When LGBT clients are dealing with rejection sensitivity

By Matthew D. Skinta, PhD, ABPP

Rejection sensitivity is a term that has garnered a lot of attention in lesbian, gay, bisexual, and transgender (LGBT) psychology lately, as many individuals who have grown up with an aspect of their sexual orientation or gender identity kept hidden are struggling with this. Worse, many still experience rejection from their family and loved ones when they do find the courage to share. It is hard to cultivate a sense of safety again that clients won’t be punished for being authentic and vulnerable in a loving relationship, and many therapists struggle with what this means for the relationships. Here are some tips for responding to rejection sensitivity in your therapy with gender and sexual minority (GSM) clients:

1. Be yourself. You may or may not have a “therapist persona” that you adopt, or simply a style of holding back your reactions and emotions in session. While this is common in some therapeutic approaches, for a client who is fearful you are judging or rejecting their authentic identity, this can come across as masked rejection. Consider workshops in approaches like functional analytic psychotherapy (FAP) that will give you practice in using your own genuine self in the therapy room.

2. Take your own emotional risks. When you’re with the client, you may notice in real-time when the armor goes on, emotions withdraw, and your attempts at connection are rebuffed. One of the best ways to draw attention to this habit is through sharing how that affects your sense of connection in that very moment.

3. Assign risks outside of session. FAP recommends taking small, daily emotional risks to cultivate courage and overcome the fear that comes with being truly seen and authentic. Writing these risks down each day is a helpful way to build the habit, and rating how risky that step feels is a helpful way to learn where we are holding ourselves short.

4. Be compassionate with the armor. It is challenging to learn safety in vulnerable relationships, and this armor developed in environments where it was necessary for protection. When you notice your client disconnecting and draw attention to it, remember what a valuable—even lovable—survival tool this is!

Learning deeply that our authentic, whole self can be loved, and that vulnerability is safe in loving relationships, is an important part of any therapeutic work with GSM clients.

Matthew D. Skinta, PhD, ABPP, is a board-certified clinical health psychologist and clinical faculty member at Palo Alto University (PAU). He directs PAU’s Sexual and Gender Identities Clinic, where he trains clinical psychology graduate students to provide culturally competent care regarding sexual orientation and gender diversity. His research and writing are focused on the use of acceptance and compassion-based approaches to treating sexual and gender minority clients, and reducing prejudice and bias in society. He is coauthor of Mindfulness and Acceptance for Gender and Sexual Minorities, with Aisling Curtin, MSc.