Can LGBT-Affirmative Therapy Help Re-Write Internalized Messages?
Featured Guest: Dr. Lauren Costine
In a heteronormative culture, how can providers use affirmative therapy to help LGBT individuals re-write the false messages they’ve internalized?
We’ll answer this with psychologist, author and activist Dr. Lauren Costine on this episode of Recovery Unscripted.
For more about Dr. Lauren’s work, visit https://drlaurencostine.com.
David: All right, I’m here with Dr. Lauren Costine. Thank you for being with us.
Lauren: Thank you for having me. I’m excited to be here.
David: Well, let’s start by having you tell us a bit about your background, your story and how you got into this world of psychology and recovery.
Lauren: Okay, that’s a great one. I’ve got 20 and a half years of sobriety.
David: Awesome, most congratulations.
Lauren: Thank you so much. Right after that I jumped into getting my Masters in Clinical Psychology and then I got my Doctorate in Clinical Psychology with an emphasis in Depth Psychology. For me that was just really understanding as deeply as I could what’s going on in the psyche specifically in our unconscious, that drives us without us knowing how or why or and we end up with all these different symptoms which one, for instance, is addiction. I, obviously, was heavily influenced by having my own addictions and I don’t just have one. I have what I call an addictive personality. Once I got rid of the drugs and alcohol, really really imperative, a lot popped up but we can get into that over time.
I’ve worked on those. Right as soon as I got my Masters, I was actually hired by the treatment center where I’d gotten sober to start doing weekend therapy. It was just basically because I understood addiction and then I was going on for further education and at that time there wasn’t as many treatment centers or wasn’t as many therapists in the field. It was more case managers and things, so, I just jumped in, got my feet wet, learned how to run groups, all of that while I furthered my education getting my license, getting all the hours and experience and supervision I could as a clinical psychologist. It just naturally became one of my niches.
It just was something I just understood and then I was really interested in helping others who I worked with understand what was going on underneath why are you using? Yes, we want to look at the behavior and we want to modify the behavior and we want to figure out from a cognitive behavioral perspective what we can do but I also want to know the why. What’s the trauma? What’s hurting. Trauma wasn’t even really a buzz word yet. Somatic therapies were just coming on the scene but we were definitely looking into trauma without actually calling it trauma yet. Just doing that deep work and loving it, just loving it.
Then I just went into a number of different directions. I’ve always had a private practice and that scaled in size depending on what else is going on but I realized that I always had to do other things. I worked in treatment centers for a long time. Then I was brought on to Antioch University and I helped build a whole program on LGBT affirmative psychotherapy. That was a Master’s program there. I was one of the co-founders and started to get really into how do we heal the trauma of growing up as an LGBTQ person in this world?
This was back in 2006. We’re still fighting for marriage equality, it’s not yet hit the scene as something that a lot of people are on board with. Also I had had my own huge challenges of coming out. I came of age in the ’80s. It was a really tough time to be a lesbian. At the time I was identifying as bi and it was not fun. Okay? It was hard.
David: Was that here in California?
Lauren: It was here in California, yes.
David: Where you’d think it would be a progressive?
Lauren: Right. I went to UC Santa Barbara for my undergrad and I came out as bi there and the Southern California folks were horrible and didn’t treat me well and talked badly about it and all the Northern folks were cool. I really saw the divide at the time in our state. I really had to get into the right therapy around my own issues, around my sexual orientation and that was an affirmative approach.
That changed my life as well. It was like another level of healing. First was getting sober from drugs and alcohol, then looking at what we call internalized homophobia, what I’ve later called internalized lesbian phobia for lesbians or pre-identified women because we’ve internalized misogyny and homophobia. We have the double component. Then there’s a multi-cultural [unintelligible 00:05:40]. If you’re a person of color then you’ve got-
David: It’s another layer.
Lauren: -right, another layer and really always being mindful of that and cognizant of how that affects one’s sense of self, ability to even like yourself. How that can really deeply influence using, right? All kinds of different using, medicating from drugs and alcohol to, for me turned out I had some alcoholism. I then dealt with a lot of love addiction stuff and attachment issues and disregulation and things like that.
