3 Questions LGBTQ+ Persons Should Ask Potential Therapists

By: Sarah Westermann

Despite an increase in acceptance of LGB identities within the counseling field, finding a Queer- or trans-affirming therapist can still be a challenge. As a Queer counselor, I am in a special position to help you begin your journey towards finding a sensitive and capable therapist. 

You can ask the questions listed below at any point, but it is especially helpful to ask your therapist these questions during a consultation or during the initial session to gauge their ability to provide competent care.

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1. “Do you have experience working with [insert LGBTQ+ identity]?”

If your potential therapist says they have never worked with the LGBTQ+ community that may be a sign that they shy away from topics of gender and sexuality with current clients or that they avoid taking on clients from the LGBTQ+ community. More discussion is needed to determine if this therapist can provide appropriate services.

2. “What training have you received on issues related to [insert LGBTQ+ identity] mental health?”

Having an affirming therapist doesn’t just mean that they are accepting of your identity, it also means that they are knowledgeable on the issues that the LGBTQ+ community faces. This does not mean that the therapist will know everything about your identity, but they should be knowledgable about and sensitive to the basic terms used in the community (i.e. knowing what cis- and trans- mean and understanding how to introduce pronouns “I go by she/her”). Your therapist should also recognize and acknowledge homophobia and transphobia that exist in our society today. You should also avoid therapists who use outdated terms such as “transves****” or who ‘forget’ to use your preferred pronouns.

3. “What is your position on “conversion therapy”?”

Both the American Psychological Association and the American Counseling Association have spoken out again the use of conversion/reparative therapy to ‘change’ the sexual identity of an individual. Conversion therapy is considered unethical and harmful. If your therapist expresses positive or even neutral feelings towards conversion therapy, leave as soon as you feel comfortable doing so. A therapist that believes in ‘conversion therapy’ has a fundamental misunderstanding of LGBTQ+ identities and will not be able to provide you with appropriate care. If your therapist is neutral towards the topic or does not know what ‘conversion therapy’ is then this therapist does not have the competencies necessary to provide you with sensitive care. 

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Reaching out for therapy takes bravery and asking these questions takes additional courage and vulnerability. Finding the courage to discuss sexuality and gender can be daunting, but doing so can lead to a richer relationship with an affirming therapist. 

Discussions on trans- or Queer-affirming care don’t end with the first session or consultation, it is an ongoing conversation. The questions listed here are just the starting point for further and deeper discussion.

Fatphobia and a Global Pandemic

How many weeks has it been since the world came screeching to a halt and we all sequestered ourselves at home to save the world? 40 days? Who’s counting? 

Through all of the anxiety and collective trauma of a global pandemic- one thing remains clear- people are more terrified of becoming fat than dying. 

How quickly did folx begin to use the pandemic as a tool to tout fatphobia through pushes to use this time to lose weight or diet. Others used the global trauma where lives are being lost to suggest that your diet can protect you from contracting COVID-19 (it can’t.). 

Choosing to participate in a push-up challenge with your friends, dieting, counting calories, or downloading weight loss apps is your prerogative, but I ask those who are-- why? We have been sold a bald-faced lie that diet will save us from death. The biggest lie we’ve been told is that folx in larger bodies die sooner than those in thinner bodies. Research indicates, though, that those in higher BMI categories live longer than those in the “normal” weight range. (Huge quotes around normal because that is a totally made-up notion). What kills folx in larger bodies? Fatphobia. 

As we sit in our homes, were sitting with things we may not have unpacked yet within us. I have so much empathy for folx that are continuing to diet or use exercise to punish or harm themselves. Diets suck, they don’t work, and counting calories is boring. Exercise is wonderful when done joyfully and from a place of love, not punishment. I can feel wholeheartedly how the stress and trauma of quarantine, job-loss, empty shelves at the grocery store would cause one’s disordered eating or eating disorder to rear its head. What I have so much anger towards is folx using this time as a platform for fatphobia- whether it’s veiled through “funny” *not* funny memes about gaining weight during a quarantine, or it’s through the promotion and sale of products that are the diet culture equivalent of snake oil. 

