Written by: Dr. Denise Renye
A queer person sits in my office describing a familiar pattern. They have spent years feeling responsible for other people's emotions, over-functioning in relationships, and struggling to identify their own needs. They can trace the pattern back to childhood. They understand how family dynamics shaped it. They can articulate the role that marginalization, shame, and adaptation have played in their life.
Yet they continue to find themselves in relational terrain that feels eerily familiar. The old themes persist, but not always in the same form. What once operated as an unconscious pattern is gradually becoming something that can be recognized, reflected upon, and, over time, transformed. They recognize the warning signs earlier than they once did. They understand how earlier experiences of marginalization, concealment, or rejection shaped their expectations of relationships. And still, when intimacy becomes possible, they find themselves pulled toward familiar dynamics: over-functioning, self-abandonment, choosing emotionally unavailable partners, or remaining disconnected from their own needs. The problem is not a lack of insight. The problem is that understanding a pattern and living differently are not always the same thing.
The distinction becomes visible beyond relationships as well. Another person speaks about finally feeling accepted by friends, affirmed in their identity, and connected to queer community. On the surface, their life looks very different from the environment in which they grew up. Yet they continue to struggle with hypervigilance, insomnia, self-doubt, and a persistent sense that they are somehow too much or not enough. They intellectually know they are safe. Their body does not.
As therapists, many of us work with individuals and couples who possess tremendous insight. They understand attachment, trauma, family systems, and the ways larger cultural forces have shaped their lives. They can often articulate the origins of their patterns with remarkable clarity. Yet insight alone rarely transforms a nervous system. Understanding why a pattern exists is not the same as being free from it.
This distinction feels particularly important in work with queer clients. Many of the challenges our clients bring into therapy are not simply intrapsychic. They emerge at the intersection of personal history and larger social realities. Experiences of marginalization, invisibility, rejection, shame, and threat do not remain external. Over time, they become both internalized and embodied. They influence not only what people believe about themselves, but also how they move through relationships, experience intimacy, and understand their place in the world. What begins as adaptation can gradually become a way of relating to oneself, to others, and to the world.
For many queer and trans people, the body itself becomes a site where social, cultural, and political realities are lived in real time. Questions of identity and belonging are not merely intellectual concerns. They are lived through the body and negotiated within relationships. This is particularly evident in my work with trans clients, as well as with parents, partners, and clergy seeking to support them. The challenges that emerge are rarely only individual. They reflect the ways larger cultural conversations become lived realities, shaping not only how people see themselves but also what feels possible in their relationships and lives.
These adaptations often persist long after the original conditions have changed. A client may intellectually know they are safe while their body remains organized around vigilance. They may understand the origins of shame while continuing to live as though they are fundamentally flawed. They may recognize a relational pattern while finding themselves pulled into it again and again.
This is where I began to find myself asking a different question. If larger cultural, political, and relational realities become embodied and repeatedly enacted within individuals and relationships, what does it mean to work therapeutically at that level? And could this work itself be understood as a form of social justice?
As clinicians who are often deeply aware of the realities affecting our communities, many of us are engaged in conversations about how best to contribute. Some participate in activism, advocacy, education, community organizing, research, policy work, or leadership within professional organizations. These efforts matter enormously and have helped create meaningful change within queer communities.
At times, I have found myself wondering whether we underestimate the significance of psychotherapy because its effects are often intimate, relational, and difficult to measure. Unlike policy, activism, or public advocacy, its impact rarely announces itself. Yet psychotherapy frequently engages the very processes through which experiences of marginalization, shame, exclusion, and belonging become embodied, internalized, and reproduced within relationships.
This is one of the reasons I have come to see work focused on embodiment, sexuality, trauma, and relational dynamics as operating upstream. Long before harm becomes visible in institutions, communities, or relationships, it is often carried in bodies and nervous systems. Long before it is enacted between people, it is experienced within them. Adaptations that once served survival can eventually shape expectations, relationships, and ways of being in the world.
The therapy room is one of the places where these patterns become visible. A queer client begins to recognize that shame is not an inherent aspect of their identity but a response to environments that required concealment. A client discovers that what they have long called intuition is often hypervigilance. A couple begins to understand how earlier experiences of rejection, abandonment, or danger continue to shape the ways they protect, pursue, and connect with one another.
The work is not simply intellectual. The task is not merely to understand these patterns. It is to develop the capacity to experience something different: to remain present where there was once shutdown, to tolerate intimacy where there was once fear, to experience desire without shame, to set a boundary without guilt, and to stay connected to oneself while remaining connected to another.
These shifts may appear personal, but they rarely remain there. The ways we organize ourselves around shame, safety, belonging, and connection often influence how we engage with others. When a client becomes less governed by shame, fear, self-abandonment, or reenacted trauma, the effects extend beyond the individual. They influence how that person participates in intimate relationships, friendships, families, workplaces, faith communities, and broader social networks.
What changes is not only how someone feels, but how they engage. A person who develops greater self-trust may become more capable of setting boundaries, tolerating difference, expressing desire, or remaining connected during conflict. A couple that interrupts a cycle of mutual protection may create new possibilities for intimacy, communication, and repair. Over time, these shifts alter the relational environments people inhabit and help create.
This is part of what I mean by working upstream. The work is not simply about symptom reduction or individual well-being. It involves engaging the patterns through which shame, fear, exclusion, and disconnection are carried forward across relationships and communities. When those patterns begin to shift, something larger shifts with them.
This does not mean therapy replaces activism, advocacy, policy work, or community organizing. Nor does it mean that individual healing alone can resolve structural inequities. Rather, it suggests that these forms of change are interconnected. If activism and policy often seek to transform the conditions in which people live, psychotherapy frequently engages how those conditions become embodied, internalized, and enacted within relationships. Working upstream is not an alternative to social change. It is one way of participating in it.
ABOUT THE AUTHOR:
Dr. Denise Renye is a licensed clinical psychologist, AASECT Certified Sex Therapist, and IAYT Certified Yoga Therapist based in Marin County, California. She specializes in LGBTQ+ affirmative therapy, queer relationships, sexuality, embodiment, trauma, attachment, and complex relational dynamics, working with both individuals and couples. Her work integrates depth-oriented psychotherapy, somatic awareness, and psychedelic integration.
In addition to her clinical practice, she provides consultation and supervision for therapists and consults with organizations on relational dynamics, communication, and workplace complexity. Dr. Renye writes and teaches on topics related to intimacy, desire, attachment, and embodied relational healing.
