Rick Miller on the Clinical Challenges of Working with Gay Sons, Mothers, and Families

• Gay Sons and Their Mothers
• Intersecting Identities
• Clinical Challenges of Working with Gay Men (and their Mothers)
• Experiential Therapy and Hypnotherapy with Gay Clients

Gay Sons and Their Mothers

Lawrence Rubin (LR): You may be known to our readers as the founder of Gay Sons and Mothers. But they may not be familiar with how extensively you’ve been trained and how long you've been practicing as a psychotherapist with a personal interest in working with gay men and their mothers. 

Rick Miller (RM): I'm a gay man who grew up really appreciating the bond and love of my mother. And, in hindsight, as an adult, what it meant for me was that I got to be myself. She didn't necessarily know that I was gay, or maybe she did, but she never forced me to do anything differently than what I did.

And growing up in a world in the 1960s where it was prescribed, this is what boys do, having a mom who let me be me — and we did a lot of things together — was pretty miraculous. I hear so many stories about people growing up whose parents abused them or forced them to do things differently.

I wrote a book several years ago for clinicians about doing hypnosis with gay men. I thought it would be relevant to do the research or to seek out research about gay men and their mothers. I looked at the literature about gay men and their mothers to include in the book. You'd think this a cliché topic and that there would be way too much information to use. I couldn't find anything! I thought, I’ll write an article about this, and it ended up turning into video interviews. And from there, I started a nonprofit called Gay Sons and Mothers.

We are educating the public about the special bond between mothers and their gay sons and how she contributes to his sense of well-being in the world. It's a multicultural story that looks at strength, at disappointment, and is a very emotional topic.   

LR: So, even before you and your mother had a conversation about being gay and you knew, you had no particular concern over sharing it with your mom. You didn’t worry how she would take it, how you'd be perceived, how you'd be treated. You were just free from the start to be you. 

RM: Well, I was free to be me, but I didn't come out to them — meaning my parents, my mother and my father — until I was 21. So, it was interesting that I had the freedom to be me, but I didn't feel 100 percent free to be me because I waited longer to come out than I probably needed to in hindsight. Today, many kids are coming out at a much younger age to their parents. Of course, the world is very different.

LR: If you intuitively felt accepted by your mom and weren’t censored or limited in any way from being you — you haven't talked about your dad — why do you think it took you as long as it did to become public about it? 

RM: Well, so, it was the early 80s. So, AIDS was hitting the press big time, and I suppose on one level, I was protecting her or them from thinking that something would happen to me, which, knock on wood, did not happen. I was afraid that I'd be rejected, and, not to sound callous, they were paying for my graduate school education, and I just made a mental note in my mind I was going to wait until I finished school to come out, which is so stupid. 

Knowing my parents, of course, they wouldn't have done anything differently. It took them a while to come around, a month or so, which I thought was horrible at the time. But I look back and I think that my parents had to go through their own grieving when I came out to them. Of course, they knew I was gay long before I came out, but hearing it was definitive. And it took them a short time to acclimate and appreciate it. I was incensed at the time. And, often, I say to children and to parents, it's okay to grieve.

LR: Incensed about? 

RM: They were not 100 percent supportive the second I came out to them. And the first thing my father did when I came out was to become a little weepy saying, “the world is unfair, and I'm worried about what that will mean for you.” I took it as supportive, for sure. And then he kind of changed the tune for a bit, and that is when things turned ugly, and again that lasted a few weeks and then everything turned around. 

LR: Smooth sailing with your parents and especially your mom ever since. 

RM: Yep. And I had a partner that I was moving in with at the time. So, what I did, which I shouldn't have done, was when I came out to them, I told them that I was moving in with the person they knew as my friend all at once, so that threw them a little bit. 

LR: Overload! Going back to the second part of the earlier question about your foundation; how do you think clinicians can benefit from awareness of it? 

