Many people in treatment with me seek to explore their relationship to gender and sexuality. I welcome working with patients who fit within the umbrella of LGBTQIA+ identities, as well as patients who identify as “straight” or “cisgender.” I have found that even people comfortable with more dominant cultural categories often wish to think more complexly about their gendered or sexual experiences, embodiments and histories. And most of us – wherever we sit on the spectrum of gender and sexuality – find ourselves in various kinds of struggle with gender norms and sexual expectations. 

In my view of the world, we still have too few words to represent the in-between identities of gender and sexuality—social categories normally defined in strictly dichotomous binary terms. We have more of these words today than we did yesterday. Yesterday we lived solidly in the binaries. We used to be simply “male” or “female,” “heterosexual” or “homosexual.” These days, there are emergent forms of sexual and gendered identity, new ways of resisting the dominance of heteronormativity and the stranglehold of binary gender. Today – tentatively and at great risk – many people live in the in-betweens of gender and sexuality. So, sometimes, the work in therapy involves finding language for sexual and gendered experiences that fall outside traditional parameters. I have worked with people who identify as queer, bisexual, pansexual, demisexual, asexual, polyamorous, transgender, non-binary, gender fluid, bigender, agender, butch, femme, intersex and others. 

As the US culture wars of the 2020s evolve, vulnerable, marginalized people are targets, subject to ever higher levels of violence and suppression. Life gets harder for us all, but especially for people already burdened by sexual, gender, and racial structural inequality. But, in spite of all the powers of suppression, beautiful new expressions of sexual and gendered life can nevertheless sprout, like dandelions through cracks in the concrete.