Advocates have been adding to the LGBT acronym for a while now. As of this writing, the most expansive version seems to be LGBTQIA2S+. Accusations of “alphabet soup” abound. People wonder if all the represented parties belong under the umbrella, and even for people who don’t question who is included, they might wonder if a shorter acronym is easier for practical purposes. 

As a sex therapist, and one with additional training and experience in gender exploration, transgender medicine, and queer relationship concerns, I’ve long used the LGBTQ+ acronym in my marketing. But it is not inclusive of everyone who seeks my help, or of my training actually. To more accurately describe my training and who I serve, I’ve adopted Pink Therapy’s term GSRD; Gender, Sexual, and Relationship Diversity.
GSRD is Pink Therapy’s way of expanding the LGBT acronym without adding more letters (and numbers). Here is how they break it down:

Gender: This encompasses gender diversity. Folks who are trans, non-binary, gender non-conforming, agender, gender fluid… they all fit under this umbrella. 
Sexual: Sexual diversity takes into account those who experience erotic marginalization. People who identify as gay/lesbian/pansexual, those involved in kink, and asexual people as well. If your sexuality differs from the mainstream, it is represented here.
Relationship: Our friends in diverse relationships might identify as ethically non-monogamous, polyamorous, aromantic, sub/dom… the permutations are endless! Which is the fun part, right?

I like GSRD as a term because it does feel like it captures everyone. A common email I receive from a prospective client reads something like this:
“I am contacting you for sex therapy because I think you might be able to help. I saw you specialize in LGBTQ+ work, and while I’m not exactly queer, I sort of am?” 

This prospective client has likely felt welcomed in queer spaces, has learned a lot about themself from queer people and resources, but might appear very hetero- and cisnormative. But, they and their spouse are deeply involved in the local fetish/kinkster scene, and they want a couples therapist who will not shame that, who they will not have to spend their therapy hours teaching, and who will not pathologize a sexual interest. They may not even need to discuss their fetish in therapy! Maybe they are having an unrelated family problem, but they need to feel safe in the therapist's office, able to bring their full selves. For so long, “LGBTQ+” has been the signal for that, even if the term didn’t necessarily fit a specific client.
​
GSRD also asks therapists, I think, to really get clear about our competencies. More and more therapy practices are posting a Pride flag on their website, and checking the “LGBTQ+ affirming” box. This is great! It is also different, however, from being knowledgeable about a community. Are you comfortable with people in an identity group, unwilling to try and change their identity? Great! You’re affirming. Have you received additional training and education, potentially including lived experience, with a certain identity? Now you can say you’re knowledgeable. The GSRD framing asks us to check in with the different ways of being in the world, and as any new term does, helps us identify where we might not be knowledgeable. 
Sources:
​https://pinktherapy.org/wp-content/uploads/2021/01/What-does-GSRD-mean-.pdfhttps://www.bacp.co.uk/media/5877/bacp-gender-sexual-relationship-diversity-gpacp001-april19.pdf

​Mary-Margaret Sweeney, MSW, LCSW, CST is a certified sex therapist licensed and practicing in the state of Indiana. You can read more about her practice and reach out about working together here.

If you want a therapist to start talking and never stop, ask them about movie portrayals of therapy. (Asking about working with insurance companies will also work. But we are going to stick with Hollywood for today.)

There seem to be two options for therapists in the movies: the Freud-like couch, where the patient does all of the talking, a long monologue at the silent, stoic therapist who may jot some notes, but otherwise might as well be a rock, usually seated in a very expensive-looking chair. This therapist is usually portrayed as male. The second option feels almost completely opposite: they are usually female. They are wearing a lot of flowing layers (scarves, shawls, big skirts), maybe funky glasses, and are a stereotype of the 1960s hippie. God forbid this latter example is also playing a sex therapist! Then there is a lot of art pieces that look like vulvas.

So which is it? Perhaps obviously, there is a happy middle for most of us. We can be professional and warm, appreciate a nice chair and funky glasses. But we all make choices about how much of ourselves we show our clients. This is in an effort to ensure that the therapy hour is about the client, and not the therapist. It works to allow our clients to hold different beliefs, opinions, and identities from our own, and not feel restricted in sharing them with us.

I know that last part has always been a challenging part of practice for me, and acutely so since 2016.

As a sex therapist with specialized training in sex therapy with queer and transgender people, you might guess that a good percentage of my clients are very liberal. You would be correct. But not all of my clients align politically left. I have witnessed similar clinical outcomes with people regardless of their political inclinations and religious affiliations. And I want to be a therapist who welcomes all. Being “affirming and inclusive” is used by many in my field to express their acceptance and celebration of LGBTQ+ community and other marginalized groups. And, inclusive means being, well, inclusive. Of everyone. And it is something I take seriously. Research shows that folks from conservative backgrounds might experience higher than average sexual dysfunction. 