RM: There's so much inherent in the videos that we share through Gay Sons and Mothers. It's not only about the relationship between a mother and a son, but that part in and of itself is so affirming. Clinicians can watch stories of sons and their mothers and appreciate what it is being gay. And it's not only mother in these interviews. Families are talked about. Extended families are talked about. Culture and religion are addressed in these videos.

So, there's a lot there, and, when mothers are struggling with their kids, I send them videos from Gay Sons and Mothers. On our website, there's a link to our Instagram page. We have a YouTube page. Sons watch. Most people — therapists included — watch these videos and have a deep emotional resonance around the issue of being included, being loved, being supported, being rejected. It's hard not to feel something when you're watching videos pertaining to these themes.   

LR: A connection. How would you respond to a therapist or to a non-therapist who’s visited your site and says, “Yeah, well, what about gay sons and their fathers?” 

RM: There's way more information in the literature about gay sons and their fathers than there is about gay sons and their mothers. And if there hadn't been any with fathers, I would have pursued that, as well. I grew up with a great relationship with my mother. I had the fame of saying to my siblings, “Mommy likes me best.” It carried me through. So, it seems completely perfect that that would be the focus of my work.  

Historically, mothers in the 1970s — or even earlier in the psychiatric and the medical field — mothers were blamed for making their sons gay. And, so, with the lack of literature out there, what's missing is that mothers have the power to raise sons who are mentally healthy, just from being a good enough mother. And, so, that premise is so important to me that I've focused exclusively on mothers and sons.

The issue of fathers and extended family is embedded in the work anyway. So, this project, Gay Sons and Mothers, is inclusive of the entire family. And we're also expanding beyond just gay sons and mothers. We're talking about trans children and all sorts of things. 

Intersecting Identities

LR: How has your advocacy and clinical work been informed by your own personal evolution? 

RM: Oh, gosh, that's such a big question, but I think I can get there. I came out in 1983 — I was already a clinical social worker. In the 1980s, AIDS was emerging, and gay men were dying in big cities, and people were afraid. Homophobia was on the rise because people were afraid of catching AIDS. I was working in the AIDS field, doing volunteer work at this time, and I started working with the gay community from the start.

Boston, where I lived, was a progressive place. So, I was known in Boston as being an out gay male therapist. I mean, there was no web at that time, but anyone who knew me would know that I was gay. But I was also practicing in a very conservative place, Boston, Massachusetts, very hierarchical, very psychodynamic. So, in the professional world that wasn't the world of AIDS, I worked in a hospital. I kept a very low profile, and I felt like I didn't fit in the hierarchy of psychiatrists, psychologists, social workers.   

I'm a social worker, and looking back at my evolution and my history, I wish I had put myself out there more because the contributions that I'm now making to the field in the last ten years as a writer, as a teacher, as someone who's done Gay Sons and Mothers, if I had the confidence to do some of this earlier, I would have done more research focusing on gay men, on gay men and their mothers, gay families. And I think I could have made a bigger contribution to the field.

What happened for me is I started my private practice in the mid 80s, and I switched to full-time private practice. So, I left the hospital. I left the agency where I was doing AIDS work, and basically, I hid in my office with the door closed for decades. And I was very successful in private practice, in part because of my clinical skills, in part because of my personality, and I got to hide.

Once I wrote my first book and I started teaching about working with gay men, I could no longer hide. And, at the time, I was probably 52 years old — 10 years ago. And I'm really glad it happened, but it forced me beyond a comfort level that was really important and good for me, and I wish I did that sooner.  

LR: So, you came out of the closet before you came out of the office. I can see that your personal story could be used as an exemplar, not only for gay therapists, but for gay men, whether still not out or out. I would imagine that you don't impose your story on others. But by living it and being genuine, as you've always struck me, you are an unintended role model.