David: Your mind was just looking for whatever that next thing was as soon as you figured out the previous thing, yes.
Lauren: 100% and I have to say that for me, when I did get sober from drugs and alcohol and I jumped into the 12 step program and recovery in that way and also did group therapy and was getting my PhD in therapy and–
David: It’s a lot.
Lauren: Just because I had that much to heal. I also jumped into work and I have to say it helped. Finding meaning and finding a purpose and being of service as a job was really really helpful in a way. I’m not saying that’s what everyone should do but for me that was really–
David: That was part of your recovery.
Lauren: It was definitely part of my recovery of not picking up again.
David: Let’s dive into some of this stuff a little deeper. You’re here at the conference Innovations in Recovery. You’re going to give a presentation why affirmative treatment is an imperative component of helping LGBTQ-Plus clients. Let’s start by having you just describe what does affirmative treatment for this population, what it means to you.
Lauren: What it means to me is looking into A, how does heteronomative or heterosexist society affect an LGBTQ person even before they know what their identity is? Because we’re growing up in a society that frustrate people and for it’s cisgender people. What is that like? Just to break it down really basically I’d say if you’re left handed this world is created for right handed folks, that’s what it’s like for us, right? The whole world is geared in this way and it has a deep effect now. If you are then raised in certain areas of the country and it’s deeply religious and that religion is deeply homophobic then you can have another layer of trauma around that.
For myself, my mother was really homophobic, so that was a big piece of my own challenges of coming out and also just the messages I got, that it was not okay. All of this it just looks at that. It really looks at it from that lens and then also looks at not only that oppression or discrimination but it also looks at the invisibility. Things are getting better. I always say they’re getting better but we’ll also take three steps forward and then two steps back.
Suddenly there is that much lesbian representation on media, again, so then a group actually has to form and start saying, “Okay, if you’re not going to put lesbian characters in shows, we’re going to have to write the shows ourselves.” It just ends up happening. The invisibility is very much of impact. You don’t see people that represent you or represent that diverse population and the opportunity really of how many ways to live in the world.
David: Subliminally that just sends the message this is not normal because you’re not seeing it.
Lauren: That is another component. Then also of getting the messages. We’re talking about all these different generations, right? Of course the younger people are saying it’s easier. Yes, that’s true in certain parts of the country. There are other parts of the country that are still completely discriminating, homophobic, LGBTQ phobic, so on and so forth. We want to be really careful to, if you live in a bubble, to not think that that’s everywhere.
David: Sure. If it’s getting better for you, it may not be getting better for everyone, is what you’re saying?
Lauren: Exactly, yes, that’s very true. The idea is that we really look at, how do we internalize these messages. As we were saying, subliminally, you get these messages that if it’s not what you see, it’s not normal, or it shouldn’t exist or what have you, then you internalize those messages, and that can be fed into the psyche at a very early age of that’s wrong. When you start realizing that might be who you are, you’re starting in the questioning phase and things like that, then you’re going to equate that with being wrong, and then you’re going to equate your sense of self.
David: I was going to say that affects your sense of self.
Lauren: Yes, that is bad and wrong and things like that. A big part of the affirmative piece is looking at that, deeply looking at that. Really, the coming out story for us is a big deal. It’s really important for a trained professional to know that, and to make that part of the story. A thing that I always say, and I’ll be talking about in my talk tomorrow, is as a trained professional, and look, there’s not a lot of schools that teach this. Don’t let your clients be the ones that teach you. It’s really important we get informed, ourselves, and we be the ones that are competent, culturally competent.
Another piece that’s really important in the mental health profession, is to know your own privileges and your own biases. What era you grew up and what messages did you learn? If you’re a straight cisgender identified person, what privileges do you have that you’re not really aware of that your client is not going to have at all? Same if you’re white, and you’re working with a person of color, things like that.
David: Yes, and just not being inclined to that.
