative care needs, concerns, and affirmative strategies for the LGBTQ population. Palliative Care and Social Practice, 15, 263235242110392. https://doi.org/10.1177/26323524211039234

 Ólafsdóttir, Þ., Weidle, B., Ivarsson, T., Højgaard, D. R., Melin, K., Nissen, J. B., Torp, N. C., Thomsen, P. H., & Skarphedinsson, G. (2022). Body dysmorphic symptoms in youth with obsessive-compulsive disorder: Prevalence, clinical correlates, and cognitive behavioral therapy outcome. Child Psychiatry & Human Development, 54(4), 939–948. https://doi.org/10.1007/s10578-021-01298-0

Trevor Project (2021). Facts about LGBTQ Suicide. https://www.thetrevorproject.org/resources/article/facts-about-lgbtq-youth-suicide/

Wijeyakumar, A & Klein, M. (2021) What is Intersectionality in Yoga and Why Does it Matter? https://www.yogajournal.com/yoga-101/philosophy/what-is-intersectionality-in-yoga-and-why-does-it-matter/?scope=anon