Becoming an LGBT Affirmative Clinician: How Do I Do it?
Clinical Considerations for Working with LGBT Clients
By: Lindsay Anmuth
James Madison University
In considering working with LGBT clients, therapists should not only ensure (at a minimum) that they are interested in that population but also whether or not they possess sufficient knowledge of LGBT individuals’ concerns, capacity/willingness to support and validate those concerns, and experience in interacting with LGBT individuals in personal or professional contexts. As such, the APA (2009) recommends that before professional psychologists engage LGBT clients, they examine their own potential biases, collect sufficient relevant information about the LGBT population, and recognize diversity within the group itself, so as to ensure that clinicians are not harming clients by reinforcing negative biases held by the client, therapist, or society. That being said, while “do no harm” is a vital fundamental principle, to be sure, many trainees and early career psychologists may strive to reach a much higher benchmark. Namely, they might be interested in becoming LGBT affirmative clinicians.
Becoming an LGBT Affirmative Clinician: How Do I Do it?
Being an LGBT affirmative clinician begins in the waiting room. For instance, consider whether your clinic happens to have LGBT inclusive magazines or pamphlets available. Do the intake forms simply present “male” or “female” as gender options? Might the forms instead provide a blank line next to the question of gender, where clients may write in their own responses? These are just a few simple methods of creating a more affirming environment.
As the initial session begins, an LGBT affirmative clinician makes use of a basic skill learned in professional training: adopt the client’s language. In this way, if a client refers to their “partner,” an LGBT affirmative clinician uses the term “partner,” as well, and does not assign a gender to that individual or assume that the client is of a particular orientation. LGBT affirmative clinicians also honor their clients’ requests for certain gendered pronouns (i.e. “he” or “she”).
When it comes to presenting concerns, many clients may seek help with self-acceptance related to their own sense of identity, morality, or internalized homophobia (Pachankis & Goldfried, 2004). Some individuals learn over time to hide their true identities, potentially through actions to avoid (i.e. overcompensating by adopting strict traditional gender roles, substance abuse, etc.), which might suggest a core sense of shame. Further, although this might be challenging ground for many clinicians, the interaction between LGBT identity and faith/morality may be an area that clients would like to address in treatment. Brynn White is a protestant chaplain working in the Department of Veterans Affairs and a staunch supporter of LGBT individuals. She offers, “I think one of the most overlooked areas in working with the LGBT population is the spiritual component. It has been my experience that many (not all) people who are LGBT who were affiliated with a religious upbringing have endured spiritual injuries…[my work] often begins with simply affirming and honoring the person as a beautiful creation that actually is not “defective,” not “less than,” not “abnormal.” As such, this existential realm may actually hold a great deal of pain as well as potential for meaningful healing.
An LGBT affirmative clinician remains open and does not presume to know why an individual might be seeking therapy. Psychology Intern Yinchi (Gigi) Li offers, “Don’t assume the LGBT person is coming in for therapy because they are distressed [about] their sexual orientation.” Indeed, although many LGBT individuals might experience higher rates of anxiety, depression, or substance use (see Heck, Flentje, & Cochran, 2013), it is biased to assume that clients present with problems because they are LGBT or to conceptualize them only in terms of their sexual orientation or gender identity. Instead, LGBT affirmative clinicians continue to follow their client’s lead in uncovering their particular concerns.
Finally, although they might not struggle with identity, many clients might still experience distress related to disclosing their sexual orientation to others. It is a commonly held myth that individuals “come out” at one point in time and, from that point on, are forever known and accepted as “out” (Ali & Barden, 2015). Emily Burt, a counselor working in the Department of Veterans Affairs, shared an experience with a veteran client: “I remember distinctly him saying that you don’t come out just once; you have to do it all the time. This was not a concept I had ever really thought of.” Indeed, individuals are faced with making a recurrent decision to come out or to refrain from disclosing their sexual minority status. With every new person or system encountered, LGBT individuals must weigh the costs and benefits to disclosing or not disclosing, any of which may be potentially risky or distressing (Ali & Barden, 2015).
As with any cultural group with which clinicians are unfamiliar, it is important to gain experience and knowledge. This discussion was by no means exhaustive; the fact is that LGBT individuals present with a wide array of complex issues, some of which may be related to their sexual orientation and/or gender identity and some of which may not. Regardless, an LGBT affirmative clinician puts the client at ease from the very beginning, follows the client’s lead, adopts the client’s language, and remains attuned to the person of the client. Further, truly affirming clinicians are knowledgeable about their own biases, complexities, and ideals.
Ali, S. & Barden, S. (2015). Considering the cycle of coming out: Sexual minority identity development. The Professional Counselor, 5(4), 501-515.
APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation (2009). Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Washington, DC: American Psychological Association.
American Psychological Association (2011, June). Competency Benchmarks in Professional Psychology. Retrieved from http://www.apa.org/ed/graduate/competency.aspx.
Heck, N.C., Flentje, A., & Cochran, B.N. (2013). Intake interviewing with lesbian, gay, bisexual,and transgender clients: Starting from a place of affirmation. Journal of Contemporary Psychotherapy, 43(1), 23-32.
Pachankis, J.E. & Goldfried, M.R. (2004). Clinical issues in working with lesbian, gay, and bisexual clients. Psychotherapy: Theory, Research, Practice, Training, 4193), 227-246.