Coming out isn’t simply a matter of finding self-acceptance — it’s a choice that’s often wrapped up in issues surrounding one’s race, age, career, and community. Lighthouse therapist Pia Johnson explains the complicated dynamics at play. 

For some people, coming out can be one of the most liberating and empowering experiences of their lives. But for others, it can be fraught and painful. In fact, some people choose not to come out at all — not because they’re ashamed of or unable to accept their identity, but because that’s simply what’s best for them as individuals. The threat of family estrangement, discrimination in the workplace, or religious judgment from loved ones can present significant barriers to coming out, to the extent that it doesn’t make sense for everyone to do so.

Despite this reality, many mental healthcare professionals will pressure LGBTQ patients to come out as part of the process of self-realization and acceptance. But while self-love is inarguably important, coming out is not a prerequisite for a healthy and fulfilled life. Let’s take a look at the three questions I encourage every mental healthcare professional to ask their patients before encouraging them to come out:

1. Do you want to come out?

For many therapists and mental health professionals, coming out is perceived as a goal or destination towards which your patient should work. But for some people, it’s simply not on the table. Don’t assume that every queer patient wants to come out — ask them.

Read More: These Are Six Strengths Unique to the LGBTQ Community

2. What are your fears and hesitations?

If your patient’s answer is “yes,” work with them to ensure they’re equipped to navigate the coming out process and any potential repercussions. If their answer is “no,” explore what might be driving their hesitation. For many patients, anxieties associated with coming out fall into the following four categories:

  • Religion: Many patients come from religious families or communities in which homosexuality is considered a sin. While therapists should absolutely work to help patients embrace their sexuality and overcome internalized homophobia, it’s also important to consider that some families may never come to that same place of acceptance.
  • Cultural and Racial Background: Different communities view homosexuality in different ways — in some, it’s a “quirk.” In others, there’s a strict “don’t ask, don’t tell” policy. Elsewhere, it’s a punishable offense. Consider where your patient is coming from — will coming out result in exclusion from their community, or worse, threaten their physical safety?
  • Age: For people like me, who knew we were gay in the ‘80’s or ‘90’s, coming out can feel dangerous, especially in less accepting areas of the country. Older patients are often reluctant to come out because of past trauma, so be mindful of the social and cultural environment in which your patient came of age.
  • Professional Settings: Some patients may come out to selective friends and family but remain closeted at work. This choice could stem from fear of discrimination or jeopardizing career opportunities, or simply from a place of wanting to keep one’s personal life separate from their professional life.

3. What tools can I help you develop to support you through this process?

Once you’ve taken time to understand and explore what factors are at play in a patient’s personal and professional life, it’s your job as a provider to help them develop tools they can use throughout the process of coming out — and prepare them for the worst-case-scenario. For many patients, the act of coming out may simply be the first step in a series of challenging conversations with friends, family, and acquaintances. Help them prepare to address different reactions, and create a plan of action should they at any point feel unsafe.

Read More: A Therapist’s Guide to Better Care for Queer Patients of Color

Remember: There’s No Cookie Cutter

There’s no one way to be queer. Different people have different experiences, and clinicians must work to understand every patient as an individual. As a queer community, we pride ourselves in accepting everyone as they are. That means people who aren’t out, too.

Some people may choose to come out selectively, others may find coming out to be an important emotional step, while still others may choose to treat therapy as the only place where they can openly discuss their sexuality. The bottom line is, you can’t push someone out of the closet if they’re not ready. You can only support them along the way.

Lighthouse is committed to connecting LGBTQ patients with knowledgeable, affirming providers. To make an appointment with Pia C. Johnson, click here.

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