Caring for Oneself and the Community While Navigating Trauma: For LBGTQ+ Providers and Affirming Providers
Julio J. Fonseca
Caring for myself is not self-indulgence; it is self-preservation, and that is an act of political warfare. Audre Lorde
The most important thing to remember is that allyship is a verb, not a noun. You can’t simply ‘be’ an ally. You need to practice it. You need to use your identity and privilege to make change happen. Dr. Evelyn Carter, PhD.
I had intended to write a slightly different column for this edition of the Group Psychologist that will likely see the light of day in some format. Still, this article is timely and urgent, given what is happening in the United States specifically and globally to some degree. Currently, the American Civil Liberties Union is tracking 339 pieces of anti-LGBTQ+ legislation. Over 100 state laws attacking transgender individuals and their rights have been passed since 2020, and there have been almost 40 executive orders signed by the President with the intent to eliminate Diversity, Equity, and Inclusion efforts, undo birthright citizenship, and target the elimination of transgender people. The legality of these orders continues to be challenged, but one thing is clear: the rhetoric in the United States against the LGBTQ+ community is inflammatory and violent (American Civil Liberties Union, n.d.).
The current geopolitical landscape and the collective national response to efforts to erase and minimize the LGBTQ+ community have fostered a feeling of uncertainty. I am a second-year doctoral student with eight clinical hours. Regardless of their identities, all my clients are affected by the uncertainty surrounding the expedited and unusual political processes. Consequently, managing this during our sessions while contemplating my future and striving to be an effective clinician feels like working on the frontlines of a battle. Did I mention that I am a second-year student? Anyone interested in this column is likely feeling massively overwhelmed with an even more pronounced version of: How can I be an effective clinician in the current landscape? How can I take care of clients and take care of myself?
Ways to Support Transgender, Gender Non-Conforming, and Non-Binary Communities
I am focusing this article on Transgender, Gender Non-Conforming, and Non-Binary communities.
IIn February 2024, the American Psychological Association (APA) adopted a policy affirming evidence-based care for transgender, gender diverse and nonbinary children, adolescents and adults, noting that recent legislative attempts to obstruct access to psychological and medical interventions for such individuals puts them at risk of depression, anxiety and other adverse mental health outcomes (American Psychological Association, 2024). What that means now is up to you as a provider, significantly as Other critical care is being halted to erase communities. I included Dr. Evelyn Carter, PhD’s quote at the top of this article because the term “ally” is often not used in its purest form. True allyship is a verb, and when it is at its best, it is embraced as a value rather than leveraged for clout or recognition. The ability to use privilege to create safer spaces—for transgender, gender non-conforming, and non-binary individuals in visible practice settings—is essential. Federal agencies and major corporations are visibly removing references and resources for these communities, starting with symbolic erasure, which is concerning. Ensuring safe spaces for these communities is crucial to fostering community and supporting clients’ mental health and wellness.
Liberation psychology provides a framework for queer and trans communities to thrive beyond mere acceptance, emphasizing resilience, resistance, and advocacy. How does this function when acceptance, the first principle, is quickly eroding? This framework is ideal, but given the current climate, it is crucial to recognize clients’ immediate needs, which may involve addressing trauma and providing more supportive work. For some clients, their day-to-day experiences are now filled with uncertainty and covert and possibly overt threats to their safety. It is no small task to create an affirming space for trans, GNC, and non-binary clients by integrating queer and trans perspectives into theory and practice. Emphasizing the importance of reclaiming histories and fostering resilience can broadly affirm their personhood (Singh et al., 2020). If this feels somewhat basic, it is because foundations often are. What is built upon them can be more nuanced and intricate, but many folks are in the mode of getting basic and foundational needs met.
Empathy vs. Compassion: What do you have to bring to the day?
Recently, my supervisors have discussed the distinction between empathy and compassion, examining how each can influence clinicians and affect our work in the dyad. Singer and Klimecki (2014) define empathy as the ability to understand and share the emotions of others, while compassion is a response to suffering that involves concern and a motivation to help. Their research highlights the concepts of empathic distress (personal distress) and compassion (empathic concern). Empathic distress refers to a self-focused adverse reaction to negative emotions, whereas compassion entails empathic concern. While necessary within specific theoretical frameworks such as psychodynamic theory, liberation psychology, trauma-informed work, and attachment-based and relational work, it is crucial to note that excessive empathy can lead to distress and potentially burnout. This is particularly significant if the therapist shares experiences or a community identity with the client.
