Out On The Couch

Traumatic invalidation carries significant implications for therapists working with LGBTQIA+ clients. It is crucial to understand what traumatic invalidation is, its discernible effects on LGBTQIA+ people, and how society contributes to an invalidating environment for historically marginalized communities. For mental health professionals, understanding and addressing traumatic invalidation within the context of working with LGBTQIA+ communities is pivotal for providing effective, empathetic, and affirmative care. 

What is Traumatic Invalidation?

Invalidation is often discussed in therapy settings and can be described as the denial or dismissal of one’s emotions, experiences, or identities by others. Traumatic invalidation transcends typical invalidation and encapsulates experiences in which emotions and identities are dismissed, resulting in emotional distress and psychological harm. American psychologist and developer of Dialectical Behavior Therapy (DBT) Marsha M. Linehan (2015) defines traumatic invalidation as “extreme or repetitive invalidation of individuals’ significant private experiences, characteristics identified as important aspects of themselves, or reactions to themselves or to the world” (p. 304). This is particularly pertinent for marginalized groups such as LGBTQIA+ individuals, whose identities are often invalidated by societal norms, cultural messages, and systemic oppression.

Traumatic invalidation targets anything from a person’s understanding of themselves or their environment, belief systems, emotions, actions, desires, and even sensory experiences (Linehan, 2015). Sources of traumatic invalidation include family of origin (parents, grandparents, siblings), other important relationships (school peers, intimate partners, colleagues, employers, coaches, teachers), institutions (schools, religious organizations, healthcare systems, military), and culture (systemic racism, sexism, heterosexism, transphobia) (Harned, 2022). 

The invalidating environment communicates that the individual’s emotions, experiences, or identities are wrong in a way that leads to emotional distress or psychological harm (Harned, 2022). It goes beyond simple disagreement or misunderstanding, as it negates an individual’s core sense of self and identity. According to Harned (2022), “these experiences can be traumatic when they are experienced as intensely emotionally and psychologically painful and have lasting adverse effects on the person’s self-concept and functioning” (p. 23). Linehan (2015) notes that traumatic invalidation “results in a threat to the person’s psychological integrity and a confused sense of internal veracity and credibility, putting the person in a state of pervasive insecurity” (p. 304). 

Invalidating Behaviors

  There are many types of invalidating behaviors, all of which share an overarching theme of targeting someone’s sense of self and sending messages that the person is “bad, wrong, unacceptable, and unwanted” (Harned, 2022, p. 316). Traumatic invalidation can occur at any age and may be perpetrated by different people, groups, or entities. It can also entail negative societal and cultural experiences, such as repeated discrimination based on one’s identity or personal characteristics (Harned, 2022). 

Furthermore, while traumatic invalidation is often caused by an accumulation of adverse experiences, it can also develop after a single occurrence of life-changing invalidation, such as being kicked out of the family home after coming out, fired from a job after transitioning, or wrongfully arrested by police due to profiling (Harned, 2022). Types of behaviors that may lead to traumatic invalidation include unequal treatment, criticizing, emotional neglect, ignoring, misinterpreting, controlling, blaming, excluding, and denying reality (Harned, 2022). 

Too often, an individual’s response or reaction to these behaviors is invalidated. The perpetrator(s) may argue that the individual is too sensitive or overreacting, or may deny the invalidation ever even occurred (Harned, 2022). The accumulation of these invalidating behaviors can lead to negative effects on the individual’s sense of self, creating messages of the individual being someone who is “unacceptable, unlovable, unimportant, incompetent, inferior” and does not belong (Harned, 2022, p. 315).

Traumatic Invalidation: Clinical Considerations

Common indicators of a history of traumatic invalidation include intrusive thoughts, re-experiencing of traumatic invalidation, shame, confusion, defensiveness, increased sensitivity to subsequent invalidation, concentrated efforts to seek validation from the invalidator, frequent efforts to obtain validation from others, avoidance and isolation, and trust issues (Linehan, 2015; Harned, 2022). While traumatic invalidation is not included in the DSM-5 criteria for posttraumatic stress disorder (PTSD), the symptoms of each are similar. 

