As a result of homophobia, transphobia and minority stress amongst other factors, there is a higher rate of mental health difficulties and conditions in the LGBT+ community compared to the general population. Also, LGBT+ individuals are more likely to be hate crimed and experience trauma in their lifetime so the need for psychological support and therapy is high. However, straight therapists often worry about whether they should work with a gay client or not because of the differences between them. In this clinical psychology podcast episode, you’ll explain why straight therapists should definitely work with gay clients and most importantly what should therapists know working with gay male clients. This is all about increasing awareness and helping the therapy to be more successful. If you enjoy learning about clinical psychology, minority stress and trauma then this is a great episode for you.
Today’s psychology podcast episode has been sponsored by Clinical Psychology: Second Edition. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
What Should Straight Therapists Know When Working With Gay Male Clients?
Something I actually like a lot more than I would ever admit is when someone eventually finds out I’m gay or non-binary, they ask me respectful questions about it. Sometimes these are trauma or clinical psychology-related questions because I talk about those aspects of my past on the podcast a fair bit to help bring the material alive. Or they’re more general questions about life, love and attraction.
As long as you ask questions respectfully then everyone is always more than happy to answer.
Also, straight therapists can absolutely work with gay male clients and any other client from the LGBT+ community. You might need to ask some extra questions compared to straight clients but that’s fine.
LGBT+ people have no unique mental health conditions compared to straight people. They only have different stressors at times because the heteronormative and cissexist world we live in.
In addition, whilst working with a gay therapist is the preferred option for any gay clients (the exact same way how straight men prefer to have a male therapist and so on), there are great advantages to working with a straight therapist. Mainly because if the client has grown up in a very homophobic and anti-gay world then being accepted and listened to by a straight therapist could be immensely powerful in their healing.
Therefore, for the rest of this podcast episode, we’re going to be focusing on the different things straight therapists should be aware of when working with a gay male client.
Why You Shouldn’t Assume He’s As Highly Functioning As He Appears?
This is one of the main things to know about gay male clients (or anyone who has trauma) because all gay men experience differing degrees of trauma by growing up in a heteronormative world where being straight is seen as natural and the default, and being gay is seen as weird or definitely not normal. Therefore, gay men often adopt, internalise and bury the shame this creates and occasionally this leads gay men to not even remember or want to remember what really happened to them in their earlier life.
Personally, another fact I find really interesting as a psychology student so I never fell into this trap, but a lot of gay men play down the importance of early life events on their adult life. This means that therapists are going to need to tease out these themes of trauma as well as shame even if these themes aren’t the presenting problems that the client has when the therapy begins. But there is a more nuanced take on that point that I’ll mention later on.
In addition, something that can happen behind the scenes when a gay man has therapy with a straight therapist is that you two will be talking about the surface-level reasons about why he’s here. Yet because you’ll have a warm, accepting tone, he’ll internalise that acceptance and it will give him something bigger and far more powerful in terms of healing than whatever the male client came in for. Since the acceptance that you’re giving him will go far beyond your words and you are effectively giving him the background for major lasting change in the client’s life. All because unconsciously he would have been preparing himself to be judged harshly because that’s basically all he knows.
I’ve mentioned this before on the podcast but this is why I developed emotional dependency on a friend I made in July/ August 2023 because he was so accepted, he didn’t care I was gay and he really liked spending time with me. For someone who came from a background of never having that and never being accepted or even tolerated, there was a strangely wonderful feeling. And my mental health was great during those few months because I was accepted and I had a friend to go out and do things with. Of course, I took this to the unhealthy level, and the vast, vast, vast majority of clients would never ever do that. Yet I’m telling you this because it shows how powerful being accepting can be.
Overall, this all comes back to not judging your client to be as high-functioning as he appears because underneath the strong exterior, there might be a lot of trauma, pain and hurt that other people have caused him. And that goes for a lot of mental health conditions and trauma experiences. Even before I went for therapy because of my homophobic upbringing and everything that entailed, I was in fear for my life, I was doing a lot of maladaptive coping mechanisms and I looking back I was a wreck at times. Yet you would never ever know it because I was so high functioning.