We are coming up on a month since the SCOTUS decision of Dobbs versus Jackson Women's Health Organization, which overturned Roe versus Wade, rescinding federal protection of abortion and sending the decision back to the states. As a sex therapist in Indiana, I and my colleagues immediately braced for impact. Our state legislature called a special session, to start July 25th, which will likely ban abortion in our state with few exceptions. To support reproductive choice is considered politically “liberal.” So what does a therapist who wishes to be accessible to all do?

On August 13th, my practice, seek&summon, will sponsor a table at a fundraiser for our state's abortion fund. I mulled this decision over, cognizant of the impact my overt display would have on potential and current clients. And then I wrote the check. I believe support of bodily autonomy and health care access is what my profession's code of ethics calls me to do, and I believe there is room for healthy, therapeutic dialogue with my clients who have questions, should they desire it. Reproductive freedom is about abortion, but it is also about my clients who utilize contraception; gender-affirming hormone therapy; those who require assistive technology to become pregnant such as IVF and surrogacy; those who use medications for unrelated ailments who will now find it challenging to access their needed pharmaceutical care because those meds might also be used to induce a miscarriage; and access to a supportive adoption system that feels less like an exploitative industry.

Maybe this puts me closer toward the therapist wearing 6 shawls, 2 scarves, and glasses on my face as well as perched on top of my head—and I will admit that as a sex therapist, I do indeed have vulva-inspired art. But we are living in a time--and I would argue, we always are--where it is a matter of clinical safety for clients to know if their therapist supports their bodily autonomy. As access to abortion care and potentially other reproductive and health care needs becomes almost impossible, I'll take the wacky therapist trope over the neutral rock if it means that my clients know that I will give them evidence-based information and help them meet their health care needs. I am proud to signal that publicly, and invite all therapists to consider their duty in an increasingly precarious time for our clients who hold oppressed identities.

​As we see students, along with their educators and administrators, forced back into the classrooms and schools where they cannot social distance, do not for one moment buy it when politicians say they are doing it for the good of youth mental health. Ask about their past record of providing funding for mental health services in schools. Did they go out of their way to ask for more social workers and school psychologists, or is this new rhetoric?

Do not believe them when they say they are doing it to relieve working families of childcare concerns. Ask about their past record on supporting paid parental leave, subsidized high quality childcare, increased minimum wages and access to higher education and job training. Does their support of working families seem sudden?

I can tell you Mike Pence's record on these issues, because he was the governor in my state while I was working in the provision of mental health care to youth, social support to youth and their families, and health education in Indiana schools. In each of these efforts, policies signed into law by this man thwarted my efforts. Not just in a vague way, but in particular ways that hindered my ability to provide the care that research tells us is best practice. Just like the US experience of the global pandemic he has been tasked with stewarding, the HIV crisis in Pence's home state ran out of control due to his late and ineffective policies, based in moralizing rather than science.

I am not at all denying that the past 5 months of distancing has been a burden on the mental health of our children, and all of us. I am therapist on the front lines of this pandemic. I see it--I live it, every moment of every day. I also know that the immense strain this puts on families, especially working moms, is real. I have worked in my communities my entire career on these issues. Those of us critiquing the return to "normal," as if that is even possible, are not denying these problems but are in fact, the people who have always seen these problems and have worked to address them. We are offended by the co-opting of our rhetoric by morally bankrupt individuals who suddenly wish to capitalize on the work we've asked them to partner with us on for generations. The photo is of me outside what is commonly referred to the as the birthplace of the social work profession, Hull House. It is one example, that dates from the 1800s, of the two-steps-forward-one-step-back work we have done to address these issues in our country for those most impacted by them. And for just as long, others who make more money and enjoy better benefits have stomped on our efforts and rolled their eyes at our "bleeding hearts"--until our language suits their public image. If you truly care about mental health, access to education, and the solubility of families, you are welcome at any time to join us in that generations-long fight.

As a therapist and someone who provides training and consultation to community groups, I have moments of pause when I share something that clearly states where I stand on an issue, a politician, or a value. Shouldn't therapists be blank slates? Creating a safe holding environment for any client who presents for care? And even as a facilitator of training, does stating my position take up too much space in the "classroom" for others learning? Maybe. Many of my colleagues would say so. Yet as a therapist who serves communities who are directly impacted by policy implementation and these creative and disingenuous turns of phrase, creating a safe space means broadcasting where I stand so clients have no question about their safety. As a practitioner of Acceptance and Commitment Therapy, my work with clients asks them to name their core values, and to then build our treatment plan around that. To stand aloof from that process myself, too, is disingenuous. 

