LGBTQ Affirmative Therapy: The Client Group You're Missing
with Dr. Lisa Marie Bobby and Miriam Grace, MA, UKCP Registered Psychotherapist, BACP Senior Accredited Therapist
The Client You Have Already Met and Never Recognized
The failure is not prejudice, it is a need for certainty.
There is a client you have probably already had, and there is a reasonable chance you did not recognize her. She is a woman somewhere in midlife. Her marriage is not working the way it used to, and she cannot quite tell you why. Something has come loose in her sense of who she is and what she wants, and when she tries to describe it she circles. You are affirming, genuinely, and you would have said so on any intake form. But nothing in your graduate training was about her specifically, so you reached for the nearest frame you had. Marital dissatisfaction. A female version of a midlife crisis. A symptom of something.
My guest is Miriam Grace, a UKCP Registered Psychotherapist and BACP Senior Accredited Therapist who has been in practice for 36 years, trained in person-centred and Gestalt work, and taught and supervised trainee counsellors at five universities. She contributed a chapter to the Routledge anthology Queering Gestalt Therapy, and she now specializes in women in midlife and beyond. She also came out herself, just before she turned 50, and ended up in a private support group of women who had done the same thing, where she did what any of us would do in that room. She asked them how therapy was going.
The answer is the reason this episode exists. Some of them were not bringing this part of their lives into session at all. Others had been put off entirely by how a therapist responded. On the whole, she told me, the women she was with had concluded that each other was a safer and better place to go than therapy.
We get into why the mechanism is a need for certainty rather than a lack of goodwill, why the relevant decade is the 1960s rather than the 2020s, what dropping estrogen has to do with a woman reevaluating her whole life, why "how did this happen" is the wrong question and "how are you going to live" is the right one, safe uncertainty as a clinical position rather than a turn of phrase, why a midlife reckoning is not a midlife crisis, and her answer to the scope question, which is the opposite of what I expected when I asked it.
Hold onto one word while you read: affirming. Nobody in her support group described a hostile therapist. They described well-meaning ones who started investigating.
"There's a lot of answers to why, but why is not the point." — Miriam Grace, at approximately 00:21:24
Moments from this episode
Episode transcript
Miriam Grace: The women I was with and myself included. We found each other a safer, better place to go than therapy.
Dr. Lisa Marie Bobby: There is a very special and distinct group of clients that many of us therapists have probably worked with at some point, without even realizing it. And it's quite possible that these clients needed our help with something that they didn't know how to talk about, and that we never asked. These are adult women, maybe even later in life, who are now questioning their sexual identity, or maybe even in the stages of coming out as a lesbian. This group has very special needs, and we need to handle this with a lot of sensitivity and specialized understanding that almost none of us ever got in our graduate training.
Miriam Grace: This lovely estrogen facilitates us to fulfill an important need for society and for evolution, which is to put our needs second. To foster connection, to mend ruptures, to love, to give, to bring family together.
Dr. Lisa Marie Bobby: And that's why on today's episode of love, Happiness and Success for therapists, we are talking to a true expert on this topic. I couldn't be more excited to talk to our colleague Miriam Grace. Miriam is a UKCP Registered Psychotherapist and a BACP Senior Accredited Therapist in the UK, and she's been in practice for 36 years now, making her one of our esteemed elders with a lot of wisdom and experience to share. And Miriam also has a lot of professional experience. She's trained as a person centered therapist, also a Gestalt psychotherapist. She's taught and supervised trainee counselors at five universities, and now she is specializing in working with women through midlife and beyond, who are coming out as lesbians later in life.
She wrote a chapter in the book, Queering Gestalt Therapy, and has a new book coming out later this year. But she's here right now to share her wisdom on this topic with us. So, Miriam Grace, so good to connect with you.
Miriam Grace: I really feel as if I'm talking to a friend because I've listened to you so much, and, I, I hope that we'll both get a lot out of talking to each other.
Dr. Lisa Marie Bobby: Well, I already feel like we're friends with you. We've just been hanging out, chatting a little bit prior to our interview starting, and I'm. I'm already a super fan, so, so, Miriam, thank you again. Just so much for joining me and our friends today on love, happiness and success for therapists because, you know, this is a really specialized client group with, I'm sure, so many, needs and, complexities that I know I haven't spent a lot of time thinking about. It was just not really exposed to it. And at least I don't think in my own practice I had a client that met this description. But like after connecting with you and your work, now there's a part of me that's wondering, oh, no, did I actually have this client in my office who was struggling with us?
And that's something that we never talked about. I didn't ask about it. Is is that something that you see commonly like this is a it's just an invisible need, I guess.
Miriam Grace: Well, the reason I started writing about this in researching is that I came out later in life, as you know,
Miriam Grace: I wasn't quite 50 and I ended up in a private support group on Facebook, and it was a hidden group. And as a therapist, I was like this, these women here, sharing their hearts, their grief, their stories. You know, how how were they finding therapy? What? You know what's happening in therapy? Are they going to therapy, or are they? Some of them were going to therapy, but sharing this part only in that group, some of them had been put off by, you know, unhelpful responses from therapists, which obviously saddened me. And, and on the whole, the, the women I was with and myself included, we found each other a safer, better place to go than therapy.
And so I thought, oh, no, okay. Right. What are we going to do about this? And now at that point, when I did come out and actually began researching around menopause, and in many ways, you know, what we're going to discuss today and this topic is relevant for all women in this sort of midlife phase, because, yes, some of us come out as lesbian, but some of us come out as a poet or, you know, a mountain climber or a fig, you know, so, you know, the, the, you know, the process. Obviously when you, when you come out around your sexuality, there's, there's, where we're in a context where you're now minoritized during a minority group.
Which wouldn't happen if you came out as a mountain climber or like, you know, you. Well, that's our use. I would say, man, climbers are actually minorities, but not in the same discriminatory in the discriminatory way. There are many of them.
Miriam Grace: Yeah, but but red but really, you know, this intersection of why why is so many women coming out right now? And I think we've got a perfect storm because I was born in the 60s, and a lot of the women that I've bonded with over the last few years, were born in the 50s, 60s, 70s, 80s. Yeah. So I, you know, people say, oh, well, it's really easy to come out and, you know, in, in the, in the 2020s, you know, it's a very accepting culture. Well, maybe not in your country, but anyway, we will get to that in a bit. But, you know, it's a very it's much easier now.
And so, I say it's not that's the, not the date that is relevant. It's 1960s and 1970s. Women didn't even have the right to have a credit card. Women didn't have laws where they had equal pay. Men were legally allowed to rape their wives. So, you know, in in terms of the history, we have to think of the context that I and, and others in my demographic grew up in. And that's, that's meeting us in 20, in the 2020s when our estrogen is dropping. And I think this is really relevant because what I've been reading and researching around the neuroscience is that the this, this lovely estrogen, facilitates us to fulfill, an important need for society and for evolution, which is to put our needs second to foster connection, to mend ruptures, to love, to give, to bring family together.
Dr. Lisa Marie Bobby: And then you're probably very aware that when the estrogen drops, some of your clients, realize that neurodivergent they have ADHD or autism. So that. Okay. Oh, yes.
Miriam Grace: So it's a they the estrogen helps with dopamine management. And people who've been undiagnosed are getting diagnosed quite often in midlife. It's another coming out.
Dr. Lisa Marie Bobby: I myself have have had a diagnosis of autism. Had no idea at all. But but it's, you know, I've been misdiagnosed in the past, so.
Miriam Grace: And I'm going off point here. No, no, no, but but yeah, that the thing is it's the, it's it's the estrogen. So this this sort of, you know, we get to, this stage when the year that we were born in is hitting, you know, they are estrogen dropping and we start to reevaluate. Now, a lot of the women that I've worked with who might have been married to men made that, commitment, in the 20s, when it was 20 or 30 years old. They made that commitment in the last century. And this is just such a long time ago, but. Yeah, well, it's starting to be a long time ago.
Yeah. No. And, things have changed. So, as we reevaluate, who am I? Who am I beyond my conditioning? Yeah. Then the the opportunity to see outside the box has really begun to expand. We've got more lesbian visibility. We're starting to think about our own needs, and we're starting to think about our own relational needs. And sometimes the the man that we're partnered with, we've just assumed that he will never meet our relational needs. Rather than thinking, you know, I have needs, and I would like my needs to be met. And it's this is not a matter of trying men thinking that they're not very good and going on their own, going on to women.
