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Key points
- Don’t be quick to assume why your client is coming; more will be there than meets the eye
- Peel back the layers—he may look good but that doesn’t mean he’s not hurting
- It can be humiliating for your client to share his pain… and to see it
As I spend more time teaching mental health professionals about working with gay men, I continue to be appreciative of the vulnerabilities and questions that heterosexuals have for me. I’m always thrilled to have people interested in serving their clients best by asking me questions they may not feel comfortable asking out loud.
The most popular question is whether it is okay for a heterosexual therapist to work with a gay man. The answer is undoubtedly: yes! Despite the fact that many gay men do feel safer working with a gay therapist, or enjoy the fact that there are no explanations needed regarding the gay subculture, there are actually advantages to working with a straight therapist. Growing up in a world where acceptance has been challenging and editing has been a norm, love and acceptance from a heterosexual is healing. When a client has the benefit of receiving this from you, it carries enormous healing potential for him. To be loved and accepted by you may be more significant than you realize.
The most important consideration when seeing a gay man in therapy? Never assume he’s as highly functioning as he appears.
Gay men experience varying degrees of trauma merely by growing up in a world where being heterosexual is normative. They often then take that shame and seek to bury it, even to the point of not consciously remembering or wanting to remember what really happened to them. Many if not most gay men will downplay the importance and influence of these early experiences in their adult lives, and therapists need to be able to tease out the themes of shame and trauma, even when those themes are not the presenting problem when the client began therapy.
There exists something I think of as “behind-the-scenes work” that takes place when a gay man enters into therapy with a heterosexual clinician. You may be talking on the surface about the client’s reason for seeking you out; but the acceptance he will absorb in your tone will give him something bigger and far better than what he came in for. This acceptance goes far beyond words and will provide the background for substantial lasting change in the client’s life, as unconsciously he will have been preparing himself for being judged.
It’s about shame
I don’t know a gay man who hasn’t grown up without experiencing shame, whether it’s for being different from other boys—or for knowing he’s gay and “shouldn’t” be. And don’t think that’s an artifact of the past: men growing up in the present, even men with liberal and accepting parents, will still experience and internalize shame. Modern communities and schools are still filled with people with traditional views of how boys should behave, and not measuring up to those standards results in being bullied or mocked. Your clients undoubtedly feel embarrassment about these past experiences and don’t necessarily want to stir up their own feelings of humiliation from these times. They feel more comfortable avoiding any mention of this past, which in turn leads to shame.
Gay men are masters of hiding their true selves and presenting a version of themselves they assume the world wants to see, and it’s easy for a clinician to be fooled by their presentation, where a socially accepted version is presented rather than the truest expression of the self.
What you see isn’t necessarily what is there
This subterfuge happens simultaneously on two levels:
- Gay men have always stressed physical appearance in our community; the rise of social media means the expectation of how to look is stronger than it used to be—and shows men the most beautiful young men preening themselves, which they and gay men across the globe have internalized as the only "right" way to look.
- In the professional world, gay men may feel compelled to excel. His job and his success may mask the feelings of inadequacy that he carries inside, and many therapists make assumptions connecting professional success with personal wellbeing.
Here your job as therapist is to dig deeper. Ask about his coming out, his experiences of being bullied, who he told about experiences he interprets as shameful, and how he used these experiences to define himself. Before jumping in quickly to reassure him, stay with the pain, keep with it, and explore how its remnants are played out in his daily life. Explore how the younger version of himself differs from the current version, and explore what still gets carried out, either externally or internally. You will see the real him, and he can shed the armor he’s been carrying around.
It's also about trauma
Another issue common in working with gay men is the ways in which growing up gay has included being traumatized. Sadly, for some, the traumas of being significantly bullied, beaten, outed to the community, and not accepted by immediate family causes lasting pain and trauma. And if they are part of a religious or ethnic community that rejects homosexuality, the results can be doubly devastating.
Why wouldn’t your client try to distance himself from these painful memories?
I’ve worked with several high-functioning successful gay men who have put their pasts behind them and have excelled in their lives and careers. But as any psychotherapist knows, sometimes the pain from the past catches up and needs to be dealt with. Of course, a referral to an expert in trauma makes sense, but if you have a good bond with your client, don’t assume a referral is necessary; as I mentioned previously, there can be dramatic healing based on acceptance from a straight clinician. If you still have concerns, then you might refer him to a trauma expert and share the case. The client may want to continue seeing you to check in on what his trauma work is bringing up for him.
Help him feel his way to healing
The best way most gay men have learned to deal with both mild and significant traumas occurring as they grew up is to push memory of the trauma aside—due to humiliation—and keep moving forward with hopes of getting to a more peaceful way to live day-to-day life. Your client has most likely done this by distancing himself from his physical feelings and using disassociation. As your client becomes involved in the therapy process, it’s natural to ask what he is experiencing inside, or to use somatic techniques.
It isn’t unusual for him to freeze in these moments, or not trust what listening to his body might mean. In my own work with many gay men, I encourage my client to pay attention to and rely on these sensations, and begin to trust that within himself is an awareness and resourcefulness that can help him focus on strength and wellbeing. I’ve created hypnotic scripts focusing mindfulness and have found them useful.
It takes encouragement and trust from your client to allow you to begin the process of using guided meditations or mind/body techniques to foster growth and wellbeing. He may have previously viewed his body as betraying him based on being perceived as more effeminate than other boys or having struggles with sports, so the notion of using his body to help him along may initially bring up fears of failure or of being retraumatized. As you are able to guide him to a space of safety and utilization of inner resources, he will be delighted and perhaps grateful for your guidance.
Tips:
- Ascertain the client’s history of being bullied
- Explore how client consciously and unconsciously tries to fit in by not being called out
- Trust that what you have is ample to help your client heal
Your goal is to normalize these experiences in order to free him from playing out these hidden aspects of his self, to bring out his true self and be authentic as well as more loved by himself and others.
