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By November 13, 2020February 19th, 2021No Comments

Gay and lesbian people come to psychiatrists for help and treatment for many of the same clinical and life issues that heterosexual people do – Anxiety, help with relationships, awareness of patterns that are interfering with their moving forward in their lives, etc. Some of these issues have little to do with the individual’s sexual orientation while others may be intimately connected to their gay identity. Either way, as the treatment gets underway, issues of sexual orientation and identity are likely to play a role in how the treatment evolves and becomes key in understanding the individual and his or her interpersonal interactions in the world at large. Consequently, a therapist with some specialized knowledge and understanding of these issues will be most helpful to the patient.


There are many important and unique aspects to working with LGBTQ population. Gay –Affirmative Psychotherapy assumes that GLB identities are normal and changing a patient’s sexual identity should not be a goal of treatment.

Therapists need to be familiar with the coming out process and must understand the complexities of internalized homophobia and heterosexism. We must be sensitive to our patient’s struggles and not cheerleaders for coming out, pushing for premature resolution of what may be deeply felt conflict and ambivalence.


HIV is another area that’s of huge importance and concern to the LGBTQ community, as many patients may require special assessment and monitoring of medications that produce psychiatric side effects and drug interactions. The syndrome itself may also present with psychiatric symptoms ranging from Depression and Anxiety to loss of memory and other cognitive changes.

Alcohol and substance abuse too is a significant issue for this population, with higher rates of prevalence than that of the general population, particularly among older gay people. And there seems to be evidence to support higher rates of mood disorders in this population. There is a lot of research attempting to explain the reasons for this, but again it underscores the need to have a therapist well versed, knowledgeable and experienced in working with and understanding the LGBTQ community.

Barry J. Richman

Author Barry J. Richman

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Barry J. Richman MD Psychiatrist NY

Manhattan, NYC Psychiatrist
(212) 889-5463