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  • Writer's pictureAlicia Guerrero

New Blog Post on!

Earlier this Fall I was approached with an interview opportunity by the folks at a new company and website that is compiling a database of clinicians nationwide who provide "Affirming Mental Health Care for the LGBTQIA+ Community." I was honestly thrilled to take them up on the chance to discuss LGBTQ+ mental health and relationships, give a little background on my practice, and become part of their important mission, so it was a resounding "Yes, please!" from me!

Since then I've been excitedly waiting for their site to go live (which it did earlier this month), and I'm really excited to share my interview, "Navigating Narratives: A Therapist’s Approach to LGBTQ+ Identity and Relationships" with everyone as my last blog post of the year.

So, without further ado... here it is!


1. Can you share your approach to supporting LGBTQ+ individuals dealing with gender identity issues?

Very often in my experience with clients, they are missing a safe, confidential space in their lives to share their story (including their gender identity journey) and perhaps process trauma, so I try to start there with every new client who begins therapy with me. I do everything I can to create a non-threatening space where they will be heard, believed, and accepted during our sessions- and remind them they only need to share what they feel ready to, there’s no rush!

2. What specific strategies do you employ to help clients navigate the process of exploring and understanding their gender identity?

As a narrative therapist, a large part of my work with clients includes identifying the common narratives they’ve adopted throughout their life so far, and exploring how those may no longer be serving them in positive ways. This is often due to the fact that those narratives usually support heteronormative societal culture rather than LGBTQ+ or BIPOC culture, or perhaps because a previous narrative helped protect them during traumatic times, but is hindering them in some way now that the traumatic incident has subsided.
A simple example is considering how holding onto the “I am/was a victim” narrative can be very limiting, compared to “I am a survivor.” Another one that comes up frequently is the “should” narrative. Anytime a client feels they “should” be thinking, behaving, or existing in some specific way, we explore where that “should” is coming from. Is this something they feel they “should” be doing according to society, their family, their partner, internalized religious beliefs, or what exactly? When we really unpack that, the client is often able to release themselves from that narrative because they see how unaligned it is with their own beliefs, morals, goals, and/or identities. And when clients inevitably have old, unhelpful narratives resurface in their mind, I remind them not to go “shoulding all over themselves”- this is their life and their story, they don’t need to conform to anyone else’s ideas.

3. Could you share a success story or case study that highlights the positive outcomes of your work with an LGBTQ+ individual struggling with gender identity issues?

Honestly, my clients’ stories are their own to tell, so I prefer not to go into specifics- but I’ve received feedback from many clients that therapy provided them a safe, non-judgmental space to finally explore or acknowledge how they truly felt, sometimes even space to finally speak something aloud for the first time. This experience is of course not only exploratory, but cathartic and healing too. It reminds me of the Maya Angelou quote “There is no greater agony than bearing an untold story inside you.”

4. Could you share insights into the common relationship issues that arise among LGBTQ+ couples, whether monogamous or non-monogamous, and how you typically work through them in therapy?

First I’d like to highlight that queer couples share many of the same struggles that straight couples do- such as frustrations over not feeling heard or how chores are split in the home, or feeling like the “spark” has gone out several years into a relationship or marriage. But in LGBTQ+ relationships specifically, traditional gender roles (and thus, the traditional power dynamic) are often tossed out the window, so it’s not uncommon to find a power imbalance causing contention for couples.For instance, when one partner has already “come out” in all areas of their life and the other has not, the power tips towards the partner who is out. Let’s say this is the same person who’s older and/or makes the most money in the relationship, this creates further imbalance. So the “less powerful” partner may feel pressure (or pressured) to take on all the domestic roles in the house despite possibly having a full-time job themselves. This usually leads to feelings of underappreciation, exhaustion, and resentment- and may activate previous trauma or attachment wounds that partner has as well. This will inevitably show up in multiple areas of the relationship. The couple may initially come in because they are “fighting over the cats,” “have intimacy issues,” or they “can’t agree on anything,” but after unpacking things, a dramatic power imbalance may be at the heart of things.

5. How do you create a safe and judgment-free space for your LGBTQ+ clients, especially when discussing their relationship dynamics?

There’s no magic wand to immediately achieve this – feelings of comfortability and safety come with time. So I usually invite clients to start wherever feels natural and encourage them to only share what they feel ready to. When combined with natural rapport building skills, this creates that ideal safe space on its own, and it’s usually not long until clients feel secure discussing their relationship dynamics, sexual desires, or sexual dysfunction. Very often in fact, it becomes the space they feel most comfortable having these conversations.

6. What techniques or strategies do you use to help couples navigate the complexities of their relationships, particularly when addressing issues related to monogamy and non-monogamy?

Couples may seek therapy because they’re considering consensual non-monogamy (CNM) and one partner is more comfortable or experienced with this lifestyle already, while the other partner might come from a traditionally monogamous upbringing and isn’t sure they’re ready to open up the relationship. For these couples, I usually take on the role of clarifying common misconceptions about CNM and helping stretch traditional/heteronormative concepts to include room for non-normative lifestyle choices, whether that include multiple partners, multiple relationships, fetishism, kink, etc. Additionally, sometimes couples have experienced betrayal trauma (which is possible within a monogamous or CNM relationship), and feel they simply aren’t able to move forward until it’s fully processed, healed, and trust is restored.

7. Given the evolving landscape of relationships and societal attitudes, how do you stay informed about current trends and research related to LGBTQ+ relationships, and how do you incorporate this knowledge into your practice?

I’ve found that my clients keep me very much in the loop as far as current trends, however I also regularly meet with other queer-affirming colleagues, which helps me stay connected to what other clinicians have been noticing in their own therapeutic spaces.I’m also active on social media which keeps me in touch with LGBTQ+ news updates here in the US and globally, which is especially important with the nonstop changes in legislature and ongoing threats to the rights of LGBTQ+ and gender non-conforming folks. Though therapy is not inherently political, my clients are welcome to bring anything in the therapeutic space, so I try my best to stay as informed and open as possible.

Thanks so much for reading y'all! Please feel free to share any questions or comments below and if you're interested in browsing posts of interviews with other LGBTQ+ affirming clinicians, I highly recommend checking out QueerPsych's blog page here!

-Wishing you peace, good health, and a wonderful New Year!


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