Doris Bersing, PhD

The Closet: Psychological Issues and Psychotherapy of Coming Out for LGBT

© Lee Serenethos

© Lee Serenethos

A very commonly used terms in our society, nowadays, gay or not gay is “coming out” that refers to disclose something that has been otherwise hidden. Dr. Jack Drescher, MD in 2004 already said the experience could be extremely dissociative for the individual “in the closet”. He said: … Coming out may be the most commonly shared cultural experience that defines the modern gay identity. Historically, the term was an ironic reference to debutantes “coming out into society” (Chauncey, 1994). In contemporary usage, “coming out of the closet” means telling another person that one is gay…Years spent in the closet can make the prospect of revealing oneself an emotionally charged experience. However, the process is not just about revealing oneself to others–in coming out, gay people integrate, as best they can, dissociated aspects of the self…” Many LGBT clients had expressed their relief after coming out and finding themselves able to live a life they could not live freely while “in-the-closet”. The University of Montreal published an article in 2013 supporting the health benefits of coming out. They found:…” Lesbians, gays and bisexuals (LGBs) who are out to others have lower stress hormone levels and fewer symptoms of anxiety, depression, and burnout, according to researchers. Cortisol is a stress hormone in our body. When chronically strained, cortisol contributes to the ‘wear and tear’ exerted on multiple biological systems…Contrary to our expectations, gay and bisexual men had lower depressive symptoms and allostatic load levels than heterosexual men. Lesbians, gay men, and bisexuals who were out to family and friends had lower levels of psychiatric symptoms and lower morning cortisol levels than those who were still in the closet…”

The study found that LGBT people who needs to ‘fight-for-life” and their rights develop better coping skills and strategies to deal with social stressors. Coming out is a major milestone in our lives as LGBT and sometimes supportive guidance through the process makes it easier and really meaningful.

The Association of Gay & Lesbian Psychiatrists stresses that coming out is a very individual process and that “… the therapist needs to become familiar with issues specific to being GLB, and in particular the issue of coming out. The assumption that GLB identities are normal need not lead to “cheer leading,” nor should the therapist encourage patients who are questioning their identities to come out prematurely or to simply reassure them that “it is ok to be gay.” Therapists can be most helpful if they have no agenda as to how patients resolve complex issues of identity, affiliation, and openness, and do not push for premature resolution in these areas… The process of coming out is complex and can take years. The process is not linear. In therapy, there can be times of great movement and change interspersed with long, seemingly quiescent periods. Therapists need to be patient, respectful and open to many possible end points – including a straight identity, a gay or lesbian identity, bisexual experiences and identity, or even the patient’s rejection of a traditional identity label altogether…” (Read more)

Respecting the client’s tempo and examining his societal circumstances (family, workplace, profession), relationships, clinical stance, and psychological assets and challenges need to be part of the coming-out assessment to guide the process towards the client wants to guide it at her/his own pace. Remember one size does not fit all and what suits one client can be very risky and detrimental to other person’s reality and life experience. Supportive? Yes, Overbearing? Never.

ack Drescher,: “…Coming out may be the most commonly shared cultural experience that defines the modern gay identity. Historically, the term was an ironic reference to debutantes “coming out into society” (Chauncey, 1994). In contemporary usage, “coming out of the closet” means telling another person that one is gayYears spent in the closet can make the prospect of revealing oneself an emotionally charged experience. However, the process is not just about revealing oneself to others–in coming out, gay people integrate, as best they can, dissociated aspects of the self.

Coming out may be the most commonly shared cultural experience that defines the modern gay identity. Historically, the term was an ironic reference to debutantes “coming out into society” (Chauncey, 1994). In contemporary usage, “coming out of the closet” means telling another person that one is gay.

Years spent in the closet can make the prospect of revealing oneself an emotionally charged experience. However, the process is not just about revealing oneself to others–in coming out, gay people integrate, as best they can, dissociated aspects of the self.

