LGBTQ+ Therapy in NYC: Psychodynamic Psychotherapy with Dr. Kull & Associates
Understanding queer experience through depth-oriented therapy in Manhattan
"It is a joy to be hidden, and disaster not to be found." — D.W. Winnicott
There is something particular about growing up knowing, at some inchoate level, that you are not what others expected you to be. Long before language, before the vocabulary of sexual orientation or gender identity, many queer people experience a kind of ontological loneliness—a sense that the self one is becoming does not quite fit the template provided by the world. This early awareness, often wordless and pervasive, shapes the psyche in ways that reverberate throughout life.
Psychotherapy with LGBTQ+ people is not simply therapy that happens to be conducted with clients who are gay, lesbian, bisexual, or transgender. It is work that must reckon with this foundational experience of difference—the ways it shapes desire, defense, and the very structure of the self. It requires a therapist who understands that coming out is not an event but a psychological process that never quite finishes, and that the question "Who am I?" is always shadowed by the question "Who was I allowed to be?"
The Psychodynamics of Difference
Freud famously said that the goal of psychoanalysis is to transform neurotic misery into ordinary human unhappiness. For queer people, one might add: it is also to disentangle which parts of one's suffering belong to the universal human condition and which have been imposed by a world structured around compulsory heterosexuality.
Winnicott wrote of the "false self"—the compliant persona developed to protect a fragile true self from a world that cannot meet it. Many LGBTQ+ people know this splitting intimately. The child who learns early that certain feelings, desires, or ways of being are not safe develops elaborate defenses: repression, certainly, but also dissociation, performance, and what we might call anticipatory shame. By the time many queer people reach adulthood, they have spent years managing the gap between internal experience and external presentation, often without realizing how much psychic energy this management requires.
This is not simply about "being in the closet," though that captures part of it. It is about the internalization of a gaze that renders one's desire illegitimate, one's self suspect. Even after coming out, even in the most affirming environments, this internalized surveillance often persists. The good-enough mother, in Winnicott's terms, provides a holding environment in which the infant can safely experience and express all parts of the self. But what happens when the world is not a good-enough mother? When the environment cannot hold certain truths about who you are?
Minority Stress and Its Discontents
The concept of minority stress—the chronic stress of existing in a world structured for others—has become commonplace in discussions of LGBTQ+ mental health. But what does this mean psychodynamically? It means that ordinary developmental tasks become complicated by vigilance. Attachment in childhood is not simply about seeking proximity to the caregiver but about managing what can be shown and what must be hidden. Identity formation in adolescence is not just about separation and individuation but about integrating parts of the self that have been disavowed or dissociated. Intimacy in adulthood is not merely about choosing partners but about risking visibility in a world that may punish it.
Consider the gay man who, as a boy, learned to monitor his voice, his gestures, the things he found beautiful. He may have succeeded in becoming invisible, in not drawing the wrong kind of attention. But invisibility, while protective, comes at a cost. By the time he is an adult, openly gay, perhaps even in a loving relationship, he may discover that he has lost access to spontaneity itself. He performs even when there is no audience. He cannot quite trust that it is safe to simply be.
Or consider the person who comes out as transgender later in life. What looks like a sudden transformation is often the collapse of a defensive structure that has been maintained for decades. The self that emerges is not new but has been there all along, split off, kept safe through exile. The relief of finally living authentically is real, but so is the grief—for the years spent in estrangement from oneself, for the relationships built on a false foundation, for the developmental milestones that happened in hiding.
On Internalized Oppression
Psychoanalysis has long understood that we internalize our early objects—our caregivers, and eventually the broader social world. These internal objects form the scaffolding of the self, shaping how we see ourselves and what we believe ourselves to deserve. For queer people, this internalization process is complicated by the fact that the world one internalizes often contains hostile or denigrating representations of people like oneself.
This is what we mean by internalized homophobia or transphobia: not simply believing negative stereotypes, but carrying within oneself a rejecting object, a voice that says you are wrong, too much, not enough, fundamentally unlovable. This internal persecution can be more punishing than external discrimination, because it operates continuously, beneath awareness, shaping desire and self-concept in ways that feel like one's own thoughts rather than the residue of a hostile environment.
Melanie Klein wrote about the paranoid-schizoid position, characterized by splitting, projection, and persecutory anxiety. Many LGBTQ+ people spend years in a version of this position, unable to integrate the good and bad, the loved and hated, the self and the world. Coming out can be understood as a movement toward Klein's depressive position—the capacity to hold ambivalence, to see oneself and others as whole rather than part-objects. But this movement is never simple or complete. The work of psychotherapy is often to facilitate this integration: to help the client internalize a more benign object, to develop what Winnicott called the "capacity to be alone in the presence of another."
Desire and Its Complications
Freud's great contribution was to take desire seriously, to insist that who and what we desire tells us something essential about the unconscious organization of the self. For queer people, desire has often been the most dangerous truth—the thing that could not be admitted, even to oneself.
This creates particular complications. Some people spend years split off from their own desire, knowing it only as a kind of background noise, something felt but not acknowledged. Others experience desire but attach enormous anxiety to it, believing that to want is to be vulnerable, exposed, shameful. Still others develop a relationship to desire that is instrumentalized—sex becomes about validation, conquest, or the frantic attempt to feel real through the gaze of another.
