Relational-Cultural Therapy for LGBTQ+ Youth
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When LGBTQ+ youth are alienated, isolated, bullied, or made to feel unsafe, their grades drop, they skip school, and they’re more likely to abuse drugs and alcohol.
Studies have consistently shown the mediating impact social support and LGBTQ+ community connection have on mental health for sexual and gender minorities. When they’re loved and accepted, they thrive. When they’re outcast and oppressed, negative messages start to get internalized.
Recognizing this, how can counselors help their young clients connect to a healthy community, and build the psycho-social resilience needed to hold onto their self-worth? One method lies with relational-cultural therapy (RCT).
What is Relational-Cultural Therapy?
Jean Baker Miller developed RCT as a form of feminist therapy in the 1970s. Her book (1976) Toward a New Psychology of Women dove into the interpersonal dynamics of dominance and subordination, how these relationships deeply impact mental health, and the strengths of cooperation, giving, and serving.
The goal of RCT is to help clients engage Mutually-Growth-Fostering relationships that cultivate Miller’s Five Good Things:
- Zest (defined as a sense of energy and vitality)
- Clarity
- Sense of Self Worth
- Productivity
- A desire for more connection
Case studies have shown how RCT can help LGBTQ+ college students and LGBTQ+ youth, and while more research is needed to explore the full application of RCT with this diverse demographic, the benefits are easy to see.
Contributing to one’s community is just as important as being affirmed by one’s community, and while this is apparent in day-to-day interactions, mutual growth also applies to the therapeutic relationship. When young people are given room to share, teach, and express what they know in session, they can really shine. For disenfranchised LGBTQ+ youth, a truly heartfelt connection with a sincere mental health professional can help them turn corners and climb mountains.
Obviously, professional boundaries should be considered, which is why RCT does not center the counselor as a primary relationship in a client’s life. Rather, RCT helps clients identify, initiate, and invest in meaningful relationships outside of the session while role-modeling what those relationships can look like in session.
Such meaningful connections can also reinforce a client’s resilience, which Linda Hartling outlines in her article (2003) “Strengthening Resilience In a Risky World: It’s All About Relationships.” Instead of focusing on the client’s self-esteem, internal control, social support, and mastery of a skill, Hartling emphasizes the importance of self-worth, mutual empowerment, authenticity, and competency via connection.
But how can this paradigm shift help LGBTQ+ children, teens, and young adults?
From Self-Esteem to Self-Worth
Building self-esteem can often sound like wishful thinking, especially to LGBTQ+ youth who feel like society doesn’t value their sexuality or gender identity. Add to this the pressure that goes along with puberty in a world obsessed with comparison, and you have the perfect recipe for low self-esteem.
Many young people often feel like their self-esteem is competitive, or at the very least performative. If their self-esteem is anchored to their intelligence, their confidence may crash if they get a poor grade. If their self-esteem is applied with makeup, they may live in the shadow of unrealistic beauty standards.
Self-worth, however, is quite different from self-esteem. Instead of hyper-focusing on confidence, or trying to “fake it ‘til you make it,” self-worth recognizes a person’s intrinsic value, as they are, here and now. Not only this, a person’s sexuality, gender, race, ethnicity, and cultural background also have intrinsic value, since each facet of their identity grants them a unique perspective, insight, experience, and wisdom.
However, it can be difficult for some LGBTQ+ youth to believe their existence has merit, especially if they’re in conflict with their family or feel ostracized by their community. RCT counselors help clients engage meaningful connections with people who actually love and respect them, while simultaneously helping clients expand their awareness towards those who already do. After all, it’s one thing to be loved and valued by friends and family, and another to believe it.
RCT counselors can help LGBTQ+ youth be mindful of who misses them when they’re not around, who believes them when they share their truth, who cheers them on during their best and worst days, and who pays attention to them when they use their voice.
The client’s worth is further underlined in session when the counselor pays keen attention to what they’re saying, shows active curiosity and engagement in their areas of interest, and appreciates what their client brings to the table.
From Internal Control to Mutual Empowerment
The coming-of-age experience is full of many hard lessons about what is and is not in one’s control. Because therapy is often self-reflective, counselors can sometimes over-focus on a client’s agency. While the positive intent is to explore how best to respond to hardship, young LGBTQ+ clients may feel like their counselor is blaming them for not having more control of the situation, or like their emotional reaction to oppression is more of a problem than the oppression itself.
LGBTQ+ youth contend with many real-world obstacles that require more than just managing their feelings, mustering their motivation, or flexing their willpower. They need help, and to feel like their social change efforts are making a difference to help others, too.
RCT favors mutual empowerment by observing how self impacts other, and how other impacts self. Since no one exists in a vacuum, it’s important for LGBTQ+ youth to create uplifting alliances. This may look like identifying friends, teachers, coaches, and role-models who are willing to co-create a healthy and safe environment.
While pursuing internal control focuses on independence and self-discipline, it can also contribute to self-isolation, making it difficult to ask for help when it’s needed. On the other hand, mutual empowerment reminds the client who is in their proverbial boat, and who is paddling towards the same goal. It also demonstrates how they can empower and embolden those around them.
