Stronger Than Ever: A Counseling Guide for the LGBTQ Community

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Mental wellbeing is often overlooked when it comes to maintaining your overall health, but in fact it is a major component. Some groups face greater challenges when it comes to tackling mental health issues, including the LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning) community. Because of the legal obstacles, social stigmas, and general misconceptions they face every day, not to mention the resulting emotional trauma, the LGBTQ population faces a unique battle for optimal mental health. In turn, it can cause a marriage to face its share of challenges.

Fortunately, there are options for treatment and counseling. This guide will go over the major mental health issues the LGBTQ community generally faces, as well as why members are at special risk. It will offer advice on seeking the best kind of treatment as both an individual and a couple, and conclude with a list of supportive resources for finding help.

What mental health disorders pose the greatest threats to the LGBTQ community?

Anxiety disorders, including post-traumatic stress disorder (PTSD) and depression, afflict about 18% of the American population in general. It’s also common in the LGBTQ community. In fact, nearly half of transgender Americans have experienced symptoms of anxiety or depression, and depression afflicts gay men at six times the rate it does straight men. This can be a challenge on its own, but if both you and your partner are coping with these kinds of inner struggles at the same time, it’s enough to add strain to any couple’s relationship.

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Depression can stem from any number of factors. Many in the LGBTQ community have clashed with loved ones as a result of their sexual identity or orientation, and even years later the pain can linger. It could be caustic language spoken in the heat of the moment that can’t be forgotten. It might be that one or more members of the family has cut off all ties. It could even be that a person hasn’t come out to certain loved ones for fear of being rejected, or worse, ostracized from the entire family. Even someone who has found their lifelong partner and lives a happy life may find it difficult to be completely content if they can’t share their joy with those they’ve known their entire life.

There are also societal issues that can lead a member of the LGBTQ population to feel anxious or depressed. Some may feel reluctant to leave the house due to harassment from the intolerant; others may be deterred by the unwanted stares they receive by dressing as the gender with which they identify. Some may even face problems in the workplace due to their LGBTQ status, whether it’s passive aggression from a coworker or flat-out discrimination that not every state has laws against.

People may attempt to cope with these issues in any number of ways, and unfortunately not everyone knows how to share their inner demons with their partner. Some worry that by telling their spouse their feelings, they would be imposing a burden. It doesn’t necessarily mean they don’t think their partner is trustworthy or understanding — often, their depression has hindered their self-esteem to the point that they don’t know how to reach out.

The LGBTQ community also struggles to cope with addiction issues: an estimated 20-30% abuse substances, and about 25% abuse alcohol. Among the general population, substance abuse is often a coping mechanism to deal with everyday stressors, but for the LGBTQ population it may also be a way to numb the pain of discrimination, prejudice, and even legal obstacles.

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It isn’t entirely uncommon for someone with an addiction to keep it hidden from their partner. If you believe your loved one may be struggling with this kind of issue, keep an eye out for the signs of substance abuse. Never make any assumptions or accusations without careful consideration and evidence. If you do find clear evidence that your spouse is abusing drugs or alcohol, let them know that your concern is about their health, safety, and happiness, and that you want to help.

For some, the darkness is so overwhelming that they consider ending it all. A staggering 41% of transgender people attempt suicide at some point in their lives — a statistic made only more heartbreaking when you consider that the rate for the general public is only 4.6%. This sector of the LGBTQ community often faces a special kind of discrimination and abuse, and studies have shown that people who are victimized, bullied, and otherwise harassed are more likely to commit suicide.

The signs of suicidal behavior are sometimes tough for a partner to recognize, but it’s important to keep an eye out if your spouse seems to be struggling — and especially if they have depression. Never write off threats of suicide as melodramatic or in-the-heat-of-the-moment. Though not every suicidal person will talk about it, for many, a verbal cry for help may come in the midst of an argument while emotions are running high; it’s crucial that if your partner does make some sort of threat or expresses a desire to die, you take action immediately. Bring it up with your partner and, if you think it will be productive, ask a psychiatric professional for guidance on how to proceed. They can help you decide the best way to approach your loved one and whether or not you should seek additional help in arranging a conversation.

Finding help

If you, your spouse, or both of you are struggling with a mental health condition, there are all kinds of options for treatment. Even if you aren’t sure if what you’re going through is depression, seeking a professional opinion is always a good place to start. Depending on your situation, you may opt to head to therapy on your own or instead pursue marriage counseling to work out problems as a couple. A combination of both is also a valuable option.

Look for counselors who describe themselves as LGBTQ-affirming or who have specific training or experience in working with those in your community. Unfortunately, there are many lapses in proper education for treating mental illness within the LGBTQ population, so you want to be sure your counselor has the necessary knowledge to give you the best treatment. You may even find it best if your therapist is also a member of the LGBTQ population.

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If you opt for joint counseling, make sure the therapist you choose is someone both you and your partner are comfortable with. Keep in mind that each person will have different feelings about it: for some who may not be completely “out” to all of their loved ones, it may be difficult to relate to a therapist who has no personal understanding of that challenge, for example. Discuss these kinds of preferences and come to a consensus for not only who treats you, but the course of treatment that’s right for both of you.

Not everyone finds it easy to admit they need help, so be prepared for the possibility that your partner may not be ready for therapy. Though you may have found a counselor who will be able to truly understand your situation, surveys have illustrated that past negative experiences with health care providers sometimes leads members of the LGBTQ community to have a general mistrust of physicians. In other words, your partner may be hesitant to seek therapy because of discrimination that may have occurred even in childhood. The fear of being rejected by a medical or psychological professional can be overwhelming — even if someone truly wants to seek help — and it’s important for you to be understanding.

If you’re having difficulty finding a qualified counselor in your area, the good news is that some LGBTQ-affirming therapists have started offering distance services. Some offer counseling over the phone; there are even those who add a more personalized touch with video chat sessions.

If there is also a substance abuse problem to address, be sure that your counselor knows about this going in. They may suggest inpatient rehabilitation, in which case the partner with an addiction can address both depression and substance abuse problems at the same time. This may mean the other partner will make visits for counseling at the treatment center. You may even continue seeing a counselor following graduation from treatment, or be referred to a qualified (remember: LGBTQ-affirmative) therapist in your area.

Don’t let the darkness fool you into thinking it’s permanent — there is help out there. The following resources are meant to help you and your partner find the best options for your psychological care. You can also reach out to local community centers, LGBTQ-friendly religious organizations, and even local colleges for additional resources and support.

You can reach the (free) National Suicide Prevention Lifeline 24 hours a day, 7 days a week at 1-800-273-8255 to speak to a trained crisis counselor in your area. All calls are confidential.

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