But it's just we've I'd never I'd never thought of myself as having anything in common with lesbians. What are the people I had most in common with were straight, married women. And we would hang out and complain about our husbands. And I thought that was normal. I didn't know that, you know, that my experience was perhaps different to theirs. So I resonated more with them. So. So it's like I say, it's a perfect storm. You've got menopause hitting often. You're if you've got kids, they're teenagers and they've got puberty hitting, you know, and
Miriam Grace: then there's this is a union idea about the second half of life. And in union thinking, it's that the first half of our adult life, we spend the, connecting, engaging with the world.
Dr. Lisa Marie Bobby: So, we make a career or family or, renovate a house or, you know, travel and connect with the world.
Miriam Grace: And then the second half of adult life is about this connection within connection with self. So the whole awakening, I think, is relevant to but probably relevant to everyone. But in terms of what I'm talking about today is relevant to all women. And also, you know, we have to remember the, non-binary clients and, trans men will have spent a significant part of their life, experiencing the same conditioning that we've experienced around, you know, put your needs second, you know, mend rupture. Don't even consider yourself as a sexual being. I'm talking a lot, but I just will just. I'll give you a, a way in in a second, but I, I was doing a paper for a conference, and I thought, oh, I'll get, a copy of cosmopolitan, which I hadn't read for years.
Dr. Lisa Marie Bobby: The last time I it is now in officially smut. Oh my God. Yeah. Yeah. Right.
Miriam Grace: But so I, so I got a copy of cosmopolitan and their tagline is something about, you know, helping young women, something or other. I took the headlines of a copy of cosmopolitan in 2023. It said things like, sex moves he'll never forget. How to lock his love down. You know, all the so the the message of the cover was. But you have to lock his love down with sex. So you sort of have to catch him, and, And was that you want to do sex that he'll never forget? It's like, well, hang on, I might like to have sex.
Dr. Lisa Marie Bobby: I'll never forget. It's like you're part of it, but. No. Right. Yeah. It's being a sexual being for the purpose of, you know, having somebody else, like. Yeah. Yeah. I'll go keep keep going. I was just resonating. Okay.
Miriam Grace: You're saying well I'm, I'm, I'm on my, I'm on my soapbox now I love it. Well I think, I think that so I feel that the the coming out process. Yes. There is a difference in women coming out later in life a different to other women going through menopause. But there's a lot of similarity. Yeah, there's a lot of resonances, a lot of unlearning are conditioning. And we're all so different from those coming out earlier. And you know, I know that the that my, my peers, you know, I would call them my sisters in my book I call them pioneer lesbians. These these are people like my wife, who came out when that, you know, when they were adolescent.
They went through some horrors. They really went through some, you know, brutal and, you know, often quite physically threatening experiences.
Dr. Lisa Marie Bobby: And we can sometimes the later in life, lesbian can feel a bit embarrassed about having sort of missed some of the, the struggles, some of the battle and sort of arrived late to the party.
Miriam Grace: But we, we have other aspects that I now believe that coming out, whether you're 19 or 49, is a trauma because of the, the deconstruction of the previous identity.
Miriam Grace: You mentioned this before we began. But the, the ripples into, you know, I lost my marriage. I lost my family home. I lost my dream of the, you know, the the 2.4 children, husband, dog estate, car. You know, I think in, in your country, you'd call it the white picket fence, you know, lost that, lost some community, lost some friends, lost a lot of money. It's really expensive. Even straight women who've got divorced will will attest to that. You know, it's it's, financially savvy to to stay married. So, you know, a lot of losses and femme. There's a phase I call coming down from coming out, which is maybe two years, 2 or 3 years down the line because we don't realize because we've had straight privilege, we don't realize that life is any different, that we're in a minority group now for the rest of our lives.
But minorities stress and this is this is why I wanted to come on the, the podcast where we talk to other therapists. It's like minority stress is real. And if these women and, you know, menopausal women as well, these women need some really good daily strategies around stress management because the impact on health, you know, the figures, the statistics, the studies I've read is it's massive. And, I don't want to go too much into this, but I got cancer, quite serious level cancer. It was stage three for, to two year, two years after coming out, my wife and I had met about, 12 months before.
So this sort of threw us into, you know, quite serious level commitments. And, you know, at, at certain points we did think I wasn't going to make it, but I am here. Nine years later, I am cancer free, and, and I'm happy. And the something about having written my book that feels as if I've been through a therapeutic process. Drawing the line under that, I feel like. Okay, I'm 61, Lisa, I don't quite and I'm not I'm not upset about aging, but I'm just very surprised you know, excited, surprising. Anything that was, Yeah, I just very surprised. I'm. I'm 61. And when when we met, you know, I was 49, I think.
And and the the joy and the euphoria and the just, you know, it's like finding my identity. Finding myself and meeting, was just so, so wonderful. And we were so young, and it felt young and innocent. So, and now we've been through hell and back. But, I feel as if, you know, we're starting to play again. We're starting to, you know, the other weekend we went to, a wildflower meadow, and you take your own secateurs, and we picked all these sunflowers and beautiful flowers, and, I just thought, oh, we're going on dates again. Let's see you.
Dr. Lisa Marie Bobby: Well, thank you so much to for the an introduction into this whole space. I mean, really, and, there is a lot here that we all need to have on our radar and, have visibility into to be able to ask the right questions and then also support our clients in helpful ways. Miriam, you gave us all such a beautiful and in-depth overview of this very complex and quite special, life experience that I think is under-recognized for us as professionals. And I have to tell you, as you were sharing your experiences, one of the things that just hurt my heart so much, and I'm sure every other therapist here with us right now had something similar like this, when you were talking about in your own stories, being part of these, you know, Facebook groups, is women coming together, going through this really powerful, empowering, but at the same time discombobulating life experience that is exhilarating but also quite stressful and so many different complexities and feeling like therapy was failing them.
Yes. Or they were talking about it at all. Okay, take us into that first. What's going on in that space where it's just it's not working. A lot of times for women who who need our support.
Miriam Grace: Well, you know, I think that we, we really well equipped to deal with all the all the course sub sub issues. Yeah. So it's it's like we we understand loss, we understand divorce, bereavement. We understand, hopefully midlife. Although, you know, I do question our training around women in particular.
Dr. Lisa Marie Bobby: Let me just say our training typically mine. It is in the diagnosis and treatment of clinical mental health conditions totally different than life transitions and development, which in my experience is often better suited for a coaching psychology. Right. But clinical psych, I don't know, said that. That's a good point. And there can also certainly be clinical anxiety, depression, as you mentioned, trauma that comes as a part of this. So so we have all the raw ingredients but still something isn't working.
Miriam Grace: What is nice I think that the, you know, the therapists, I feel like I want to say what is working. Okay. The therapies, the therapies that take the client back to sensation awareness, these these are very, you know, Jekyll terms, but where the locus of evaluation is centered in the client, her listening to her, voice, we know how to do that. And that is, you know, that is the tool of our trade.
Dr. Lisa Marie Bobby: But I think we can get a bit, sidetracked.
Miriam Grace: There's a few red herrings that I think therapists get sidetracked by.
Miriam Grace: One is, is the the puzzling question that your client has probably going round and round, which is how did this happen? How was I apparently straight and now I'm not or or was I straight or was I in denial and and so on.
Dr. Lisa Marie Bobby: And the therapies can get caught into that because they're thinking, well, that's weird, you know, how did this happen?
Miriam Grace: And, I think, you know, I would say to the therapist would say, you know, hold them, but hold in mind, you know, Kubler-Ross stages of grieving. This is bargaining. This is denial. This is this is this is something the client needs to go through. You don't need to get involved with the how.
Dr. Lisa Marie Bobby: You can you can read my book that says quite a bit about, you know, the socialization, the minimization, the, you know, being trained not to notice our, ourselves as sexual beings.
Miriam Grace: There's a lot of answers to why, but why is not the point. It's how. How are you going to approach your life? How are you going to soothe yourself? How are you going to believe yourself and love yourself? You know, in this place. So that said, that therapist needs to, you know, not believe that finding the answer is important. It's finding. It's finding the compassion is finding the self awareness. The I still believe that the client will self adjust and self-regulate around around what they need to do. If we provide the environment for their system to work it through.