There’s Going To Be Trauma
Continuing to focus on trauma before we look at shame, another common difficulty about working with gay men is that growing up in certain situations, environments and even the media can lead to different degrees of traumatisation. Unfortunately, a lot of these traumas can include being significantly bullied, not being accepted and even being abused by family, being outed to the local community and being beaten. Then you have the religious angles too where a young person’s community, family or religion might reject their homosexuality (and by extension them) completely.
The results of this trauma can be devastating.
Naturally, any gay man would want to distance himself as much as possible from these painful memories. However, the real problem is for a lot of gay male clients (like I found out) is that you can be as successful and high-functioning as you want but unless you deal with the past, the past will deal with you.
That all led to my breakdown in August 2023 because everything just collided together.
When this trauma work pops up, a logical first step might be to refer the client to a trauma specialist but if you have a good relationship with the client then this might not be needed. My therapists, both times, weren’t experts in trauma work but they still did a brilliant, life-changing job.
There’s Going To Be Shame
I’ve met a good amount of gay men in my life as friends and at social events, and I’ve read online even more. I don’t think there is such a thing as a gay man who have never experienced shame because of the homophobia baked into society, and this is a lot more noticeable when the gay man is growing up. Also, this homophobia is very present in the current world and even men who have amazing, accepting and liberal parents, they’ll still experience shame. All because of the world we live in.
Especially as we all still live in communities and schools that are filled with people (bigots) that have strong traditional beliefs about how men should behave and if they don’t follow these stupid rules they will be bullied, mocked or beaten.
Therefore, there’s a very high chance that your client will feel embarrassed about their past experiences, and they don’t want to stir up their own feelings of humiliation from the past. They’ll be more comfortable avoiding any triggers or memories of these past events, so this leads to shame.
But unless the client can work through these past events then they will never heal.
On the whole, you should know that gay men are great at hiding their true selves and presenting themselves as something they believe the world would want to see. I understand this feeling because I call myself a survivor and someone who has never lived or thrived or really understands who I am. I am a lot of things from a student, a youngest child, an aspiring clinical psychologist, writer, podcaster, publisher and on and on. But if you had to ask me who I am really, but I have no idea.
In my personal email drafts there’s a small message I wrote out for my best friend that describes the effects of my past perfectly and why I have no idea who I actually am and I will actually share it here. It’s interesting and it really captures the extreme ways that gay male clients have to present themselves. I was never allowed to be gay in my childhood, teenage years and most of my young adulthood, so this is the result.
For context, me and my best friend had only known each other 3 months and they came round to sleep over for a night. And they were the first gay person and friend my family had ever met before.
That's why I wanted them to meet you. The real reason I like you as a friend is because you're just wonderfully you. You can be gay as fuck at times and it's great. You wear feminine and masculine clothes without a second thought and you couldn't give a shit if you look gay. And I love that, because I think that's who I would have liked to have been as a kid.
But that kid was slaughtered and murdered and burnt alive a long time ago. That kid had every bone in his body shattered and his screams were stomped out when no one helped him. So he died alone, terrified and murdered.
He would have a beautiful kid though.
So everything I’ve ever done to is survive because I was so scared and I perceived that I had to present myself in a certain way to prevent anything bad happening.
In addition, this idea of presentation and making sure that you fit in can happen in two different ways as well. Firstly, gay men feel like they have to be successful and excel in the professional world so that the professional success and job can hide the feelings of inadequacy that are buried in him because of the bullying, trauma and homophobia. And one error therapists can make here is that because professional success is high then the client’s personal well-being is high too.
Secondly, gay men have always stressed physical appearance in the community and the rise of social media has done nothing to stop this trend. This has actually only increased the need for gay men to look perfect, strong and like they’re not experiencing any difficulties at all. As well as they have the idea that there is only one “right” way to look.
Ultimately, it’s easy for a straight therapist to be fooled that a gay male client is perfectly fine without any trauma because all they see is this socially accepted version instead of the client’s true self.
One way how a therapist can dig past the mask and presentation is to ask about the client’s coming out, who he told about his shame, his experiences of bullying and how he used these experiences to define himself. Then before you reassure him, you might want to stay with the pain and explore how it continues to impact his daily life. In a way you’re exploring how his younger self is different from his current self and sense of expression, so as this conversation goes on you’ll start to see the real him.