– See more at:

Coming out may be the most commonly shared cultural experience that defines the modern gay identity. Historically, the term was an ironic reference to debutantes “coming out into society” (Chauncey, 1994). In contemporary usage, “coming out of the closet” means telling another person that one is gay.

Years spent in the closet can make the prospect of revealing oneself an emotionally charged experience. However, the process is not just about revealing oneself to others–in coming out, gay people integrate, as best they can, dissociated aspects of the self.

– See more at:


Time To Heal: What Psychotherapy to Use?

Psychotherpay: Finding Nemo!

Copyright Teerayut Yukuntapornpong

Many patients or clients often ask what is the difference between different approaches of psychotherapy and although much has been written about, there’s no simple answer. Just as people respond differently to different drugs, you might do better with one type of therapy than with another. Many people find that a blended approach — one that draws on elements of different schools of psychotherapy — suits them best. There are many forms of psychotherapy, but some of the most popular forms are psycho-dynamic therapy, cognitive behavioral therapy, humanistic, and couples therapy, which in reality can be based on any other theoretical approach but emphasizing systems oriented therapy.

Although embracing a particular approach of psychotherapy, as a clinician, has to do with your philosophical values and your concepts of health and human potential, knowledge of what can work better or not with your clients is needed. Remember it is not about what you want or like but what could be more efficient and meaningful to your clients.

Cognitive-behavioral therapy (CBT)

CBT helps you identify self-defeating thoughts and start to develop behaviors that are more constructive. And unlike, psycho-dynamic approaches you do not need to explore into issues of the past. CBT is about what happens in your mind, now and how it affects your behavior.

Psychodynamic therapy

In contrast to CBT, which focuses on conscious thoughts, psycho-dynamic therapy emphasizes feelings that are often beneath the surface yet still influence your behavior. The goal: to help you recognize how old, unresolved problems shape the way you operate today. The therapist will guide you to recognize the links between past and present so you can become more self-aware to avoid same patterns or connections. For a comparison between psycho-dynaminc and behavioral therapy click here The Huffingon Post gave it a try as well (Read more)  And my colleague Peter Strisik, Ph.D from Alaska did a more extensive job (Read his take on it). In my own practice, I called myself a humanistic-existential psychotherapist, practicing frequently the tenants of Gestalt Therapy. Of course, at this point, they seem confused and ready to run away from something so esoteric and unpractical. Yes indeed, perhaps the big difference is we do not focus on the past but on what happens in the here and now.

Humanistic therapy

This approach establishes you as the main tool in therapy, your own healer with the potential to achieve your ultimate goals. Human resilience and self-healing are at the core of this approach. The process helps unfold your self-healing potential, stimulates creativity, and promotes personal growth.

A very simplistic way to explain it is that the existential approach in psychotherapy is organized around life on earth itself and the social, cultural and spiritual ramifications of it, that is, the “human condition.” People’s existential issues are related to their mortality and impermanence, their experience of freedom of choice (or lack of it), their sense of worthiness, and their sense of separation/connection with others. We review the contributions of Kierkegaard, Nietzsche, Heidegger, Sartre, Bugental, Binswanger, Fromm, Laing, Sullivan, May, Frankl, and Yalom. We identify five themes that pervade existentialism:

  1. Meaning in life is found in the living of each moment;
  2. Passionate commitment to a way of life, to one’s purpose and one’s relationships, is the highest form of expression of one’s humanity;
  3. All human beings have freedom of choice and responsibility for our choices
  4. Openness to experience allows for the greatest possible expansion of personal expression; and
  5. In the ever-present face of death itself, we find the deepest commitment to life itself.

We also address the relationship between experiential psychotherapy, the existential approach, and Heart-Centered therapies. Needless to say that there is not a system that can really explain the complexity to f the human phenomena and of course, there is not a system that alone can give you a quick fix or a cure. The solution is in the phenomenological understanding of the situation and of the human being involved, the comprehensive analysis of the situational elements, and of the comprehensive concept of care -versus cure- that we clinicians take into account to provide the bio-psycho-social-spiritual dimensions of care.

