For many LGBTQ (lesbian, gay, bisexual, transgender, queer/questioning) people, growing up was distressing due to homophobia and transphobia. Schools felt like a scary place for those who were scapegoated as queer. LGBTQ people of color have often reported even more difficult experiences due to the additional stress of racism and racial bullying. Many of the gay men’s personal narratives that I have heard are not vastly different from my own. Regardless of national origin or skin color, we are part of a tribe with similar stories of growing up in a homophobic and transphobic world where our true essence was repeatedly assaulted.

As LGBTQ people, we have connected around the theme of “love is stronger than hate,” which has raised awareness about our injustice and suffering. Addressing these issues has helped people become more concerned about the mistreatment of not only LGBTQ kids, but also any youngsters who do not fit with the mainstream. More work needs to be done to make the world a safer place for marginalized people. Anyone dealing with oppression does not deserve to suffer in silence and needs encouragement to reach out and get support. Love and healing are more accessible than our painful moments want us to believe.

Injustice and trauma inflicted on LGBTQ people as a result of growing up in oppressive environments deserve empathy and healing. When it comes to healing, psychotherapy offers a variety of approaches to work with trauma, including the experience of growing up gay in a heterosexist world. Many mental health professionals who work with LGBTQ clients rely on “top-down” approaches that emphasize cognition and the examination of thoughts, beliefs, and interpretations. Cognitive approaches can help clients identify and challenge maladaptive thoughts and develop more flexible ways of understanding their experiences. Many clients have benefited from cognitive restructuring in psychotherapy and developed skills in identifying and disputing irrational or maladaptive thoughts.

In my clinical experience, however, when it comes to healing from years of assault on one’s core identity, including feelings of shame and humiliation related to same-sex attraction, a cognitive approach may not always be sufficient or accessible. For some queer trauma survivors, intense emotional or physiological reactions can interfere with their ability to think through an experience in a deliberate and reflective way. Trauma can involve changes in arousal, attention, memory, emotion, and bodily awareness. For these clients, a body-centered or “bottom-up” approach can provide an additional pathway for exploring and regulating trauma-related responses.

Rather than relying on the thinking brain as the only path to healing, trauma-informed therapy can also attend to physiological sensations, emotions, impulses, movement, and other experiences that may occur outside deliberate conscious awareness. These processes involve distributed neural systems rather than a single “trauma center” of the brain. Integrating attention to both cognition and bodily experience can therefore provide a more comprehensive approach to trauma treatment.

Educating clients about a bottom-up approach and the basic workings of the nervous system can help enhance and clarify the somatic-focused therapy process. For many LGBTQ clients, trusting a professional or an authority figure might not be easy due to their history with a discriminatory health care system, religious bigotry, police violence, school trauma, and family betrayal. Establishing a therapeutic alliance with LGBTQ clients can be facilitated by explaining the therapeutic process, including the potential role of the nervous system in trauma recovery, and asking their permission to provide somatic-focused therapy.

Our body comes with an already built-in autonomic nervous system (ANS) that regulates many vital functions. The ANS is involved in regulating functions such as heart rate, digestion, breathing, and physiological responses to stress. It also communicates extensively with the brain and other bodily systems. The ANS is an important part of our experience of arousal, stress, rest, and recovery, and physiological states can influence how we experience safety and connection with others.

The concept of neuroception, developed by Dr. Stephen Porges, describes the proposed automatic detection of cues associated with safety and threat. Unlike deliberate cognitive appraisal, this process is understood as occurring largely outside conscious awareness. Environmental cues such as sound, smell, temperature, facial expressions, tone of voice, and eye contact can influence how we experience our surroundings and other people. In this sense, our nervous system can respond to perceived threat or safety before we have consciously analyzed what is happening.

It is important, however, to distinguish between established findings about the autonomic nervous system and the more specific claims associated with Polyvagal Theory. Polyvagal Theory provides one influential framework for understanding relationships among autonomic regulation, social engagement, defensive responses, and perceptions of safety. Some of its specific neuroanatomical and physiological claims remain subjects of scientific debate. I therefore use these concepts here primarily as a clinical framework for understanding bodily and relational experiences rather than as settled neurophysiological facts.