Help Him Find His Way Towards Healing
Pushing away the memory of the trauma to one side is the best way that a lot of gay men have learnt to deal with their mild as well as significant traumas, and they keep moving forward with their lives in hopes that one day it will get better and they’ll live more peacefully. This is typically done by distancing himself from his physical feelings and using disassociation and when your client becomes more involved in the therapy process, it’s natural to ask what he’s feeling on the inside or to use somatic techniques.
If the client freezes when asked these questions or if they don’t trust what listening to his body might mean, then this is normal and okay. This is just something you’re going to have to work with him and he’ll open up in time.
On the whole, your client needs to trust and be encouraged by you so you can do the healing work with him. And sometimes, there will have to work around his presentation and his body, and your client might feel like his body is betraying him because he might have been perceived by others as more effeminate than other boys or he might have struggled with sports. So the idea that he needs to use his body, listen to it and use somatic techniques (if that’s something you’re doing in therapy) might be terrifying or he might be concerned about being retraumatised. This is why you’re important, because as a therapist you provide a safe space for your clients to use and practice these strategies and techniques and they can draw on their own strength.
All leading the client to heal, be delighted that there is hope for a better future and the client might even be grateful for your guidance. If this is the case, then I love the idea of CBT pie charts so you can show the client that therapists give the client the tools and techniques but it is them that actually does most of the work with the therapeutic change needed to improve their lives.
Clinical Psychology Conclusion
Overall, we’ve covered a lot of great content in today’s podcast episode that will help straight therapists to understand gay male clients a lot more. The lessons from this podcast episode can be boiled down into make sure you trust yourself and your skills to help your client heal, explore how the client consciously as well as unconsciously tries to fit in with their socially accepted presentation and learn the client’s history of being bullied.
Honestly, those three things might sound simple and working with gay male clients as I mentioned earlier. As one myself who’s been through therapy twice for homophobia-related trauma and I’ll go to therapy within the next two months (there’s a waiting list) for sexual violence, us gay male clients aren’t anything unique. We certainly aren’t special when it comes to clinical psychology, and we have a lot of the same mental health difficulties and conditions as other people. It is just the reasons, minority stress and the factors we experience that make us different.
And being aware is a massive bonus and very helpful in therapy.
But as long as you’re kind, accepting and the same amazing therapist that you are with straight clients, you’re going to be great at helping gay male clients.
And who knows how many extra lives, you’ll improve, help and maybe save by being accepting.
My guess is, a lot more than you ever thought possible.
I really hope you enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
Clinical Psychology: Second Edition. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
Have a great day.
Clinical Psychology References and Further Reading
Alexander, C. J. (2020). Working with gay men and lesbians in private psychotherapy practice. Routledge.
Balasubramaniam, H., & Alex, J. (2024). Internalised Homophobia and Interpersonal Relationship: A Systematic Review. International Journal of Indian Psychȯlogy, 12(1).
Ellis, A. E., Meade, N. G., & Brown, L. S. (2020). Evidence-based relationship variables when working with affectional and gender minority clients: A systematic review. Practice Innovations, 5(3), 202.
Gill, S., & Randhawa, A. (2021). Internalised homophobia and mental health. Indian Journal of Health & Wellbeing, 12(4).
Hoy-Ellis, C. P. (2023). Minority stress and mental health: A review of the literature. Journal of Homosexuality, 70(5), 806-830.
Malley, M., & Tasker, F. (2020). “The difference that makes a difference”: What matters to lesbians and gay men in psychotherapy. In British Lesbian, Gay, and Bisexual Psychologies (pp. 93-109). Routledge.
McConnell, E. A., Janulis, P., Phillips II, G., Truong, R., & Birkett, M. (2018). Multiple minority stress and LGBT community resilience among sexual minority men. Psychology of sexual orientation and gender diversity, 5(1), 1.
MONGeLLi, F., Perrone, D., BaLDUcci, J., Sacchetti, A., Ferrari, S., Mattei, G., & Galeazzi, G. M. (2019). Minority stress and mental health among LGBT populations: An update on the evidence. Minerva Psichiatrica, 60(1), 27-50.
Ong, C., Tan, R. K. J., Le, D., Tan, A., Tyler, A., Tan, C., ... & Wong, M. L. (2021). Association between sexual orientation acceptance and suicidal ideation, substance use, and internalised homophobia amongst the pink carpet Y cohort study of young gay, bisexual, and queer men in Singapore. BMC public health, 21(1), 971.
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