Nonetheless, there is enough research about the patient/client being the best agent of change and the personality of the therapist being more important than the “approach” itself. Interesting, isn’t.

You can always try to do some research when trying to find the right therapist for you but let’s say that is you are ready and the therapist has enough empathy and active listening, compassion, and of course knowledge, you will be safe independently of the “approach” she/he uses.

Good Luck and do it, it is worth it… Go find Nemo!

A Victory for Therapists and LGBT: U.S. Supreme Court Says No To Conversion Therapy

NCLR June 30, 2014

NCLR June 30, 2014

I was so happy when earlier today, I received, like many of us, an email from Kate Kendell, Esq, the fabulous executive Director for The National Center for Lesbian Rights (NCLR) saying “…Earlier today, the United States Supreme Court declined to review a challenge to California’s law—which NCLR and Equality California helped draft, pass, and defend—that protects LGBT children from conversion therapists. The decision clears the way for enforcement of the first law in the nation that protects kids from unethical counselors and therapists who engage in these dangerous practices to try to change their sexual orientation or gender expression.

For therapists all around the globe these are GREAT NEWS, as NCLR picture shows “…you can not switch off who you are…” While as many as 1 in 3 LGBT people have been subjected to conversion therapy, whether by a licensed clinician, a religious leader, or another trusted adult, the trauma of these experiences can make it difficult to come forward. (Read some survivor stories)

It is really scaring to think that professionals who had studied the harmful effects of pushing a personal agenda into a psychotherapy client can be unethically oblivious of the devastating effects of conversion therapy (Read More About Conversion Therapy

What is next? Converting people of color into white or converting right brain people onto left-brain for the sake of somebody’s new agenda or bias? Give me a break. We therapists are supposed not to harm and be the catalyst for our clients’ process, it is not our place to change anybody but help them to explore their path and desires.

NCLR has launched the project NCLR has launched Born Perfect: The Campaign to End Conversion Therapyin the next five years by passing laws across the country to protect LGBT kids, fighting in courtrooms to ensure their safety, and raising awareness about the serious harms caused by these dangerous practices.

The Forgotten Elders: They Also Benefit From Psychotherapy.

Elder WomanGeorge Kraus, a geriatric clinical psychologist debunks the stereotypes about working with elderly populations, and shares his discovery of the joy and gratitude that come from intimate contact with wise elders. He, wisely, address three important myths regarding psychotherapy and/or counseling with seniors:

  • Myth #1: Psychotherapy with the elderly is time wasted, because the elderly client has so little time to enjoy any gains that might be made.
  • Myth #2: The grief, loss, and somatic and socioeconomic burdens of the elderly are too excessive to warrant believing they could get better.
  • Myth #3: Old people are staid in their ways; they are too stubborn to change. Dr. Kraus emphasizes the fact that In America, “…we honor the young for their beauty, strength, and vitality. However, in other places on the globe, old men and women are objects of veneration. This leads to a curious consequence: the less we acknowledge what can be respected, admired, or even venerated in the parents and grandparents of the world, the more we make ourselves orphans who lose a piece of our faith, security, and connection to a past that we risk repeating. This has been part of my joy in working with older adults: I am able to honor them, to sit at their feet, marvel, and learn. As their therapist, I have become their faithful student, their privileged witness, and my life is ever richer because of it…” Read his article

Psychological Issues for LGBT Sexual Orientation

Copyright : leedsn

Copyright : leedsn

When discussing psychological issues involving our LGBT folks, we want to depathologize those issues and assure our clients, there IS NOTHING WRONG with them. The issues of sexual orientation, homosexuality, coming out, stigma, family rejection, homophobia are at the forefront when working with LGBT people. Even traditional organizations as the  American Psychiatric Association, founded in 1844 – the world’s largest psychiatric organization that is a medical specialty society representing growing membership of more than 35,000 psychiatrists and the voice and conscience of modern psychiatry, works together to ensure humane care and effective treatment for all persons with mental disorders states that being part of the LGBT spectrum is not a mental illness…. THANK YOU, What a concept!