RM: Well, thank you for saying that, and it served me very well in my practice. I grew up in an upper-middle-class family with well-being and mental health and good physical health. And, to me, that's how everyone lived in the world, and that is so not the case. And so, as a gay man who had a sense of self, who worked with gay men, I served as a role model to other gay men, to all my clients really but specifically to other gay men who didn't have the good fortune that I did or didn't have the personality that I did.  

So, my being outgoing was a very good clinical skill, and, fortunately, in my early 20s, I was in therapy with a therapist who was gay, who had a very good sense of himself, who had a great sense of humor, and who allowed me in the process of therapy to love myself. If I had chosen one of those uptight, analytical therapists in Boston instead, I don't know where I would be right now.

When I was looking for a therapist, I was given the name of eight different people. Back in 1983, I was calling their answering machines. On some, I was hanging up because I was frightened by them. Others shamed me through their tone, and thank God, I didn't work with them. 

Clinical Challenges of Working with Gay Men (and their Mothers)

LR: What are some of the clinical challenges you've found in working with gay sons and their mothers? 

RM: Long before I ever knew I'd be working with gay men and their mothers, I had a gay male client who was really struggling with confidence. He grew up in the projects outside of Boston, and his father left the family, and deprivation was a big part of his upbringing. So, one day, for whatever reason, I had his mother join him in a session and it was like the heavens opened up.  

I understood him so much more, and the bond and the strength of their relationship was amazing. It helped so much in the clinical work. He was a catalyst that led to this project, Gay Sons and Mothers. Every now and then, I'd have another mother and son together, but it wasn't why they were in therapy. Once I started working on this project, various people consulted with me, families for help with their families. For some, in the field of psychotherapy, for others, through the nonprofit where, for free, I just consult with people and help them along.  

What's been interesting is one mother and son that I'm working with right now in therapy are enmeshed with each other, and they're seeing me every two weeks. On certain days, it feels like couples therapy and I really have to work with them to detangle and let go of their expectations with each other. And, so, this is a divorced mom with an only child who's gay, and they expect each other to meet needs that goes well beyond what they should be for a mother and a son.

This isn't the case in all circumstances, but I think it's a great example of how it can be a bit of a burden on both ends to have this close bond that goes kind of way too far on both ends.   

LR: So, enmeshment is one of the challenges. I imagine acceptance is another. 

RM: So many gay men are way too careful, and they're not coming out to their families as soon as they might, or they give absolutely no details about their private lives to their families who really want more from them. So, that is another challenge, that in being careful, even once they come out, being careful continues to be their MO, even when they don't need to be, and people want more from them. They want to hear more details about their day-to-day lives or what they struggle with, or are they in a relationship with someone?

LR: And I wonder if these particular men are so cautious and close to the chest with their families, if they're even more so outside of the home. 

RM: Correct. I'm working with a bunch of men in their 50s, let's say in their 60s, who came out in an era where it wasn't okay to be gay. And even though it's fine now and they have jobs where they are out, they, without even realizing it, are kind of slipping into modes of privacy and protecting themselves because it's a habit that's been with them through their life.

LR: I was going to ask you a little bit later about working with elderly gay men. But this seems like a good point to interject the question of, “what are some of the clinical challenges in working with elderly gay men whose mothers, I imagine, have long passed?”

RM: The most significant challenge is that they grew up in an era where they couldn't be out, where it wasn't safe, and many older men were kind of forced indirectly or even directly to live conventional lives and got married and had children without even questioning the freedom of living life as a gay man.

I had a great-uncle who was gay, and he never came out to my family. When I came out to my parents, they said, “Well, Paul has lived a good life. So, we know that you'll live a good life, too.” But this great-uncle, my grandmother's brother, was in his 80s when I came out. And he said to me, “I really appreciate that you have freedom that I didn't have, and I hope that you will keep my secret from your family because I just don't feel comfortable being out there.” 

LR: Well, I wonder if that fear of abandonment, being cast out by remaining family is that much greater to an elderly man?