During this time, I ask you to invite more gentleness with yourself and your body. Allow it to change during this time because your body is doing all it can to protect you. And that protection may be food. That’s okay. I also ask that you check-in with how you may be harming fat folx in your community. That meme that you shared with the fat joke may be harmless to you, but it is a dagger to those who’s body you’re making the butt of the joke. Ask yourself what purpose sharing your workout on social media serves. Would your workout mean the same if it was for you alone? Does sharing that workout alienate fat folx in your life? 

We are already participating in beautiful altruism during this time by staying home and wearing masks for vulnerable folx we may never meet. Participate in altruism by ending your personal promotion of fatphobia.

Finding Anti-Diet Community

Seeing yourself in others is imperative to breaking free from diet-culture.

In the iconic, girl-culture clique comedy Mean Girls, the act of solidarity in body hatred and connection through oppression is clearly portrayed when the girl gang and new girl Kady stand by the mirror poking and prodding at their “less than perfect” form. The teens one-by-one remark on a body part they hate. When it’s new-girl Kady’s turn, she pauses- perhaps without a fault to dole out- and she reluctantly remarks that her breath stinks in the morning. The other teens sigh in relief, as if to say, “whew, she is one of us.”.

It is in the vernacular of all womxn to have language around what body parts they loathe, what diet they’re currently trying and how best to hide their fruit-labeled body shapes behind the “right”silhouette. (this is utter bullshit- where the horizontal stripes!) And when one finally drops the self-hate, the tedious time it takes to body-check, self-scrutinize, weigh out grains of rice on the food scale, it’s hard to find a group of friends where these actions aren’t part of the bonding experience. 

This isn’t to say that all womxn everywhere only spend time together scrutinizing themselves. But, it does happen, ever so subtly in our everyday interactions with others. How we discuss what we ate over the weekend, “were you ‘good’ this weekend?” as if our food choices could damn us to an eternity in Hell. Or how we debate over what diets or “lifestyle changes” (EYE ROLL) are best, swapping tips, tricks and cauliflower-rice recipes. The subtle language of diet-culture is integrally woven in how womxn interact. And when one finally decides to leave Diet Land behind, where do they go for support and understanding? 

Part of my process for finding solace and safety outside of diet culture was sussing out who actually was safe. If a friend is posting before and after pictures, selfies at the gym, “healthy” recipes with some remark on how “good” they are being, I know this person is not someone I go to when I’m feeling the ever-crushing weight of diet-culture. Part of working through eating disorder or disordered eating recovery is about creating safety in relationships that will support your recovery, not subtly undermine it with diet talk or veiled fatphobia. This may be a mourning process and may mean holding some relationships a bit farther away while in recovery. 

Finding community is so important when you’re recovering from the life-long diet culture hangover. For me, this has been long hikes with other anti-diet folks, and  talk over pancakes about demoralizing food. If you are failing to find someone in your current circle that can hold space for you to do this work, looking to a fat-positive, anti-diet community may be helpful. Joining the Austin Fatties book club can surround you with fat-positive babes that commit to reading work by other fat-positive people. Or joining the All Bodies Hikes I facilitate monthly. These hikes are a diet talk-free space, where folx of all abilities can enjoy nature and create community. If you’re outside of the Austin area, there may be a community for you. Seeing yourself and your story in others is imperative to breaking free from diet-culture. Or be a badass and create that community! I set out to create the All Bodies Hikes because I felt Austin was sorely lacking in spaces that felt undoubtedly safe for fat folx. 

Humans crave connection and acceptance. Our culture upholds patriarchal beliefs that womxn should constantly be minimizing themselves, striving to never be “too much”. But we are not beholden to the faults of those who came before us. You can live free from diet bullshit and you don’t have to do it alone. And if you can’t find a fat-positive badass community, come join mine- it’s pretty great over here. 

Fighting back against Health and Wellness Culture

In the words of my favorite weight-inclusive coach Shohreh Davoodi (look her up, she is amazing), “Health and wellness are not moral obligations”. Read that again and let it sink in. Health and wellness are not synonymous with goodness. You are not a better person because you are more fit, well, or healthy than the person next to you.