Talking about a concept, the APA states that “…the concept of sexual orientation refers to more than sexual behavior. It includes feelings as well as identity. Some individuals may identify themselves as gay lesbian or bisexual without engaging in any sexual activity. Some people believe that sexual orientation is innate and fixed; however, sexual orientation develops across a person’s lifetime. Individuals maybe become aware at different points in their lives that they are heterosexual, gay, lesbian, or bisexual… Read More

Gay and Lesbian Couples Counseling

Copyright : Rudolph Pieterse

I am always looking for the latest, the newest article or event related to LGBT well-being or LGBT rights, just a passion of mine, and part of my practice. However, some things like the Iliad by Homer and the Bible are timeless. Not always the newer is the better. For instance, I ran into a wonderful article by by Michael C. LaSala, Ph.D., LCSW in Gay and Lesbian Well-Being for Psychology Today where he addresses the issues of  “Helping Same-Sex Couples Who’ve Lost That Loving Feeling”

Dr. LaSala stresses the importance  -in the midst of our fight for same sex marriage, he addresses how to avoid same sex divorce, and said “…What about couples’ therapy? If your relationship is having problems and you are pursuing this step, that’s a good sign–the prognosis for your partnership is good because people who take action to save (or improve) a troubled relationship often manage to do so. However, if you’re looking for someone to referee your conflicts, or to finally convince your thickheaded partner of your unassailable sense of fairness and the truth, you’ll be sorely disappointed. Over the past 25 years, I have done quite a bit of relationship therapy and here is some of what I have learned that you should keep in mind as you move forward…”

Sometimes, I think couples, LGBT or others just wait too long to seek therapy and sometimes it is too late when they come to see me for help. Perhaps this article will help you to do the right thing in a timely manner (wink-wink). Read Dr. LaSala article

Same-Sex Marriage, Next stop? The U.S. Supreme Court!

Lesbian Marriage

Copyright : Jack Young

On Wednesday,  On June 25th, 2014 the U.S. Court of Appeals for the Tenth Circuit issued a historic ruling affirming the December 2013 decision from U.S. District Judge Robert Shelby in Kitchen v. Herbert that the amendment to the Utah Constitution barring marriage for same-sex couples violates the U.S. Constitution.  NCLR and Human Rights  won a landmark victory in their Utah marriage equality case in the Tenth Circuit Court of Appeals–the FIRST federal appeals court to rule in favor of marriage equality since the Supreme Court struck down the Defense of Marriage Act (DOMA) last June, and the FIRST EVER to hold that same-sex couples have a fundamental right to marry.

The 2-1 ruling by a panel of the Denver-based 10th Circuit Court of Appeals marks the first time a federal appellate court has upheld same-sex marriage. One year ago, on June 26, 2013, the U.S. Supreme Court struck down portions of the federal Defense of Marriage Act, a landmark ruling that extended federal benefits to gays — though the high court stopped short of ruling that same-sex marriage was a constitutionally protected right. Read More

Therapy for older LGBT individuals

happy lesbian couple.When addressing the needs for counseling and therapy for the LGBT population, we are already stressing the importance of this segment of our society, however like with any group of people, we cannot just compile ALL issues for all of the group in only one issue or set of issues as the solutions are not one size fits all, either. In 2011, David Richards’ article ‘Working with older LGBT people’ (  explores the challenges of working therapeutically with older LGBT men and women, for gay, lesbian and heterosexual practitioners”. He stresses the generalities of working with this population but as expressed by Carly Hall: “… there are some issues that I would like to raise in the interests of older lesbians. I speak as a lesbian growing older, a client, a healthcare professional and a researcher…First, to address LGBT as one general group I believe is incorrect. Even taking out the bisexual and transgender, one is still left with two hugely diverse groups. Political, sociological and economic influences over the years, combined with the biology of being a woman, will inevitably make older lesbians’ experiences markedly different from those of gay men of a similar age.Women who today are over 65 (born pre-1947) and identify as lesbians are acknowledged by health and social care researchers to be a difficult group to reach; ‘convenience’ samples may not always be representative of the wide group. But there are findings from pertinent research studies, including my own, which may have relevance for the therapist.  Read Carly Hall’s article (

