Social justice in the therapy room: advocating for bisexual individuals

The American Psychiatric Association (2020) defines bisexual as, “The capacity for emotional, romantic, and/or physical attraction to more than one sex or gender that may or may not manifest itself in terms of sexual interaction”. Within the LGBTQ+ community, individuals that self-identify as bisexual are the largest subgroup, outnumbering those that identify as gay, lesbian, or transgender (APA, 2020). Research has shown that bisexual individuals are at an increased risk for mental health and substance abuse problems, and more specifically depression, suicidal ideation, and eating disorders when compared with their heterosexual and gay or lesbian peers. While there are multiple explanations for these disparities, it has been argued that stress related to discrimination and stigma is one of the primary contributing factors. In order to better understand how the marginalization of bisexual individuals impacts their mental health seeking behavior and how best to advocate for this group and those that identify as members, it is important to understand some of the ways in which they experience marginalization.

Negative stereotypes such as; bisexual individuals are confused, bisexual individuals are sexually promiscuous, and bisexuality is not a legitimate sexual orientation, have resulted in the stigmatization of bisexuality. More specifically, there are three specific areas of stigmatization experienced by the bisexual community: 1. Biphobia or prejudice against or dislike of individuals that identify as bisexual, 2. Monosexism or the belief that individuals must be heterosexual, gay or lesbian. 3. Bi-erasure or the dismissal of the existence of bisexuality. In one study bisexual women shared their experiences of marginalization and identified these commonly experienced negative stereotypes and stigmas, “bisexuality as a temporary phase on the path to a fully realized lesbian or heterosexual identity and bisexuals as immature, confused, greedy, untrustworthy, highly sexual and incapable of monogamy”. The women in the study reported that these misrepresentations were not only inaccurate but also made them feel not seen, heard, or understood, and ultimately invisible and dismissed.

Several studies have indicated that bisexual individuals confront double discrimination. This additional level of marginalization is based on the findings that heterosexual, gay, and lesbian individuals may all have negative attitudes toward bisexuality. This is especially relevant when considered in the context of Meyer’s Minority Stress Model, which emphasizes the importance of the degree in which an individual integrates their sexual identity and finds a community that impacts their mental health in a positive way. In regards to bisexual individuals finding such a community to help safe guard their mental health, because of sexual orientation–based discrimination, bisexual invisibility, and bisexual erasure, many bisexual people lack a community of support that is affirmative of their sexual identity. In addition, bisexual individuals are more likely to hide their sexual orientation identity than gay men or lesbians, which can lead to an increase in stress and anxiety (APA, 2020).

Impact on Mental Health Seeking Behavior

These experiences of marginalization of bisexual individuals not only affects their mental health but also impacts their likelihood to seek out and benefit from mental health services. In fact, studies have found that bisexual individuals may seek mental health services less frequently than their gay or lesbian peers; and may rate these services as less helpful than their peers. Studies have also found that the marginalization and stigmatization experienced by bisexual individuals significantly and negatively impacts their desire to seek mental health treatment. It is not difficult to imagine how bi-erasure (the dismissal of the existence of bisexuality) would lead some bisexual individuals to be hesitant to seek out counseling. That coupled with negative experiences both in the larger community and within the mental health community more specifically could create a situation in which a bisexual individual would not only be unable to see the benefit in seeking out mental health services but on a deeper level may not feel safe enough to reach out for help. 

Advocacy and the Role of the Therapist

While there is certainly a need for interventions to address the mental health of individual bisexuals, it has been argued that the primary need is for social and structural interventions that acknowledge and celebrate bisexual identity. In thinking about how to do that as a clinical mental health professional, I believe that looks like providing education about bisexuality to the families of bisexual individuals as well as the community at large, using affirming and inclusive language, providing workshops for local mental health care professionals (including those that work in schools and community agencies), and advocating for policies and programs that support the acknowledgment and celebration of bisexual identity. 

Social Work License Map provides the tips and strategies below on supporting and working with bisexual individuals (https://socialworklicensemap.com/blog/how-to-be-an-ally-to-people-who-are-bisexual)

How Anyone Can Support Bisexual Individuals

• Believe that bisexuals exist. 
• Accept sexual identities without reservation. 
• Respect relationships equally, whatever style they are.
• Speak out against bi antagonism and bi erasure in everyday life. 
• Celebrate bi culture. 
• Accept whatever label someone chooses. 
• Read, learn and enagage bisexual individuals or resource centers.
• Remember that one person does not represent all.

Strategies for Mental Health Professionals Working with Bisexual Individuals

Check your own biases. Recognize if you view things through the lens of monosexism so you can acknowledge any biases you may have about others’ sexuality.

Use affirming language. Respect that people may use different labels for their identity and ask them what they prefer to use in conversation.

Use inclusive language. Acknowledge bisexual-plus people instead of referring to just “gays” and/or “lesbians.” Be mindful of how phrases like “gay marriage” erase bisexual people who are in same-sex relationships and who are married.

Educate yourself. Learn about the bisexual-plus community and how the connections between identity, behavior and attraction can look different for people. Recognize that bisexual individuals may have unique needs and that gay-affirmative work is not inherently bi-affirming.

Educate others. Support bisexual-plus people by teaching their family members, coworkers and the community about bisexuality.

Create community. Consider offering a support group for bisexual individuals, or if you offer a support group for LGBTQIA+ individuals, be sure that it is fully inclusive and feels welcoming to all members

Bisexual Individuals seeking therapy ~ You can use the strategies listed above for supporting bisexual individuals and for the mental health care community as guides for asking questions of therapists to ensure that you have found someone that will accept you as an individual and provide a safe and supportive environment.

Resources

American Institute of Bisexuality: AIB encourages, supports and assists research and education about bisexuality, including through funding and promotion.

The Bi+Youth Project: This Bi+ organization organizes, advocates and works to empower Bi+ Youth (ages 13-29) through talks, game nights and video projects to change the narrative about their community through storytelling and media representation.

Bisexual Resource Center: The BRC creates resources, provides support, and helps to build community for bi/pan/fluid people; it also provides a list of organizations in the United States  and around the world. 

Bi.Org: This AIB project serves as an online community with articles, essays and other content to support members of the bisexual community and to help families understand their loved one.

American Psychiatric Association. (2020). Mental health facts on bisexual populations.https://www.psychiatry.org/psychiatrists/cultural-competency/education/lgbtq-patients