Lauren: I have to say that this is a process. I personally work on understanding my own white privilege. It’s not like it’s just, “Okay, I understand intellectually that I have white privilege, so then I’m done.” Sometimes I’ll be reminded of something, like the recent white savior complex in movies, and I’m like, “I actually had to be taught that because it’s so ubiquitous, and as a white person, it’s not something that I would ever see stand out. That’s the same if you know, “Most of the characters are cisgender white men saving the world. How is that going to affect all of us that aren’t that?” Really thinking about that. Then there’s a psycho educational piece.
David: For the therapists.
Lauren: Yes, for the therapists, exactly. Then they bring that into if it’s a treatment center, bring it into your curriculum. If it’s one-on-one, be up on stuff, and then help your client along the way. Then, of course, really looking at, and when you educate someone about what’s going on inside of themselves, then really looking for it, the inner critic or the symptoms or not feeling good enough, or perfectionism or all these things that can rise up, or chronic relapse, or what’s behind that chronic relapse, really looking at seeing what piece of that has to do with being LGBTQ? Not the whole piece.
I’m not saying the whole piece, because obviously addiction, and any addiction, is complex. There’s many components to it. Make sure that that is pieces in the slice of pie. Because if that’s overlooked, it’s a big problem. I’ve worked with a lot of LGBTQ folks who have come from treatment centers that didn’t even ask the sexual orientation. There was just something that let that client know maybe it wasn’t safe to come out. It’s really hard to stay sober if you’re not in a place where you feel like you obviously can be yourself.
David: You’re supposed to be vulnerable and open and honest. That’s just not possible in that situation.
Lauren: Exactly, yes.
David: You touched on a little bit, but if you could go back and describe some more of that landscape of growing up in the heteronormative culture, what that does, and I don’t know if you described it in the presentation notes or not, but some examples of the big and small traumas that they can come out of that.
Lauren: Big trauma is your bully. Say your gender expression is different than what the average kid in your school is, and you’re targeted, and you’re bullied day in and day out, that’s going to be a big trauma. If you grow up in an environment where there’s a violent abusive person in the house, and then they use LGBTQ slurs at the same time as they’re being aggressive and violent, that’s going to be a big trauma.
Little traumas are the ones that we were just talking about, because those are the little cuts that are it’s the invisibility, it’s the lack of mirroring, it’s the being in church and hearing that it’s a sin. It’s the ones that are not as obvious, but are going to be sinking in daily and they add up. Exactly. For instance, I was not raised religious at all. I always say that my family’s religion was capitalism. It was.
David: Is that a California’s religion thing?
Lauren: I don’t know. My dad went to Harvard Business School, and it was all about capitalism and making money and that’s what it was. There was no religion. I didn’t get that, but my mother grew up in a conservative world, and she just really adopted a conservative, more closed minded, look at things. Even though her decorator may have been gay, and we drove through Reddit village and said this is gay, this is where gay people are, everything else was not okay. Then when she started to suspect things about me, she started saying very derogatory things.
She didn’t get super angry. One of the things she said to me was like, “Are you sure you should join a sorority?” going into undergrad. I didn’t want to join a sorority, to be honest with you. That wasn’t my thing. I was a wild pink haired rebel type. I’m like, “I’m never going to a sorority.” It’s just a little dig there. It wasn’t having a conversation. My parents didn’t know how to communicate. It wasn’t like we sat down and said, “Okay, I saw you with this girl. What’s going on? Can we talk about it?”
David: She didn’t really want to know. It was just a jab.
Lauren: It was a jab, and it was very shaming. I felt shame anyway in certain ways. That’s a kind of trauma, and it makes it very clear, “Okay, I can’t be myself and let me just continue to hide and be sneaky.” That’s what addicts do. We’re really good at that, and we learn that early on. It’s not a great thing to be added through. You’re sneaky, anyway, because you want to smoke or try a drug or try a drink or something like that. You maybe have problems with authority and all kinds of things as a child, and then on top of it, you’re going to start hiding other things, so it compounds.
David: Right, yes, that’s what I was going to say. Once that becomes a more part of your life, and that can spill over into addiction, into sobriety, and it just becomes more natural feeling for you.
