For Bi+ Folks, Therapy Can Be Radical Self-Care. But Only if Mental Health Providers Affirm Our Identities.

A woman looks down as she talks to a therapist.
Photo illustration by Slate. Photo by iStock/Getty Images Plus.

This piece is part of the Radical issue, a special package from Outward, Slate’s home for coverage of LGBTQ life, thought, and culture. Read more here.

Therapy is a useful tool for anyone seeking to be more content with their life. For members of the LGBTQ community, it can be particularly necessary, given that we are three times more likely than others to experience depression, anxiety, or similar mental health issues. Bisexual, pansexual, and queer (often condensed to bi+) women are at an even higher risk when compared with lesbian-identified women. And people who are “in the closet” face higher stress hormone levels and more symptoms of anxiety and depression than those who are open about their identity.

I spoke to Mario Rodriguez, a therapist who has worked with patients of all sexual identities in New York City. I asked him how his LGBTQ patients are different.

“Therapy is usually meant to be about learning to better something about yourself in order to be more content with your life,” he told me. “That’s not at all what it’s like when working with marginalized people, because when it comes to things like homophobia or transphobia, the problem comes from other people.”

Therapists have no control over systemic forces. They can’t make people more accepting or fix discrimination. What they can do, according to Rodriguez, is help LGBTQ patients with self-acceptance and coping mechanisms. And considering gay and lesbian people are more likely to report a past suicide attempt than heterosexual people, and bi+ people are even more likely to do the same, therapy can mean the difference between life or death. But only with a therapist who understands our specific needs.

Before I came out, I was intimately aware of how mental health concerns were exacerbated by the closet. Young people who identify as bisexual are statistically more likely to self-injure, and I was no exception. I struggled with depression, suicidal ideation, and cutting throughout adolescence. At the time, I didn’t tell my therapist that I had same-sex attractions, which perhaps would have assisted her in determining a treatment plan. But I can thank her for encouraging me to develop healthier coping mechanisms in place of self-harm.

It wasn’t until adulthood, once I had finally started dating and sleeping with women, that I began experiencing anxiety. I was constantly and inexplicably paranoid that my parents suspected my bisexual identity somehow. It was always on my mind, even when I was trying to sleep.

I used an online service to find a therapist who had specifically worked with LGBTQ patients for more than three years. I was impressed that the LGBTQ community could even be someone’s area of specialization. At the same time, someone who sees patients within that community doesn’t necessarily understand bi+ patients or even bi+ women specifically. We have unique social and health concerns and face our own set of stigmas, but sometimes, medical health professionals perceive us as a subset of the lesbian community.

Throughout our sessions, my therapist frequently used the phrase homosexuality instead of bisexuality. He also referred to my relationship with a woman as a “homosexual” relationship even after I corrected him to the accurate “same-sex relationship.” Labeling relationships as homosexual or heterosexual based on the sex of the people involved contributes to the erasure of bisexuality. I was frustrated because I expected someone with three years of professional experience to already know that.

One day, I expressed that I was tired of dating men who left me feeling objectified, and he asked if I had considered the possibility that I was a lesbian. I was floored. It felt like an invalidation of the numerous times I had described an attraction to men, as though the label I had chosen wasn’t being believed. And it felt like my valid criticism of the way men were treating me had translated as lack of sexual desire.

Bisexual women are constantly being told that our identity is just a phase. Either it’s a robe we allegedly try on during our early college years or a midpoint before we come out as fully gay. We also face higher levels of hypersexualization than lesbian and heterosexual women, making us more vulnerable to sexual violence. I realized that, while seeing a therapist was radical by itself, it was even more radical to recognize how those issues affected my life and seek a mental health professional who understood that. I couldn’t achieve what I wanted in therapy if I wasn’t receiving bi-affirmative care.

Rodriguez suggested using websites like to look for a therapist. “They help you search by area, insurance, issues you want to deal with, and help you search for a therapist by race or religion or whatever else it is that you need,” he said.

Psychology Today lets you specifically indicate your sexual identity so that you can find a mental health professional who is knowledgeable in that area. Other databases include the Lesbian and Gay Psychotherapy Association and the Bisexuality-Aware Professionals Directory, but you can also ask friends for recommendations on bi-affirmative therapists.

Switching to a therapist who was aware of bisexuality meant that our sessions were never about leading me toward another identity. She was careful to use language that made me feel seen and affirmed, even celebrated. These are things that all patients, regardless of who they are, deserve to experience. And by giving me that care, my new therapist was doing something incredibly radical, too.

Read all of Outward’s special issue on Radicalism. And queer your ears with a special radical-themed episode of the Outward podcast.