Authors: Dr. phil. Ulli Biechele, Dipl.-Psych. Margret Göth, Dipl.-Psych. Thomas Heinrich, Dr. Dipl-Psych. Jochen Kramer and Dipl.-Psych. Andrea Lang
Not all psychotherapy is the same and not all counselling is the same. There are different approaches to treatment, so-called “schools of therapy” (which are also used in counselling). The individual schools hold in parts very different conceptions of the human and forms of treatment. There are also differences in attitudes towards LGBTQI* people in this respect.
Important when choosing a particular therapy: to which “school” a therapist belongs is one side of the equation. But how the therapist brings their own life experience and experience with LGBTQI* clients into their work is just as important.
The different schools of therapy:
In psychoanalysis, current psychological issues are related to unresolved conflicts in childhood, in particular. Psychoanalytic therapy aims to (re)discover conflicts that have been repressed in the subconscious, bring them back into consciousness and help to resolve them with the help of therapy. Possible methods here include e.g. dream interpretation, free association (expressing everything that comes to mind). Historically speaking this form of therapy lasts for a number of years and takes places via therapy sessions on the couch. Today however, psychoanalysis is also carried out while sitting or over a shorter period of time.
Therapy based on depth psychology is a derivative or newly developed form of classical psychoanalysis. It is less strictly related to the analysis of childhood and includes elements and methods of other forms of therapy.
Behavior therapy (BT) assumes that all thinking and behavior is learned. If a person finds their behavior or thinking to be problematic or self-harming, they should unlearn such ways of thinking and behavior in behavior therapy – regardless of the reasons for which they started to think or behave in that way in the first place. Behavior therapy can be thought of as a form of training yourself into new ways of thinking or behaving. A number of methods are used to do this, e.g. “homework”, self-assurance training, relaxation exercises etc.
Person-centered psychotherapy or counselling is based on the humanistic view of the human. According to this view, every person knows deep inside themselves where their life should lead and what they will/won’t or can/can’t do. In cases where this knowledge is overlaid by bad experiences, concealed by commands and prohibitions, it is necessary to mobilize one’s own self-healing powers. Person-centered psychotherapy is therefore like taking a field trip into your own inner being in order to get to know or rediscover your desires and needs, to understand yourself better and thus be able to take better care of yourself.
Systemic therapy is a further development of family therapy. It does not look at people in isolation, but rather in their social relationships. The focus of counselling and therapy is the current issue or goal determined by the person seeking therapy themselves. With systemic therapy the aim is to enable new perspectives and (re)activate skills and resources in the living environment. This includes for example being given exercises to do at home. If desired, considering the family in which the person grew up can also be included in the therapy.
Body-oriented procedures such as depth psychology-oriented bioenergetic analysis refer to the unity of the body, mind and soul. Psychological problems and psychosomatic symptoms are explained by the fact that in our westernized world, the mind is considered the most important part of humans and the body is sometimes neglected. Body therapy tries to create a balance here: through training body awareness, relaxation exercises, breathing and expression exercises, and through touch and massage. This enables a more holistic experience and way of conducting oneself, leading to greater wellbeing, stronger self-esteem and more liveliness.
Gestalt therapy also focuses on people as the sum of the body, mind and soul. Above all, it is about having better access to your own feelings and therefore having more self-strength. In terms of therapy, perception exercises, body work, conversation and focusing on the “here and now” should help.
Transactional analysis is all about communication between people. According to this method, every person has three levels of communication: the child-self, the adult-self and the parent-self. The majority of conflicts in daily life arise when people encounter one another on different communication levels. Requests for information can often be perceived as accusations. Therefore this therapy aims to identify such communication issues and practice new forms of expression, especially on the “adult level”.
Psychodrama, as a depth psychology-oriented process, primarily relates to encounters with other people who shape our lives and determine our feelings and behavior. These encounters and other difficult situations recreated through role-play. In addition to re-enacting, new perspectives can be gained and other options of how to act can be tried out and experienced. Promoting your own spontaneity and creativity also enables you to deal better with situations that you previously found stressful.
Schools of Therapy and Attitudes towards Sexual Orientation and Gender Identity
The only school of therapy that has expressly dealt with the topic of being gay or lesbian is psychoanalysis. Its founder, Sigmund Freud, regarded homo and heterosexuality as equal and equally worthy. However, his successors later shaped the image of being gay or lesbian as being an illness ever since. In this way, male homosexuality has often been explained as being as a result of having a dominant mother and a weak father. Until a few years ago, all psychoanalytical training institutes refused to educate openly homosexual candidates. For this reason, until recently there were almost no openly gay or lesbian psychoanalysts. This has changed of late however, and more and more heterosexual psychoanalysts treat their gay and lesbian clients with great respect using in-depth knowledge. The same applies for depth psychology-oriented procedures.
None of the other schools of therapy have yet dealt with the topic of homosexuality at all, or if so, only very marginally. Practicing therapists in the past have therefore often oriented themselves according to prevailing societal opinion. As long as homosexuality was considered “abnormal”, forms of treatment were also offered to “cure” it, i.e. drive it out. BT in particular has distinguished itself in this regard with the aforementioned “trainings” in which gay men were supposed to “unlearn” finding pictures of naked men attractive by using electric shocks.
Systemic therapy and counselling emerged primarily from family therapy. Therefore, traditional forms of it tend to stick to the classic heterosexual family portrait. However, newer forms have overcome this and engage with all persons, couples and groups without judgment.
In terms of therapies influenced by humanism (person-centered psychotherapy, gestalt therapy), but also other forms which view all people as equal and that we are all OK as we are, there is a danger of overlooking the fact that lesbian and gay people have not only their own individual problems, but also those that society creates for them. If everything difficult in life is related to you yourself, and never related to your situation as a member of a minority, in certain circumstances you might find yourself growing tired of having to explain it over and over again.
Trans* people were also viewed as being “ill” across the schools of therapy. Only in recent years has psychotherapy looked at trans* people differently: i.e. not as within a category of illnesses assigned from the outside, but rather as a healthy self-description. In order for health insurance providers to cover the costs of treatment for gender reassignment surgeries, it is still necessary today to state the diagnosis of a disease. This will hopefully change over the next few years: the World Health Organisation is currently revising the diagnosis system. At the moment, it is important that psychotherapists are aware of this themselves and also inform their clients accordingly: the diagnosis as a disease is only due to formal requirements! Being trans* cannot be determined from the outside. There is also no suitable test procedure to do this.
Today, all schools of psychotherapy focus on the wellbeing of the person seeking help in theory and in practice, and according to their own standards. However, this cannot hide one fact: until now, no school of therapy has ever looked into whether LGBTQI* people need their own special standards. LGBTQI* psychotherapists have written numerous contributions to this theory themselves, as they noticed that something was missing.
Last updated: 03/09/2021 - 16:08