Does It Really Matter If My Therapist Knows I’m Bi+? YES!
We all need to talk about the elephant in the therapy room.
I’ve known I’m bi+ for almost 50 years. I’ve survived depression and anxiety…for almost 50 years. During that time I’ve worked with a range of therapists — psychologists, licensed social workers, behavioral health technicians, and those with other counseling credentials. I’ve also been treated by doctors, physician assistants, psychiatrists, psychiatric nurse practitioners. I’ve done two stints in a psychiatric hospital, and been supported and coached by both trained and untrained peers in one-on-one and group settings.
Yes, I’ve survived. No, I haven’t thrived. But not from lack of effort or ability on the part of those with whom I’ve worked. Oh, sure. Some were not my favorite humans. One or two, in my opinion, should not be working with humans. I can say the same about some garbage haulers I’ve worked with, too.
My experience with the mental health business — and, yes, it’s definitely a business — over the last four decades has not produced a miracle cure for what ails me. It has, at times, seriously frustrated me. My second stint in the psych hospital, for example, came about because I really needed an adjustment to the meds I was put on during the first stay. Unfortunately, I couldn’t get in to see my psych doctor due to an emergency closure of the clinic because of a mechanical issue. I went into crisis and had to re-admit myself to the hospital for five days just so that a doctor could change my dosage!
Yes, I have survived. Yes, I have gotten some relief and made some progress. Because I did my best to apply the strategies I was taught, used the psych meds I was prescribed, attended the sessions I was scheduled for, talked through my experiences and made solid intentions to change my thinking, my behavior, my lifestyle, my ingrained habits. In fact, the most consistent feedback I’ve heard from all the caregivers I’ve worked with over these decades was: “You seem to be making some progress, so keep doing what you’re doing and it’ll continue to get better.”
Well, it didn’t. Not always, and not that much.
And then, a little over a year ago, I said to my current therapist, “So, do you think my depression and anxiety might be related to my being bisexual?”
I wish I’d snapped a candid photo of her reaction when I said that. Just imagine one of the Loony Toons characters giving the standard bug-eyed response, but with the happy dial turned up to 11! She later told me that, right up to that point, she felt completely puzzled about how we were going to proceed. As I described all the various approaches I’d tried and all the not-quite-success I’d achieved, she mentally crossed out ideas from her list of techniques. When she asked me, “What brings you joy? Makes you happy?” I responded, “I honestly can’t remember the last time I felt truly happy and I’m not real clear on what joy feels like.” Yeah. I was a challenge. But now she had an angle.
She reacted so strongly to my divulging my bi+ orientation because she had, just a couple of months before, completed a professional development course about using trauma-focused care with bisexual clients. And that made all the difference. Well, it has made quite a difference in our working relationship, anyway.
But why was it so important to bring my bi+ orientation into the therapy session? How has it helped both of us create better therapy sessions? And why do I think that all bi+ humans should disclose to their therapists?
Why Disclose Your Bi+ Identity to Your Therapist?
In my view, the simple answer is “because it’s the elephant in the room.” And therapy rooms tend to be pretty small!
You may think that your bi+ identification is private, personal, something you only share with those you are most intimate with. Or, as in my case, not a single human for over half your life. Yeah, that’s right; not one. That seemed logical to me and it was the line of thought I followed for many years. I didn’t consider my bi+ identity a “secret,” just “nobody else’s business.” It was one of the things that I kept in that part of my self that I did not share lightly, indiscriminately, casually…ok, at all! In fact, when a dear, dear friend told me she was bisexual, I didn’t even self-identify to her. That took me several more years.
I talked with therapists and caregivers about many aspects of my life that I considered personal, private, intimate. But not that one. Why not?
Because no one ever asked me!
In all the intake paperwork and interviews I’ve completed — and there have been many, not one asked me about my sexual orientation. Actually, I did mention it to one previous therapist; but we were so focused on the effects of my current job situation on my depression, anxiety and even my physical health, that we never even discussed my bi+ orientation. Had he asked me, “When did you first realize you’re bisexual? And when did your depression and anxiety start?” he and I would certainly have noticed how perfectly those coincided!
Didn’t happen.
Recently, I have completed some medical forms that do ask my orientation. And I have duly noted I’m bi+. (I don’t remember, but I think the forms I filled out before meeting my current therapist asked. Maybe she never saw my entire medical chart, though.) Still, not one medical professional has yet commented or otherwise indicated they’ve read it. I figure that, just as I used to believe, they see it as extremely private and a potentially “tender” topic.