Pat Ogden’s, Stephen Porges’, Bessel van der Kolk’s, and Peter Levine’s research and writings have expanded my understanding of the relationship among the nervous system, the body, experience, and trauma. Trauma and chronic stress can influence patterns of physiological arousal, attention, emotional regulation, and threat detection. These processes may help explain why some LGBTQ people with histories of being judged, humiliated, threatened, or violated continue to experience anxiety or heightened sensitivity to cues associated with rejection or danger, even after the original circumstances have changed.

Previous homophobic and transphobic mistreatment can condition expectations of rejection or danger and can contribute to feeling unsafe even when an immediate threat is absent. What we carry in the aftermath of trauma can influence how we respond to subsequent situations. A body-inclusive therapy can help clients become more aware of these responses and develop greater capacity for regulation, flexibility, and connection.

There are many body-oriented methods for trauma healing, including Somatic Experiencing (SE), which was founded by Peter A. Levine, Ph.D. Levine developed SE in part from his observations and ideas concerning defensive responses in animals and humans. SE is a body-oriented approach that helps people explore physiological responses associated with stress and trauma, including sensations, movements, postures, and impulses.

SE proposes that unresolved defensive responses may contribute to persistent patterns of physiological activation and that carefully tracking bodily experience can support greater regulation. SE is intended to work gradually and within a person’s capacity to remain emotionally and physiologically regulated. Research on SE is still developing. A randomized controlled study published in 2017 found reductions in PTSD symptoms among participants receiving SE compared with a waitlist condition, although the researchers noted that further research was needed.

Within Levine’s model, SIBAM provides a way of tracking different dimensions of experience: Sensation, Image, Behavior, Affect, and Meaning. These elements can help a therapist and client notice how bodily sensations, images, movements, emotions, and meanings interact during a therapeutic session.

LGBTQ people who grow up with mistreatment can discover the stories of their experiences reflected in patterns of emotion, bodily sensation, and nervous-system responses. The queer body remembers the experience of growing up in a world with cruelty. Having over three decades of providing LGBTQ-affirmative psychotherapy, along with research and numerous trainings on body-mind therapy, I have learned that the cumulative stress of mistreatment can become deeply embedded in a person’s emotional and bodily experience and can influence patterns of arousal and regulation.

For example, one gay high school student with symptoms of anxiety disclosed to me that he hears several homophobic remarks a day, along with experiencing bullying and harassment. Such ongoing stress can activate physiological stress responses. Naturally, as a target of hate and mistreatment, he wants to defend himself or escape the abusive situation. Often, due to a lack of protection for many LGBTQ youngsters, neither fighting nor fleeing may be possible during such situations. When a person repeatedly experiences threat without having effective ways to respond or escape, the resulting stress and helplessness can contribute to persistent trauma-related symptoms.

In other words, experiences of threat can leave a person with strong defensive impulses and physiological responses that continue even after the original situation has ended. Such patterns can contribute to hyperarousal and heightened vigilance. Anxiety, panic attacks, rage, hypervigilance, sleep difficulties, exaggerated startle responses, digestive problems, and other symptoms can occur in people experiencing trauma-related dysregulation. These symptoms, however, can have many causes and should not automatically be attributed to trauma or to one particular nervous-system state.

On the other hand, some trauma survivors experience hypoarousal, numbness, detachment, or dissociation. These experiences can occur when a person becomes overwhelmed and unable to respond effectively to a perceived threat. Faced with isolation, confusion, bullying, physical attacks, and ongoing lack of safety, a child may experience circumstances that exceed their capacity to cope, particularly when there is no empathic person available to provide protection or support.

The concept of a window of tolerance, associated with Dr. Daniel Siegel and widely used in trauma-informed clinical practice, describes a range of arousal within which a person can remain sufficiently regulated to process experience and respond effectively. Outside this range, some individuals may experience hyperarousal, while others may experience hypoarousal, shutdown, numbness, or dissociation.