Lauren: I think, and I’ve worked with so many folks. It’s very hard to undo even, in recovery, the sneakiness because it can be so ingrained of like, “This is the only way that I can do things.”
David: It’s how I’ve gotten by this far.
Lauren: Yes, not without getting shamed. If I want to make sure that I’m not going to be shamed by someone or judged by somebody, or told I can’t do that or whatever, I’m just going to figure out a way to do it.
David: Looking at the affirmative therapy, I think LGBT issues are becoming more well known, or more addressed. A lot of treatment providers are saying, “We have LGBT friendly.”
David: What’s the difference there? Why is affirmative difference able to address these issues in a better way?
Lauren: I’m so glad you asked that, because one of my other talks actually addresses that directly. I’ve changed this a bit around. Friendly is, okay, how I always love to preface that is psychotherapists are some of the kindest people on the world. We get into this field because we genuinely want to help people, it’s not for the money. It’s I really want to help someone, I’m really supportive and empathic and open and stuff like that.
That’s great, that’s a wonderful start but that is not enough. Friendly might be like it’s fine if you’re gay or lesbian or coming out or what have you but then having zero training on what is the internalizations of the phobias. Zero training on heteronormativity and the invisibility we were talking about. Another component is our history. His story, her story and their story is what I like to call it.
David: Describe that. What do you mean?
Lauren: History is for the male component of history and then their story for trans and binary folks. One of the classes that I have developed and then taught for many years and then I brought into a treatment program that I helped developed in LGBTQ affirmative track was bringing in all the LGBTQ folks that have been around since we can really track it and say, “Hey, this amazing person what what man was a gay man, and he had a life partner for 20 years and they were in love and would you know that? He’s one of the most famous poets of United States history.” It’s not taught in the schools. There’s different states like California that have passed acts to actually teach it but then they don’t because it’s really hard to get some teachers to actually teach it and it’s really hard to-
David: Sure, hard to implement it.
Lauren: -very hard implement, thank you, also. It’s, again, that invisibility, not feeling like we have people that have contributed to civilization. I have to tell you this is really one of the most empowering parts of affirmative therapy that I practice, really getting people to study what our ancestors have done before us and how part of civilization they have been and realizing that we’ve always existed and we will always exist and we’re not just something that– It’s not a choice. It came around the minute the world was–
David: It’s a modern fad.
Lauren: Yes, and it didn’t just come around when the word was developed. When we do look into each history, it’s from an LGBTQ lens. It’s not saying, well, that person identified as lesbian. Obviously, we don’t know. Or were they identifying as trans? They didn’t have that language yet. But obviously they were this or this and that and here is the story that we have. A friendly therapist is not going to know all that.
They’re not going to bring that into the room, they are not going to bring that into the treatment. Other pieces they may have a very basic intake paperwork where my paper work has all choices on there for them to answer and that immediately says this person is aware of different pronoun choices and different identifications from gender expression to identity. All of it.
David: Yes, and just battling that invisibility I guess.
Lauren: Yes, the friendly piece they’re going to be very open and loving and let me help you and sure I’ll hold your hand through this but they’re not going to know how to do all this. Even the coming out process is not going to mean necessarily something. Now I know there will be LGBTQ folks that are not formally trained that may be in our community. They also may not be trained specifically in this approach.
What I’ve also found along with teaching in the history, her story and their story is really getting into the internalization messages. These internalized phobias. If there’s homophobia out there when you internalize that, how is that deeply impacting you daily? How is that affecting your desire to pickup because suddenly something is triggered. You’re not feeling that great inside. You cannot tolerate the feelings. There’s a difficulty in regulating whatever you’re feeling inside. I’m going to pick something up.
David: Coping with that.
Lauren: Yes, get this feeling. This has has helped me lead to another thought. When you grow up in a world like ours where it’s so challenging to be different, especially around sexuality or gender which is such a hot button for people that have so much phobia around it, also your ability to regulate is going to be affected because you’re going to have a harder time building that resilience as you’re growing up if you know you’re different or if you’re teased or if you’re bullied or if your family is not accepting of you being different or if you’re ashamed or all these things.