Unfortunately, today “wellness” and “health” are just *very* thinly veiled fat-phobia. The wellness industry in Austin in particular is huge. Establishments carry juice cleanses and restrictive meal plans; all manner of gyms and studios live on virtually every corner of the city. And yet, 1 in every 4 households in Austin report feeling food insecure. And Texas ranks 7 in top states with the highest amount of food deserts.

So, in a city that boasts being the 14th fittest city in the U.S, we are leaving a lot of folx behind in terms of health, while maintaining the belief that health and wellness are the standard, and falling short of that mark makes you “less than”.  

The folx being criticized for their “poor food choices” or “unhealthy behaviors” are often people of color, marginalized folx, people living with disabilities and the LGBTQ+ community. You cannot talk about the health and wellness industry without talking about its classist and racist roots.

The truth of it is, health is not determined largely by health behaviors. Eating a well-rounded, intuitive diet (without restriction, or food rules), and exercising joyfully influences self-care and health but social differences account for most health differences. Working a high-stress job, long hours, lack of access to a variety of foods, lack of access to good medical care, and genes all play a larger role than people give credit for.

This is all to say you cannot determine someone’s health by the size of their body. I will be screaming that to the heavens until I die. You cannot tell if someone is healthy by how they look, and you have no idea of their health behaviors by the size of their body. And guess what- if someone is not living up to an individual definition of “health” that’s okay. Everyone has a different definition of what health and wellness looks like for them. Just because it doesn’t align with yours does not mean they are less worthy of respect or kindness.

These thoughts all come from an uncomfortable conversation I was roped into recently. Someone asked me if I felt a certain celebrity (who is in a larger body) was a bad role model for “promoting obesity”.

Whoa. I had to remind myself to breath for a moment because my voice caught in my throat. I am unsure why I, in that moment became a spokesperson for what is deemed “good” and “bad” role modeling for fat folx, but I did. And it’s important to note here that I live in a straight-sized body. Meaning, while larger, I can shop in just about any store and my accessibility is not generally affected daily. This celebrity on the other hand, lives in a larger body than mine, is more marginalized and her access in the world is more limited. It isn’t fair that I was asked to weigh in. But I was. So, I did.

What I made clear to my thin friends asking this outrageous question was that we would not be asking this question if the celebrity was participating in the same “unhealthy” behaviors and was thin. Plain and simple this was fat phobia rearing its ugly head. The comment that followed was, “but she’s obese! That’s not okay!”. Whew! Slow down, honey! I can only fume for so long before I blow up. I took another deep breath and launched into my tried-and-true “BMI and the ‘obesity epidemic’ are false and drenched in fat phobia”. BMI has been proven to be an ineffective measure of health and weight. You can read up on that elsewhere and I will definitely be back to address that.

And again, whether someone is living a lifestyle you deem “unhealthy”, it is none of your business. I also talked about different factors that affect health, like I mentioned earlier. And I tried to stress that we would not be discussing this person’s health behaviors if they were thin. Also, newsflash! People in the BMI “overweight” category also have longer life expectancies than those in the “normal” weight. Tell me again how weight is the only determinant of health?

This conversation was very uncomfortable for me. It was frustrating. And I don’t know if I changed minds but I am grateful for the opportunity to spark a little dissent in the conversation and hopefully they will think a bit harder when these fat phobic thoughts come up for them. And maybe not.

Unfortunately, we cannot change the world in a day. And we cannot show everyone the error of their fat phobic, diet culture, thin-privilege ways. What we do have control over is how we educate ourselves and how we call out this kind of sh** when we see it. Be mindful of yourself, and your needs, and if these conversations come up for you and they are too triggering, know you are allowed to walk away and take care of yourself.

Health and wellness culture are probably here to stay for a hot minute, but through feminist, soul-shaking work, we can scream into the void and attempt to break through the noise.

If you want more information on how to shake up diet culture, change your relationship with yourself and your body, let’s connect!

Finding the right therapist

For most folks, finding a therapist is the hardest and most daunting part of therapy. Unfortunately, the hardest work should be done in session and instead it’s done scouring the internet for someone that looks like the right fit.

