Moshe Ben-Yosef, MFT
At a recent LAGPA workshop led by Dr. Mary Andres on the subject of bisexuality, a discussion took place that highlighted some of the struggles that clinicians face in regard to labels of sexual identity. Part of this difficulty is that we work in a field that requires diagnosing and labeling. After all, it is part of our education, it is what managed care demands so reimbursement can be justified, and especially in community based settings where variations of cognitivebehavioral therapy are enforced in order to target and alleviate symptomatic behaviors. However, while individuals who seek treatment regarding concerns about their sexuality or gender identity may exhibit symptomatic behaviors, ultimately their questions are of an existential nature. Given this premise, in what ways can therapists support and validate those questions and give room for the client to find their own answers, without the constraints of labeling?
Not only is labeling and diagnosing an essential part of our field, but from a neurological perspective, humans need to make sense of the world. Assigning labels and grouping achieves the goal of making sense of the things around us. However, the templates we have set up are based on past experiences and knowledge, so that new experiences get aligned with those which most closely resemble them. If we cannot find something with which to compare these new experiences, then we are faced with the task of making new connections and integrating new information. While it is evident that diagnosing and labeling are primary functions, how does that ultimately affect that client who does not feel that they fit within any particular label? How do they go about finding their own truth, and what becomes our role? If someone cannot be labeled, how can they be visible? How do we assist them in creating their own visibility?
As we grow up, are educated and practice in a heteronormative society. It is easy to overlook blind spots that we may have.
First, it would be worthwhile to address the issue that sexuality and gender are still seen linearly. There is a growing acceptance of fluidity, but even then, the understanding is that it is movement that occurs from one pole to another. My family systems oriented lens leads me to view issues regarding gender and sexuality as more than just linear. For example, instead of viewing a person as “4” on the Kinsey Scale, they can be viewed in a particular dimension of their sexuality sphere. Certainly not seeing past a linear concept can contribute to blind spots, because looking at concepts linearly limits movement to only back and forth.
There is also the issue of competency. It would be misleading to assume that any member of the GLBTQ community can treat another member who identifies as GLBTQ or wishes to remain unlabeled. If an individual is only familiar with the labels of GLBTQ and has perceived notions of what each letter within this community acronym is supposed to mean and the behavior that is expected, what are the ramifications in dealing with individuals who do not fit into those preexisting terms and expectations? Without proper training a clinician might not be aware of the blind spots which might prevent them from collaborating with a client on a new truth, as they would try to make sense of behaviors based on past constructs.
There are labels beyond GLBTQ which individuals use to describe the fluidity of their sexuality. In the 1990's Michael Stipe identified himself as queer, and Sophie B. Hawkins as omnisexual. Of course, today there are many more terms which describe fluidity in both gender and sexuality. There is a reason that these new labels are bring created. Individuals are recognizing that current constructs are not only limiting, but by forcing individuals to fit into preexisting boxes in which they do not feel they fit, core parts of their self are being made invisible. What awareness do we have about those terms? How do we balance providing psychoeducation without passing judgment on what is expected?
Clients seek therapy because they are in crisis, and regardless of the situation at the core is usually a question of identity: “Who am I? How will I handle this? What am I supposed to do? And ultimately, will the answers I seek be congruent with the person I am, and the type of action I would like to take?” This is the client's anxiety about their identity. How do we acknowledge its existence while supporting the client's journey to uncover and acknowledge parts of themselves that have been deemed invisible by society? How can we provide a safe, nonjudgmental environment for clients to explore parts that are real to them despite the fact that we may not have a definite label or category to attribute to it? Essentially, what would it take on the part of the clinician to provide the safety and support necessary to allow a client to self identify, be comfortable with that self identification, and feel visible and validated?