The resilience and the ability to tolerate uncomfortable feelings is a big part of being able to stay sober. My talk is really about when we go in this affirmative lens we’re starting to build internal resilience. We’re starting to build a capacity to tolerate being uncomfortable more often. That helps us not only stay sober but be able to regulate our emotions and have a stronger emotional recovery, if that makes sense.
David: Because you need that for the addiction recovery.
Lauren: Yes, and you need it for life and it’s just very helpful as you get out there in the world as a sober person and now you’ve also dealt with this piece of you that has been so discriminated against or invisible or denied or repressed or whatever and now you’ve build the internal psychological muscle to sit with it and then you can sit with feelings and sit with triggers, and sit with challenging relationships and all the things that really when you get out there in the world are things you have to deal with all the time.
David: I want to touch on your book Lesbian Love Addiction, understand the urge to merge and how to heal when things go wrong. We don’t have to take a ton of time but introduce us to that. What are some of the unique challenges. We’ve been talking about LGBTQ more in general. What are some of the challenges in the lesbian community you’ve seen there related to love addiction and emotional health that thing?
Lauren: That’s great, and I’ll definitely try to be quick. When you have two women together it’s a totally unique dynamic. There’s a couple of things that go on. Women who meet and have chemistry with each other and then also have attachment issues and trauma from the piece we just talked about, the lesbian piece, all that piece and say their relationship with their mother was not that healthy, for instance, or the mom was not that accepting or whatever it was and they really don’t have the resilience and the emotional stability inside. When they have chemistry with someone they’re going to just, what we call merging [crosstalk]. Yes, the U-Haul joke is there for a reason. What does a lesbian bring on a second date?
David: A U-Haul? That’s the joke?
David: I have to know that one. That’s good.
Lauren: It’s really good and it’s actually true. We don’t have the norms we have to worry about. No one’s like, “Is the guy going to call me again?” There’s none of that traditions or, there’s none of that constricting us. A lot of us just do it whatever we want and the chemistry can be really intense.
David: That feels good, [crosstalk] anytime. That’s-
Lauren: Really good.
David: You know better than I do. But yes.
Lauren: No, but you’re right. It’s a good point. Love addicts have a couple of things going on which is an addiction to the falling in love process and the mistake is mistaking intimacy for intensity. The intensity everyone thinks it’s intimacy. Suddenly you’re feeling very intimate with someone that you actually don’t know very well and you dive into a relationship. It doesn’t have the foundation of a relationship of getting to know each other and really getting to know whether you’re an actual fit and then each person will have insecure attachments when this happens. One might be more interesting, the other might be avoiding and eventually it’s going to be a disaster.
David: Because that will catch up with you [unintelligible 00:29:35].
Lauren: Yes, and it’s epic proportions. It’s just like the [unintelligible 00:29:38]. There’s a lot of heart ache and trauma and pain. The breakups are horrible, they’re very painful and then some folks can’t handle it, then they try to get back together and they think it will work the next time because you get the good feelings back again and then it doesn’t. Then maybe you just you just date somebody else as soon as you’re recovered and it’s actually just like the last person just in a different body. There’s a lot of ways that it comes out. I personally had this issue. I had to go to a number of different treatment places to get better and then through that came the book.
It was like another part of my confessions because I was reading everything I could out there on love addiction. There’s a lot of great stuff but nothing was geared towards women who love women, it was all he-she so I had to do all this translating and I said I’m tired of translating.
Let’s get something that’s directly focused for us and at the same time I also brought in the idea of the female brain. I know the female brain is controversial. There are some feminists that say, “We don’t want to do that.” The bottom line is there are aspects of our brain, a cisgender female brain, and there is studies now showing a trans female is much more similar to a cisgender female brain than a male brain.
David: What’s the controversy? I’m not familiar with that.
Lauren: Well, there are some feminists that believe that if we say that our brains are different, that that will be used against us. It’s like, “That’s why you’re weaker.” All these different things.
Lauren: Now it’s why we’re a little different from each other. Some of those things are really great and some of them not so great. We’re very relationally oriented. You get two women relationally oriented, can’t wait to be in a relationship, love the high of it. Those are all of the components that brought that all together into the book.