How do you find a therapist that feels right for you? How do you find someone that you can be comfortable enough with to let your guard down and really work on some tough sh**?

For most, they start at a large, online directory like Psychology Today or Therapy Den. Here, you can search for clients in your zip code, based on their area of specialty, or by insurance. But, when you finally find one that looks right, and you finally get someone to email you back or answer your call (why is it so hard to get a call back? More on that in a moment), what’s next?

From someone who’s been on both sides of the couch, I can tell you the first meeting is the most important and it can feel like a match made in heaven or send you running. Trust your gut- if it feels good, go for it! If you’re not 100% sure if this person is right for you, know that it is ok to shop around. Most therapists will offer you a free, 30-minute consultation. And they should! This is as much in the benefit for the client as it is the therapist. The consultation gets both parties to take each other in and make sure it feels like a good fit all around.

“Finding a therapist shouldn’t be harder than the therapy itself.”

What are some things you should ask at your consultation? This is totally up to you, but a few good questions (that I have answered and am happy to, time and again) would be to ask about how the therapist sees client issues, what “lens” they view client concerns from. Asking if your future therapist participates in their own therapy is a valid question and can suss out a therapist who may not be actively doing their own work (that’s a red flag if they aren’t!). Questions about fee, sliding scale fee options, if the therapist prefers weekly or bi-weekly sessions are all great questions for you to gauge if you’re ready for the time and financial commitment of therapy.

Take note of the space, as well. Take in your surroundings, the art, test out the couch for optimal comfiness. Your physical comfort in the room is important! If your body is unable to relax, then you won’t be able to access the emotional and mental energy to be vulnerable with your therapist. I have been to therapists before who have blank walls and I personally need some art to stare at while I bare my soul!

For those who’ve called a potential therapist or emailed to no avail- I am so sorry. I hear from so many people that it can be a battle just to get someone to answer your call for services. Just know that your hard work and struggle to find someone who will be perfect for you is worthwhile when you finally find your “person”. Having a therapist that you look forward to see, who greets you with joy and excitement, and who makes you feel seen is the best gift and investment you can give yourself.

I love matching folks with the perfect therapist for them, even if that isn’t me! If you want to learn more about working with me, or need help navigating the minefield of finding your own therapist, let’s connect!

Is Being Body Positive Possible?

Okay—I hear you. “How can I be body positive in a body like this?”. “I’ll love my body when I lose all this extra weight”.

Becoming accepting of your body or even overjoyed to live in your body does not come overnight. You cannot sprinkle magic fairy dust over yourself, have a good nap and wake up bursting with body-positive energy. The idea of body positivity feels so far away when we’ve been sold our whole lives that we are not enough and too much all at the same time.

If you ask any woman how she feels about her body, she will almost always answer with something she wishes to change. And who’s to blame her? We are constantly bombarded through social media, advertising, television and film that we do not measure up. The diet and weight-loss industry are a $73 Billion/ year industry and they’re not in the business of making women and men feel in love with themselves. That won’t sell their latest cream or weight-loss program.

If you were born on an island with no outside influences telling you that you aren’t good enough 24 hours a day and you were surrounded by people living in bodies of all shapes and sizes you probably wouldn’t be obsessing over the absence of a thigh gap. But that isn’t reality.

So how do we get to body acceptance or even body positivity without the magical island of diverse bodies?

First step is a big one: Stop dieting. Just stop. Delete the My Fitness Pal App. (No seriously delete it right now- it’s a pain anyway). Stop the diet talk. Don’t engage when your friends want to discuss their Keto Diet, or what counts as Paleo. This means setting hard boundaries with people you love which is hard—I totally get it. But the first step in accepting your body is to quit punishing it for existing.

There are numerous studies that show that dieting does not work. One such study states that 95% of people who go on diets will regain weight in 1-5 years (http://cswd.org). There is also an entire body of work on Set Weight Point. Set Weight Point states that there are many more factors that contribute to body size and weight than diet and exercise. One huge factor- genetics. Something you can’t change with dieting!  Your body knows where it needs to be to function properly. This may not be the weight you wish it to be, but dieting will only temporarily change your weight while wreaking havoc on your metabolism and energy.