The DSM-5 criteria for PTSD requires exposure (directly or indirectly) to death, serious injury, or violence, or threat of death or serious injury/violence, referred to as Criterion A (American Psychiatric Association, 2013). In some instances, traumatic invalidation may have occurred after or in association with a Criterion A traumatic event that led to PTSD (Harned, 2022). Research shows that traumatic invalidation can have just as much–or even more–of an impact on mental health as other events that do meet Criterion A for PTSD (Mechanic et al., 2008; Spinazzola et al., 2014).

Effects and Experiences of Traumatic Invalidation

Traumatic invalidation can lead to chronic self-invalidation, in which individuals learn to undermine or dismiss themselves in a way that parallels how they have been treated by their environments. This includes self-criticism, ignoring one’s own needs, self-blame, and minimizing one’s accomplishments (Harned, 2022). Individuals may also react to traumatic invalidation by doubting themselves or believing they are not able to make intelligent decisions or important life choices, leading them to rely on others for direction (Harned, 2022). Not trusting oneself can show up as fear of responsibilities, basing behaviors on those of others, and feeling disconnected from one’s intuition. 

Sometimes, individuals form a different way of coping with traumatic invalidation, and become perfectionistic and strict about their behavior. They set unrealistic standards that inevitably lead to feeling like a failure, which results in more self-invalidation (Harned, 2022). Traumatic invalidation frequently induces anxiety in relationships and leads to difficulty trusting that other people are safe. Individuals may be afraid to rely on others, anticipate abandonment, have one foot out the door, and expect invalidation. 

They may also try to mold themselves in inauthentic ways, focus more on the needs of others, and seek reassurance (Harned, 2022). Chronic messages about being unacceptable can lead to an individual questioning their own validity or seeing themselves as “less than.” People who have been traumatically invalidated may fear taking up space, feel like something is wrong with them, feel different and alone, and question their own existence altogether (Harned, 2022). 

Society as an Invalidating Environment

Traumatic invalidation often occurs due to societal prejudice, discrimination, and lack of understanding surrounding diverse gender and sexual identities (Harned, 2022). Society’s adherence to hetero- and cisnormative standards invalidates the experiences of LGBTQIA+ individuals, leading to feelings of invisibility and marginalization. The assumption that heterosexual and cisgender identities are the norm can be traumatic for queer and trans people (Meyer, 2003).  

Furthermore, LGBTQIA+ individuals are subjected to microaggressions, which are subtle but impactful expressions of invalidation that communicate “hostile, derogatory, or negative messages” toward a person’s identity (Harned, 2022; Sue et al., 2007). Additionally, the failure of laws and institutions to protect the rights of LGBTQIA+ individuals contributes significantly to invalidation and marginalization (Harned, 2022). Access to healthcare, employment, and housing can be negatively impacted, leading to further trauma and distress. These actions convey negative assumptions about a person’s gender identity or sexual orientation, exacerbating emotional dysregulation and trauma-related distress (Haltzenbuehler, 2009).

Extensive research indicates that traumatic invalidation related to race, ethnicity, sexual orientation, and gender identity leads to PTSD symptoms (Bandermann & Szymanski, 2014; Pieterse et al., 2010; Reisner et al., 2016). Societal norms, prejudices, and discrimination perpetuate an environment in which the experiences of LGBTQIA+ individuals are negated, leading to emotional turmoil and psychological trauma. 