Polyvagal Theory offers one interpretation of these defensive and immobilization responses, including the proposed role of different branches of the vagus nerve. However, the specific physiological mechanisms proposed by Polyvagal Theory remain debated. It is therefore more accurate to describe dorsal-vagal shutdown as a component of the Polyvagal framework rather than as an established explanation for all forms of trauma-related hypoarousal.

Hypoarousal and dissociation can be associated with numbness, withdrawal, detachment, and difficulties experiencing pleasure or connection. Some people may turn to risky behaviors or substances in an attempt to escape emotional deadness, anxiety, or other painful internal experiences. Suicidal thoughts can also occur in people experiencing severe psychological distress and trauma, although they cannot be attributed to any single physiological state. Such symptoms always warrant appropriate clinical attention and assessment.

As stated earlier, somatic approaches conceptualize some trauma-related symptoms as involving persistent or dysregulated defensive responses. Healing can involve helping clients recognize these patterns and develop greater capacity to tolerate and regulate bodily and emotional experience. Working with many members of the LGBTQ community, I have noticed that when numbness and detachment become a gay man’s dominant state, he may be more likely to engage in risky behaviors as a temporary relief from inner deadness.

Thrill-seeking behaviors such as excessive gambling, hypersexuality, and crystal methamphetamine use are a few examples of how some gay men may attempt to escape emotional flatness or other painful internal states. The same behaviors can also be used to cope with anxiety or other forms of distress. One person might turn to substance use or other perilous behaviors to escape his inner deadness, while another person might use them to dampen anxiety. It is important to recognize that such behaviors can have multiple contributing factors and that trauma may be one important factor in how some individuals develop maladaptive coping strategies.

As discussed earlier, as a “bottom-up” approach, SE emphasizes attention to bodily sensations and physiological responses before moving toward broader emotional and cognitive meaning-making. Dr. Levine developed SIBAM to chart this process, moving among bodily sensations, images, behaviors, affects, and meanings.

The SE session involves teaching the client to track body sensations, including sensations associated with traumatic experiences. Experiencing body sensations related to homophobic or transphobic events in a safe and carefully paced way may allow clients to approach aspects of their experience without becoming overwhelmed. Some clients report changes in sensations such as heat, vibration, trembling, relaxation, or tears during this process. From a somatic perspective, these experiences can be understood as part of the process of regulating and integrating previously overwhelming experiences. It is important not to assume, however, that a particular bodily sensation objectively represents the “release” of stored trauma.

For example, Cyrus (names and other details have been changed in respect for privacy and confidentiality), a cisgender gay Iranian man who grew up suffering from homophobia and racism, came to therapy to work on his “coming out issues.” After he felt safe enough to address his traumas, our work progressed in helping him develop awareness of the “felt sense” of his internal states. We worked slowly and paused periodically to notice any sensations, movements, impulses, images, gestures, or feelings.

Sometimes he experienced an uncomfortable heavy sensation in his chest and stayed with it without becoming overwhelmed. Other times he noticed spontaneous movement of his body rocking from side to side, which felt soothing for him. We paid attention to any subtle movement or protective responses that were emerging. For example, one of the protective responses that had not been available at the time he was dealing with school bullies began to emerge. I invited Cyrus to notice the movement of his hands and what might be coming up. He described sensing strength in his arms and an impulse to use his hands to push back.

By slowing down the process, he was able to explore that impulse while remaining connected to the present moment. By tracking his body sensations and movements, Cyrus was able to move through painful memories and experience spontaneous trembling and shaking. Alternating, or “pendulating,” between sensations associated with the traumatic event and sensations associated with safety and strength was also part of the process that supported his ability to self-regulate.

Eventually, our work together led to a greater embodiment of his pride in being a gay person of color. It also helped Cyrus develop a sense that his past traumas did not have to determine the rest of his life. He discovered that love and a sense of safety could become more accessible than his past experiences had led him to believe.

