‘Our therapeutic tools must be queered – not discarded, but reclaimed and repurposed’

I often encounter clients who carry a profound emotional weight, yet struggle to name its origin. This weight isn't solely personal or psychological. It's social. It's structural. It's the cost of living in a straight world that bestows rights and marks progress through its own lens. I know this reality intimately – because I live it, too.

My clinical work as a psychotherapist is rooted in a specific cultural and psychological terrain: that of queer men navigating grief, belonging, and meaning in a world that has historically rendered our lives peripheral. While queer women and nonbinary people may face parallel and intersecting experiences, my specific expertise and lived reality centres around the experience of queer men.

Recent research has reinforced the depth of these struggles. Studies highlight how caregiver rejection, cultural concealment, and lack of familial mirroring still remain prevalent for queer individuals, particularly among Latinx and racialised communities. Trans and nonbinary young adults report uneven support within family systems; siblings are often more supportive than their parents, but many children experiencing parental rejection.

Queer guys aren't only navigating the challenges of being queer in a society that once pathologised us – we're contending with the pressure to measure our lives by milestones that don't reflect the unique trajectories of our lives.

Milestone heteronormativity 

Milestone heteronormativity is the term I use to describe a cultural framework that defines life's meaning through a narrow, heterosexual script. Worth unfolds through a predictable series of publicly recognised rites – graduation, marriage, childbirth, retirement, and death. These milestones are extended across generations, sanctioned by law, religion, and media. They are not just private moments; they are culturally endorsed markers of legitimacy. 

My milestones were coming out to my primary care provider, seeking therapy for isolation, negotiating nonmonogamy in my romantic relationship, cultivating my chosen family. But for me, there were no celebratory rituals. There was no applause. Living 'outside the scripts', I simply moved through these big life events, unacknowledged by the culture around me.

As queer people, our milestones, whether joyful or painful, rarely land in spaces that know how to hold them. We experience estrangement, cultural exile, or conditional inclusion within their families of origin. Even when we return to our families or faith communities, our lives often remain unmirrored. Heterosexual experience remains the societal default, everything else is deviation, elective, or indulgence. Sure, legally, things such as same-sex marriage have changed. But structurally and symbolically, the scaffolding of life remains heteronormative. As Miller and Tabor (2024) argue, queer lives continue to unfold 'off-schedule' in relation to dominant life course expectations. 

Grief for what goes unseen

Consider 'Zach' (a client from my guidebook on mental health for queer guys), who attends his cousin's wedding and his colleague's baby shower on the same weekend. He offers gifts, smiles for photos, claps during speeches. But something aches beneath the surface. He drinks more than usual that night. In our therapy session, he wondered why he felt so heavy. The answer, we concluded, wasn't shame or envy, but grief and a feeling of erasure.

The grief isn't for what Zach lacks, but for what has gone unseen. For the moments of queer joy, love, and resilience that pass without ritual. For the life he was told to want and had to unlearn in silence.

This experience is echoed in studies of queer family-building. Goldberg and Allen (2022) describe how LGBTQ+ adoptive parents who experience 'failed matches' or child removals often endure profound loss that is rarely acknowledged. Their grief is real, but invisible – compounded by a culture that doesn't recognise non-biological kinship as sacred.

And the grief doesn't only arise from events that occur – it often emerges from what never happened. Duran and Thacker Darrow (2024) capture this poignantly in their study of queer identity development, where participants mourned imagined versions of their lives: the acceptance they never received, the rituals they never had, the safe futures that were never promised. This is the wound at the heart of milestone heteronormativity: not the absence of love, but the absence of cultural reflection.

Mourning without mourning rights 

When milestone heteronormativity leaves our joys unacknowledged, our grief often goes unnamed. And when grief is unsupported or silenced, when it becomes internalised and chronic, it calcifies into something heavier: disenfranchised grief (Doka, 1989).