RM: He had an incredible social network. He lived in Washington and was cryptographer for the CIA because keeping secrets was something that they did well. So, he had the love of a community of people, and my mother, his niece, and us, meaning my mother's children who were generations below him. And he was still worried about our knowing. It was just a pattern that was ingrained for the time with which he was raised. It's that simple.

LR: Can you imagine taking homosexuality, or any significant part of your identity, to the grave?

RM: When he died, my mother and I went to Washington to clean out his house — he saved everything. There was a pile of letters that his gay friends wrote to him in the 1950s and the 1960s about falling in love with men that they met in cruising areas in parks, and how they couldn't tell their spouses and how tortured they were.

We were cleaning out his house with three of his close friends. My mother came to me, without saying anything, handed me the pile of letters, and I read them. And I thought poor Uncle Paul would die if I kept these letters, so I shredded them and threw them out. And it is my biggest regret because in these letters was the reality of gay history lived by all these men.

But, in my desire to be loyal to my great-uncle, I threw them out. And this was maybe three or four years after I had come out. I was still living in a careful way and more worried about loyalties. If I had these letters now, what they would mean? Oh my God.  

LR: What clinical challenges have you experienced working with gay sons of mothers from other cultures, the Caribbean culture, the Asian, the Southeast Asian, or even African, where homosexuality is shunned and punished, sometimes even fatally?  

RM: In these cultures, homophobia is rampant and masculinity and norms around masculinity are such that fathers are not accepting of their gay kids. Religious norms are such that being gay is a sin and these are beliefs that communities buy into without questioning. So, fathers are often emotionally and physically abusive to their sons. Mothers are forced to choose between their husband or their child.

Some mothers choose their husband over their child. I had a guy that I interviewed who was Latino, and his mother said to him, “First comes God, then comes your father, and then comes you.” So, when he came out, they sent him to an aunt's house far away to Texas where he would somehow have a different life for himself. He ended up responding to a personal ad from someone who he didn't know at the time was a human sex trafficker, and he became a victim of human sex trafficking. It's a tragic story, and he's now an advocate for all of this. But his parents kicked him to the curb and still don't accept him. 

LR: Have you worked with men and mothers and their parents from other cultures, where the parents themselves were afraid of being sanctioned, punished, or harmed?

RM: You're saying that with a great degree of sensitivity and attunement. Most situations, that is exactly what the parents are feeling, but they don't recognize that in themselves. What they recognize is what they're supposed to believe, and that's what they've gone along with. I've worked with Mormon families who have rejected their children. I've interviewed a Latino Mormon man whose mother read his journal and packed up his bedroom one night and put all his belongings in the garage and said, “You're not going to live here anymore. What you're doing is a sin.”  

Eventually, they came around and made up years later. These horror stories unfortunately exist. Some families that are less severe than the examples I gave don't let their kids come to family holidays. They insist that they not come out to extended family that there’s all these conditions. There's a woman named Caitlin Ryan who’s done a lot of research through her organization called the Family Acceptance Project. Her work shows that LGBTQ family members can gain acceptance with their children or their siblings through being exposed to other people that give a message that it's okay.

And that's essentially what we're doing through Gay Sons and Mothers. We're sharing stories saying, “Look, we're out in the world and everything is fine.” And as family members realize that it's okay, they are far more accepting of their gay children. So, that's the message that we need to get out into the Latino, the Asian, the Black communities, and the best way that they're going to accept it is by hearing stories through people like themselves.

If they're hearing from a gay social worker who's White that it's okay, maybe some percentage of people will listen to me and be comforted, but they're going to hear it most from another father who's found through his own experiences that it's better to have a relationship with their child than to reject them.   

And that's essentially what we're doing through Gay Sons and Mothers. We're sharing stories saying, “Look, we're out in the world and everything is fine.” And as family members realize that it's okay, they are far more accepting of their gay children. So, that's the message that we need to get out into the Latino, the Asian, the Black communities, and the best way that they're going to accept it is by hearing stories through people like themselves.