Miriam Grace: So I think therapists sort of get in the way a bit and then we bring our own assumptions because we're we're all sexist. We're all homophobic. Trainers are supervisors are our clients are, you know, we can't not be.
Dr. Lisa Marie Bobby: So this is this something are you saying, because we are all products of homophobic, because gymnastic culture is in a lot of ways baked in whether or not we. Yeah. Yes.
Miriam Grace: Yeah, we we we we might be, accepting and liberal in some way.
Dr. Lisa Marie Bobby: Not going to see I mean, this this is where the episode that you did, that amazing episode with doctor, is it Diane Estrada? Diane Estrada. Yeah. Yes. Yeah, yeah. And. No, it's it's it's what? You know, where I just sort of felt so met by what she was saying because, you know, we we how can we see our blind spots. We can't. And, you know, I'm sure you like I, we look back, early client things. I'm thinking.
Miriam Grace: I cannot believe I said that or I didn't see that. And we, you know, I, I believe it's our commitment not to beat ourselves up, but to to keep ourselves open. So fluid, fluid sexuality exists. And it's more common in women.
Dr. Lisa Marie Bobby: Men can experience it too, but it is more common in women.
Miriam Grace: Women, women have lots of changes in the in their sexuality. And as I've already said, we've got the hormonal element as well.
Dr. Lisa Marie Bobby: We know that, you know, people's personality in midlife can can change.
Miriam Grace: Well, personality is not quite the right word.
Dr. Lisa Marie Bobby: Their expression of their personality can can change.
Miriam Grace: They they might, say no more and so on. So, so I would, I would suggest, you know, there's the there's the red herring of don't don't worry about how it happened. It's just like this happens. Women, women have life cycles. Women have phases. You know, we're not taught about women, particularly as in any way as different. The standard client is the male client. And that's, you know, that's our training. That is also have you read Invisible Women? Have you read that book by, Caroline? Criado Perez. She it's about the data bias. So it's not a psychology book, but she's talking about how, you know, cars, seatbelts, defibrillators, medication, they're all tested on, men because they're more reliable subjects, because they don't have a hormonal fluctuations.
So, you know, let me move on if it's okay.
Dr. Lisa Marie Bobby: Just, you know, for our friends here listening, I am very curious to know if in your, community or a social media groups that you are a part of just so that therapists can have this on their radar because you want to hear the answer to this question. What did you hear your your peers, your sisters saying about what was happening in terms of their subjective experience with the therapist that made them either feel like you know or not bring it up at all, what was going on inside of them.
Miriam Grace: The therapists like us need to know, I think that's one thing was about, they pushing pushing a woman to sort of come to a conclusion around her sexuality. You know, it's like like investigation. Yeah. Yeah. And, rather than just allowing, I think, real her, philosophers says, you know, just stay with the question. Stay with the question. And, holding the uncertainty. Some people said that the therapists, even LGBT plus therapists, were a bit skeptical about fluidity or bisexuality or, you know, it's like, however she presents whatever her lived experience is that that is valid. You know, it's like she doesn't have to turn up to therapy with a dossier, charting her history and why, you know why.
Why? Yes, exactly, exactly.
Dr. Lisa Marie Bobby: So so this I get all kind of stress and and start, almost investigating. And people feel like they need to substantiate these things that they are experiencing or even wondering about when I'm extrapolating. Here's tell me if this is wrong, but it's like when this is also kind of new and nebulous. It it's it feels, like it it's sort of, like pressurizes it in a way that. That's right. And and it's it and I think it's, I think that therapists get anxious.
Miriam Grace: So, so this, this concept, and that I explore it in my book a bit about,
Miriam Grace: safe uncertainty. And I don't know if you've heard of this concept, but, we tend to, as human beings, link certainty to safety. So, you know, we want to know what's going to happen, and then we feel safe. And if we don't know what's happening, well, we don't know whether our client is gay or or or confused or whatever. We start to feel a little bit unsafe, and we go. We go for certainty because it makes us feel more safe. And I think, I think, you know, just really want to encourage therapists to remember, you know, the the absolute thing that you have is the capacity to stay with the uncertainty, the not knowing and how scary that is for your client and maybe for you too, you know, and and the questions, questions about your, your self, you know, it's like, am I meeting this client?
Am I not meeting this client? Do I need to know more about lesbians or, you know, just just be, where, where they're at and and say, gosh, this is so it's so unnerving not having the answers, isn't it? You know, share that with them. You know, I don't have the answers. You don't have the answers. And here we are, listening to you. So, so I think that I think people therapists, people in general, they want to know why they want to have a theory, they want to, you know, summarize it encapsulates it. Yeah. Labor label it.
Dr. Lisa Marie Bobby: And, and I think, you know it takes great professional maturity and courage to not do that. Oh absolutely. And for the record, I will say that that that is likely true of pretty much all of our clients. You know, one of my other personal heroes is certainly Doctor Diane Estrada, but also a doctor, Bill Doherty, who has been on the show, like so Star Trek. He's amazing. But, you know, I've I've heard him say that on numerous occasions that a lot of what therapists try to do is fabricate a story that like why things are the way that they are, that is not particularly useful to anybody.
I mean, maybe to like, okay, I guess that makes sense. And patterns, you know, self-compassion, certainly, but it's not necessarily going to change anything. And so you're saying that when therapists get all hyper about that, as opposed to being able to be in the moment, be in the room, just accept and allow, it can really shut things down. Yeah. Yeah. And and I'm also wondering too, if, if this has come up in your experience, with other clinicians or as a clinical supervisor, I could also see, although I don't know, this is a question, but,
Dr. Lisa Marie Bobby: you know, it it's sort of turning into, oh, this is a manifestation of a problem like, yes, are unhappy in your marriage or this is a female equivalent of a midlife crisis, or perhaps a symptom of something as rather than this, awakening that's like this as, as you say, the the pink haze of estrogen starts to look at it all of a sudden, you have this time and space for the first time, maybe in decades, if you're a mother. Right? Like an image. Oh yeah. Who, who am I. And what do I what's. And it's right as opposed to this problem. So us to that I mean do you feel like that can sometimes be a vulnerability of therapists.
So working with clients around this. Yes, absolutely.
Miriam Grace: I think that I think that therapists pathologize something that's, that's natural and normal. And you said about, you know, midlife crisis, I think that a midlife reckoning is available for all of us. And I think take it, you know, it's like, go there, go, go there to your midlife reckoning. Again, Jung said about one of his clients who said, Thank God he had a breakdown.
Dr. Lisa Marie Bobby: Which sounds sounds bizarre, but, you know, in a sense, it it's only through the breaking down of the existing conditioning, the existing structures and the existing belief system that a client can say who but who? Who am I? Who am, who am I?
Miriam Grace: So, yeah, it, I would say don't don't pathologize, a woman's expansion or her or her crisis or her distress. And I think this, this is another thing is, is that because psychology is so, you know, it is it's a it's comes from the patriarchy is that the emotionality is seen as a problem rather than, you know, it's just neutral. It's it's just, you know, crying, you know, being distressed, being intense, being madly in love with somebody, being utterly heartbroken. It's like, well, wow, you know, you're alive. You know which which why why does the therapist need to dampen that down and start talking about Limerick's and obsession and infatuation?
Dr. Lisa Marie Bobby: Allow in the United States to get insurance to pay for it is one mesa. But yeah, I need to hear you talk. I mean, you have a heart of such such a true counselor. And, you know, my background is in capstone psychology as well. And I think that that's that, that heart of it. But at least in the United States, I think that so many therapists get forced into this box where they need to medicalized a pathologized emotions, because that's what we're here to treat and part of medically necessary treatment. And so you need to be able to find a way to create more separation and, and bring the function of feelings back.
Because what what is this telling you about who you are and what you, me and what's true for you. And I just love this as it was. Miriam Grace I know I don't have a ton more time with you. I know we have to wrap this up soon, but I have. I have two more questions. Two more questions for you. Well, and you know what? Maybe since we don't have a ton of time, let me ask the most important one. And perhaps you can fold the other in. I think that one of the big, ethical considerations that always comes up for me on this show, speaking with people such as yourself who have a very deep expertise in a specialized, presenting issue population.
