As a queer femme doctoral student in social work and a practicing mental health clinician who is also a recipient of mental health care services, I tend to be out, loud, and–if not exactly proud–consistently working on alleviating my own internalized shame. After all, homophobia, misogyny, and stereotyping mean that someone like me is not entirely unlikely to be branded the c-word: crazy.

In this blog, I will discuss the importance of acknowledging lived-experience practitioners in the social work field, and how disclosure and support can strengthen both academia and practice settings.

Our Community Strength and Struggles

I want to preface a mention of risk factors with a nod to strengths: Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and affiliated (LGBTQIA+) community members are creative, resourceful, and resilient. At the same time, we experience considerably higher rates of depression, anxiety, and substance use disorders as well as suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI) than our heterosexual and cisgender counterparts (Wiliams Institute, 2021). Some negative health outcomes may be attributed to the discrimination and stigma that we experience, per Dr. Ilan Meyer’s minority stress model (Meyer & Frost, 2013); in relation to this, Meyer explores the notion of community resilience or “minority coping,” which highlights how communities can enhance often-marginalized individuals’ well-being (Meyer, 2015). This is vital to consider due to existing unequal underlying social structures that put the onus on individuals to lift themselves up by their proverbial bootstraps. (Meyer, 2015). 

Community resilience may be reflected in the type of livelihood we choose to pursue; engaging in work that is meaningful and helps others can also help us cope and feel connection. It may not be surprising, then, that queer, trans, and gender non-binary (QTGNB) people seem to be well represented in social work and related fields, as evidenced by robust participation in LGBTQIA+-specific nonprofits, clinical practices, affinity groups, and committees. My QTGNB colleagues and I recognize the need for culturally affirmative care while, statistically, we have a higher chance ourselves of experiencing challenges to our mental health.  

My own lived experience with depression and trauma has informed my approach to service provision and collaboration with clients, as well as my prospective doctoral research topic. It feels a little scary to “come out” as a queer provider with a mental health history, no matter how many times I do it, and I find myself apprehensive that at some point the other shoe might drop. That something bad could happen if I keep revealing that I have been in therapy since I was a teenager, that I was hospitalized for depression, that I have survived trauma both complex and capital T. They’ll think it somehow has to do with my sexual orientation, or vice versa–that childhood trauma somehow “made” me queer (as if that was possible, and not that I would choose to be any other way). 

What if I am not taken seriously? What if I lose credibility? Many of the other providers I see on #TherapistTwitter use pseudonyms; some will even post about the importance of authenticity and sharing openly without ever disclosing their names. Others share their full names and credentials and are vocal proponents of lived experience being taken into account as clinical expertise for the purposes of both research and practice. I know others are out there. Why, then, is there so little acknowledgement of lived-experience social workers, including LGBTQIA+ ones, both in social work education and in the field? Why do I feel so lonely out here? 

Normalizing Our Lived Experience

Rather than being told I’m brave when I disclose about having lived experience, I want disclosure to be normalized. I want others to feel less alone in these shared identities, and I want it to be possible for other community members, particularly those with multiple marginalized identities, to “come out” without risking their jobs and their social networks. I want authenticity to be safer in our classrooms and workplaces. I want academia to assume that my work, among others’, is intended for both clinicians and for recipients of care, because we can be, and often are, both at the same time. I am critical of the power dynamic and false binary consistently perpetuated by our mental health care system–too often, it’s us v. them, professionals v. clients. I want academia and social work practice to acknowledge that clinicians can simultaneously be mental health care recipients and practitioners.

Because my research topic of interest is QTGNB therapist self-disclosure of lived experience within communities of practice, and I have spoken in class discussions and posted on Twitter about being part of my target population, all my cohort members—along with my professors—are aware of my dual status. In fact, I disclosed in my doctoral program application essay, and I have had numerous pieces published in which I discuss my lived experience. It’s no secret. I don’t talk much about myself with clients, but I’m also not going to lie about who I am, especially not to other queer social workers. Talking about our lived experiences with mental health care is how we destigmatize receiving mental health care.

I chose to study social work because of its holistic approach to formulating interventions with individuals, families, groups, and communities. At its best and most competent, social work practice promotes not only support of but empowerment among marginalized communities. It encourages practitioners to question the cultural norms that disenfranchise populations including BIPoC, LGBTQIA+ people, and immigrants, and it helps us connect individual hardships to a bigger picture: the institutionalized systems of oppression and privilege within which our society operates. I have developed many critiques of the social work profession, its contributions to maintaining the status quo, its problematic and racist historical roots, and its potential for paternalism–but an examination of those critiques is beyond the scope of this post.

So meantime I will say that I love the ideology behind the day-to-day work of building relationships and effecting change, which is why I pursued an MSW with a concentration in Community Organizing long ago rather than a degree in counseling. I had never intended to become a therapist and shied away from the idea of it for years, but eventually, clinical work called to me as I continued to participate in activism and organizing. I have struggled at times to bring my full self to the work because of my own mental health history, but I’ve found that the older I get, the less willing I feel to compromise my authenticity for the sake of maintaining a default patriarchal, white supremacist, cissexist, and classist definition of “professionalism.” 

