The need for LGBTQ-centered mental healthcare
When her therapist went on maternity leave, Jourdan Porter pressed pause on her sessions after the therapist’s temporary replacement said her then-fiancé, a transman, “didn’t count” as male.
Porter, 24, has experienced depression since age 12, has a learning disability and was diagnosed with bipolar disorder last fall. Yet she took a therapy hiatus because “it was better than going to him.”
She now sees a therapist who decorates her office with Philadelphia’s Pride flag, which includes black and brown stripes to represent the city’s LGBTQ-plus community of color.
“We talk about a lot of things that are gay or gay-related and it’s definitely a different vibe because I didn’t have to explain myself as much,” said Porter, a woman of color and lesbian living in West Philadelphia.
Porter is pursuing a dual degree at Widener University, which would give her a doctoral in clinical psychology and a master’s in human sexuality. She has provided therapy to many LGBTQ-identifying people of color.
Clients may be more likely to bond with a therapist they feel shares their identity, particularly when starting therapy, Porter said.
It can be difficult to tell a stranger “your deepest, darkest things,” she said, adding many clients want to feel like “you’re going to get me.”
Gabriel Snell, practice manager at Walnut Psychotherapy Center, an LGBTQ-focused therapy provider on Walnut Street near 15th, started taking testosterone at age 25. The therapists who helped him through his transition, providing emotional care and notes in support of gender-affirming procedures, also identified as trans.
The support they offered went beyond what therapists advertising themselves as queer-accepting could provide, Snell said.
“As accepting as you want to be, actually having the knowledge of how relationships work and what it means to be a queer person in the world — you have to actually know,” he said. “Being accepting is wonderful, but there’s a deeper level of knowledge that you have to have a certain level of to be able to work with people.”
Lesbian, gay and bisexual adults are more than twice as likely as their non-identifying peers to experience a mental-health condition, according to the Substance Abuse and Mental Health Services Administration.
Meanwhile, LGBTQ community members are at higher risk of suicide, particularly transpeople — 48 percent of whom considered suicide in the last year, compared to 4 percent of the general population, according to a National Center for Transgender Equality 2015 report.
On top of finding a therapist who understands the LGBTQ experience, cost often acts as a barrier to mental healthcare. The “asininely expensive” price of therapy is exacerbated for members of the LGBTQ community who may face job discrimination and find it “insurmountably difficult” to be hired, Porter said.
“Even those entry-level jobs are often front-of-house or being a secretary,” she added. “People want the people who look ‘normal’ to do those front-of-house things.”
She said her friends who are cis, straight and passing get these jobs and can work their way up through companies, often securing benefits.
Tia Pinkson-Burke, a therapist at Walnut Psychotherapy Center, said poverty seems to disproportionately affect LGBTQ people who are routinely discriminated against, especially transpeople, people of color and those living with disabilities.
“There’s less access to jobs in the first place, less access to stable housing, less access to education — and then, even when people do get employed, there’s a lot more discrimination that people face, or unfair firings, harassment getting to and from work, harassment from folks at work, whether they’re coworkers or patrons,” she said.
An LGBTQ-specific scholarship fund
At Walnut Psychotherapy Center, about 90 percent of clients and 95 percent of practitioners are LGBTQ, said Danna Bodenheimer, clinic founder and director.
Therapists at the center, founded in 2015, use a long-term psychodynamic approach focused on identity, trauma and attachment.
“We’re dealing with clients whose sense of reality has often been assaulted, denied, played with,” Bodenheimer said. “A lot of what we’re really interested in is helping reestablish somebody’s connection to their own truth.
“We see trauma at the hands of ignorance of the existence of our clients’ bodies, souls, minds, and the presumption that people like our clients don’t really exist,” she added.
The center operates 30 scholarship slots that reduce the average rate of a therapy session from $75 to about $30 for people making less than $27,000 annually. But as the clinic grows, the scholarships are becoming financially unsustainable, which prompted the formation of Walnut Wellness Fund, a nonprofit, last November, Snell said.
In a $75 therapy session, a therapist earns $45, while the rest covers rent, business expenses and administrative staff fees. The reduced rate means a pay cut for the therapist and a shortage for remaining costs.
The Walnut Wellness Fund is meant to formalize the scholarship offerings and make them financially viable. The program would benefit transgender people living below the federal poverty line, and two-thirds of the slots will be reserved for people of color.
Center staff aims to have an operating budget of $80,000 annually for the fund, enabling about 10 scholarships for two years of therapy while also paying therapists a living wage.
Since the project’s launch, enough money has been raised to cover 10 percent of the clinic’s rent, but not yet enough for a scholarship, Bodenheimer said, noting the difficulty and frustration of securing funding as a new nonprofit. Most grant donors will assist only those nonprofits that have existed for at least three years.
“It does feel like sort of a hall of mirrors,” Bodenheimer said. “Meet this guy, come meet this guy, this guy knows the answers … but does anybody actually open their wallet? That hasn’t happened for us.”
Providing a safe haven in a broken system
While the Walnut Wellness Fund is in its early stages, center staff remains devoted to its LGBTQ-oriented mental-health services.
“The idea is that issues that may be happening in the present, we can journey into the past and look for patterns, undo past trauma or history and help people develop deep understanding and insight as to why these things could be happening in the present,” said Biany Pérez, the center’s clinical coordinator. “What makes us stand out is we’re also looking at oppression and looking at, ‘What does it mean to be queer in this society in a Trump era and this historical moment,’ and really creating space for people to be seen and heard.”
Many clients use the center’s all-gender bathroom to change into clothes representing their authentic gender before a therapy session, Snell said. Others speak openly with therapists about making a living through sex work, selling testosterone or trading opiates for Suboxone. More share their feelings on the dysphoria created by disappointing gender-affirming surgery results, the stress of reminding a doctor to use correct pronouns or having to dress and present as a particular gender to keep a job.
“This is the only hour a week that they get to really be themselves, and especially with another person,” Snell said. “Being able to offer that, it makes me want to tear up.”
In preparation for the fund, which is predominantly aimed at people of color, the center is focused on diversifying its staff, Bodenheimer said.
“We don’t want to be a white-majority-led agency, so we’re making hiring decisions that put the white folks in the minority here. … We want [clients] matched with people who understand their experiences and they feel seen and held by,” she added.
The clinic also offers consulting and training services on creating an LGBTQ-affirming space to other mental-health centers. Profits are applied to the Walnut Wellness Fund.
Pérez said she hopes the fund will change the culture around mental health so that it will be accepted as a basic need. She cited the trauma the LGBTQ community experiences from issues like high rates of violence against transwomen of color.
“In our field, unfortunately, there are still people who pathologize and just look at [LGBTQ people] as the problem,” Pérez said. “We understand that the system is the problem.”