Right. For me, a part of ethical practice for all of us needs to be visibility into our own, and have boundaries is the right word. But like,
Dr. Lisa Marie Bobby: what is good enough in terms of knowledge and competencies for a counselor to do, do a reasonably decent job with a client who needs to do this work, versus what are some indications that a counselor might need to refer out so that they don't? Perhaps, I don't want to say harm a client, but not really, fully meet a client's needs just just due to our own and his ignorance. The right word. It's like there needs to be that. How do we make that choice as a as a clinician, I can. I think that yes. Or client. I think that's a really good question.
Miriam Grace: I think in terms of visibility, when I was looking for a therapist, when I was coming out, I was scrolling through the lists, looking at people's photos, and I'm like, is she wearing plaid? As a sign?
Dr. Lisa Marie Bobby: That she's a good sort of signal, or this person has, like, a piercing, maybe that maybe they're friendly or, you know, inside. Yeah yeah yeah yeah yeah yeah yeah.
Miriam Grace: So so it would, it would be really helpful to put to put visibly your positive support rather than just being neutral and leaving your clients to find out, to say that you are affirmative of Lgbt+ people. So, you know, I would, I would like I would like therapists to put that, you know, on that on their details as a start.
Dr. Lisa Marie Bobby: And I the question now what what do we actually need to have in terms of training competencies? Experience in order to do that in a legitimate way? Because anybody feel like, oh, yeah, I love gay people. They're great without actually knowing. Yeah.
Miriam Grace: And this, this was one of the big this is one of the big complaints from, from that group that we were talking about is this, somebody said my therapist when I told my therapist I was gay, my therapist said, it's no big deal. And that that was so upsetting for the client because it's like it was a big deal. It was like ruining her life that she was gay. It's like it is a big deal. So, I think I think that, I think I really do think that it is within the competency of most therapists who are, who are open and aware of that, that prejudice, that bias, the, you know, the, the possibility of not knowing and who are experienced in saying to the client, you know, I don't understand that.
Could you explain a little bit more.
Dr. Lisa Marie Bobby: I think, you know, I really would like to say on behalf of all female clients, you know, or on behalf of all emotional clients, which is, is, you know, so if, if you can hold and support somebody who's very distressed, then then you, within your competence, say, and what would be outside my well and, and and listen since, since we do have to wrap up, let me just say that I believe I was also so important that if we're in, is this an okay or, and to your point, we can absolutely hold space for people and allow unfolding and exploring. But I also think that it, it helps to have some at least exposure to what could be true.
So so let's talk a little bit about where people can find your book and where they, can also connect with you in case they want to do some potentially even case consultation. Yes, yes, yes. And I'll tell us.
Miriam Grace: Well, I'd love to do a case consultation and I would like to do an online seminar.
Dr. Lisa Marie Bobby: So, if people want to find me my websites really easy, it's Miriam Grace one word.uk. So that's my website. And you can find these resources pages and so on. Certainly when the book's out, I would love to do some online seminars where you can just sort of top up your existing skills and, and, and I just, you know, you can't stop me being passionate and talking about this, so I can see you trying. I can see you're trying to bring this to a close, and I've still got what's now, you know, so, I'm always welcome emails and and connection from from colleagues and would be, you know, very happy to answer any questions.
It has to. Okay. So Miriam grace.uk Miriam, it has been such a pleasure. Thank you so much for joining me today.
Miriam Grace: Oh, it's been so lovely to meet you and hang out with you.
Dr. Lisa Marie Bobby: Okay. Friends, thank you so much for joining me for this past episode. I don't know about you, but personally, I found it so interesting to hear from Miriam Grace's lived experience and also all these decades of professional wisdom about the things that we need to have on our radar. And, you know, one of my big takeaways is not so much even about like, what we need to know specifically about supporting people through these changes, but really coming back to our roots as it's not just clinicians, but truly as counselors, how do we stay open and curious? How do we hold that space and create an environment where our clients can think through their own nebulous feelings and ultimately arrive at their own answers in the space?
A very gentle acceptance that they may really need to have in their relationship with us, particularly if they're getting a lot of pushback or recrimination for other parts of their life. So a great reminder for Miriam there, as well as some links to some resources. But the other thing that I also wanted to share is that, you know, this episode, I think, for me is such a fantastic example of why it is so important for all of us in this field to have community and connections with other clinicians, even even if it is just, you know, like listening to a podcast. But like, I think that what we do is so inherently isolating, right?
Like day in, day out, we're not we're not talking to each other. A lot of times we're talking to our clients, and then trying to save a little bit of emotional energy or really go home. Right. But what what can then happen is that we're sort of just having our own professional experiences and these little silos, and it's so important to get perspective from other clinicians, even ones, I think, especially ones that are doing things that are different than what you're doing. And that's why I love having just a diversity of thought and different opinions and niches and perspectives represented on the show, like today's conversation with Miriam.
And I wanted to give you some resources to get more of that. So one of the things you heard, Miriam, but I talk about where some historical episodes on this show and if you're like, wait, what? What episodes? So obviously scroll back through the podcast feed. But also you can get access to not just episodes, but like articles, that YouTube videos of different things, access to like downloads and resources. They're all for you at growing self.com/therapist. So that's like a big landing page with all kinds of resources. And if you scroll down, you'll have access to every podcast I've ever done and then some. And there's also a search bar.
So, you know, Miriam was referencing what I did with Doctor Diane Estrada, which was excellent on how to uncover your cultural blind spots as a clinician and try to, keep things more visible inside of yourself. I also referenced again the amazing episode with doctor Bill Doherty where he's talking, about, actually, you know, we've done a couple of episodes together now for love, happiness and success for therapy. So the one that I was thinking about was related to, therapists and the impact that being a therapist can have on your relationship and on your own personal growth work and your own, work in therapy, your own development, which was so interesting.
Anyway, so just go to growing self.com/therapist and you could search, you know Bill Doherty and the search bar and it'll come up. And the very lastly, you know while you're there on that page, one of the resource that you might consider, is something that I put together a while ago. I call it the Therapist growth Collective. And this is intended to be a community space where therapists can come together and develop real relationships with each other. It is a membership community. It's very, very low cost, but it has a ton of value. And so if you have been craving a consultation group, you know, like a small group of therapists to come together on a monthly basis and talk about cases and, and not just cases, but like you.
Right. How are you feeling? Are you getting burned out? Is stuff getting triggered for you? The place to do that is in a safe, home based group of peers who know you, who love you, where there's a lot of trust that has been built over time. And so that's why we do home based groups on a monthly basis. As part of that, we're also doing private practice success coaching on the second Thursday of the month because so many, therapists, you know, we we want to have private practices just like the Golden ring. But, you know, actually the part about doing therapy is like part of that, like a fraction of it.
There's there's all this other stuff that is to happen in order for a private practice to happen. In my experience, at least, many therapists are not prepared for. And so this will give you a space to ask questions and to put together a game plan. On the third Thursday of the month, we are doing a high impact either Siu awarding training or you know, if if the training doesn't technically meet criteria to award continuing education credits to maintain our licensure, it will always be designed to support you and your growth, love, happiness and success. So, I am very pleased to let you know that our organization was recently awarded Continuing Education Sponsor status through the APA now, as well as the NBCC, and there are certainly a variety of of monthly events that are free for our members that would award continuing education credits, but and also really trying to design content and learning experiences for you that will help you in other ways, like so, for example, we have, training coming up here in a few weeks with, some accountants.
Oh, I did a podcast on the scroll back from. They said, you can you can get a little sense of what we're going to be talking about, but an accountant who specializes in private practice, businesses and is coming in to talk with us about, you know, over the years, the biggest mistakes that she has seen therapists in private practices make financially. Right. Like, where are we losing money and not even realizing it? Where are we, making mistakes even with regards to how we're filing taxes, which apparently can cost many, many thousands of dollars, depending on how you do it. So she's going to come and shed light on that.
So if you're a private practitioner, please, please join us because that's going to be a really good one. And again, it's not necessarily clinical training, but because so many of us are in business like things we need to know. And then lastly, on the last, Thursday of every month, we are doing drop in case consultation. So especially if you are a practitioner who doesn't have, a good community in know to be able to come in and talk about the cases like what Miriam Grace was talking about today. You know, I have this client who is, you know, starting to question her sexual orientation and identity later in life.