In psychotherapy, we are interested in what desire reveals about object relations. Whom do you desire, and what does this tell us about your internal world? Do you pursue people who are unavailable, recreating early experiences of longing without satisfaction? Do you lose desire once a relationship becomes secure, suggesting that safety and arousal have become incompatible? Do you find yourself desiring only in contexts that feel illicit or transgressive, as if permission itself extinguishes want?
These are not problems to be solved but patterns to be understood. The aim is not to make desire "healthy" in some normative sense but to help the person develop a relationship with their own wanting that feels less punishing, more integrated, more possible.
The Question of Recognition
Contemporary relational psychoanalysis has moved away from Freud's drive theory toward an understanding of the self as fundamentally constituted through relationships. We are not isolated minds seeking discharge of instinctual tension; we are relational beings seeking recognition, attunement, and the experience of being known.
For queer people, the question of recognition is central. What does it mean to be recognized when so much of oneself has been rendered unrecognizable? How does one develop a sense of realness when the world has insisted, implicitly or explicitly, that certain truths about oneself do not exist or should not?
Jessica Benjamin writes about the need for mutual recognition—the experience of being seen by another as a separate subject, not merely an object. For many LGBTQ+ people, this has been impossible in formative relationships. Parents may love their child but fail to see them; the child learns to be loved for who they are not. Friends may be kind but cannot quite imagine the internal world of queer experience; the self remains isolated even in connection.
Psychotherapy offers something rare: a relationship in which the therapist's primary task is to see the client as they actually are, not as who they should be or who others need them to be. This is not the same as cheerleading or simple affirmation. The work is to create a space in which all parts of the self—the defended, the disavowed, the shameful, the too-much—can be brought into the room and survived. To be seen in one's full complexity, including one's difficulties and contradictions, is a profound relational experience.
Coming Out as Unfinished Business
We tend to think of coming out as something that happens once: you tell your family, your friends, your coworkers, and then it is done. But psychologically, coming out is never finished. It is a continuous process of deciding, in each new context and relationship, how much of oneself to reveal and how much to withhold. Even those who are publicly out often find themselves negotiating visibility, managing the gap between what is known and what is felt.
There is also the question of coming out to oneself, which is often more difficult and takes longer than external disclosure. Many people come to therapy years after they have told the world they are gay or trans, still struggling with internal prohibition, still unable to fully inhabit their desire or identity without conflict. The external coming out was the easier part; the internal work of integration remains.
Fairbairn wrote that the child in an abusive or neglectful environment internalizes bad objects to maintain the fantasy that the parents are good. If the parent is bad, the child is in danger; if the child is bad, there is hope—change yourself and you will be loved. Many queer people perform a version of this psychic maneuver: better to believe there is something wrong with you than to accept that the world is hostile to your existence.
The result is a self divided against itself. Coming out to the world does not automatically undo this division. Psychotherapy is the space in which the work of internal integration can happen—where the hostile internal object can be externalized, examined, and gradually replaced by something more benign.
What LGBTQ-Affirmative Therapy Requires
What does it mean to offer truly affirmative therapy to LGBTQ+ clients? It is more than displaying a rainbow flag or listing "LGBTQ+ friendly" in one's directory profile. It requires a therapist who brings both theoretical sophistication and personal comfort with queer experience.
The therapist must understand the particular ways that queer experience shapes unconscious life: the early sense of difference, the necessity of hiding, the internalization of a hostile gaze, the complications of desire and attachment. They must be able to recognize when a client's difficulties are shaped by minority stress and when they are more universal struggles that happen also to occur in a queer person.
This requires being able to talk openly about sex, desire, bodies, and identity without discomfort or avoidance. It requires understanding that being queer is both a meaningful identity and a contingent fact, both a source of pride and sometimes a burden, both political and deeply personal.
Most importantly, the therapist must be willing to sit with the not-knowing, the ambiguity, the slow work of helping a client discover who they are when the defenses soften, when the false self recedes, when the demand to be legible finally quiets.
Psychodynamic Therapy for LGBTQ+ Clients in Manhattan
At Dr. Kull & Associates, we practice psychodynamic psychotherapy grounded in relational and object relations theory. This work is not brief or solution-focused. It is exploratory, oriented toward understanding rather than symptom elimination. We work with LGBTQ+ individuals and couples in New York City, both in person at our Columbus Circle office and online throughout New York State.
Dr. Ryan Kull is a gay therapist who has spent years researching and writing about the psychological experience of LGBTQ+ people, particularly around themes of identity development, minority stress, and the search for meaning in a world that has often felt inhospitable. His clinical work draws on psychoanalytic theory, particularly the British object relations tradition (Klein, Fairbairn, Winnicott), and contemporary relational approaches.
If you are looking for LGBTQ therapy in NYC that takes queer experience seriously—not as a demographic category but as a profound shaping force in psychological life—we invite you to reach out for a free consultation. The work is difficult and slow, but for many people, it is the only thing that finally makes sense.