David: Then I read that you’re working on a second book?
David: This one is about internalized misogyny and how to heal the trauma of growing up in a sexist world. What can you tell us about that?
Lauren: Obviously you can see a theme here. I like to work on the internal messages that we get growing up. I’m also a feminist and an activist in ways but at the heart of it, I feel always that, as long as we’re working on healing ourselves, the world will continue to get better in these areas that need to get better. In my dissertation, I’d done a lot of research on where did the patriarchy start and where did this shame-based society start and how did we get so misogynistic? Where did this come from? Where is this hatred of women come from? My dissertation took me into this whole thing.
David: I’m guessing that’s all the way back. [laughs]
Lauren: That’s right.
David: I don’t know where you’d plan to start on that.
Lauren: 3500 BC was a good place to start. Then I put it to the side and I started doing these other things I’m focusing on as I’ve been telling you, and then the election started. No matter where you were on the side of the election, the 2016 election, what struck me the most and where the aha moment and where this book, again, re-emerged to be born was when I saw the misogyny when the first woman tried to run for presidency. I was blown away at the way sexism and misogyny was used to fight her campaign.
David: Different standards.
Lauren: Yes, different standards, from the voice to whatever it was and we’re seeing it again. There are people that are really following what’s going on now and noticing that there’s, again, different standards for any woman that’s running for the nomination. That’s when I was like, “Okay, my dissertation needs to become a book.” But it was 10 years old at that point so I’ve been working on modernizing it. There’s so much more information now but really getting to the root of– This misogyny goes back further, we can trace it back to about 3500 BC.
That is ancestor after ancestor after family system, after family system, after culture after culture training and teaching the men and the women, all people in our world to view women in a certain way. Of course, those messages are internalized. How does that affect the way we feel about ourselves? Honestly, a big piece of it is how we end up treating each other. The sisterhood piece is very big and it’s very powerful and then there’s a part of it that women are not going to do each other. Examine that, and looking at the women that do side with men that have been proven to be sexual predators, what’s going on there. It examines and explains and looks at the psychological lens of all of that.
David: A lot to unpack there. [laughs] Good luck finishing your book. It sounds great.
Lauren: Thank you, thank you.
David: All right, we’ll wait for her to finish the announcement. We’ll just wrap up with two more questions. Just to wrap up, what are one or two things that you wish more treatment providers understood about LGBT issues that they could then use to help more people heal?
Lauren: Just do your homework. Learn about the affirmative approach, bring it into your treatment centers, bring it into your intake paperwork, have a group about it that involves everyone just about sexuality and bringing positive sexuality into it, what’s healthy relationships and what are all the different sexual and gender identities in the world that we’trying all living together with and how can you create space inside of your treatment center for that to be a part of the healing process. An LGBTQ person is going to land in your treatment center, be prepared.
David: That’s a good way to sum it up, I like that. We wrap up with this final question. Everyone who gets up everyday, works in this field, gets themselves in this type of service, they have their own personal reasons for wanting to do that because it’s hard work, it’s straining at times, could you end by summing up why this mission is so much important to you?
Lauren: Gosh, I love that question, it’s really hard to answer. It’s just a calling. Before I got sober, I couldn’t figure out what I wanted to do with my life and the minute I realized that it was about helping people understand their own psyche and understanding what’s going on inside of themselves and why they make decisions that they do and how they can change that, how we can actually become more empowered and manage our lives differently and really live the life that we want to live, it’s amazing to be on the journey with folks. It’s an honor and a privilege to be able to walk this journey with people and help them wake up and get on the path really, a path of self awakening.
David: That’s a good point that you would think or on the surface that whoever that person is, they’re going to understand their psyche better than anyone but a lot of times we’re blind to who we are, what’s going on in our head.
Lauren: 100% it’s such a great point. I love to help people figure out what their truth is by having that objective trained eye to help them go inside and figure out what is going on.
David: Yes, all right, Lauren, thank you so much.
Lauren: Thank you so much, David. It was great to be here.