Types of traumatic invalidation related to sexual and gender identity include:

Criticism

• Messages around identity being “immoral” or “wrong” (p. 350)
• Use of slurs or offensive language
• Unfavorable portrayals or characterizations
• Subtle, indirect instances of prejudice 

Unequal Treatment

• Systemic bias in areas like housing, education, and employment 
• Experiencing subpar healthcare and being treated by providers who lack  knowledge about affirming care
• Being treated with less politeness or consideration than other people
• Facing refusal of rights or services due to one’s identity 

Ignoring

• Being overlooked in classrooms or meetings
• Dismissing sexual or gender identity as insignificant
• Assumption of heterosexual or cisgender identity by default
• Having requests to use correct name or pronouns ignored
• Lack of acknowledgment of the significance of one’s identity  

Emotional Neglect

• Facing indifference to the suffering caused by discrimination
• Having insurance coverage declined for gender-affirming care
• Deprivation of support or assistance due to sexual or gender identity 
• Being told that discussions about identity-related bias are excessive 

Excluding

• Being expelled from home or community upon coming out or revealing identity
• Being restricted to using gender-binary public restrooms
• Consistently being exposed to media featuring primarily cisgender heterosexual characters 
• Having partners excluded from family events 

Misinterpreting

• Having one’s sadness misinterpreted as anger
• Hearing that LGBTQIA+ individuals should not be around children because of their identities
• Facing accusations of predatory behavior when using a restroom that matches one’s gender identity

Controlling

• Being instructed or strongly encouraged to conform to heteronormative culture
• Telling an individual to wear (or not to wear) certain clothing or styles
• Receiving threats of being “outed” if one does not conform or comply  

Blaming

• Being blamed for experiencing traumas
• Being blamed for systemic discrimination-induced inequalities
• Being blamed for the behavior of others
• Being blamed for society’s issues
• Being judged for feeling hurt by discriminatory acts 

Denying reality

• Being told that discriminatory incidents one experienced never actually happened
• Experiencing others denying differential treatment based on one’s sexual or gender identity
• Being labeled as irrational for perceiving bias
• Being told that one is overreacting to offensive comments or jokes
• Being assured of equal treatment despite evidence to the contrary 
• Being dismissed as inaccurate when perceiving instances of discrimination 

 (Harned, 2022)

Impact on Marginalized Identities

 Clearly, the impact of traumatic invalidation on LGBTQIA+ clients is profound and multi-faceted. Ongoing traumatic invalidation is difficult to treat, and members of marginalized groups are likely to be at risk of invalidation and discrimination in daily life (Harned, 2022). Clients may grapple with their authentic LGBTQIA+ identities due to societal invalidation, leading to identity confusion and challenges in self-acceptance, self-worth, and emotion regulation. LGBTQIA+ clients may experience intense emotions related to past or ongoing experiences of traumatic invalidation, which can contribute to anxiety, depression, and other mental health concerns (Harned, 2022). These challenges may be compounded by continued experiences of discrimination and injustice (Harned, 2022).

Traumatic invalidation can undermine trust in the therapeutic relationship, as clients may fear further invalidation from their therapists. Furthermore, traumatic invalidation can reactivate past traumas, intensifying emotional distress. This may manifest as heightened emotional responses, difficulty in discussing certain topics, or avoidance of conversations related to clients’ identities (Meyer, 2003). Active listening and creating a safe space for open dialogue are essential tools for identifying these cues. 

The erosion of trust, both within therapeutic relationships and broader society, can hinder the healing process. Validating emotions and experiences fosters a sense of safety and understanding in the therapy room. Additionally, techniques such as mindfulness and emotion regulation empower clients to process and manage emotions stemming from traumatic invalidation. Exposure techniques can further help clients confront invalidated emotions within a supportive therapeutic context (Harned, 2022).

 Addressing Traumatic Invalidation

 It is essential for therapists to create a validating and affirming space for LGBTQIA+ clients. Recovering from harmful invalidation is most likely when the right support is provided. This is where therapeutic intervention comes in. 

• Supporting clients in checking facts can help them challenge unhelpful trauma-related beliefs and reduce the likelihood of re-experiencing invalidation (Harned, 2022). 