This is the first time I've worked with a client with this presenting issue. And what how would you guys handle the situation? What should I be thinking about? Or the things that I should be not doing right, and just this exchange of ideas. And so this is it with a group of peers, but it's also facilitated by a very experienced, typically doctoral level clinician or a master's level clinician who is, an approved supervisor as well as a clinician themselves. And so, you know, bring bring your tough cases because we all have them, no matter how long you've been doing this work, sooner or later there's going to be a case where you're like, Right.
And and also that, like scope of, of competence. And how do we draw those lines? Right. Many clients green light. I know what to do with this. And there are some clients that are clear red light. I don't know enough about the treatment of severe bipolar disorder to take on this client. Therefore I shall refer. That's also relatively easy. What was easy is this like yellow light situation. It is a new situation and we don't even know what we don't know. It could be a presenting issue. It could be a certain type of client demographic that are having some complexities, complexities. And I'm also a really big believer in the growth part of growth, love, happiness and success.
We need to have new experiences as professionals that give us opportunities to learn and grow and develop, and taking on a client who is maybe at the edge and then giving ourselves opportunities to read the books, take some trainings, do case consultation, you know, like that puts us back into green light, territory. And it's often such a powerful win win for everyone. I think that if you're aware, especially that you're working with the client where you need to pay extra attention and you are doing your own work and developing yourself professionally in order to meet those needs, you're going to do a phenomenal job. But where do you get those support systems?
And case consultation can be a very big piece of that. But also it is, in my opinion, as a clinical supervisor, very true that therapists operating in isolation can be really vulnerable, to, again, not knowing what they don't know. And so if you're in a, yellow light situation with a client to be part of a professional community and case consultation and get feedback from others, like, yeah, this is really a pretty specialized thing, or I have done training in this work and here are some things that you don't know. And given that you might consider referring that, you should know that as opposed to continuing to work with a client that's really outside your scope of competence, and you don't even know.
Right? So it's an ethical misstep that we're all, I think, vulnerable, vulnerable to making. And then bonus points if you have a relationship with another professional that, you know, like, and trust is part of a community that you feel fantastic about sending that referral to because that's another part of that equation. It's not just being aware of our own limitations, but then it is part of our professional, responsibility to be able to facilitate a referral to somebody who can provide continuity of care or see things through, and having other relationships with other professionals. This is how we do that, rather than just, you know, sending somebody to Psychology Today.
So anyway, if this appeals to you, come join us. Growing self.com/therapists. You'll get access to all kinds of resources, including podcast episodes, but you'll also see a section to learn more about what's going on in the Therapist Growth Collective. And, if it sounds good to you, invite you to submit an application and join us and we'll see you then. Group one of these days. All right. That's it for today. Thanks so much for tuning in. And I will talk to you again soon. Take care.
What to take with you
The failure is not prejudice, it is a need for certainty.
Miriam's finding is that women coming out in midlife experienced therapy as reproducing the same incomprehension they met everywhere else, and that the mechanism was the therapist's own discomfort with not knowing.
The relevant date is not this decade, it is the one she was formed in.
A woman who made her marriage commitment in her twenties made it in a different century, under conditioning that told her to put her needs second. That conditioning is meeting her right as estrogen drops.
Coming out at 49 is a loss event, and the second wave arrives late.
The deconstruction of a previous identity costs a marriage, a home, a community, friendships and a great deal of money. Then two or three years later, the phase Miriam named herself: coming down from coming out, when straight privilege is gone and minority stress becomes permanent.
Why is a red herring. How is the work.
The client is circling how this happened. The therapist gets recruited into the puzzle. The redirect is toward how she will live, soothe herself, and believe herself in this place.
A midlife reckoning is not a midlife crisis.
Emotional intensity is information, not a symptom to be dampened.
You are almost certainly already within your competence.
This is the inversion. If you can hold and support someone who is very distressed, and you can say out loud that you do not understand a term and ask your client to explain it, you are inside your scope. The correction is less certainty, not more certification.
What we cover, in order
- What is a later-in-life lesbian, and why is this a distinct client group?
- Why does therapy so often fail women who come out in midlife?
- What role does menopause play when a woman starts questioning her identity in midlife?
- How should a therapist respond when a client discloses a midlife sexuality shift?
- The blind spot underneath all of this
- Safe uncertainty, and why your discomfort is the actual obstacle
- Midlife reckoning, not midlife crisis
- Do you need specialist training to work with a client coming out later in life?
- One more thing about minority stress, because it is a health issue
- Make your affirmative stance something she can actually find
- Why reading this article is not the same as doing the work
What's in this article
More common than the two of us realized, which is part of why we recorded it. And Miriam widens the frame deliberately: the unlearning she describes applies to all women in midlife, some of whom come out as a poet or a mountain climber rather than as gay.
It turns out to be necessary and not sufficient, and that gap is the whole episode. Nobody in Miriam's support group described a hostile therapist. They described well-meaning ones who started investigating.
Three things, all of which she states on tape. Stop asking why and start asking how. Stop treating a developmental reckoning as a symptom. And say out loud when you do not know something, instead of moving quietly toward certainty to make yourself feel better.
I asked her a version of that question directly and she declined the premise. Her answer is in the article and it is the most relieving thing anyone has said to me on this show in a while.
Because Miriam's explanatory frame runs through it, and I did not see that coming. Her argument is that estrogen facilitates the work of putting your own needs second, and that when it drops, a woman starts to reevaluate.
LGBTQ Affirmative Therapy: The Client Group You're Missing
There is a client you have probably already had, and there is a reasonable chance you did not recognize her.
She is a woman somewhere in midlife. Her marriage is not working the way it used to, and she cannot quite tell you why. Something has come loose in her sense of who she is and what she wants, and when she tries to describe it she circles. You are affirming, genuinely, and you would have said so on any intake form. But nothing in your graduate training was about her specifically, so you reached for the nearest frame you had. Marital dissatisfaction. A female version of a midlife crisis. A symptom of something. If you have been doing this long enough to have a memory like that surfacing right now, you already know how this work changes you, and you know the particular flavor of that discomfort.
I want to be straight with you about why this article exists. LGBTQ affirmative therapy fails these women, and the answer to why is not the one most of us expect. It is not hostility and it is not prejudice. It is our own discomfort with not knowing, which pushes us to start investigating a woman who needed room instead. That is what my guest on this episode has spent years documenting, and when she said it to me I had to sit with the fact that I do not actually know whether I got this right in my own practice. I do not think I had a client who matched this description. But after talking to her, there is a part of me wondering whether I did, and whether she was in my office waiting for a question I never asked.
Here is what I want you to do with that feeling, though, because it is useful and it is also the exact point where most clinicians go quiet and handle it alone. This is the kind of thing we talk about constantly in the Therapist Growth Collective, and I mean that literally: a therapist brings a client they think they mishandled, and a room full of colleagues who have been there says the useful thing back. Reading an article about a client group is one kind of learning. Having somewhere to put the discomfort afterward, with people who will not flinch and will not perform reassurance, is a different one. I am going to give you real clinical content in this piece, from someone with 36 years in the room. I would also like you to have somewhere to take it, because the frameworks are the easy part and you already know that.
My guest is Miriam Grace, a UKCP Registered Psychotherapist and BACP Senior Accredited Therapist who has been in practice for 36 years, trained in person-centred and Gestalt work, and taught and supervised trainee counsellors at five universities. She contributed a chapter to the Routledge anthology Queering Gestalt Therapy, and she now specializes in women in midlife and beyond. She also came out herself, just before she turned 50.
What Is a Later-in-Life Lesbian, and Why Is This a Distinct Client Group?
A later-in-life lesbian is a woman who comes out, usually in midlife or after, having previously lived a life that read as straight to her and to everyone else, most often including a long marriage to a man. It is a distinct client group for one reason: the identity she is arriving at is new, but the conditioning she is arriving from is decades deep, and the losses involved are concrete rather than abstract.
Miriam came out just before 50 and ended up in a private, hidden support group of women who had done the same thing. She did what any of us would do in that room. She asked them how therapy was going.
