M wasn’t clicking with their new therapist, and they just couldn’t figure out why.
They were both people of color, something that M had specifically sought out in the hopes that their shared identities might strengthen their connection and improve the quality of their sessions. But after a few sessions, M, a 27-year-old fishmonger who lives in Minneapolis, didn’t feel like they were getting anywhere with the specialist they’d chosen.
M would try to talk about behavior that troubled them, like their substance use and their pattern of starting fights with family members for attention, but their therapist would always respond with vague affirmations and empty platitudes. This frustrated them to no end.
“[It was] the kind of positive self-talk you might see on Instagram,” M told VICE. “She mentioned something like, ‘We are all broken vessels, and cracks are how the light gets in.’ And I was like…lol but I’m literally putting my job in jeopardy because I can’t stop spiraling, and I kind of need a wake-up call more than I need support around my inherent goodness?”
The therapist, who was straight, also seemed to fixate on M’s queerness, as if the reason they engaged in all of this problematic behavior was because of internalized self-hatred, and all they needed to change it was a little self-love.
“It was as if she thought I’d never considered that my trauma could have something to do with my queerness,” M said. “I actually think about that often and usually to creative and generative ends. I don’t think that the answer is to vapidly accept and affirm my queer and transness. I don’t seek out therapy to affirm those parts of my life. That’s why I have friends and community. I seek out therapy to help me untangle deep knots in a safe space.”
M’s problem might seem counterintuitive. In a world where queer people are marginalized, isn’t an affirming therapist a… good thing? It feels almost sacrilegious to complain about this, considering how American psychiatrists considered homosexuality a mental illness up until about 50 years ago, and how upsettingly common conversion therapy and transphobic gatekeeping practices still are. Perhaps that’s why this problem is rarely discussed publicly. But queers aren’t saying they want to return to the dark old days of electroshock therapy. They’re just asking for their therapists to push back on their bullshit, the same way they would with any patient.
The issue might be one of cultural competence, which writer Nick Keppler defined as a therapist’s “ability to work with people of different backgrounds without falling into condescendence or simplification” in a 2017 VICE article about how to break up with your therapist. Cultural competence is vital, explained Ruth R. Linden, the president of healthcare navigation agency Tree of Life Health Advocates, in that same story, for any therapist-client relationship to work.
So, if it’s not working?
“Then it is time to leave,” said Linden, “even if you can’t put a finger on what’s not right.”
For June, a 27-year-old leatherdyke from Brooklyn who wants therapy to be a transformative process that helps her grow, unconditional affirmation is anything but helpful.
“The first therapist I started seeing never asked me questions, never tried to call me on my bullshit,” June told VICE. “I need to exist as a well-rounded person in the world. That means I am not going to be right 100 percent of the time. I’m not going to make the best decisions 100 percent of the time. Part of being an adult queer person who wants to unlearn non-consensual power structures and stuff like that is learning how to own up to your own shortcomings, find answers, and better yourself. That’s really the only reason to go to therapy, in my opinion.”
There are certainly instances where a therapist’s super affirming technique can be a good thing, welcomed by their queer and trans clients. McKenzie, a 58-year-old trans woman from New York City, told VICE that it was actually quite helpful to have an outside voice affirming her gender during the first stages of her transition, when she needed all the validation she could get.
As their sessions wore on, however, McKenzie grew tired of this unconditionally validating approach. It’s not that she doesn’t want her therapist to affirm her gender—that part’s fine! It’s just that she wants to trust that her therapist will challenge her on her more questionable thoughts and behaviors so that she might grow and change as a person.
“Just because it feels like the world is critical of me doesn’t mean I need affirming all the time,” McKenzie told VICE. “I wonder if [my therapist was] trying to bolster me up in a transphobic world. But [it came] at the expense of pushing me to examine my life, my actions, and my feelings a bit more critically.”
Other individuals interviewed for this story expressed similar frustrations with therapists who seemed to think that their clients needed identity affirmation above all else. They noted that sometimes this fixation on their queerness takes focus from their deeper-seated issues and behaviors they’d like to change. Kaye, a 29-year-old musician from Brooklyn, told VICE that she has grown especially tired of this.
“It’s gotten to the point where I’ve had to point blank ask them if there’s anything they think I’m doing that’s self-destructive or worth examining, and I get nothing out of it,” Kaye said. “[It’s like they treat] transition and queerness as both a monolithic excuse and absolute solution for any problems I face.”
Failing to see a client for all that they are can have major consequences—to say nothing of how much time and money the client will be wasting week to week. If all a therapist does is affirm a queer patient out of fear they’ll shatter their fragile queer being with the first bit of criticism, that patient will never grow and develop as a person. They might become the worst version of themselves, wreaking havoc on their own lives and the lives of everyone they love, and all with the tacit endorsement of their unconditionally affirming therapist.
If your therapist isn’t quite challenging you the way you think they should and you think it might have something to do with you being queer or trans, remember that you can always bring that up with them. I did this a few months ago with a therapist who I felt was not adequately pushing back on some of the behavior I described during our sessions. I suspected his reluctance to do so might have had something to do with my being trans, and him not knowing how to treat me without explicitly affirming me.
Weekly therapy is expensive, so I considered ending our sessions, but first I wanted to see what would happen if I raised this problem with him. I told him that I felt like I was just monologuing about my life with no intervention and that I needed him to play a more active role so that I might gain insight into how I’ve responded to stressful situations so that I can respond more healthily in the future. I made it clear that this was important to me and that it was something I expect from my therapist. He clearly heard me, as the quality of our sessions and the insight I gain from them has improved tremendously; I can’t recommend addressing the problem with your therapist before you try anything else strongly enough.
But if that doesn’t work?
“It’s never too late to find a new therapist,” June said.
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