Quitting the diet game is a huge step and it may be one that you fall back into now and then. That’s okay! The road to body acceptance isn’t one that only moves forward. It’s oftentimes a life-long process. Once it feels like you’re beginning to quit the diet game you can move on to:

Step two: Removing influences from your life that make you feel crummy. This step can definitely occur in concurrence with step one and is also a step you will continue to do. Removing influences that make you feel like crap can look like un-following social media influencers that push unrealistic or unhealthy body standards.

A good rule of thumb is if you scroll past a post and it makes you feel like you’re not enough, you’re not eating the right thing, doing the right exercise, or not living your life well enough, unfollow them. Instead, fill your feed with folks that live in a variety of bodies. In this wide world, there is so much more body diversity than what we see in traditional media.

Removing the icky influences also looks like the boundaries we talked about earlier. You may need to set hard boundaries with friends and family about comments they make about their bodies in front of you, or about the comments they make about you. Shut that sh*t down!

There are loads of ways to do this that are respectful and empowering all at the same time. You can walk away from diet or body talk, or you can use my favorite line, “your diet (or weight or exercise routine) is the least interesting thing about you. Let’s talk about something more fun!”. Borrow it and use the crap out of it.

Step three can be super fun and challenging all at once. Step three is to cultivate a joyful relationship with movement. What do all those fancy pants words mean? Basically- if you hate running- stop running. If you can’t stand sit-ups (who does?) stop doing them! Movement is so, so much more than the socially-prescribed gym routine.

If you enjoy walking, or hiking, encourage yourself to make time to walk through your neighborhood or find a nature trail in your neighborhood. It may go against the “no pain no gain” mentality, but movement and exercise does not equal punishment. Movement is not something to endure, it should be something you feel excited and energized by! This step is my favorite because it was the hardest for me to overcome. I used to be the girl who went on about her workout (borrring).

But in reality, I often dreaded going to the gym and doing the cardio routine I thought was “healthy”. Since embracing the idea of ‘Joyful Movement”, I’ve discovered that I love going on leisurely bike rides. It totally makes me feel 10 again. I love hiking and taking pictures of butterflies I find. I play outside with my dogs, and I put on music and dance. These are all ways to be active, move my body in a loving way, and practice self-care without punishing myself.

I guarantee that if you let go of all your notions of what a “good” work out is and focus on what interests you, you will find something you love.

Step four can be fun too- maybe it means a shopping trip! Step four is quit wearing clothes that you don’t love and get rid of all of those “goal” clothes. You know the ones. That pair of jeans that haven’t fit in ages, that you’ve dieted for to try to get back into. Those jeans do not represent anything except something that is no longer serving you. The feeling of stepping into a closet filled with clothes that bring you joy and fit your body comfortably is a great feeling. I recommend taking a friend with you who makes you feel empowered and go find something that makes you feel like you can conquer the world.

The fifth and final step is practice, practice, practice. Practice self-compassion and love. This is the longest-lasting step and I hope that it is life-long for you.

In a world like this one, one that will probably not change what it values anytime soon, the only way to hold on to your new-found body acceptance is to practice everything that has gotten you here.

Practice setting boundaries with friends, practice healing that negative and harsh voice in your head and practice feeding the voice that reminds you of the goddess you are. Practice cultivating joyful movements that make you feel good and leave the punishment in the trash where it belongs. Continue to reject the diet industry and rebel against what we’ve been taught. Eat foods that feel good. Quit labeling foods in your mind as “good” and “bad”. Food is food! It’s home, it’s a comfort, it’s friendship, warmth, and joy.

There are probably a million and one steps I could go on and on about but that’s what I got for you today. I could talk about this topic forever and I plan to continue singing the praises of loving your body no matter what until I’m hoarse.

           If you’re interested in working on your relationship with your body, I would be thrilled to go on that journey with you. Feel free to reach out at 512-825-1508 or email me at brianna@embracetherapyaustin.com