The answer is the reason this episode exists. Some of them were in therapy and simply not bringing this part of their lives into the session at all. Others had been put off entirely by how a therapist responded. And on the whole, she told me, the women she was with had concluded that each other was a safer and better place to go than therapy.
She also widened the frame more than once, deliberately, and I want to pass that on because it protects the whole conversation from reading as niche. Some women in this life stage come out as a lesbian. Some come out as a poet, or a mountain climber. The unlearning is the same unlearning. And our non-binary clients and trans men spent a significant part of their lives inside the same conditioning about putting your needs second and not considering yourself as a sexual being at all.
One more thing worth naming, because Miriam does. Sexual fluidity is real and it is more common in women, which is well established in the longitudinal research rather than being a matter of opinion. Lisa Diamond's ten-year study of nonheterosexual women found that two thirds of them changed the identity label they had claimed at the start, and that the distinction between lesbian and bisexual identity turned out to be a matter of degree rather than kind (Diamond, 2008). Miriam's point about this is clinical rather than academic. Some therapists, including some LGBT+ therapists, are quietly skeptical of fluidity, and a client should not have to turn up to therapy with a dossier substantiating her own experience.
Why Does Therapy So Often Fail Women Who Come Out in Midlife?
Therapy fails these women through a need for certainty, not through a lack of goodwill. The clinician does not know what is happening, feels the discomfort of that, and resolves it by starting an investigation. The investigation pressurizes something that needed space, and a normal developmental reckoning becomes a case to be solved.
Miriam was emphatic that we are not short of the raw ingredients. We understand loss. We understand divorce and bereavement. Where she thinks we get sidetracked is subtler than incompetence, and I think that is what makes it worth an hour of your attention.
The clearest example she gave me came from her support group. A woman told her therapist she was gay, and the therapist said it was no big deal. Sit with that for a second, because it is a sentence that a kind, affirming clinician says out of genuine acceptance. And it was devastating, because it was a very big deal. It was, in the woman's own words, ruining her life. The therapist was signaling acceptance. The client heard her experience being made small.
That is not a training gap you can close with a certification. It is a listening gap, and it closes when someone else is paying attention to your work. Most of the clinicians I talk with figured out that something had gone slightly wrong in a session like that long before they figured out what to do differently. That gap between sensing it and naming it is exactly what a room of colleagues is for, and it is why professional isolation and peer connection is not a soft topic in our field. It is a clinical quality issue.
What Role Does Menopause Play When a Woman Starts Questioning Her Identity in Midlife?
Miriam's answer is that menopause is not a coincidence in the background, it is part of the mechanism. Her frame is a convergence of three things, and it is the piece of this episode I keep thinking about.
First, the conditioning. Her argument is that the relevant date is not the 2020s, it is the 1960s and 70s, the decade these women were actually formed in. People assume it must be easy to come out now, and in some ways it is. But a woman who made her marriage commitment in her twenties made it in the last century, in a world where a woman could not hold a credit card in her own name and had no legal guarantee of equal pay. She was formed inside that.
Second, the hormonal shift. What Miriam has been reading in the neuroscience is that estrogen facilitates something evolution and society both wanted from women: putting your own needs second, fostering connection, mending ruptures, giving. When it begins to drop, that facilitation drops with it, and a woman starts to reevaluate.
Third, the developmental turn. She layers in the Jungian idea of the second half of life. The first half of adult life goes outward, into a career, a family, a house, the world. The second half turns inward, toward connection with the self. My version of this, which I said to her on the recording, is that the pink haze lifts and suddenly there is time and space for the first time in maybe decades, and the question that arrives is who am I and what do I want.
Put those three together and you do not have a pathology. You have a predictable convergence.
How Should a Therapist Respond When a Client Discloses a Midlife Sexuality Shift?
Hold it as grief, stay out of the question of how it happened, and redirect toward how she is going to live. That is the short version, and it is close to Miriam's exact instruction.
The client is going round and round on a puzzle. How was I apparently straight, and now I am not. Was I straight, or was I in denial the whole time. And the therapist gets recruited into that puzzle, because it is genuinely interesting and because we are trained to find the pattern. Miriam's advice is to hold the client while holding Kübler-Ross in mind. This is denial. This is bargaining. This is something she needs to go through.
Then the redirect, which is the most usable thing in the whole episode. There are plenty of answers to why, she told me, but why is not the point. How is the point. How are you going to approach your life. How are you going to soothe yourself. How are you going to believe yourself and love yourself in this place.
The clinical logic underneath it is straightforward if you trained in anything humanistic. The therapist does not need to believe that finding the answer is the important part. The client will self-adjust and self-regulate around what she needs to do, if we provide an environment where her system can work it through.
Two practical notes on this. The first is a pacing point, because investigation mode is often just enthusiasm arriving too early, and it is worth knowing the signs that you are moving too fast with a therapy client. The second is that there is a real difference between knowing this redirect and executing it at four in the afternoon with a client who is actively asking you to solve the puzzle for her. Our coaches and clinicians rehearse exactly this kind of thing with each other, out loud, before they need it. That is not remedial. It is how the move becomes available under pressure.
The Blind Spot Underneath All of This
Miriam said something in the middle of our conversation that a lot of people are going to quote, and she said it as a senior accredited psychotherapist with 36 years behind her. We are all sexist. We are all homophobic. Our trainers are, our supervisors are, our clients are. We cannot not be.
I asked whether she meant that we are all products of homophobic and misogynistic cultures, and she said yes. It gets baked in whether we want it to or not. We might be accepting and liberal and thoughtful, and we still are not going to see it, because a blind spot is by definition the thing you cannot see.
She then named the episode of this show that made her feel met on this, the conversation on cultural competence blind spots with Dr. Diane Estrada, and she made the point that all of us look back at early client work and wince. I cannot believe I said that. I cannot believe I did not see that.
And then the part that keeps this from being a guilt exercise: her stated commitment is not to beat ourselves up. It is to keep ourselves open. That distinction matters enormously and it is why this material belongs in a peer setting rather than in private. On your own, "I am biased in ways I cannot see" curdles into shame fairly quickly. In a room of colleagues, it becomes something you can actually work with. Our clinicians do this in supervision and in the Collective constantly, and the reason it works is not the insight, it is the witnesses.
Safe Uncertainty, and Why Your Discomfort Is the Actual Obstacle
The obstacle is not your knowledge gap. It is what your nervous system does with the gap. Human beings link certainty with safety, so when a clinician does not know whether her client is gay or confused or something else entirely, she feels unsafe, and she moves toward certainty because certainty feels better.
This was the strongest conceptual contribution in the episode and it was not in our plan at all. When I asked Miriam what her peers had actually said about their subjective experience with a therapist, the first thing she named was the pushing. Being pushed toward a conclusion about her own sexuality before she had one.
Her alternative comes with a concept she explores in her book, safe uncertainty. It is a genuine idea in the systemic literature rather than a turn of phrase, and it is worth knowing where it comes from: Barry Mason's original 1993 paper argued that premature certainty is actively counterproductive when one of the central aims of therapy is to open up the possibility of other possibilities (Mason, 1993). Miriam's application of it is beautifully plain. The thing you have is the capacity for not knowing. Say it out loud. Tell your client that it is unnerving not to have the answer, and share the not-knowing with her rather than resolving it privately by picking a theory.
She also quoted Rilke on staying with the question, and she said something I would put on a wall: it takes real professional maturity and courage not to label it.
I will name the obvious thing here, which is that this is hard in a way that has nothing to do with your intelligence. If you have ever sat with a client and felt that low hum of what if I am doing this wrong, you already know how much pressure there is to reach for an interpretation just to make the hum stop. Sitting in not-knowing is a skill, and skills need someone else in the room. Our team practices this on each other, and the Collective exists partly because tolerating uncertainty is much easier when you are not the only person in your professional life doing it.
Midlife Reckoning, Not Midlife Crisis
Stop calling it a crisis. Miriam's line is that a midlife reckoning is available to all of us and we should take it, and I have not been able to stop thinking about that word choice, because reckoning implies agency and crisis implies malfunction.
I asked her directly whether she sees clinicians turning this into a manifestation of a problem. You are unhappy in your marriage. This is the female equivalent of a midlife crisis. This is a symptom of something. She said yes, absolutely, therapists pathologize something natural and normal.
