Presenting issues: Intersections of trauma
Therapy Today, October 2024

In the summer of 2020, I (Anthony) experienced a surge in referrals from black clients, especially African and Caribbean men. They were seeking support to process their emotions of fear and sadness triggered by the death of George Floyd on 25 May 2020, and the subsequent resurgence of the Black Lives Matter movement.

For many black queer men this retriggered racialised trauma that was exacerbated by the isolation of lockdown due to the COVID-19 pandemic, and the homophobia they experienced having to return to living in their family home. Such clients sought me out as a black queer male therapist who could understand and relate to their unique challenges. As well as feeling deep compassion and empathy for my clients, I found it genuinely inspiring to see more black male clients accessing therapy to process their experiences, despite past stigma in seeking support for mental health. 

One client, Ibrahim,* stands out for me. He sought therapy after a break-up with his boyfriend, feeling anxious and insecure. An investment banker in central London, Ibrahim was one of the few black people in his firm, and he often faced microaggressions and the pressure to code-switch. He was out to his family, but they refused to accept his sexuality, which strained his relationship with his boyfriend. Coming from a deeply religious Nigerian background, Ibrahim had endured homophobic bullying from his cousins and physical abuse from his father, who tried to ‘beat the gay out of him’. These experiences left Ibrahim estranged from his father and struggling with his identity. In our sessions we worked to process the trauma of his past abuse and explored the pressure to conform to hypermasculine norms. 

Ibrahim’s experiences left a lasting impact on me and my therapeutic work. His case encapsulates the mental health needs of black queer men who face intersecting traumas of racism, abuse and homophobia. In recent years reports and research have shed light on the poor mental health outcomes experienced by black and minority ethnic individuals within the LGBTQ+ community. More than 60% of black and minority ethnic LGBTQ+ participants in the UK experienced anxiety and depression, according to a report conducted on behalf of Stonewall.¹ Specifically, queer men within this population face heightened mental health risks, with gay and bisexual men twice as likely to experience depression or anxiety than heterosexual men.² Black queer men are particularly vulnerable due to discrimination and stigmatisation within some black communities, contributing to traumatic experiences in their lives that impact their mental health.³ 

Barriers 

Adherence to masculine ideologies can lead to reluctance in black men to seek help for mental health-related issues.⁴ The concept of black masculinity influenced by race, gender, social class, sexuality and religion often leads to maladaptive coping and a lack of emotional expression.⁵ The conflict between adherence to black masculinity and homosexuality within the black community can create internalised homophobia, contributing to stress and maladaptive coping strategies.³

The deterioration of men’s mental health and increased suicidality continue to be pressing concerns, and the crucial changes needed in the NHS and third sector services that support men recently gained the attention of Parliament. The UK Government’s Health and Social Care Committee conducted a thorough inquiry into men’s health from December 2023 to May 2024, gathering evidence from individuals, organisations and charities supporting the health and wellbeing of men in the UK.⁶ I had the opportunity to give evidence on behalf of BACP on the mental health of men, highlighting BACP’s R.A.I.S.E. campaign, which outlined how to support men to identify and manage depression they may experience. 

Therapy Today, October 2024

Research 

There has been limited research on trauma-informed integrated counselling and coaching approaches tailored to the intersectional and queer-affirmative needs of black male queer clients. Realising this gap existed, I decided to focus on this area for my master’s research in integrative counselling and coaching.⁷ 

As well as exploring ways of working in therapy with the trauma being presented by black queer male clients, I also hoped to offer a genuine space for therapists to reflect on working with trauma in black queer men. Therapists were likely to be encountering the same lack of guidance on trauma-informed, queer-affirming practice that I encountered, so I was curious about the nuanced ways in which therapists were working with this client group. 

Interviews were conducted with therapists who identified primarily as male, black and British, with a range of sexualities including heterosexual, gay and bisexual, and one heterosexual woman who identified as Indian. All the therapists interviewed had developed integrative models of practice, which felt helpful to their clients. Often their core approach was based on person-centred therapy, and different elements of integrative practice were used as appropriate. 

Conceptualising trauma 

For black queer men, both isolated or repetitive traumatic incidents from childhood can affect their sense of self and often result in post-traumatic stress disorder (PTSD).⁷ Anti-gay bullying, childhood abuse and racial discrimination are key sources of trauma in this cohort. 

Childhood abuse, primarily emotional and psychological, is often compounded by homophobia within the black community.⁸ Anti-gay bullying in childhood can affect self-acceptance and relationship development.⁸ Additionally, racial discrimination is a pervasive traumatic experience for black individuals, resulting in anxiety, depression, and PTSD.⁹ The intersection of these traumas exacerbates psychological distress among black queer men.