If they're hearing from a gay social worker who's White that it's okay, maybe some percentage of people will listen to me and be comforted, but they're going to hear it most from another father who's found through his own experiences that it's better to have a relationship with their child than to reject them.

LR: I imagine there’s a significant number of these families that don’t make it successfully through therapy with you. This young man is left feeling just as isolated and rejected as before.

RM: Right. Or the young man will stay in therapy and build his own community, but, unfortunately, not with his family, outside of the family and elsewhere. That said, I am a family therapist. I’m a couples therapist. I'm totally optimistic. I never give up on families reuniting. And, last year, I worked with a fundamentalist gay man in his 30s, really successful in his career and in his life. But he didn't come out until his 30s to please his parents. I had three joint sessions with him and his mother, with the hopes of bringing them together. He never thought it would happen.

I met with her alone first, and she was talking about the Bible and blah, blah, blah, blah. They didn't stick with the sessions, and eventually started talking to each other. A couple of months ago, she was potentially diagnosed with cancer, and that's what brought them together more than anything else. And I wish it could have been sooner.

LR: How would you advise straight therapists working with gay men, beyond the standard of “unconditional acceptance?”   

RM: You raise a very important issue about unconditional acceptance, and many well-intentioned straight therapists try way too hard with their gay clients. In my life, socially, I'll go to a party, and they'll say, “Oh, do you live where all the gay people live? And do you know so and so, and so and so, and so, and so?”

LR: Gay Jewish geography.

RM: Exactly, and often I do. But therapists who try to promote unconditional acceptance and convince their clients that they're gay-affirming and then offer, “Oh, I have a neighbor who's gay,” which actually may induce a lack of trust. The best way to promote unconditional acceptance is to simply say, “I’m straight. Are you comfortable working with me? I am accepting, and I've worked with other gay clients. But, please, if you feel any bit of discomfort, let me know. Let's talk about it.” To me, that's unconditional acceptance, and that's more welcoming than doing a sales pitch that ends up sounding like a microaggression more than anything else.

So, my mentor, Jeff Zeig, accepted me for who I was, and he’s a straight man. There was something so profound in that experience for me. Was he the first straight man that accepted me? No, but it was wonderful to have a mentor who didn't care if I was gay, didn't pathologize me, and said, “Write a book about working with gay men, the field is lacking this information.” It was so validating. And so, what he did for me, which all therapists ideally do for their clients, is embrace, love, support, and send me out into the world to be successful.

That is unconditional love, and that is what straight therapists can do for their gay clients. And what I say in the work that I do is you're giving your clients a bigger gift of healing than you would even recognize because your clients are coming into your office with their presenting problem, whatever that happens to be. It may have nothing to do with being gay. And, through the love and the acceptance and the respect that you're showing to them, they're getting additional healing from the experience of being in your office.  

So, frequently, when people want a referral to a therapist who's a gay client, frequently I'll say, “Why don't you work with a non-gay therapist? Because there is extra work that you can have done, as a result.” Some people will do that, some people won't.

LR: I used to think it important to be colorblind, but we must see color to validate the experience of the “other.” that idea. Similarly, one can’t be gay blind, because being blind to that does not suggest acceptance. It suggests walling off and not affirming that person, not accepting that person. So, I imagine that a clinician working with a gay person has to be very cognizant of the stories, the history that this person brings into therapy.

RM: Yes. The words that are coming to my mind are cultural competence. And that's what we need in the field these days. And I, too, did the same that you just described. I worked with an Asian gay man and a Black gay man, and I cringe when I think to myself or I even probably said things aloud that it's not as bad as you perceive it to be, which is absolutely not true.

LR: It’s not affirming.