Her argument about why runs deeper than individual clinicians making individual mistakes. Psychology comes out of the patriarchy, and it inherited a reflex to treat emotionality as a problem rather than as neutral information. She reached for Jung on a client of his: thank God he had a breakdown. Which sounds bizarre until you follow it, because it is only through the breaking down of existing conditioning and existing structures and existing belief systems that a client can get to the question of who she actually is.
Then she said the thing that will end up as a clip. Crying, being distressed, being intense, being madly in love, being utterly heartbroken. Well, wow, you are alive. Why does a therapist need to dampen that down and start talking about limerence and obsession?
I gave her the American answer, which is that in the United States we do it to get insurance to pay for it. That is not a joke and it is not cynicism, it is the structural reality that so many clinicians here get pushed into a box where they have to medicalize and pathologize emotion because that is what constitutes medically necessary treatment. We have written a whole piece on rethinking the medical model in therapy if you want to go further into it.
And this is where I said the thing on the recording that I actually believe most strongly about my own field. My training, and probably yours, is in the diagnosis and treatment of clinical mental health conditions. That is a genuinely different skill set from supporting a life transition or a developmental reckoning, which in my experience is often better suited to a coaching psychology. There can absolutely be clinical presentations layered into this. But if all you have is a diagnostic frame, then a woman having a completely appropriate reckoning looks like a patient. This is the whole reason our team is built the way it is, with coaches and therapists working side by side, and it is a large part of what clinicians come to us to learn.
Do You Need Specialist Training to Work With a Client Coming Out Later in Life?
No. That is Miriam's answer, and it is the opposite of what I expected when I asked.
I put the scope question to her directly, because I ask it of every specialist who comes on this show. What is good enough in terms of knowledge and competency for a counselor to do a reasonably decent job here, and what are the indications that you should refer out rather than not fully meet a client's needs?
She declined the framing. She said it is within the competency of most therapists, on two conditions. You have to be open and aware of your own prejudice and bias, including your own possibility of not knowing, which is a skill in its own right and closely related to staying non-judgmental when values collide. And you have to be experienced at saying to a client, I do not understand that term, could you explain a little more.
Then she said the thing that I think will send this episode to a colleague. If you can hold and support somebody who is very distressed, you are within your competency.
I want to make sure that lands properly, because the correction this client group needs from us is less certainty, not more certification. You are not disqualified. You are, most likely, already equipped, and the missing piece is a stance rather than a credential. If you want the fuller version of the scope conversation, we have written about recognizing the edge of your competence as its own topic, and it is worth reading alongside this as a counterpoint, because this episode is the case where the honest answer turned out to be that the clinician was already competent.
Imagine finishing a session like the one in this article and being able to put it in front of colleagues who actually understand what just happened, and getting real responses back the same afternoon. That is what the Therapist Growth Collective is. Live conversations, free CE, and a room full of people doing this work.
Come See What It's LikeThere is one more thing she asked of us, and it costs nothing. When Miriam was looking for her own therapist, she was scrolling through directory photos hunting for a signal. Is she wearing plaid. Does this one have a piercing. I offered the side ponytail and we both laughed, and then the ask arrived: put your affirmative stance visibly in your professional details, rather than being neutral and leaving your clients to work it out from a photograph.
That is worth taking seriously, and the APA's practice guidelines for working with sexual minority persons make the same point in more formal language, that self-reflective and visible affirmative practice is part of the professional standard rather than an optional extra (American Psychological Association, 2021). It is also a genuine question about what you disclose and how, which is its own skill, and we have covered how much self-disclosure is too much in detail. Deciding what to say about yourself on a public profile is not a small thing, and if you have been putting it off because you were not sure how to phrase it, that is exactly the sort of thing worth workshopping with colleagues instead of guessing at alone. People in the Collective bring their profile copy in and get real feedback on it.
One More Thing About Minority Stress, Because It Is a Health Issue
Miriam named a phase in this that I had never heard articulated, and she coined it herself. Coming down from coming out. It arrives two or three years after the event, and the reason it is delayed is straightforward: a woman who has had straight privilege her whole life does not immediately register that she is now in a minority group, permanently.
That is when minority stress becomes a live clinical concern rather than a sociological one. Her point to me was that these women, and menopausal women generally, need genuinely good daily strategies around stress management, because the health impact is substantial. She is not speculating. Minority stress as a framework is well established, and Ilan Meyer's foundational review documented how stigma, prejudice and discrimination produce a hostile social environment that causes measurable mental health consequences, through prejudice events, expectations of rejection, concealment and internalized homophobia (Meyer, 2003).
Miriam did briefly share something from her own life here, a serious health event that came a couple of years after she came out, and she is well now, nine years clear. She raised it herself and she raised it in service of this point about health. I am not going to draw a causal line, because there is not one to draw. I am including it because she chose to.
The clinical takeaway is more prosaic and more useful. If you have a client in the first three years of this, the work is probably not identity work anymore. It is stress management, and it is the ordinary, unglamorous, daily kind. That is a place where a coaching approach genuinely outperforms a diagnostic one, and it is the sort of case our coaches and clinicians hand back and forth constantly, because the client needs both and rarely at the same intensity.
Make Your Affirmative Stance Something She Can Actually Find
Two things, and they are both small enough to do this week.
Say it in your professional details. Not "LGBTQ friendly" buried in a list of nineteen specialties, but a real sentence in your own voice about being affirmative of LGBT+ people. Miriam scrolled photographs looking for plaid because nobody had given her anything better to go on. You can give her something better to go on.
And get comfortable saying you do not know a term. Out loud, to the client, with the follow-up question attached. Could you explain a little more. That single move does more affirmative work than a weekend workshop, because it hands the authority on her experience back to her.
If you are thinking about where your practice goes from here, this is also a real signal about specialization, and there is a version of this where a client group you did not know you were serving becomes the thing you are known for. That is a conversation worth having with someone rather than in your own head, and it is one we have with clinicians regularly, whether that ends up being about finding your niche as a therapist or about a broader shift in how you work. The Collective is where most of those conversations start for people in our orbit, and it is free to look at.
Why Reading This Article Is Not the Same as Doing the Work
I want to be honest with you about something before you close this tab.
The frameworks I just walked you through are real and they work. Why versus how. Safe uncertainty. Reckoning rather than crisis. Miriam has 36 years of evidence behind them and I would use every one of them tomorrow.
But here is what almost always happens, and I say this as someone who has done it. You read a piece like this one. Something clicks. You feel a little clearer. You make a mental note to try the new approach next time it comes up. And then it comes up, at the end of a long day, with a real woman crying in front of you who is asking you directly to tell her how this happened, and your nervous system does what it has done for your entire career. You reach for the frame you know. You find the pattern. You say something kind and slightly too certain, and afterward you cannot quite name what went sideways.
That is not a motivation problem and it is not a competence problem. You are trying to override a trained reflex, alone, in the exact moment the reflex is strongest. That is the hardest possible conditions for new behavior, and it is close to impossible to do without someone else paying attention.
I also want to say the permission part clearly, because I know who is reading this. You do not need to have failed at this to want support with it. The best clinicians I know invest in their own development not because something is wrong with them but because they understand how skill acquisition actually works. Being interested in getting better at this is a sign of professional sophistication, not an admission of anything.
What works is having somewhere to bring it. A colleague you can message after a session that did not sit right. A room where you can say "I think I pushed her toward a conclusion and I am not sure why I did that" and get a real response instead of reassurance. Somebody who has had this client and can tell you what they wish they had done.
I said this at the end of the episode and I will say it here too, because it is the honest answer to the question this article has been circling. What we do is inherently isolating. Day in and day out we are talking to our clients, and then we are trying to save a little emotional energy to take home. We are not talking to each other. And what happens then is that we all end up having our own professional experience inside our own silo, without perspective from anyone doing it differently.
That is the gap the Therapist Growth Collective was built for, and it is worth being specific about what it actually is rather than calling it a community and hoping you fill in the rest. Practice success coaching on the second Thursday of the month. Continuing education on the third. And on the fourth Thursday, case consultation, where you bring your hardest cases to an experienced supervisor and to colleagues who know your work well enough to see what you cannot.
