Addressing the Continuing Need for LGBT Competency Among Mental Health Practitioners

Addressing the Continuing Need for LGBT Competency Among Mental Health Practitioners

By: Derek Giannone, B.A.

Master’s Candidate at Drexel University

Some months ago there was a thoughtful and well-written article posted on this blog that reviewed clinical considerations for working with LGBT clients and how clinicians may become LGBT affirmative (Anmuth, 2016).  Recently, I have been fortunate to assist a colleague with a project investigating LGBT competency among psychologists in New York state.  During my time on the project, I have been exposed to the importance of LGBT competency among psychotherapists and some of the current limitations of our field in addressing the needs of this important population.  While Anmuth (2016) reviewed tangible means by which therapists may become LGBT affirmative, this article aims to extend her post by discussing the concept of LGBT competency and it’s importance, the current state of competency in psychology, and how we should move forward as a field.

LGBT Competency

LGBT competency is defined as the “attitudes, knowledge, and skill competencies that therapist need to provide ethical, affirmative, and competency services to LGBT clients” (Bidell, 2005, p. 268).  There has been an increasing interest in recent years concerning practice with, and research on, the LGBT community.  The American Psychological Association (2012) has stated that being knowledgeable of the LGBT community and fostering the skills needed to work with this population in diverse settings should be important goals for all practitioners working with LGBT client.  As a result of the increased recognition of the importance of LGBT competency in practitioners, researchers have developed quantitative measures of competency with, and knowledge of, the LGBT community (Bidell, 2005; Ponterotto, Rieger, Barrett, & Sparks, 1994; Pope-Davis, Reynolds, Dings, & Nielson, 1995).  Most recently, Bidell (2005) developed the Sexual Orientation Counselor Competency scale to accurately assess competency in counselors and therapists.  These measures provide us a means by which to understand the current state of the field in terms of these competencies, and provide a way to assess individual practitioners. However, it is unclear how widely these tools have been utilized in the field.

Many factors contribute to the importance of increasing LGBT competency in the field of psychology.  Individuals who identify as part of the LGBT community comprise 3.5% to 5% of the United States population (Gates & Newport, 2012), a number that increases to 11% when including both sexual behaviors and attractions (Gates, 2011).  Further, membership in this community often entails variety of unique stressors and risk factors (Fredrikson-Goldsen, Hoy-Ellis, Goldsen, Emlet, & Hooyman, 2014).  Higher rates of victimization, loneliness, and HIV/AIDS, which are notably more common amongst older members of the LGBT community.  As a minority group, they may be exposed to stressors from microaggressions and an awareness of the pervasive nature of oppression in our society, past and present (ALGBTIC, 2012).  These risk factors, amongst others not mentioned here, may explain why LGBT individuals search for therapy and counseling services at five times the rate of their heterosexual counterparts (Rutter, Estrada, Ferguson, & Diggs, 2008).  These facts provides a strong argument for the importance of addressing the unique needs of this population, and for attempting to facilitate acceptable levels of competency in clinicians.

Current State of the Field

The field of psychology has certainly made significant progress in understanding and addressing the unique experiences and needs of the LGBT community.  In 1975, the American Psychological Association (APA) passed a resolution declaring that homosexuality (sic) should not be considered an impairment and psychology should lead the way in reducing stigma surrounding mental health and homosexuality (APA, 2012).  Since this declaration, the field of psychology has contributed valuably to the promotion of mental health in LGBT populations and the development of tools to aid practice, education, and research.  One notable contribution is the development and updating of guidelines for psychological practice with lesbian, gay, and bisexual clients, which were developed from empirical research in diverse areas relating to LGBT issues.

However, despite these advances, researchers suggest there is still much work to be done in addressing disparities in LGBT treatment (Bidell, 2013).  While members of the LGBT community experience psychological issues and seek treatment at higher rates than their counterparts (Institute of Medicine, 2011), they also report higher levels of dissatisfaction with treatment (Lyons, Kieschke, Dendy, Worthington, & Georgemiller, 2010). Many psychotherapists report a lack of preparedness, training, and competency in treating members of the LGBT community (Graham, Carney, & Kluck, 2012).  Addressing these disparities remains an important task for clinicians, researchers, and organizations in the field of psychology.  Some suggest that the problem may have its roots in the structure of the education and training received by clinicians (Bidell, 2013; Rutter et al., 2008).  While clinical doctoral programs typically require a course in multicultural issues, courses or supplementary trainings focused on competency in treating LGBT clients are relatively uncommon (Fredriksen-Golden, Hoy-Ellis, Goldsen, Emlet, & Hooyman, 2014).