The National Association of Social Workers’ (NASW) Code of Ethics (2021), a set of standards for U.S. social work practice, merits a critical review in relation to these issues. It advises social workers in section 6.04, part b, that particular attention should be paid to populations (presumably including LGBTQIA+ ones) who have experienced oppression. Part (d) explicitly instructs social workers to work to oppose discrimination based on various identities and group memberships, including sexual orientation and gender identity (SOGI) (NASW, 2021). Noticeably and dismayingly missing from the CoE is any mention of protections for social workers or social work student interns who are part of oppressed and exploited populations, and who are themselves vulnerable to workplace discrimination in settings relevant to the profession. Per section 3.09 (f), we are expected to accept employment or internships only “in organizations that exercise fair personnel practices” (NASW, 2021), which begs the question of why social workers and students, rather than a dues-charging professional social work association itself, should be left to ensure that these organizations treat us fairly. While section 3.02 of the CoE touches on issues related to education and training, the NASW makes no mention of trauma-informed pedagogy as an ethical must.

The Importance of Acknowledging Our Stories

In my experiences of social work education and training, it has been rare that a professor or continuing ed trainer acknowledges the very real possibility that attendees themselves have lived experience. As a result, crucial topics end up being left out of the conversation. What if we risk overidentifying with clients based on lived experiences with certain conditions, treatments, or psych meds? Can we discuss in the classroom, not just in our siloed individual supervisions, how to effectively address that? Are we afraid that we will be viewed as unfit to practice by our colleagues and supervisors? Why is lived experience generally considered an asset in substance use counseling, but largely unacknowledged–and, when it is acknowledged, undervalued–among mental health care practitioners? Why isn’t lived experience commonly viewed instead as a valuable form of expertise that can inform research?

Failing to acknowledge that discussions of trauma and mental health can resonate with or–to draw on a term that I fear is frequently misused–“trigger” workers, not just their clients, does learners a disservice. Trauma-informed pedagogy, in which educators take into consideration an understanding of how “violence, victimization, and other experiences may have impacted the lives of the individuals involved and to apply that understanding to the design of systems and provision of services so they accommodate trauma survivors’ needs and are consonant with healing and recovery” (Butler, Critelli, & Rinfrette, 2011; Harris & Fallot, 2001; N. J. Smyth, 2008, as cited in Carello & Butler, 2015), is vital in social work education. 

We workers, along with our clients, need to be approached with this lens, particularly in clinical courses related to trauma and mental health themselves and during the seemingly endless COVID-19 pandemic. The persistent overemphasis on “self-care” in social work education and practice mean that the concepts of invaluable structures such as community care, institutional care (i.e. from employers at social service agencies and administrators in social work educational programs), and mutual aid are frequently left out of the conversation. This leaves the onus on social workers and social work students–who practice in the field in either internship or job settings along with taking our classes–to fend for ourselves over and over again. 

Conclusion

How can we begin addressing some of these issues? We can advocate for worker and intern rights with NASW–fellow social workers, check out this initiative to revise the Code of Ethics. We can talk about workplace and classroom wellness with our colleagues, peers, and communities of practice and organize for change. We can focus our research efforts on the benefits of self-disclosure–this is my plan for my own capstone project. Social work education and practice can do better. It must. Our futures as social workers and as lived-experience practitioners depend on it.

References:

Carello, J. & Butler, L. (2015, July 1). Practicing what we teach: Trauma-informed educational practice. Journal of Teaching in Social Work, 35 (3), 262–278. https://doi.org/10.1080/08841233.2015.1030059

Meyer, I. H., & Frost, D. M. (2013). Minority stress and the health of sexual minorities. In C. J. Patterson & A. R. D’Augelli (Eds.), Handbook of psychology and sexual orientation (pp. 252–266). Oxford University Press.

Meyer, I. H., O’Neill, K. & Wilson, B.D.M. (2021). LGBTQ people in the US: Select findings from the Generations and TransPop studies. Williams Institute.

National Association of Social Workers. (2021). Code of ethics: English. Retrieved February 2, 2022 from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English 

Theophano, Teresa (2022). The Queeresilience Project. https://sites.google.com/view/the-queeresilience-project/home?authuser=0 ​​

Teresa Theophano, LCSW is a New York City-based licensed clinical social worker, freelance writer/editor, and doctoral student in social work at University at Buffalo, State University of New York (SUNY). Teresa currently works as a program director, trainer, and psychotherapist at a small geriatric mental health nonprofit. She is a contributing writer to The Affirmative Couch among other online venues, and with Stephanie Schroeder, she is co-editor of Headcase: LGBTQ Writers and Artists on Mental Health and Wellness (Oxford University Press, 2019).