That last one is the reason I am mentioning it in this particular article. Case consultation is exactly where you bring the case this whole piece has been about. I have a client who is starting to question her sexual orientation and her identity later in life. This is the first time I have worked with this presenting issue. How would you handle it, what should I be thinking about, and what should I be careful not to do. That is the conversation. You do not need a certification to have it. You need somewhere to have it.
If something in this article landed somewhere specific, that is the signal. Come have a look at what the Therapist Growth Collective actually is before you decide anything. No pitch and no pressure, and if it is not the right thing for where your practice is right now, we will tell you that too.
xo,
Dr. Lisa Marie Bobby
About this episode's experts
Miriam Grace, MA
Miriam Grace has been a psychotherapist for 36 years, which makes her one of the genuine elders of our field, and she wears it lightly. She is a UKCP Registered Psychotherapist and a BACP Senior Accredited Therapist, trained first as a person-centred therapist and then as a Gestalt psychotherapist, and she has taught and supervised trainee counsellors at five universities. She ran a full private practice in Derby for nearly three decades and now works remotely from Sheffield. She contributed a chapter to the Routledge anthology Queering Gestalt Therapy, written specifically as a voice piece for later-in-life lesbians and what they need from us.
What makes her useful to talk to is that she is inside this in two directions at once. She had already begun researching menopause when she came out herself, just before 50, and then found herself in a support group of women going through the same thing and could not stop asking them the clinical question. She now specializes in women through midlife and beyond, and she is unusually clear that this work is not a niche. It is a life stage that almost all of our women clients will pass through, and most of us were never taught to see it as distinct.
She has a new book coming, and she is actively looking for colleagues to talk to. On the recording she said she would love to do case consultation, she is planning online seminars for therapists once the book is out, and she welcomes emails from colleagues with questions. That is a fairly rare offer from someone with her standing, and if this topic is live in your caseload it is worth taking her up on.
Dr. Lisa Marie Bobby
Licensed psychologist, licensed marriage and family therapist, board-certified coach, and AAMFT clinical supervisor. Founder and clinical director of Growing Self Counseling and Coaching, where she has led and supervised a team of clinicians for over a decade. Author of Exaholics: Breaking Your Addiction to an Ex Love. Host of the Love, Happiness and Success podcast and Love, Happiness and Success for Therapists.
Questions therapists ask about working with women coming out in midlife
A later-in-life lesbian is a woman who comes out in midlife or after, having previously lived a life that read as straight to her and to everyone around her, most often including a long marriage to a man. The term is used by the peer communities and the clinical literature. What makes it a distinct client group is that the identity is new while the conditioning is decades deep, and the losses involved are concrete: a marriage, a family home, a community, friendships, and often a great deal of money.
Not through prejudice, but through a need for certainty. Faced with a client who cannot yet articulate what is happening to her, a well-meaning clinician starts investigating how it happened, whether she was always this way, whether it was denial. That investigation pressurizes something that needed room, and converts a normal developmental reckoning into a case to be solved. Women in peer support groups describe therapy reproducing the same incomprehension they met everywhere else.
It is part of the mechanism rather than a coincidence. Three things converge. The conditioning of the decade a woman was formed in, which told her to put her needs second. The drop in estrogen, which psychotherapist Miriam Grace describes as the hormone that facilitates exactly that self-subordination. And the Jungian developmental turn from outward connection in the first half of adult life toward connection with the self in the second half. Together they produce a predictable reevaluation rather than a pathology.
Hold it as grief, stay out of the question of how it happened, and redirect toward how she is going to live. Kübler-Ross's stages are a useful frame for what the client is moving through. The three redirect questions are: how are you going to approach your life, how are you going to soothe yourself, and how are you going to believe yourself in this place. The therapist does not need to believe that finding the answer is the useful part.
No. Miriam Grace's position is that this is within the competency of most therapists, on two conditions. You have to be open and aware of your own bias, including your own capacity for not knowing. And you have to be comfortable saying to a client that you do not understand a term and asking her to explain more. Her summary is that if you can hold and support someone who is very distressed, you are within your competency. The correction most clinicians need is less certainty, not more certification.
Safe uncertainty is a systemic concept, originating with Barry Mason's 1993 paper, describing a therapeutic position that holds uncertainty rather than resolving it prematurely. Human beings link certainty with safety, so a clinician who does not know what is going on with a client feels unsafe and moves toward certainty for relief. The alternative is to name the not-knowing out loud and share it with the client rather than privately picking a theory.
It is a phase named by Miriam Grace, arriving roughly two to three years after a woman comes out later in life. The delay happens because a woman who has had straight privilege her whole life does not immediately register that she is now permanently in a minority group. This is when minority stress becomes a live clinical concern and when daily stress-management strategies matter most.
Miriam Grace argues that coming out is a trauma whether you are 19 or 49, because of the deconstruction of a previous identity. For women coming out later in life, that deconstruction is unusually concrete. She also notes that later-in-life lesbians sometimes feel embarrassed about having arrived after the harder fights that her peers who came out as adolescents actually faced.
Miriam Grace's reframe is that it is a midlife reckoning rather than a crisis, and that a reckoning is available to everyone. Her argument is that psychology inherited a reflex from the patriarchy to treat emotionality as a problem rather than as information. Crying, intensity and heartbreak indicate that a person is alive, not malfunctioning. In the United States there is an additional structural driver, in that clinicians are pushed to medicalize emotion because that is what qualifies as medically necessary treatment for insurance purposes.
State it explicitly in your professional details and directory profile, in your own words, rather than remaining neutral and leaving clients to infer it. Miriam Grace describes scrolling therapist photographs looking for signals when she was seeking her own therapist, because nothing in the written profiles told her what she needed to know. The second practical move is being willing to say out loud that you do not understand a term and asking the client to explain, which returns authority over her experience to her.
Sources cited in this episode
- American Psychological Association, APA Task Force on Psychological Practice with Sexual Minority Persons. (2021). Guidelines for psychological practice with sexual minority persons. https://www.apa.org/about/policy/psychological-sexual-minority-persons.pdf
- Diamond, L. M. (2008). Female bisexuality from adolescence to adulthood: Results from a 10-year longitudinal study. Developmental Psychology, 44(1), 5-14. https://doi.org/10.1037/0012-1649.44.1.5
- Mason, B. (1993). Towards positions of safe uncertainty. Human Systems: The Journal of Systemic Consultation and Management, 4(3-4), 189-200. Reprint: https://sfwork.com/resources/interaction/04Mason.pdf
- Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697. https://doi.org/10.1037/0033-2909.129.5.674
- Mason, B. (2019). Re-visiting safe uncertainty: Six perspectives for clinical practice and the assessment of risk. Journal of Family Therapy, 41(3), 343-356. https://doi.org/10.1111/1467-6427.12258 Optional fifth citation, held for Hayley's decision. This is Mason revisiting his own concept 26 years later and is arguably the more current reference.
Resources, people and organizations mentioned in the recording: Alman, A., Gillespie, J., and Kolmannskog, V. (Eds.). (2023). Queering Gestalt Therapy: An Anthology on Gender, Sex and Relationship Diversity in Psychotherapy. Routledge, to which Miriam Grace contributed a chapter, at routledge.com; Caroline Criado Perez, Invisible Women: Data Bias in a World Designed for Men, cited by Miriam at 00:24:35 as an analogy for training that never treated women's life cycles as distinct, with no publisher URL included pending Hayley's decision on linking commercial book pages, and note that the raw transcript renders the author as "Caroline Tirado Perez," which is wrong; Elisabeth Kübler-Ross on the stages of grief, referenced by Miriam at 00:21:02 as the frame for what the client is moving through; Rainer Maria Rilke, referenced by Miriam at 00:25:47 on staying with the question, paraphrased in the article rather than quoted; C. G. Jung, referenced twice, on the second half of life at 00:10:17 and on "thank God he had a breakdown" at 00:30:38; Dr. Diane Estrada, named by Miriam at 00:22:49 as the guest whose episode on blind spots made her feel met, and the existing LHSFT episode is Uncovering Blindspots: Cultural Competence in Therapy; Dr. Bill Doherty, named at 00:28:51 on therapists fabricating explanatory stories, with two existing LHSFT episodes, Therapists in Therapy and Counseling Across Political Divides; and Miriam Grace's own practice and writing at miriamgrace.uk, with a new book forthcoming whose title is deliberately not stated here because it is not confirmed.