On the path to recovering from trauma and living a passionate life, one needs resources. In Sensorimotor Psychotherapy, Pat Ogden describes resources as “anything that enhances the quality of our lives or provides what we need to meet life’s challenges.” She also discusses different categories of resources, including internal and external resources. It is important to note that a resource needs to be tailored to the needs of the individual.

For instance, some clients might find certain body movements, such as rocking or dancing, helpful. Their body might respond positively to such an experience by releasing tension or increasing a sense of comfort. Other clients might notice feeling lighter in their body after watching a comedy or playing with their pets. No one should feel judged for not finding certain resources helpful. One size does not fit all.

One resource that can benefit gay men is the discovery and embodiment of the meaning of their gayness or queerness. In one of my articles, “Gays in Search of Meaning,” I discussed how, by embracing what is inherently purposeful about our gayness, we can start to live a more soulful life.

Helping gay men connect to their gay essence and find the numinous qualities inherent in being gay can be an enlightening process. Gay people may have a unique relationship with the experience of being “different.” Growing up feeling different from the majority can, for some individuals, create opportunities to question socially conditioned assumptions and develop an identity outside dominant cultural expectations.

As Eckhart Tolle, the author of The Power of Now, suggested:

“...realization that you are different from others may force you to disidentify from socially conditioned patterns of thought and behavior. This will automatically raise your level of consciousness above that of the unconscious majority, whose members unquestioningly take on board all inherited patterns. In that respect, being gay can be a help. Being an outsider to some extent, someone who does not fit in with others or is rejected by them for whatever reason, makes life difficult, but it also places you at an advantage as far as enlightenment is concerned.”

It is important to note that concepts like soul, enlightenment, or spirituality can be triggering for many LGBTQ people who were harmed by homophobic religions. Throughout human history, many religious institutions have committed atrocities against LGBTQ people. In the name of their god, some have murdered queer people or denied them their human rights.

For many LGBTQ people who were targets of hate by homophobic institutions, knowing their right to a soulful life with depth and purpose can be a resource. Such awakening can become embodied when it occurs within the context of somatic therapy. In my experience, many gay men have added meaning and a sense of aliveness to their lives by participating in body-inclusive psychotherapy while working on discovering a deeper meaning of being gay.

Such a feeling of aliveness, and its underlying bodily sensations, can stand in contrast to the fear and humiliation that many gay men had to endure while growing up in a heterosexist world. In The Body Keeps the Score, Dr. Bessel van der Kolk describes how body-centered approaches to healing can provide experiences that contrast with the helplessness, rage, or collapse associated with trauma.

Finally, how far the LGBTQ community has come in the struggle for equal rights reflects how brave we are as a community. Our bravery can continue by facing traumas we experienced while growing up in oppressive environments that did not nurture our true essence.

Not every LGBTQ person experiences trauma while growing up, and LGBTQ experiences are diverse. For those who have experienced trauma, discrimination, or chronic rejection, somatic-focused psychotherapy can offer a meaningful pathway toward healing, self-regulation, connection, and liberation. Healing is not simply an intellectual process; it can also involve learning to inhabit the body with greater safety, awareness, and compassion. By bringing awareness to the body, nervous system, emotions, and lived experience, somatic therapy can help LGBTQ people reconnect with parts of themselves that may have been shaped by years of fear, shame, or rejection. For many, healing involves not only understanding what happened to them, but also developing a deeper sense of safety, aliveness, and belonging within their own bodies. As Resmaa Menakem, author of My Grandmother’s Hands, stated, “Healing does not happen in your head. It happens in your body.”

© Dr. Payam Ghassemlou, SEP, MFT, Ph.D., is a Licensed Marriage and Family Therapist (Psychotherapist) online anywhere in CA, OR, and FL. www.DrPayam.com, www.SomaticAliveness.com

 

Licensed Marriage and Family Therapist

MFT33893

Florida telehealth provider registration number  (TPMF1589)