Being misgendered in an exam room. A nurse who raises an eyebrow when you mention more than one partner. A provider who dismisses your anxiety, your depression or your pain. These are major trigger points for queer people coming in for care.
For many LGBTQ+ Ohioans, trauma doesn’t always just show up as flashbacks. Most times it looks like not making an appointment at all.
“The most obvious way I think trauma shows up is just not coming in for care,” says Natalie Stark, director of onboarding and training for behavioral health at Neighborhood Family Practice (NFP). “If a patient can’t be sure that they can see someone who is going to make a safe space for them where they aren’t questioned or judged, they’re not coming.”
NFP, a network of community health centers in Cleveland, creating a safe space starts with treating the whole person. That means centering primary care, sexual health and mental health together, and using trauma-informed therapies like EMDR (eye movement desensitization and reprocessing) to help patients undo years of shame and stigma tied to gender, sexuality and the body.“So much of our mission at NFP is rooted in a trauma-informed approach,” Stark says. “That you are an individual. That you matter. We see you as a human being who is deserving of fulsome care.”
That approach starts with something deceptively simple: asking patients what they want. For LGBTQ+ patients, that can mean naming things that have never felt safe to say out loud: “I’m queer.” “I’m trans.” “I have multiple partners.” “Sex hurts.” “I’m scared.” At NFP, behavioral and sexual health aren’t separate or siloed. They are woven together from the very first conversation.
Untreated or undertreated mental health diagnoses have a major impact on a person’s sexual health and sex life. According to at least one study, more than 60% of people with major depression experience some form of sexual dysfunction, and in some samples that number climbs above 80%.
Sexuality “is an important component of health, period,” Stark says. “As human beings, we are sexual beings, full stop.”
When trauma is connected to a person’s sexuality, gender identity or body, it isn’t just a memory. It can quietly shape every decision – from who they date, to how they have sex, to whether they seek care at all.
That’s where EMDR comes in.
“EMDR is an evidence-based treatment,” Stark says. “It uses the power of our brain through bilateral stimulation to move traumatic memories from being stuck into being better understood.”
A core part of EMDR, Stark explains, is identifying and tracing back patients’ negative beliefs about themselves that are rooted in traumatic experiences: “I am unworthy. I am damaged. I can’t keep myself safe.’”
Once negative beliefs are named, the therapist can begin working with the patient to understand where the negativity shows up in their daily life, how it shapes the choices they make and what healthier alternatives might look like.
For queer and trans people, shame may show up as internalized homophobia, transphobia and sex-negativity, all reinforced by family, faith communities, school and policy.
“Shame is able to continue on and keep growing when we don’t talk about it,” Stark says. Naming it is the antidote. “That is one of the most powerful tools that we have as clinicians,” Stark says. “If we talk about it, if we acknowledge it, it actually is what combats it most effectively.”
For LGBTQ+ patients who have been burned by health systems before, trust doesn’t happen just because a clinic says, “We’re affirming.” It shows up in small, specific choices.
“Visibility matters,” Stark says. “Anybody can put a Pride flag in their front windows … but we also know that when people see that, it is an indicator: ‘This is a space that you’re welcomed in. You are deserving to be here just as anybody else is.’”
All NPF staff members are trained in the basics of sexuality and gender to ensure that caregivers use correct pronouns, and that affirming language shows up in the exam room long before a patient ever reaches therapy. “Our electronic health record also has pronouns,” Stark explains. “When I’m getting ready to see a new therapy patient, I look at the chart to see what pronouns they use. Then when I greet them using those pronouns, they’re like, ‘Oh, thank you.’ It’s as simple as acknowledging, “I see you.”
Because NFP operates on an integrated care model, behavioral-health providers aren’t working in a separate wing. They’re side-by-side with primary care and sexual health clinicians, sharing information and coordinating care.
“Our model is integrated care, which means in order for a patient to get to that identified desired outcome for their health, we have to look holistically at the person,” Stark says. “It’s not just the medical, it’s not just behavioral health, it’s not just sexual health, it’s not just dentistry, it’s not just their medication needs through pharmacy. It’s literally all of those pieces.”
That can mean a therapist flagging sexual health needs that a primary care visit didn’t catch. “It’s not uncommon that I may reach out to a PCP and say, ‘Hey, I think this patient needs X, Y, or Z,’” she says.
Stark recalled one patient leaving a long-term relationship and beginning to explore sexuality again, with hints of past unsafe practices. “I mentioned to their PCP, ‘Hey, I think they’re coming in pretty soon. I wonder if they would be a good candidate for PrEP,’” Stark says. “And now, they’re on PrEP!”
For many marginalized patients—especially newcomers who are LGBTQ+—trauma-informed care also means addressing survival needs. Often the biggest barriers are practical, not emotional. NFP steps in to close the gaps for patients who can’t get to their appointments, can’t afford follow-up visits or medications and are simply trying to make it from today to tomorrow. “One of the things that we’ve done a lot is say, ‘That’s fine, we’ll figure it out. We’ll get you bus tickets,’” Stark says. “We are currently working on improving transportation for patients to get to and from clinics or the pharmacy.”
Community health workers and social workers also help patients navigate employment. “They are well-tapped into where the job connective points are in the community,” Stark added.
For patients dealing with housing instability, anti-immigrant bias or anti-LGBTQ+ discrimination, wraparound support becomes part of the healing itself.
When you’re untangling trauma tied to your gender, sexuality or body, there’s no quick fix. Stark is careful to name even the smallest progress as real wins.
“I believe anytime someone shows up to a therapy appointment and hangs in there in conversation about tough stuff with me, that’s a success,” Stark says. “When patients begin shifting their language—whether they notice it or not—about themselves or a situation that’s foundational in their trauma, that’s a success.”
Success doesn’t have to be dramatic. “Success is often so small, but so big,” Stark adds. “Anytime someone says in a session, ‘I didn’t think of it that way,’ that’s success, because now you are looking at it from a different angle. Trauma really narrows things. To look at something differently requires you to open up. That’s a success. That is saying the trauma is not going to control what’s happening here. I’m in control.”
For many LGBTQ+ Ohioans, navigating restrictive policies, public disputes, and ongoing questions about their identities creates a persistent mental-health strain. Stark names that reality with clarity.
“You matter. Period. You matter,” she says. “I know there have been actions and conversations that may suggest otherwise, but those messages are rooted in fear. They cause real harm—and that is not the work NFP does.”
She emphasizes that while NFP cannot control the broader environment, it can determine what happens within its own walls. “We understand the challenges facing LGBTQ+ people. We will continue to show up as a safe, affirming space—and we remain committed to learning, growing, and meeting the needs this community brings to us, both in the clinic and beyond.”🔥
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