60% of black and minority ethnic LGBTQ+ participants in the UK experienced anxiety and depression 

The therapists who took part in the study highlighted the persistent mental health and social challenges faced by black queer men who experienced trauma. As one participant noted, ‘With a lot of my clients their experiences are rooted in abuse, rather than just coming to terms with identity. It’s usually been quite a challenge.’ ⁷ 

The trauma for black queer men extends beyond these direct experiences to include family isolation and a lack of representation in the gay community. Another participant emphasised, ‘There are too few social spaces for black queer men to meet and network.’ The participants further observed that their clients often felt traumatised by fetishisation within the gay community. One explained, ‘I think [it’s about] feeling in one sense objectified, fetishised and desired. The trauma has often been in the fact that people have used them and built them up to various levels but then wanted to try to diminish them and disempower them as well.’  

Intersectional 

Supporting black queer men in recovering from trauma necessitates addressing the profound impact of intersectional differences, such as black masculinity, ethnic identity and sexual orientation, on mental health, traumatic experiences and help-seeking behaviours. Traditional white, Eurocentric therapeutic and coaching frameworks often fall short in addressing the cultural and racial identities of clients from the African diaspora, failing to account for the impact of colonialism on perceptions of mental health and healing.¹⁰ 

A decolonised approach to therapy emphasises cultural competence, challenges power and privilege, and explores concepts of ‘otherness’.¹¹ It highlights the significance of healing and recovery from trauma at both individual and collective levels. This approach further adopts an anti-oppressive framework, recognising that many responses to trauma are adaptive and understandable reactions to systemic oppression and historical violence. According to therapist and author Myira Khan, effective work with clients’ intersectional differences requires acknowledging their lived experiences of power, privilege and oppression: ‘To be blind to structural and systemic inequality is to be blind to our client’s truth.’¹² 

Queer-affirming approaches also play a crucial role by offering unconditional acceptance, helping therapists dismantle heteronormative ideologies and fully attend to the psychological challenges faced by LGBTQ+ clients.¹³ One participant emphasised, ‘I accept the diversity in the room. You just focus on the person-toperson relationship.’⁷ 

Alliance 

Establishing a strong working alliance emerged as a pivotal theme in the study to foster effective trauma-informed interventions, echoing the emphasis of previous research on its critical role in effective practice.¹⁴ One participant succinctly captured this sentiment, stating, ‘The relationship itself is all. It’s the only thing we have to work with.’ ⁷ 

To build this alliance participants highlighted the importance of being genuine, sharing their own experiences with sexuality, and valuing their clients through core therapeutic conditions. This authentic approach not only fostered trust but also minimised power dynamics, reinforcing intersectional and antioppressive practice. Black male participants in particular emphasised the need to eschew traditional masculine stereotypes and norms of blackness, with one participant noting, ‘It’s important to be really aware of ourselves in that relationship, not colluding with blackness or black maleness.’ ⁷ 

Challenges in establishing a working alliance presented in transference and countertransference – sometimes the therapist experienced transference by being positioned as a family member of the client, particularly one who had victimised them. Equally, therapists acknowledged their own countertransference by seeing their clients as family or friends whom they had wanted to help in the past. 

These findings highlight the barriers posed by traditional black masculine gender norms and that a robust, authentic relationship is indispensable for clients to process and heal from their trauma. 

African-centred 

The practitioners who participated in the study often felt that European and white-centred therapeutic models were less helpful in addressing the trauma needs of black queer men. They suggested using an African-centred therapeutic framework that acknowledges and validates diverse cultural and racial identities. This was reflected by one participant: ‘I have not found a great deal that has been helpful in European models of psychology and therapy in helping me engage with or work with black queer men.’⁷ 

Participants described a lack of knowledge gained during their core training of the intersectional differences that might impact this group and other populations. Much of UK core training has traditionally focused on European white models that work with diversity as a single difference from the white European norm. A more helpful approach may be for training to embrace intersectional differences and allow these to be fully explored in an authentic way using self and self-disclosure sensitively, with therapists questioning their own preconceptions or biases. 

Action for change 

Understanding systemic oppression and the impact of power and privilege enables trainee therapists to be consciously aware of their own knowledge base when working with clients. Training courses should consider working with an anti-oppressive model that acknowledges the systemic injustices of power, privilege and oppression. This enables a recognition of intersectional differences and how these context-based issues around the client also contribute to their distress. This is powerfully explored by Khan who discusses models that work within diversity.¹¹ 

Addressing clients’ intersectional identities within therapy can be part of practice and can be used therapeutically to repair rupture and transference within the therapeutic space. The therapists who participated in the study felt that simply working in a person-centred way without acknowledging these intersectional differences did not go far enough in opening up the therapeutic space and building the client’s trust.⁷ Openly addressing intersectional differences and the internal conflicts of their black queer male clients was also vital to progress in trauma recovery. 

We also need to hear additional voices within the therapy professions talking about the intersectional differences that contribute to trauma experienced by clients. This study focused on black British queer males – it may be useful to incorporate additional other black queer experiences or ethnic minority queer experiences to contribute to further understanding of these intersectional differences. 

A key responsibility as practitioners means working ethically with our clients and considering the context of their distress. The psychological distress experienced by our clients is often part of their experience, and with black male queer clients we need to ensure that we are not making the clients the problem by pathologising their experience but equipping ourselves to understand their struggles and distress. 

* Names and identifiable details have been changed for anonymity.