Are you an Identity-Based Therapist? Pros and Cons of
Practicing Identity Therapy

Recently I was consulting with a fellow therapist when we began discussing identity therapy. We were talking about their experience of burnout, fatigue, and the stress of experiencing collective trauma alongside their clients.

As we talked, a term popped into my head: "identity-based practice."

First, let's define the term and how I am using it:

Identity-Based Practitioners (or Identity-Based Practices) are Practitioners who:

1. Have a marginalized identity (racial, religious, LGBTQIA+, neurodivergent, etc.).

2. If the identity is invisible, they choose to make it public and incorporate it into their marketing strategy.

3. The majority of their clientele share their identity.

When you run an identity-based practice: moral injury and burnout are magnified as we process collective trauma alongside our clients.

After our consultation, I pondered how I, too, had transitioned to being an identity-based practitioner. I work primarily with ADHD and Autistic young adults, and many of them have additional marginalized identities on top of this. As more mental health providers are stepping into public spaces, I have seen an increase in identity-based practitioners. I believe there are a lot of pros to this, but some additional unique challenges come when running an identity-based practice.

Pros and Cons of Practicing Identity Therapy

Here are some of the pros and cons I experience as an identity-based therapist:

Pros:

I feel more connected and authentic as a therapist. Since shifting to working exclusively with Autistic and ADHD clients, my therapeutic style has shifted. I am less serious and more at ease. I mask less. I use humor and cuss more. I move my body more and connect through stories and shared life experiences when appropriate. I feel more aligned and more at ease in my body. This means many wonderful things for me, such as:

• More organic connection

• Deeper connection

• Less burnout and fatigue due to less masking

• Increased meaning

• Autistic joy and connection

• I learn more about my special interest (Autism) through my work with clients

• I deepen my understanding of myself while listening To Autistic and ADHD clients express their inner worlds

Honestly, the pros are so significant I wouldn't turn back to being a generalist practitioner. But it also comes with some unique challenges.

Cons:

1) There is more emotional activation. My clients’ stuff hits on more of my stuff. Their raw spots are often my raw spots. Their pain points are often my pain points. Their trauma is similar to my trauma, meaning my stuff is activated more.

I take care of myself through being engaged in my own therapy, drawing on mindfulness and defusion strategies. I also have reduced the number of clients I see.

2) Parallel Processing of Trauma. Therapists have now become familiar with parallel processing of trauma with clients (thank you to the COVID-19 pandemic and racial and political trauma).

This parallel processing of collective trauma is magnified when there are shared identities in the room. In today's cultural moment, this is most poignantly felt by BIPOC and LGBTQIA therapists.

3) Moral Injury. There is a heightened sense of moral injury when you are an identity-based practitioner. My DMs and inbox overflow with requests from Autistic individuals seeking support. Every week I turn away Autistic clients who either want an assessment or an Autistic therapist. I recently had to close my waitlist. There are no openly Autistic Psychologists in my state to refer them to. My referral list of Autistic informed therapists is meager, and they also have waitlists. 

When I turn people away, I am turning away my people. When I don't connect with a client, I am an Autistic therapist who is failing to connect with one of my people. When I can't help an ADHD client get ahold of their executive functioning challenges, I am failing one of my people. These moral injuries are amplified for folx with compounding marginalized identities (such as LGBTQIA ND therapists or BIPOC ND therapists).

Whether or not to disclose an invisible identity or to build a practice around one of your identities is a personal decision. And there are several factors to consider. To summarize: in my experience, it both makes my practice more meaningful but it also makes it more intense.

How to Support Yourself as an Identity-Based Therapist

Those of us who are identity-based practitioners need to take additional care when thinking about self-care. Here are a few of the practices that have helped me:

1) Being engaged in my own therapy. It is critical to know what my stuff is and what belongs to my client. Particularly when we have shared identities in the room. Being actively engaged in my own work helps with this.

2) Joining consultation groups with people with shared identities. I recently joined a Queer-affirming Neurodivergent consultation group. This group has been one of the best things I did for my practice this year. Connecting with other neurodivergent therapists has been a lifeline.

3) Consider workload: There is a reason you're reading this blog post. There is a reason you occasionally see promotions to buy digital products from me. It's because I've realized I must diversify my work. I can't do 30-40 hours of identity-based therapy hours a week. I diversify through:

• Running groups

• Consultation with other therapists

• Assessment

• Selling digital products/Affiliate marketing/Social Media Partnerships

4) Intentional media use: I save my activation and protect my nervous system. While I value being informed, I am thoughtful about the media I consume. If I know a certain rabbit trail of media stories will hijack my nervous system, I avoid it. I can't control the activation of parenting ND kids or running an identity-based practice. So, I limit exposure to unnecessary nervous system activation. Yes, this likely means I am less informed than is ideal, but I must be diligent in protecting my nervous system.

If you are an identity-based therapist, I would love to hear from you. What do you love about it? What is hard about it? What helps ground you?

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