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Creating a welcoming space for LGBTQIA+ clients

Written by Aaron Testard, LMFT, LPCC

A rainbow concept for LGBTQIA+ people.

As a mental health professional, you must do the work to avoid hurtful mistakes commonly made when working with LGBTQIA+ clients. An LGBTQIA+-friendly practice is not the same as an LGBTQIA+-informed one—and it’s time to close the gap.

Here are 12 common mistakes that clinicians make when working with LGBTQIA+ clients, along with six simple, affirming practices.

12 common mistakes therapists make that break trust

  1. Being neutral about microaggressions or systemic injustices.
  2. Using heteronormative language in intake paperwork or during interviews.
  3. Using outdated terminology.
  4. Failing to use proper pronouns or misgendering your client, especially when you do it repeatedly.
  5. Not understanding basic ideas about sex and gender.
  6. Taking an “all relationships are the same” approach.
  7. Being overly apologetic or defensive after making a mistake with terminology or pronouns.
  8. Being evasive about sex and gender when a client wants to talk about it.
  9. Asking invasive questions about the client’s sex life, body, or gender transition that are not clinically relevant.
  10. Being unaware of your own homophobia, transphobia, or heterosexism, and/or denying it.
  11. Not staying up to date on current events that affect LGBTQIA+ people.
  12. Pushing clients to take steps toward coming out or a transition that they are not ready for.

6 simple practices for affirming LGBTQIA+ clients

1. Use the client’s language to define them and their practices. Sexuality and gender cannot be categorized neatly into binaries; rather, they exist on a spectrum of possibilities. A client may feel neither completely feminine nor masculine—ask them where they see themselves on a spectrum, rather than forcing them to choose one or the other.

Be aware that the LGBTQIA+ community includes more groups of people than the acronym lists. There are other sexual identities, such as aromantic, demisexual, and sexually fluid, as well as gender identities, such as agender, bigender, and nonbinary. In the spirit of inclusivity, keep in mind that there are many ways of identifying other than as lesbian, gay, bisexual, transgender, queer, intersex, or asexual.

If you’re ever unsure, ask a client which words they prefer to use. The more open we are about gender and sexuality, the more effective we will be in working with the LGBTQIA+ community.

2. Know and use the most up-to-date terminology. Increasingly, the LGBTQIA+ community is nonbinary and inclusive. Many people feel more comfortable using the term “queer” rather than putting a specific label on their sexual orientation or gender identity. Despite past negative connotations, queer is now an acceptable term to use in many contexts—but remember that not everyone chooses to define themselves as queer. Always be sure to ask what term your client prefers.

Use gender-affirming language—and avoid outdated, potentially offensive terms. For example, use “trans” or “transgender” rather than the outdated term “transvestite.” One easy way to be more inclusive is to swap out the phrase “both men and women” for “people of all genders.”

3. Include LGBTQIA+ literature and imagery in your waiting area and office. This immediately signals to your client that they’re in a safe environment, as do gender-neutral restrooms. If it’s not possible to provide gender-neutral restrooms, acknowledge it to your trans and nonbinary clients.

In addition, be aware of how you greet clients. Avoid using gendered terms of address such as “ma’am” or “sir.”

4. Include queer- and trans-inclusive language in your paperwork and intake forms. On all paperwork, leave the “sexual orientation” and “gender” options blank instead of requiring clients to pick from a list of options. Let the client define their sexual orientation and gender, rather than limiting what they can choose. If you must provide a predefined list of options, be as inclusive as possible.

Using the correct pronouns is a recognition and a validation of who a person is. Be aware of—and don’t assume—anyone’s pronouns. Consider including your own pronouns on your website, business cards, and marketing materials, and in your email signature.

5. Familiarize yourself with local LGBTQIA+ resources, and be prepared to offer them to clients. It can be useful to have a list of legal, medical, and social institutions that are supportive and competent. Especially if you work in a smaller city or town, don’t be afraid to reach out to these resources and establish their level of LGBTQIA+ competency before referring clients. This is especially important when referring high-risk clients to outpatient programs or hospitals.

6. Be an active ally in helping and validating clients. Our LGBTQIA+ clients often deal with frequent—or even constant—experiences of invalidation in the world. It’s important to be mindful of this and to avoid neutrality when clients bring it up. In other words, be an ally and side with the client.

Resources for becoming an LGBTQIA+-affirming therapist

The self-study course “A Complete Guide to Becoming an LGBTQ+-Affirming Therapist” features five experts in the field. Through step-by-step video modules, intake and assessment materials, and pertinent case studies, you can develop individualized, turnkey treatment approaches for every step of your client’s unique self-discovery process. You’ll walk away with clear strategies for comfortably engaging clients around cultural norms, gender, sex, relationships, and terminology.

Get started today.

Aaron Testard, LMFT, LPCC, is a psychotherapist in private practice in Berkeley, California, with nearly 20 years of experience. He received his MA in counseling psychology from the California Institute of Integral Studies and is a trained drama therapist, sensorimotor therapist, and practitioner of the Gottman couple’s method, EMDR, and DBT-informed client work. He served as director of clinical programs at the Pacific Center for Human Growth, an LGBTQIA+ counseling and support center, and as an addiction counselor, a high school counselor, and a consultant for a felon reentry program. His current practice focuses on sexual and gender identity, working with adults, adolescents, and couples.

Learn more about Aaron Testard’s educational products, including upcoming live seminars.

About the publisher

For more than 40 years, nonprofit organization PESI, Inc., has provided cutting-edge continuing education to professionals across the nation. Working alongside the world’s leading experts, PESI educates and instructs the general public, public organizations, private industry, students, and professionals in acquiring, developing, and enhancing their knowledge and skills.

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