It's been a year since I led my first training as a self-employed person. My website was being built (painstakingly, with great frustration and much coffee, by me, definitely not a website designer), I was meeting with potential clients, and also my accountant, my attorney, and sussing out which bank would be best for my business account. Thankfully I am married to a former data analyst, and god made Quickbooks intuitive enough for even a theatre-kid-turned-social-worker to understand. 

It became clear so quickly that while you go out on your own to do the work you're great at, you actually spend about 80% of your time doing things you've never done before. Administrative tasks, marketing, selling. It's a wild ride. 

Many people have asked me over the last year about self-employment, and I try to answer honestly. There is a whole lot of self-employed, self-empowerment, "girl boss" culture right now out there, and it does look super attractive. How many times have you seen a beautiful photo of a beach, someone's front porch, a trendy coffeehouse, and the caption #myoffice ? If you follow me, you've seen it a couple times at least. And, yes, it is true that I have put some serious work time in on my front porch with my dog at my feet. But this is also not the full picture. I've written a little before about the realities of the last year, and I wanted to write a few posts to address specific questions people interested in working for themselves have brought to me. Here is today's topic.

How do you swing it financially?
A self-employed colleague, Julie Kratz, told me that it took about a year for her to start getting consistent clients, and that she had been told the same by other consultants. That has been true for me too. And in that first year before you're making real money, you're also spending a lot to start your business. Because I wasn't opening a brick and mortar store, buying light fixtures or inventory, or even renting office space, I didn't think about how much money I would still be spending. But, oh did I. Office supplies. Technology--I had a laptop, but needed a projector, adapters because every room seems to have a different plug situation, a printer and then money at copy shops when that printer inevitably died. Membership dues and continuing education hours for the licenses I hold as a social worker, therapist, and yoga teacher. Malpractice insurance for both therapy and yoga. Meals with potential clients, and meals when I am traveling for work. Attending networking events. An accountant, an attorney, photographer for a professional headshot. Registering as an LLC with the state, and registering my website URL, the associated email address, and the software I use to design my logos, fliers, business cards, and social media posts. Sure, you can write all this off on your taxes. But writing something off doesn't mean it is free! The huge cost that stopped me from leaving my job even earlier than I did? Paying for health insurance without employer help. The next time you get your pay stub, really look at how much money your employer puts toward your health care. Get on the ACA Marketplace and do find out what health insurance will cost you before you leave your job. The price will shock you.

It takes a certain amount of planning and saving, and privilege, to be able to spend more to make less, and to not know for certain when that math will flip in your favor. A few things that helped me feel more secure taking this risk? 
-First and foremost, again, economic privilege. Plenty of people start successful businesses without it, but it sure does make it easier.
-I have a few skills that I knew could yield immediate income like teaching yoga and providing therapy. Of course, gaining these skills also cost a lot of money and time. But I had already made that investment when I set out on my own, so I had them at my disposal.
-I had a previous career in the tech start-up world and I knew it was not a forever thing while I was there. Luckily I had the foresight and ability (privilege again! See?)  to save a lot of my income at that time, knowing that I would likely want it later when the time came to do something weird. Here we are!
-I do have a partner who shares my household expenses, and we are both very comfy living on the cheap.

You need to get really honest. You do need to be brutally honest with yourself about how much money you need, what you can sacrifice and for how long, what you have saved, and how you will handle emergencies. An example? Earlier this year I had the unanticipated experience of traveling to Northern Ireland and presenting a workshop in Belfast. Because I have family in Ireland and I had the flexibility with my time in a way traditional employment never allowed, I decided to backpack Ireland and Northern Ireland the entire month leading up to the work engagement. I budgeted for a year to make that happen, including renting out a room in our home and trading rent for dog-sitting during the two and a half weeks of the Ireland trip where my partner joined me. Brilliant! All planned out! The night before I left, while I was busy congratulating myself on the execution of this plan, our furnace died, it was in the 30s where we live, and we had to find $2500 within hours, on my way to the airport. 

You will be tested. I felt that at many points I was being tested on how much I really wanted this. And you can call this "manifesting" or "prayer" or, like me, the practical outcome when we focus our time and energy fully and intentionally.  Whatever you call it, as soon as I said "I am 100% in for this thing I am doing," it started to work in a new way. I could see the light at the end of the tunnel. I am a year in, and this happened very recently. 

Limit your "free" work. You will get so many exciting connections to potential work, only to be told that they intend to compensate you with "exposure." Unlike booking a Southwest flight, I can't choose to pay my bills with either "Dollars" or "Points." AT&T has only accepted my dollars up to this point in our relationship, with no regard to my vast exposure points, and so dollars are what I need to earn. Look, there is something to be said for getting your name and what you have to offer in front of the right people. But my experience has been that if they know they can get it for free, they value it less, and assume you will give it away again. When I have worked for free, it has not generated the paid work that "exposure" was supposed to get me. But doing work for pay has generated a lot more paid work. I don't know what alchemy this is, but it is true. Charge what you're worth, give some discounts to non-profits and others with limited budgets, but don't put yourself out of business before you even get going. 