Yes, it is! But that’s exactly why we bi+ humans need to encourage all medical professionals — and mental health professionals particularly — to pay attention to it. As I think about it now, I’ve come to believe it’s as critical a piece of information as our allergies, our names, our dates of birth, which we are constantly asked to verify. We need to say, “Hey, and you know I’m bi+, right? Please keep that in mind as we’re working together.”
How Does Disclosing Improve Your Therapy?
Simply put, the more a therapist knows about you and your way of being in the world, the more likely they can help you find ways to make it better. Think of it this way: You wouldn’t ask a first responder to help you cross a rain-swollen river without mentioning, “Oh, by the way, I don’t know how to swim and I’ve never liked being in water.”
Like me, you might consider your bi+ identification as just a bit too intimate to share with a therapist. Similar to, for instance, whether you prefer oral sex. Or what types of foreplay you find most stimulating. “Sure,” you might think, “if I were consulting a sex therapist, I could see talking about that. But my mental health therapist? Ewww! That’s too personal.”
I agree: we all have our personal boundaries and we need to respect them. But a good therapist will assure you that your discussions are confidential. Plus, if you disclose information that isn’t relevant to their work with you, they’ll simply ignore it.
Your bi+ orientation is very relevant!
In my case, my therapist helped me look at my bi+ orientation in a completely different way. She pointed me to research (I’m a researcher both by training and inclination, so that really helped me) about trauma-based treatments of depression and anxiety now being used with bi+ clients. Wow! Over the years, I had been asked, more than once, by caregivers if I had ever experienced trauma in my life. “Well, no. Never been in a war zone, suffered abuse, witnessed violence.”
Unfortunately, my previous therapists had, like me, accepted that response and moved on. I now have a much more nuanced understanding of “trauma” and a much clearer understanding of just how pervasive it is in a bi+ human’s life. Even when you’re the only human who knows you’re bi+! In fact, that fact alone has perpetuated really deep wounds in me that I’m now working to heal.
Because my therapist now knows more about the sources of my lifelong depression and anxiety, she’s able to direct me to strategies that can help me more. And because I’m overly self-analytical (well, yeah! I’m bi+, right?), I can also look back over my history of therapies and figure out why so many didn’t completely work.
Most importantly, every time I see my therapist, I now work toward thriving, not just surviving.
How Will Your Disclosure Help Improve Therapy for Bi+ Humans?
In the online bi+ communities that I wander through on a regular basis, I see reports of bi+ humans’ encounters with uneducated, ignorant, and just plain biased therapists. Yes, they exist. You may not be as lucky as I was, to stumble upon one who had just completed training and professional development that significantly improves the way they interact with us.
If you do disclose your bi+ orientation and you don’t feel that your therapist pays attention to it, or discounts it, or — and this, unfortunately, does happen — tells you that you’re “just confused,” you not only can but should get up, walk out, and report them to the local certifying or credentialing agency. Mental health practitioners like this do harm, and you should not let that happen to you.
On the other hand, if you have established a good rapport with your therapist but you find that they seem reluctant or unequipped to talk about how your bi+ orientation relates to your therapy, you can help them gain awareness. As a bi+ client, encourage them to read and think about the APA Guidelines for Psychological Practice with Sexual Minority Persons. Emphasize the importance of Guideline 3: Psychologists strive to affirm bi+ identities and examine their monosexist biases. While these guidelines are directed to members of the American Psychological Association, other therapist organizations have also begun recognizing the need to learn about and work with us bi+ humans better. But not everyone has heard the message, or fit it into their practice.
Yes, this is self-advocacy. It’s also not that hard to do. After all, therapists are trained listeners. They take in information presented by their clients so that they can help them work through their problems. It’s how the counselling process is supposed to work.
If we don’t inform our therapists that we identify as bi+, we continue to allow ourselves to be invisible, to be underrepresented in discussions about our mental health needs, and we just may be short-circuiting the very efforts we’re making to get better.
AUTHOR’S NOTE: Depression and anxiety are soul-crushing illnesses that often encourage us to isolate ourselves or worse. Professionals and trained peers are available 24/7 to help. I know; they helped save my life. Reach out, you’re not alone.
National Suicide Prevention Line: dial 988 or connect online at 988lifeline.org
The Trevor Project (for young LGBTQIA+): dial 1–866–488–7386; chat 678–678; connect online at thetrevorproject.org
Visible Bi+ is a space for members of the Bi+/MSpec community to share their voices. We’re striving to increase authentic visibility and dispel the many misconceptions which fuel biphobia and bi-erasure. Join us and SHARE YOUR STORY!