Bill Clinton Adds Voice to Wife’s Support of Gay Rights

By Amy Chozic for the New York Times

Hillary Clinton official Secretary of State portrait crop Former President Bill Clinton, in a video message to be broadcast this week, says he was “honored and grateful to be among the voices urging” the overturning of the Defense of Marriage Act, the measure he signed into law in 1996 that barred federal recognition of same-sex marriages.

Mr. Clinton’s remarks will be included in a special program to honor gay rights activists that will be shown on Thursday on Logo TV, a cable channel aimed at gay and lesbian viewers. The special, called “Trailblazers,” will mark the first anniversary of the Supreme Court’s decision to overturn the marriage act, and will pay tribute to two figures in the case: Roberta A. Kaplan, a lawyer, and Edith Windsor, the plaintiff. “As marriage equality spreads across the states, the number of people impacted by these two amazing women will only continue to grow,” Mr. Clinton said. Read More

Orange is The New Black Key to Success : Openness to Lesbian Sex and Love and of course the Transgender Tipping point

Needless to say that by now, almost everybody in the LGBT community has seen or heard of Orange Is the New Black. The reaction to Orange Is the New Black — based on the memoir by Piper Kerman — has been intense, from among both viewers and critics. But its place of origin is not the thing that is most surprising about the show. Orange, after all, is a show that features a primarily female cast — made up of mostly unknown actors, with a few exceptions — and an unlikely protagonist in Taylor Schilling’s Piper Chapman. She is often selfish and unlikable, but she provides an entry to a world that (I hope) few of its viewers will ever see: inside a New York women’s prison. The series is compelling, bringing LGBT issues to the forefront of society awareness. Said by many like on Why You Need To Stop What You’re Doing And Watch “Orange Is The New Black” by Jace Lacob (

The series also offers a take on LGBT love like stated by Alyssa Rosenberg for the Washington Post ‘Orange Is The New Black’ and the meaning of love  (, or simply put by Kiley Thompson you could find; “…7 reasons to drop everything and watch this Netflix show right now, who said Whispers in the workplace hallways about “chocolate and vanilla… swirl.” You keep seeing pictures of women in orange or taupe scrubs. People at Starbucks keep referencing someone named “Piper” and her sorta-kinda-love-hate girlfriend “Alex” and bemoaning the fact that one of them won’t be around much in Season 2. One actress reminds you of a dark-haired version of that girl that was on “That 70s Show.” And you don’t have Netflix, so you don’t care. But you should. (

What do you need to know about this show, and why should you watch it? To be honest, a released-all-at-once season of a television show keeps writers like this one from figuring out the best way to recap and review a show. And that is a blessing and a curse, because we’re all used to weekly installments slow-cooking our show love. Instead, we get it all at once, an amazing all-you-can-eat buffet that leaves us choking on great stories and trying to figure out how to explain it all to a hungry bystander. and then, last but no least offering a refreshing and courageous view of transgender issues (nearly a year after the Supreme Court legalized same-sex marriage, another social movement is poised to challenge deeply held cultural beliefs) as seen in San Francisco and reported by the Time Magazine in its June issue (” …In the beaux-arts lobby of the Nourse Theater in San Francisco, men in deep V-necks and necklaces walk by women with crew cuts and plaid shirts buttoned to the top. Boys carrying pink backpacks kiss on the lips, while long-haired ladies whose sequined tank tops expose broad shoulders snap selfies. About 1,100 people, many gleefully defying gender stereotypes, eventually pack the auditorium to hear the story of an unlikely icon. “I stand before you this evening,” Laverne Cox, who stars in the Netflix drama Orange Is the New Black, tells the crowd, “a proud, African-American transgender woman.” The cheers are loud and long. Almost one year after the Supreme Court ruled that Americans were free to marry the person they want … Brava!