It’s LGBTQ+ Pride month, and we wanted to take the opportunity to discuss one of the main things that interferes with Pride: internalized stigma. In this post, we’ll review what internalized stigma is, why it matters for LGBTQ+ mental health, and how DBT can address it.
What is internalized stigma? Why does it matter for LGBTQ+ mental health?
Stigma is the negative beliefs that society holds towards a group of marginalized people, such as LGBTQ+ people. When a queer person hears anti-queer prejudice enough from the culture around them, they may start to believe it. This internalized stigma may be quite explicit and conscious—a queer person may fully believe and endorse inaccurate messages, believing that they and other queer people are “less-than” or “bad” in some way.
But internalized stigma can also be more insidious or subconscious, leading a queer person to struggle with chronic shame or a sense of “not-enough-ness.” It can contribute to difficulties with identity uncertainty and self-judgment. It’s common for queer people — particularly bi+, nonbinary, or other queer people who live outside of typical binaries — to stressfully question whether they’re “actually queer,” “queer enough,” or expressing their queer identities in the “right” way.
Just like other LGBTQ+ minority stressors (e.g., discrimination), internalized stigma negatively impacts mental health. Clinically, we know that stigma-related events and thoughts can directly influence queer people’s emotional wellbeing in real-time and contribute to impulsive behaviors and urges. Internalized stigma may show up in our queer client’s behavioral chain analyses in the form of judgmental thoughts as well as shame, disgust, fear, anger, or hopelessness. When it does, it deserves to be highlighted and addressed as a treatment target.
How DBT Can Address Anti-LGBTQ+ Internalized Stigma
DBT offers a variety of techniques and skills effective for reducing internalized stigma, increasing pride or self-comfort, and reconnecting LGBTQ+ clients to queer joy.
Psychoeducation & The Biosocial Model
From the very beginning of treatment, DBT clinicians can help their LGBTQ+ clients combat internalized stigma by introducing it as a part of the Biosocial Model. A clinician can briefly review the research supporting the Minority Stress Theory, informing the client of the ways that discrimination and stigma negatively impact LGBTQ+ mental health. They can explain how a chronically queer-invalidating environment can contribute to emotional dysregulation generally or to internalized stigma and shame specifically. Beyond highlighting minority stress and internalized stigma as a potential important target for therapy, therapists can demonstrate their support of LGBTQ+ people and show their clients that LGBTQ+ issues are welcomed to be discussed in the therapy room.
Highlighting and Cognitive Modification
When clients express explicitly negative views towards LGBTQ+ people or their own queer identities and experiences, DBT therapists can nonjudgmentally highlight these thoughts and work towards reducing them. As with other distorted thoughts, therapists can help clients change the content of these thoughts to be more accurate, nonjudgmental, and compassionate. And they can help clients notice and challenge the stigmatized thoughts that do not help them towards creating their life worth living. To do this most effectively, it is important for DBT clinicians to do their own learning and un-learning around sexuality, gender, and cultural expectations, so that their own internalized cisheterosexism, allonormativity, and other queerphobias do not interfere with treatment.
DBT Skills
Finally, there are many DBT skills that can be helpful in directly and indirectly reducing the harm of internalized stigma. For example, Checking The Facts or Mindfulness of Current Thoughts can help clients notice, challenge, and detach from anti-LGBTQ+ thoughts. Self-Validation, Wise Mind, and mindfulness skills can help clients directly observe, nonjudgmentally describe, and affirm their internal experiences of sexual attraction, gender identity, and queer desires. Accumulating Positives and Opposite Action can be used to support clients in reducing queer-related shame or disgust by engaging in activities that connect them to the LGBTQ+ identity, affirm their identities, or prompt queer joy and gender euphoria.
These techniques (and more!) can help DBT clinicians support their queer clients in overcoming internalized stigma, so that they can fully engage in Pride, this month and every month!
In honor of Pride month, DBT-LBC™ is also hosting a giveaway of Dr. Felhing’s new DBT-based book The LGBTQ+ Mental Health Workbook: Find Emotional Resilience, Self-Love, and Queer Joy with Dialectical Behavior Therapy! If you would like to enter to win a free copy of the book, please email [email protected] about your interest in the book. Winners will be randomly selected on June 25th. Increase your odds of winning by entering on multiple platforms by finding DBT-LBC™ on Facebook, Instagram, or LinkedIn. One winner will be selected per platform.
Also, in honor of Pride month and for the month of July, you can use the Promo Code PRIDE50 to receive 50% off of one of our previously recorded webinars that highlight and support this important work.