The grass is always greener. I have had several people say, "Well yeah if I had a partner that helped pay the bills I could do this too." Or: "Well sure, if I didn't have kids, I could work for myself as well!" Don't guess at the resources of others, pals. You are rarely correct. Yes, having a working partner does help--and, his job isn't high paying, stable, and doesn't cover our health care. Doing this was asking a lot of him too, and it required a commitment to communication and vulnerability that we have not had to muster before. We do not have children to care for, that is true--and we chose that, so we could pursue other things,namely work that is meaningful to us, if not secure. Also most of the people I know who own their own businesses have children. I don't know how they do it, but they do. Oh, also? Know other people doing this. They will talk you down when you need it, they usually also have weird daytime availability to do it, and they will rejoice with you in your wins in such a heartfelt way, because they understand it in a way others won't. Find you a village, and love them hard. That isn't financial advice, but it is so important. 

Most of us who work with victims of trauma are very aware of the behavioral cues that may come with their experiences. There is no shortage of training on the topic. Sexual assault victim advocates want law enforcement to know that the shock of the attack may look like hyperarousal...or, hypoarousal. We educate the legal system on how memory may be impacted after a traumatic event. And as the discussion of childhood trauma moves to the mainstream--like, Oprah did a special about it kind of mainstream--teachers are receiving trauma-informed care trainings to recognize trauma in their students. We share memes that say "The kids who need the most love will ask for it in the most unloving ways," and we try and help educators understand that the behaviors that feel like indifference or disrespect may indeed be cries for help, and that when schools punish this behavior, we may very well be punishing a kid for having abusive parents. A history of sex abuse. The death of a loved one. 

Behavior is communication.

Why then, do we understand this for our clients, urging their teachers to consider alternatives to suspension, creating endless PowerPoints for police officers, only to see the same signs of trauma in our colleagues.--and dismiss it right away as bad behavior?

In my trauma-informed self-care training, we delve into the overlap of trauma survivors taking on roles in trauma work. To give back and to make meaning of our experiences, we may seek to work on the very issue around which we have experienced trauma. My theory in this workshop is that we have a lot of people working with trauma survivors who are not only subject to vicarious trauma via the client, but who are also being consistently re-triggered in their own trauma history. And if enough folks at the same organization have that experience, you can guess that the work culture may not be the healthiest one in the office park. Things may begin to break down.

Think back to the last time you were in a job that you really, really didn't want to do anymore. How did you behave? Some of the common things I am told when working with clients around employee morale include:
-coming to work late, or leaving early, or both
-taking long lunches, or disappearing to run "errands," but everyone is suspicious of where the employee really is
-makes any excuse to be out of the office, generally
-someone who used to be diligent in their work now misses deadlines, makes excuses
-an employee who was usually very friendly and team-focused withdraws, and maybe even shows hostility toward colleagues

If we work in social services, and we have a client who begins to exhibit behavior like this, what do we do? Do we come out swinging? Do we write them up? If we're practicing in a trauma-informed way, we sure don't. We have a conversation. We ask probing questions. We go into that conversation assuming that these are likely symptoms of the bigger picture and that the client requires more support, not less. So why is it different with our colleagues? If we would ask a client, "What's been the barrier to you missing your sessions with me? Is there something making you uncomfortable about our time together?" why can't we start with "I've noticed a change in your work performance and behavior. Is there a reason you don't seem to want to be in the office? Is there something or someone here making you feel unsafe or uncomfortable?"

Productivity is important. Employers invest salary and benefits compensation into a person, and the demands of the job don't allow for many folks to dip out during the week. But the more I have sat with my own history of trauma, how it has been poked in my time as a social worker, and working in an incredibly toxic environment that I've worked hard to understand and grow from, I have come to this: we cannot call ourselves trauma-informed, if we only attend to the trauma of our clients. We cannot call ourselves trauma-informed if we create office cultures where gossip and bad boundaries are the norm. We cannot call ourselves trauma-informed if there is an unaddressed history of turnover, hostile relationships with former or current employees or community partners, and a practice of meeting these facts with defensiveness rather than honesty. We do not let our clients ignore their most problematic behaviors and relationships, and we should not let ourselves do it either. 

Did anything in this post sound familiar? Mary-Margaret would love to work with you to investigate your workplace culture, either via her trauma-informed self-care training and/or her consulting and team-building services. Shoot her an email here!