I first witnessed this in a client who had lost his partner of 11 years and in our session asked, 'why does it feel like my entire relationship never existed?'. For him, there was no legal marriage. He had to fight for hospital visitation rights. His partner's family claimed the body and excluded him from the funeral. At work, he said only that 'a friend' had died. He grieved alone – not because his pain was private, but because it was culturally illegible. He had learned, early and often, that 'gay grief' didn't belong in a public space. There is no social script, no ceremony, no witness. Just pain, endured alone. For queer people, this form of grief isn't rare, it's structural. It is recurrent. It is often chronic.

During the Covid-19 pandemic, these dynamics intensified. A recent synthesis of LGBTQ+ grief experiences during the pandemic identified the loss of affirming spaces, kinship networks, and identity visibility as layered and persistent griefs – often experienced without public acknowledgment. Many queer people didn't just lose loved ones, they lost the very infrastructures that allowed them to be themselves.

Grief also emerges from intersections. In Uppal and Kelly's (2020) case study of a South Asian lesbian migrant, the authors document how culturally complex forms of loss i.e estrangement, invisibility, partner bereavement etc were magnified by the intersection of ethnicity, sexuality, and migration. The result was what they termed 'compounded disenfranchisement': loss experienced in multiple registers, none of which society had language for.

I've worked with clients grieving:

• Partners never legally recognised
• Years spent in the closet
• Rejected gender expression or non-hegemonic masculinity
• Queerphobic harm and systemic neglect
• Estrangement from families of origin
• The lingering legacy of the AIDS epidemic

These are not abstract or academic losses. They show up in session as numbness, self-blame, or a quiet sense of brokenness. This is ambiguous loss – clients mourn the father who never accepted them, the wedding they never had, the adolescence they didn't get to live authentically. Sometimes, they grieve a future version of themselves that could have thrived in a more affirming world.

When therapists validate disenfranchised grief, we do more than offer empathy. We engage in cultural repair. Curtin and Garrison (2018) emphasise that addressing grief in same-sex couples requires not only compassion but also cultural humility and systemic awareness. Without this, clinicians risk retraumatising clients by reproducing the very erasure they came to heal.

We must create space for mourning without permission slips.
We must name grief where society has imposed silence.
We must give people back the right to feel.

Queering the tools of therapy

Many queer clients enter therapy naming symptoms: chronic anxiety, hypervigilance, depression. Too often, these are framed as individual dysfunctions. But in my experience, they are expressions of grief and adaptation – responses to othering, cultural silence, and systemic abandonment. A trauma-informed approach must begin here.

To be effective, our therapeutic tools must be queered – not discarded, but reclaimed and repurposed. In CBT, for instance, we often challenge 'irrational' beliefs. But when queer clients internalise the message that they are unworthy of love or safety, that belief is not irrational, it is inherited. It's been shaped by years of invisibility, rejection, and media absence. These thoughts must be contextualised before they can be restructured.

Gestalt therapy's empty chair technique becomes a portal when queered. I've witnessed clients speak to their younger selves – the version outed at school, exiled at home. One man, facing the memory of being publicly shamed at age 17, started with rage, moved into tears, and finally whispered: "I'm sorry no one protected you." That moment wasn't a resolution. It was a ritual of recognition.

But beyond adapting established modalities, we also need tools that centre queer lifeworlds. These are the ways of working that I return to most:

• Reauthoring life markers

Clients are invited to define their own developmental landmarks. Moments like 'the first time I asked for what I wanted' or 'the night I stopped apologising for my joy'. These alternate milestones challenge heteronormative timelines and affirm the legitimacy of queer becoming. As Duran and Thacker Darrow (2024) show, queer identity development often involves grief, redefinition, and meaning-making outside traditional scripts.

• Ritualising grief

I often co-create rituals with clients: letter-writing to the person they once were, building altars for chosen family, silent vigils for what was never celebrated. These practices give shape to invisible losses and offer dignity to queer grief. Curtin and Garrison (2018) emphasise the importance of culturally specific mourning practices, especially when public space refuses them.

• Naming Disenfranchised and Ambiguous Loss

Introducing terms like ambiguous loss or intimate loneliness can transform a client's relationship with pain. Suddenly, what seemed like personal pathology is recognised as collective wound. Grief narratives imposed by families or clinicians, particularly on trans and nonbinary youth, can cause additional harm when they pathologize identity rather than validate it.