Future Directions

Increasing LGBT competencies among mental health professionals in the future will undoubtedly require both increased awareness and the allocation of resources at many different levels.  Amongst others, private practitioners, health systems, universities, and treatment facilities all have the ability to make a significant impact on their level of competency in addressing the unique needs of the LGBT community. There is a high degree of likelihood that practitioners of all kinds will encounter clients throughout their career and will need these competencies for successful treatment. Organizations and universities should aim to develop sufficient levels of competency in their trainees and practitioners. Some suggestions that come to mind are as follows:

  • Developing curriculum specifically geared towards imparting knowledge of LGBT issues in the psychotherapeutic process and skills
  • Providing workshops and guest speakers that focus on the LGBT community
  • Supporting and enhancing continuing education opportunities for practitioners
  • Subsidizing practitioner attendance to continuing education workshops

These suggestions may be important strategies in future efforts to increase competency in working with LGBT clients, and further recognizing and affirming the feelings and lifestyles of those in their community.


American Psychological Association. (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. American Psychologist, 67(1), 10-42. doi: 10.1037/a0024659.

Anmuth, L. (2016, May 31). Becoming an LGBT affirmative clinician: How do I do it? [Web log post]. Graduate Students & Early Career Psychologists (Section X), Society of Clinical Psychology (Division 12), American Psychological Association. (Published on the web:

Bidell, M. P. (2005). The Sexual Orientation Counselor Competency Scale: Assessing attitudes, skills, and knowledge of counselors working with lesbian, gay, and bisexual clients. Counselor Education & Supervision, 44(4), 267-279. doi: 10.1002/j.1556-6978.2005.tb01755.x

Bidell, M. P. (2013). Addressing disparities: The impact of a lesbian, gay, bisexual, and transgender counseling course. Counselling and Psychotherapy Research, 13, 300-307. doi: 10.1080/14733145.2012.741139

Fredriksen-Goldsen, K. I., Hoy-Ellis, C. P., Goldsen, J., Emlet, C. A., & Hooyman, N. R. (2014). Creating a vision for the future: Key competencies and strategies for culturally competent practice with Lesbian, Gay, Bisexual, and Transgender (LGBT) older adults in the health and human services. Journal of Gerontological Social Work, 57(2), 80-107. doi: 10.1080/01634372.2014.890690

Graham, S. R., Carney, J. S., & Kluck, A. S. (2012). Perceived competency in working with LGB clients: Where are we now? Counselor Education and Supervision, 51(1), 2-16. doi: 10.1002/j.1556-6978.2012.00001.x

Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: The National Academies Press.

Lyons, H. Z., Kieschke, K. J., Dendy, A. K., Worthington, R. L., & Georgemiller, R. (2010). Psychologists’ competence to treat lesbian, gay and bisexual clients: State of the field and strategies for improvement. Professional Psychology: Research and Practice, 41(5), 424-434. doi: 10.1037/a0021121

Ponterotto, J. G., Rieger, B. P., Barrett, A., & Sparks, R. (1994). Assessing multicultural counseling competence: A review of instrumentation. Journal of Counseling and Development, 72(3), 316-322. doi: 10.1002/1556-6676.1994:tb00941.x

Pope-Davis, D. B., Reynolds, A. L., Dings, J. G., & Nielson, D. (1995). Examining multicultural counseling competencies of graduate students in psychology. Professional Psychology: Research and Practice, 26(3), 322-329. doi: 10.1891/088970108805059525

Rutter, P. A., Estrada, D., Ferguson, L. K., & Diggs, G. A. (2008). Sexual orientation and counselor competency: The impact of training on enhancing awareness, knowledge and skills. Journal of LGBT Issues in Counseling, 2(2), 109-125. doi: 10.1080/15538600802125472


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