Compassion, or empathic concern, involves less distress and a response characterized by kindness and practical assistance. The distinction made by Singer and Klimecki (2014) emphasizes less on the client’s emotional distress and more on their well-being. They also note in their research the neural basis for understanding empathic concern and compassion. Empathy and compassion affect the brain differently, leading to different emotional responses. When we empathize with someone’s pain, our brain activates areas that process pain, making us feel stressed and emotionally drained. Conversely, compassion activates parts of the brain linked to positive emotions and motivation, making it easier to help others without feeling overwhelmed. Research shows that practicing compassion can reduce stress and prevent burnout, allowing people to care for others in a healthier way (Singer & Klimecki, 2014). Maybe easier said than done now, but something to keep front of mind when ensuring we keep our wellness and welfare centered.
Self-Care
We hear about self-care often, but do we as clinicians integrate this into our work and life? (Asking myself this question as a doctoral student, the answer felt imprecise.) In a literature of self-care, Posluns and Gall (2019) present comprehensive data on the risks of emotional exhaustion from continuous one-way care relationships. Additionally, they frame some areas for us to consider as we consider how we care for ourselves. Each of the following domains may differ based on the clinician’s background and interest, and each may vary in attention, but they are worth noting.
Domains of Self-Care (Posluns & Gall, 2019)
- Awareness
- Recognizing work-related stressors and their impact.
- Engaging in self-reflection, mindfulness, and supervision to prevent burnout.
- Balance
- Maintaining a work-life balance to prevent emotional exhaustion.
- Strategies: Leisure activities, professional boundaries, realistic workload expectations.
- Flexibility
- Ability to adapt to stressors and cope with setbacks.
- Emotional regulation techniques like cognitive reappraisal and journaling improve resilience.
- Physical Health
- Exercise, sleep hygiene, and a balanced diet contribute to overall well-being.
- Mental health practitioners often experience sleep deprivation andphysical health concerns due to the sedentary nature of their work.
- Social Support
- Personal relationships (friends, family, therapy) and professional support (supervision, peer consultation) are essential for maintaining emotional health.
- Strong social support is linked to lower stress levels and higher job satisfaction.
- Spirituality and Meaning-Making
- Finding purpose and connection in the work prevents burnout.
- Mindfulness, gratitude practices, and nature-based activities improve Resilience and emotional balance.
While this list is not comprehensive, it provides a framework for consideration as reminders we sometimes offer to our clients yet often neglect ourselves. The expression “Physician, heal thyself” undoubtedly exists for a reason. Keeping some of these in mind may help us avoid burning ourselves out during this critical era of community need.
Path Forward
My desire in writing this column during the recent public and violent rhetoric against the LGBTQ+ community is that perhaps we can find inspiration in understanding community needs and our role as LGBTQ+ providers and allies. The importance of community and a sense of belonging, and how we can support some of the most vulnerable as providers, community members, and allies.
Being honest with ourselves about our therapeutic roles, emotional and spiritual capacity, potential complacency, and feelings of fear while prioritizing self-care will be essential for building community-wide resilience and survival. History has repeatedly shown that the LGBTQ+ community endures because we support one another. If not now, when?
References
American Civil Liberties Union. (n.d.). American Civil Liberties Union. Retrieved February12, 2025, from https://www.aclu.org/
American Psychological Association. (2024, February). APA policy supporting transgender, gender-diverse, and nonbinary people’s access to evidence-based care. Retrieved February 12, 2025, from https://www.apa.org/news/press/releases/2024/02/policy-supporting- transgender-nonbinary
Posluns, K., & Gall, T. L. (2019). Dear mental health practitioners, take care of yourselves: A literature review on self-care. International Journal for the Advancement of Counselling, 42(1), 1–20. https://doi.org/10.1007/s10447-019-09382-w
Singer, T., & Klimecki, O. M. (2014). Empathy and compassion. Current Biology, 24(18), R875–R878. https://doi.org/10.1016/j.cub.2014.06.054
Singh, A. A., Parker, B., Aqil, A. R., & Thacker, F. (2020). Liberation psychology and LGBTQ+ communities: Naming colonization, uplifting resilience, and reclaiming ancient his-stories, her-stories, and t-stories. In L. Comas-Díaz & E. Torres Rivera (Eds.), Liberation psychology: Theory, method, practice, and social justice (pp. 207–224). American Psychological Association. https://doi.org/10.1037/0000198-012