RM: Right. The best thing that we can do is to hear the experiences that our clients are bringing to our offices and trust that to be true. The other best thing that we can do to become culturally competent is to go to workshops or watch videos like this or read a few books or speak to your gay friends and family members about their experiences to get educated. It's not hard to do. I find that in our field of mental health there are many people who are well-educated and liberal in their thinking, so that they feel like they have all that they need to know.

But their gay clients are testing them indirectly and don't feel safe because they're presenting a norm that may be uncomfortable. The other thing that I found, and I've mentioned this to you before, is that the field in general, of course, is run by metrics and numbers. And the most successful clinicians and teachers in the field have large numbers of followers and huge turnouts to their conferences. When I teach, sometimes I get 20-25, maybe 40 attendees, if I'm lucky, at a big mental health conference. Well, that's not good for the conference.

So, I'm not advancing as I'm teaching about working with LGBTQ people. And there are very few courses offered at huge conferences, which is unfortunate. So, my advice to people who are organizing conferences is to put us in panels with other people, and that way we can kind of gain exposure and educate people.

LR: So, the idea of a gay-affirming therapist is more cliché than anything else I would think because if you're not a person-affirming therapist, you're not going to be a gay-affirming therapist. Am I getting it, right? 

RM: Yeah, yeah. And I mean, interesting. A clinician that's worked a lot with the gay man or the LGBTQ population by nature is gay-affirming. I know through conversations with a person who has worked a lot with the LGBTQ population is gay-affirming, and they've cultivated acceptance and skills that are affirming and comfortable. As a person, are you a gay-affirming person? I'm not asking you that. I know that you are, but I'm asking people who are listening to this. Do you understand what it's like living life as an LGBTQ person in today's world?

And if you're honest with yourself, maybe there are things you don't understand, and there's ways of getting information. If you pretend that you are, you're fooling yourself. People are going to see beyond that.

LR: They’re going to catch up.

RM: So, when you go to therapy, you should be talking about your sexual life. Many gay clients, out of shame, won't even broach the idea of sex with their therapists. Or, when they talk about sex, their therapist winced because they don't believe in open relationships, or they think that gay men are too sexual, and their biases are coming forward. I have a number of people that I've worked with over the years who have fled treatment, based on certain things that their doctors have said, or their therapists have said.

I have a number of gay male clients who don't even tell their doctors that they're gay. I mean, what's happening here? First of all, they should be working with a different doctor, where they feel comfortable, or they should be challenging their doctors, so they can feel comfortable talking about their sexual behaviors and what's happening in their lives. Many gay men, out of being nice and accommodating and living invisible in the world work with heterosexual therapists and never, ever mention the idea of their sexual life or using pornography or anything like that.  

And I think it's the responsibility of their therapists to ask them, “Tell me about your sexual life. Are you in a relationship? Are you monogamous? How is your sexual life? How do you enjoy using pornography?” And if you, as a therapist, can set the tone of comfort and let your clients know that you're okay with this, they're going to talk a lot more. But even as a gay male therapist with some people, I have to coax them into letting them know, “Look, I talk about this all day. I’m okay. It's totally fine to talk about it.” Their faces turn red. They get embarrassed. They think they shouldn't. It really is okay.

LR: And one of the ironies is that there are certain taboos that the field of psychotherapy has inherited. Don't ask someone about their sexuality. Don't ask someone about their trauma history. Don't ask someone about racism because you'll provoke them, you'll hurt them, you'll shame them. And I think it's this sort of silent collusion it sounds like, with some gay men that I won't ask, so you don't have to tell. 

RM: There is a big movement in the field of sexual health and sexual education, especially in the last few years, where many more therapists are getting trained and there are organizations like the AASECT. Anyways, that's just one. There's a bunch of training programs, where clinicians are now getting trained to deal, talk, and treat sexuality in the field of psychotherapy.

Tammy Nelson, who's a great couples therapist, also does a lot of sex education. And she says, “You can't work with a couple unless you talk about sexuality, and you can't do couples work without talking about sexuality.” And the same goes with working with gay men in a thorough kind of way.