In session, RCT counselors explore themes of mutual empowerment by asking how the client decides things in class, how they encourage other students to cooperate, and how people rely on them differently.
From Social Support to Authentic Connection
Social support is of vital importance to LGBTQ+ youth as they develop their personal identity, yet some many well-wishers and fair-weather friends may support sexual and gender minorities at an arm’s length. Even counselors who work with LGBTQ+ youth may hide behind a veil of sterile professionalism, leaving their clients feeling like they’re moving through a cut-and-paste treatment plan with no real attention to detail.
When this is the case, efforts on the counselor’s part to affirm their client may feel hollow, as if “that’s what you’re supposed to say” or “that’s what you say to everybody.”
To dive deeper into authenticity, RCT counselors encourage and validate clients’ efforts to practice open communication and personal vulnerability. This can look like identifying safe people to open up to, or learning to express one’s sexuality or gender identity in different ways if that’s so desired. Since cultures of vulnerability can be few and far between for some kids, RCT counselors may use the therapeutic relationship to role model what a safe, authentic connection—complete with healthy boundaries—can look like.
Authentic connection requires tailoring the session to meet each client where they’re at and honoring the process in the moment. Taking time to understand, empathize, and see the world from their view can foster emotional attunement between the client and their counselor, evolving the artificiality of therapy into a meaningful link between two genuine people. Having an authentic connection with a client doesn’t compromise a counselor’s professional boundary, yet it does acknowledge the inherent power dynamic, the identities of both individuals in the room, and how meaningful the therapeutic relationship is to both the client and the counselor, respectively.
From Mastery to Competency Through Connection
Young people are inundated by messages of mastery. They’re told to get an A+, get the trophy, make the scholarship, win the popularity contest, get the promotion, and on and on.
Those who anchor mastery to personal value can sometimes feel like they have to be good at everything. Or, if mastery sounds far-fetched, they may give up before they begin for fear of failure or looking like an amateur.
Linking value to a graded performance can be exceptionally problematic for LGBTQ+ youth, who may or may not meet the social expectations set out by heteronormative and cisnormative life goals. Yet even if they relinquish such goals in favor of their own, the concept of mastery itself can create a paradoxical competition, pitting the self against the self.
Children, teenagers, and young adults are growing all the time, so they naturally want to be better, which begs the question: Better than who? Better than the rest? Better than themselves?
If one has a healthy sense of self, aspiration is just continued affirmation. That sounds great! But if one has a fragile sense of self, aspiration can feel distant or even impossible. And if one has a despairing sense of self, then aspiration can mutate into self-deprecation or self-censorship, leading young people to believe they have to stop being themselves in order “to be better” or fit in with the heteronormative status quo.
As Judith Jordan points out in her article (1999) “Towards Competence and Connection,” mastery contains within it a very charged conceptualization of master over subject, placing a client’s personal growth on a premise of self-subjugation. Building off Jordan’s use of “competence” instead of “mastery,” Hartling observes how many clients begin their therapeutic journey because of a decline in confidence. Competency through connection emphasizes the importance of collaboration, mentorship, and community help to strengthen the client’s resilience and build their confidence in themselves.
RCT counselors may ask a client what games they like to teach other kids, what they know that they can share with a group, and what their favorite subjects are in school. Peer-to-peer interactions that let LGBTQ+ youth help other kids their age can really add to their sense of purpose and belonging.
In session, RCT counselors may take time to let their clients teach them something from their world. What do they love? What are their hobbies? What is their favorite fictional universe? Competency through connection demonstrates how one doesn’t have to be an expert to help other people or connect in meaningful ways, and that everyone has something valuable to contribute.
Applying RCT with LGBTQ+ Clients
For LGBTQ+ youth, their relationship with their counselor can be instrumental in developing trust and psycho-social resilience. For some kids, it may very well be the first time they have discussed the deep and complex aspects of their sexuality and gender identity with an adult outside their family. For others, it may be the first time an adult has valued their thoughts or opinions at all.
Unfortunately, many licensed mental health practitioners run the risk of burnout by filling their workload, resulting in fatigue, forgetfulness, or an overall disinterest in the session. Young clients can pick this up in seconds, especially if they’re starved of meaningful connection. They know when an adult is engaged with them, and when they’re just going through the motions because there is no relational attunement.
This is why RCT counselors emphasize the importance of an authentic, meaningful connection that affirms the client’s intrinsic value by paying active attention to who they are. It can take a little more compassion, time, energy, and focus, but that’s exactly what LGBTQ+ youth need to thrive and grow.
Alex Stitt, LMHC
Writer & Contributing ExpertAlex Stitt is a nonbinary author, queer theorist, and licensed mental health counselor living in Hawaii. As a proud Queer Counselor, they work to educate professionals in the mental health field interested in working with LGBTQ+ populations. Their textbook, ACT for Gender Identity: The Comprehensive Guide, demonstrates how to apply Acceptance and Commitment Therapy to gender self-actualization.