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Seven Tips for Working with Folx in the LGBTQ+ Community

From the Perspective of an Ally*

Over the past 1.5 years, I have had the great privilege of serving as the primary therapist for most Carolina House clients at The Estate, our six-bed, gender-inclusive residence. To say it has been a process of growth and learning would be an understatement. After all, I am a cisgender, heterosexual, white woman – in other words, I’ll never truly understand the life my LGBTQ+ clients lead and the unique challenges they face as they navigate eating disorder recovery. That said, I’m fortunate to be able to share some of the lessons I have learned, to assist others in the future.

  1. Please don’t let this post, and my voice, be the main place you learn about this. Go and seek out voices within the LGBTQ+ community. Here are a few places to start: Let’s Queer Things Up from Sam Dylan Finch (https://letsqueerthingsup.com/), Trans Folx Fighting Eating Disorders (https://www.transfolxfightingeds.org/), and Decolonizing Fitness (https://decolonizingfitness.com/). This is the tip of the iceberg; dig in and learn all kinds of things from folks who live these experiences and are generously sharing their knowledge.
  2. Believe your clients: This is solid advice regarding ALL your clients, including those outside the LGBTQ+ community. When your client has an identity that society has tried to oppress, believing them becomes absolutely essential to their life and recovery. It is amazing how far “I see you, and I believe you, and you matter” can go in a therapeutic relationship, and far too many of these folx have been thoroughly denied throughout their lives.
  3. Remember that your client sets the pace. Something that has been most challenging for me at times is slowing myself down when working alongside a client in the process of coming into their full identity. I get so excited for them to have the opportunity to be themselves that I’m practically ready to lead a parade through their life! But that’s incredibly unhelpful in the end – rather, what is essential is providing space for your client to be safe in setting their own rules, their own pace, and their own goals. Maybe they’re ready to be out to their family; maybe not. Maybe they’re ready to introduce new pronouns to the community; maybe not. Maybe they want to start a form of transition – maybe they aren’t ready yet; maybe they never will want this. Which brings me to my next point…
  4. Make no assumptions about what it means for a transgender or gender-nonconforming person to transition – or if they want to transition at all. Perhaps they are exactly as they wish to be, and it’s actually everyone around them who needs to transition their own thoughts and perceptions! Additionally, remember that not all transitions are medical – there are so many options for clients to explore their gender identity that are impermanent and not the least bit medical, and many are really fun and fully available while in treatment. Also, treatment providers need to be fully supportive and affirming around transition processes, whatever they may be. Please get to know who in your own community can help clients through these processes. This will be essential.
  5. Body Dysmorphia =/= Gender Dysphoria! While this seems obvious, it’s an important reminder that while many folks in gender-diverse identities may experience high levels of body discomfort, there may be absolutely nothing dysmorphic about it. Additionally, for transgender and gender-nonconforming folx who have an eating disorder, their behaviors may or may not have been about altering their body to fit their gender. A misperception I had when I started working with this amazing group of people was that their eating disorder behaviors were almost always in service to their gender dysphoria. While that is sometimes true, the (very) little research we have indicates that it’s not so common. That said, it’s a good reminder to explore with all our clients what need their behaviors are meeting.
  6. Upon assessment, remember to collect necessary information – not information that fulfills your personal curiosity. As standard operating procedure, I ask every client their assigned sex at birth (in those words), their gender, their sexual orientation, and their pronouns. It does not matter what their intake paperwork says, what they are wearing, or how they are presenting – each client gets asked the same questions. Later in the assessment, I ask all clients about their medical histories, including major surgeries. That’s it. I never need to know more than a client wants to tell me about their body and its parts – but I’m always open to them sharing anything with me, of course. I also share my pronouns at the beginning of groups and am trying to remember to do so more regularly at the beginning of therapeutic relationships. I’m not perfect – but I’m working! Which brings me to my final point…
  7. Be humble and ready to fumble. When I heard these words from Ericka Hines at the BEDA Conference several years ago, I knew immediately that they were essential to my practice of inclusive, intersectional therapy. Wow has that ever proven to be right! I have made countless mistakes while learning, and I hope I have shown humility and grace when I’ve done so. I work hard to quickly apologize and move forward, and not make the mistake worse by making it about me being in my feelings! This means having peers I can consult with and doing a lot of my own work to ensure that I’m always serving my clients best.

 

There are so many more lessons I could share from this work, but these are probably my top seven – at least for today! I end every talk with a call to action, and that call brings me to the asterisk next to the word ally.

Being an ally is something that involves action – you must do the work to support the community. These lessons and this labor cannot be left to the LGBTQ+ community alone; it’s essential that those of us with a million intersecting privileges carry this information forward. Additionally, ally is not an identity we can claim – it is something that, at best, we can earn, and only people in-community can determine if we have.

About Rachel Porter, PsyD, CEDS

Rachel joined the staff of Carolina House in 2008, after completing her doctoral degree in Psychology at Nova Southeastern University in Fort Lauderdale, FL. Rachel became interested in aiding persons struggling with eating disorders midway through her coursework at NSU when she began working as a Counselor at The Renfrew Center. As she approached the end of her scholastic career, Rachel helped to develop a pre-doctoral psychology internship program at The Renfrew Center and was one of the Center’s first interns.

Rachel has experience in facilitating and forming different psycho-educational and process groups and enjoys group therapy as a primary modality for change. While at Renfrew, she developed Cinematherapy 1 and 2, a therapeutic group which incorporates film as a vehicle to explore inter- and intra-personal issues. She also developed a beginner’s Power of Now group utilizing mindfulness as a primary building block to change.

Along with eating disorders, Rachel has experience with neuropsychological testing and has worked with children classified as Severely Emotionally Disturbed. She utilizes a variety of different psychotherapeutic modalities and techniques, including family and group therapy, insight-oriented psychodynamic therapy, cognitive behavioral therapy, and existential therapy. She is interested in incorporating Dialectical Behavior Therapy into her individual therapy as an adjunct to the mindfulness skills she teaches and practices.

Outside of work, Rachel enjoys hiking through the change of seasons, movie-going, reading, cooking, playing with her cat, and listening to music.

View all posts by Rachel Porter, PsyD, CEDS