Experiential Therapy and Hypnotherapy with Gay Clients

LR: Really just validating the very core of their existence. After reading your book and chatting with you these last months, I know how important experiential therapy and hypnotherapy are in your practice. What is it about those two modalities that has been so productive for you in your work with gay men and their mothers?

RM: Long before I was trained as a hypnotherapist, I was doing guided meditations with people, relaxation exercises. I got a little bit of training in mind-body work through some colleagues of mine, but I was just using my own intuition to do this kind of work. And what I learned later, as I got trained in hypnotherapy, was that I was doing work that was incorporating somatic experiences. Gay men grow up dissociating from their bodies because their sexual impulses are evil or wrong, or because they suck at sports.  

So, the norm of pushing a part of the body away is reality for gay men. And when you think about doing any form of somatic or experiential work, it incorporates breathing, comfort within, well-being as part of the experience on a somatic level. That is so profound for someone who's been pushing that aspect of themselves away their entire lives. So, what I found is that being trained in hypnosis, not just with gay men but gay men in particular who are willing to do it, provides a sense of happiness that's coming from inside of themselves, which is an unbelievably healing experience.

So, that's kind of how I started doing it and what I love about doing it. And, of course, with hypnosis, what we do is encourage success and well-being and agency from within, that for many people they haven't had their entire lives, so it's a profound experience. 

LR: I wonder how working with gay men who've experienced trauma lends itself to experiential work in hypnotherapy. 

RM: Let me just say that probably anyone growing up gay has experienced trauma, hopefully in milder forms rather than more severe forms. But gay men who have experienced more severe forms of trauma are far more distressed emotionally by that pain and cut off from their bodily experiences, at least healthy and pleasurable ones. And I would say similarly for gay men who grow up in minority populations that they, too, have experienced many forms of trauma. For example, LGBTQ adolescents are far more likely to have mental health-related issues, including suicidal ideation and abuse.

So, by the time they reach our offices as adults, they've learned to be protective and defended and to not trust how the world perceives them. So, many people don't want to do any form of experiential work because it feels too threatening.   

I've learned to respect them and not do it if they don't want or to go slowly in experiential work and do certain things with their eyes open. I sometimes don't use the word hypnosis. I'll call it guided imagery. I'll do a little bit with them using my voice, and if they feel comfortable and get something from it, then we continue. It's something that's very threatening to people. Regarding trauma, finding a place of comfort and well-being within is huge.

And people who don't believe that they have the ability to find that place frequently do so with the help of a good therapist and are immensely grateful for accessing something with a sense of safety with themselves that they themselves didn't believe they had.

LR: And I would imagine safety, in general, is a major issue for a gay man or any person who has been marginalized or excluded or persecuted in some way. Can you describe the most challenging countertransference relationship you've had with a gay client, a male client?

RM: I went to the gay gym in the 1980s in Boston, the Metropolitan Health Club, aka. So, on a routine basis, I would run into my clients on the gym floor. I still do. And being in the shower and running into them, I don't know if that's countertransference, but therapists are used to being boundaried. And then suddenly in our small world, we're at the same place at the same time. That's a challenge. I think some of the times that I struggle with particular countertransference cases are with people who are so rigid and so uptight that they are unwilling to let themselves be connected with me and perceive me as a threat. And I get in this struggle and this challenge with them as a result.

And one funny vignette is that I lead groups for gay men, and that's a great treatment modality for people to really understand their struggles because it isn't just one person telling them what's happening. They're seeing it in other people, and there are great opportunities for healing by also supporting people who are dealing with the same issue. So, in this particular group, after two years, it dawned on me that the group thought that I was a big flaming queen and way too out there for them. They were all kind of conservatively dressed, really uptight. Their world was very different.

So, I asked the group this day to rate me on a scale of 1 to 10 how they viewed me, as masculine 1, or effeminate 10. I don't know where this came from. It just popped into my mind one day. So, we went around the room, and the majority of them rated me from 9 to 9.5. I was like, what?