• Discuss risk factors that may increase trauma-related symptoms, such as emotional vulnerability, avoidant coping, and high-risk situations (Harned, 2022). 

• Identify vulnerability factors that increase sensitivity to stress, such as paying attention to physical/biological needs (getting enough sleep, eating, movement, monitoring use of mood-altering substances, etc.).

• Increasing involvement in pleasurable activities, and staying mindful of daily life demands, can help increase resilience (Linehan, 2015). 

• Harned (2022) encourages the use of “random acts of exposure,” combined with “saying yes” to opportunities that increase positive emotions and move closer to feeling freedom from suffering, to reduce avoidance of emotions or isolation (p. 393). 

• Therapists should encourage clients to be mindful of high-stress situations or events (e.g. contact with perpetrators of past traumatic invalidation), and help them learn to reasonably anticipate these situations occurring, rehearse how to safely leave, and/or cope effectively in advance (Harned, 2022).

Some helpful reminders for therapists working with clients with a history of traumatic invalidation:

• Cultivate Cultural Humility: Educate yourself about LGBTQIA+ experiences, terminology, and challenges. Understanding the unique stressors faced by LGBTQIA+ individuals will enhance your ability to provide effective support.

• Validate Experiences: Affirm clients’ emotions, experiences, and identities. Demonstrate empathy and understanding, validating their feelings and perspectives.

• Challenge Biases and Microaggressions: Be aware of your own biases and challenge microaggressions that you may unintentionally perpetrate during sessions. Promote a safe space for clients to share their experiences openly.

• Advocate for Clients: Be an advocate for your LGBTQIA+ clients both within and outside of the therapy room. Support their access to resources and work towards creating a more inclusive society. 

Traumatic invalidation, stemming from a society that perpetuates discrimination and bias, can have profound effects on LGBTQIA+ therapy clients. As therapists, we play a crucial role in comprehending the nuances of traumatic invalidation and creating affirming therapeutic spaces. By affirming emotions and experiences, targeting traumatic experiences, cultivating mindfulness, challenging bias, and advocating for our clients, therapists can support the resilience and well-being of LGBTQIA+ individuals, helping them heal from the impacts of traumatic invalidation.

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Bandermann, K. M., & Szymanski, D. M. (2014). Exploring coping mediators between heterosexist oppression and posttraumatic stress symptoms among lesbian, gay, and bisexual persons. Psychology of Sexual Orientation and Gender Diversity, 1, 213–224.

 Harned, M. S. (2022). Treating trauma in dialectical behavior therapy: The DBT prolonged exposure protocol (DBT PE). New York, NY: Guilford Press.

Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”?: A psychological mediation framework. Psychological Bulletin, 135, 707–730.

Linehan, M. M. (2015). DBT skills training manual (2nd ed.). New York, NY: The Guilford Press.

 Mechanic, M. B., Weaver, T. L., & Resick, P. A. (2008). Mental health consequences of intimate partner abuse: A multidimensional assessment of four different forms of abuse. Violence Against Women, 14, 634–654.

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.

Pieterse, A. L., Carter, R. T., Evans, S. A., & Walter, R. A. (2010). An exploratory examination of the associations among racial and ethnic discrimination, racial climate, and trauma-related symptoms in a college student population. Journal of Counseling Psychology, 57, 255–263.

 Reisner, S. L., Hughto, J. M. W., Gamarel, K. E., Keuroghlian, A. S., Mizock, L., & Pachankis, J. (2016). Discriminatory experiences associated with posttraumatic stress disorder symptoms among transgender adults. Journal of Counseling Psychology, 63, 509–519.

 Spinazzola, J., Hodgdon, H., Liang, L., Ford, J. D., Layne, C. M., Pynoos, R., Kisiel, C. (2014). Unseen wounds: The contribution of psychological maltreatment to child and adolescent mental health and risk outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 6, S18–S28.

Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M. B., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62, 271–286.