These interventions are not decorative. They are acts of resistance. They reclaim affective and symbolic space for those told their stories don't matter. Because queer people have been told, in a thousand ways, that our grief is illegible, our joy excessive, and our love peripheral.

Naming, validating, reclaiming: A call to action

If milestone heteronormativity is the architecture of erasure, and disenfranchised grief its emotional fallout, then therapy must become a site of reclamation. Not only of wellness, but of narrative dignity.

The queer clients who I see are not just asking to feel better. They are asking to be allowed to grieve what they never had, name what the world refuses to see and wondering if there is a place in their culture where my love, loss and joy make sense. These are not rhetorical questions. They are clinical ones. As mental health professionals, we must answer them with more than empathy. We must answer them with action. That means:

• Expanding what counts as grief – to include estrangement, non-recognition, ambiguous futures, and unspoken milestones.
• Practicing cultural humility – recognising that many of our models were not built with queer lives in mind.
• Challenging the assumption that inclusion equals safety – especially for queer and trans clients navigating institutions that still reward conformity.
• Honouring ritual, silence, and storytelling as valid therapeutic forms – especially when traditional language fails.
• Asking ourselves regularly: Who gets mirrored in our spaces? And who is still being asked to translate their pain into palatable forms?

We are not here to help queer people 'adjust' to a world that erases them. We are here to help them reclaim the right to feel fully human – on their own terms. When we name what was silenced, validate what was dismissed, and reclaim what was denied, we don't just foster psychological healing. We participate in cultural repair.

• Rahim Thawer's book The Mental Health Guide for Cis and Trans Queer Guys is out now.

References

Abreu, R. L., Gattamorta, K. A., Gonzalez, K. A., Capielo Rosario, C., Roman Laporte, R. L., & Domenech Rodríguez, M. M. (2023). LGBTQ Caregiver Acceptance Scale (LCAS): Development and validation with a Latinx sample. Journal of Family Psychology, 37(6), 875–887. 

Bailey, D., Calasanti, T., Crowe, A., Di Lorito, C., Hogan, P., & De Vries, B. (2022). Equal but different! Improving care for older LGBT+ adults. Age and Ageing, 51(6), afac142. 

Boss, P. (1999). Ambiguous loss: Learning to live with unresolved grief. Harvard University Press.

Boss, P. (2007). Ambiguous Loss Theory: Challenges for scholars and practitioners. Family Relations, 56(2), 105–110. 

Bosse, J. D., Dion, K. A., Campbell Galman, S., & Chiodo, L. M. (2022). Transgender and nonbinary young adults' perception of sibling and parental support for gender identity. Research in Nursing & Health, 45(5), 569–579. 

Curtin, N., & Garrison, M. (2018). "She was more than a friend": Clinical intervention strategies for effectively addressing disenfranchised grief issues for same-sex couples. Journal of Gay & Lesbian Social Services, 30(3), 261–281. 

Doka, K. J. (1989). Disenfranchised grief: Recognizing hidden sorrow. Lexington Books.

Duran, A., & Thacker Darrow, N. E. (2024). LGBQ+ college students' expressions of grief during sexual identity development: Photographic insights from a qualitative study. International Journal of Qualitative Studies in Education, 37(7), 1884–1906. 

Duran, A., Thacker Darrow, N. E., & Chan, C. D. (2024). Narrating the importance and navigation of family relationships among LGBTQ+ BIPOC college students. Journal of College Student Development, 65(3), 254–271. 

Goldberg, A. E., & Allen, K. R. (2022). "Failed" matches, child removals, and disrupted placements: Devastating and invisible losses during the family-building journey for LGBTQ adoptive parents. Journal of Family Nursing, 28(4), 368–380. 

Gutierrez, D., Zeiger, K. D., Rago, C., Rodriguez Jimenez, K., Schiff, B., & McGee, S. (2024). Loss of safe spaces: Ambiguous loss and minority stressors of BIPOC LGBTQ+ communities amidst the COVID-19 pandemic. Sexual and Gender Diversity in Social Services, 37(2), 337–363.