LR: All gay men.

RM: All gay men. So, one of the men, after he rated me, said, “I can see you skipping down the streets with shopping bags. And, frankly, that irritates me.” So, I laughed, called my partner, who said, “Oh my God, you're one point away from Richard Simmons.” What came from that, though, was an awareness in myself that my comfort level and my own mode of self-expression was a threat to men who didn't feel comfortable living free, and that there was friction around that.  

So, the very people who were choosing to work with me because of my comfort were also judging me simultaneously. Again, I laugh about it, so I wouldn't say that's a challenge.

LR: What did you do with the ratings once they came in?  

RM: Well, I laughed, which was a great clinical intervention. I talked about internalized homophobia and how significant it is to not allow ourselves to feel comfortable with others who are comfortable with themselves. And I continued loving them and showed them that I was completely fine hearing that, which made a huge difference. Then I got a couple of phone calls of apology over the week. People called and said, “I'm so sorry. I should have given you an eight instead of a nine.” I think what's really important is being able to take the projections that people are hurling at us.

LR: And not be defensive.

RM: And let them know it's okay that they think this way, and humor works great in therapy. I laugh a lot as a way of accepting people and kind of bolstering the connection with people.

LR: My guess is, Rick, that the guys who rated you so harshly had a fear of being perceived as that swishy, flamboyant, Rodeo Drive, shopping bag-carrying queer.  

RM: Yes, and one more component which is interesting is that I'm Jewish, and none of these men in the therapy group were Jewish at the time. And you're Jewish, too, and it's kind of part of our subculture to be expressive and to be emotional and to be okay conveying these parts of our personalities. And they were threatened by a freedom that was part of my upbringing, part of the culture. 

LR: How have you helped your gay clients reconcile their sexual identities with their religion, where they come from religious backgrounds that shun, punish, and ostracize?

RM: Such a complicated question. I've helped many people with this, and other people I wish I could have done more or that I could do more, depending on how entrenched these messages are and how evil they feel they are for acting on their impulses. In a more general and positive sense, being affirming, helping them accept themselves, having a role model, finding other friends that love them, finding other spiritual homes for themselves if they're willing is how they can grow and feel better about themselves.

But many people, like fundamentalist Mormons, certain groups, were so brainwashed and entrenched in their cult that we're talking years of deprogramming before they could love themselves. So, sometimes I’m honest with my clients that I just don't agree with what you've been taught, and I think it's done damage for you. And I'm working with a Mormon gay man for the last 20 years who still feels as though part of himself is evil. And it's just a shadow that he has to live with. I have to tolerate it in working with him all these years later. It's just a part of who he is. It’s painful.

LR: My guess is that, when you stop practicing, you'll have had to arrange the next emotional caretaker for him.

RM: Yeah. And he has so many people that love him and convince him otherwise, and it's still –

LR: It doesn’t matter.

RM: It’s ingrained in his early years of being.

LR: My last question is, if you could talk to the younger Rick Miller, therapist, who had come out recently, who was beginning to flourish as a psychotherapist but had all those doubts and questions, what would the current Rick Miller, gay male therapist, say to him?

RM: Two things. One is “your personality is your biggest asset and your best clinical skill. Don't worry about anything else.!” The other thing I would say to the younger me is, “fuck ‘em if they can't take a joke. Take more risks. Don’t worry what the field of psychiatry thinks of you as an individual, establish a viewpoint and put it out there instead of keeping it to yourself. Because you have really important things that people in the world need to know about.” That would be it.

LR: You matter.

RM: Yeah, yeah. By the way, years ago, I wanted to do an 800 number, 1-800-you matter.

LR: And?

RM: And I never did it, but it's still there. You matter. It's a great message.

LR: On that hopeful note, Rick, thanks so much for this time together.

RM: My pleasure!  

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