Working with Lesbian, Gay, Bisexual, Transgender and Questioning Clients
January 12th, 2012
By Dr. Andrew Mendonsa, Psy.D., Suicide Topic Expert Contributor
As you would with any client, be sure to conduct a complete and comprehensive interview. Be sure to ask about what they thought life would be like, versus what reality is. Is there a loss of a dream? Any traumas? Are they ‘out’ or in process of coming out? It is wise to remember and even educate folks that ‘coming out’ is a lifetime process and not a discreet event. People may ‘come out’ at different levels in different settings (e.g. family, friends, work, etc). Be prepared to ask questions over time, as answers will change as clients feel more comfortable and safe.
LGBTQ clients are at increased risk for mental health problems. Various research studies suggest that substance use, mood disorders, depression, anxiety and suicide rates are higher at various points in LGBTQ clients. Because of this you must feel comfortable asking the hard questions, such as questions around high risk behaviors (prostitution, drugs), criminal justice problems, safety and the need for high levels of care. Remember, the more information you have, the more you can do for your client.
Clarify terms early. Does your client prefer to be referred to as a ‘he’ or ‘she’? Is there another name they would like to be known as? When discussing a case with colleagues, how would your client like to be referred to?
Most LGBTQ actually do not seek services specifically related to their sexual orientation. Instead they are likely to seek services because of aspects of their life affected by their orientation. It is important to clarify this early in the treatment relationship.
Find the right professionals for your client. If your client needs medications or a psychological evaluation, be sure to refer them to a provider who has training and experience with LBGTQ clients. As you would with your client, do not be afraid to ask referral sources why they are a good referral for your client.
Understand human development. While your client might be LGBTQ, they are still humans. Understanding human development and the complexities of what LGBTQ clients struggle with, will give you an excellent framework for therapy. Encourage your clients to tell you how their development is the same or different from traditional developmental models.
Allow yourself to learn. No one is an expert automatically. Clients are sympathetic to providers willing to learn and grow with them. Be open to supervision, outside agency consultation, research and continuing education. It is a clinician’s ethical obligation to explore their own beliefs about LGBTQ issues and decide how they affect the clinical picture. Is there comfort and acceptance of same-sex intimacy as a healthy lifestyle?
Have an inviting office. Is your office inviting for LGBTQ clients? Is there any mention of same-sex lifestyles in artwork or books? Does your bookshelf have LGBTQ-related books? Are there resources in the waiting area that are LGBTQ-friendly? If applicable, is there mention of LGBTQ treatment competence on your website?
Resources (from various publications and websites)
- Bernstein, G.S,. & Miller, M.E. (1995). Behavior therapy with lesbian and gay individuals. In M. Hersen, R.M. Eisler, & P.M. Miller (Eds.), Progress in behavior modification: Vol. 30 (pp. 19-45). Newbury Park, CA: Sage.
- Hart, T. A., & Heimberg, R.G. (2001). Presenting problems among treatment seeking gay, lesbian, and bisexual youth. Journal of Clinical Psychology, 57, 615-628.
- Israel, G.E., & Tarver, D.E. (1997). Transgender care: Recommended guidelines, practical information and personal accounts. Philadelphia, PA: Temple University Press.
- Kaysen, D., Lostutter, T.W., & Goines, M.A. (2005). Cognitive processing therapy for acute stress disorder resulting from an anti-gay assault. Cognitive and Behavioral Practice,12, 278-289.
- Martell, C. R., Safren, S. A., & Prince, S. E. (2003). Cognitive-behavioral therapies with lesbian, gay, and bisexual clients. New York: Guilford Press.
- American Psychological Association (APA) Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients http://www.apa.org/pi/lgbc/publications/guidelines.html
- APA Division 44 (Society for the Psychological Study of Lesbian, Gay, and Bisexual Issues). http://www.apa.org/divisions/div44. Contains information regarding APA’s position on working with LGB clients, current LGB research, and the Division 44 newsletter.
- The Bisexual Resource Center. http://www.biresource.org/ The Bisexual Resource Center is an international organization providing education about and support for bisexual and progressive issues.
- The Kinsey Institute. http://www.indiana.edu/~kinsey/ The Kinsey Institute conducts research on sexual behavior and health and individual and gender differences in sexual response. Listing of current publications on their website.
- The Queer Resources Directory. http://www.qrd.org/ International site with wide range of information and links to other sites including information on religion, parenting, legal issues, and health issues.
- International Foundation for Gender Education. http://www.ifge.org/index.php Foundation addressing a broad range of issues related to gender and sexual orientation. Website includes information about printed resources, employment issues facing LGBT individuals, and current LGBT-related news.
- Transcend: Transgender Support & Education Society. http://www.transgender.org/transcend/index.htm. Organization dedicated to addressing the social, political and economic conditions that negatively impact transgender and intersex individuals. Provides peer advocacy and information about selecting an appropriate service provider.
Related Articles:
LGBT Therapy and Me: Choosing the Best Therapist
Coming Out as an Adult
©Copyright 2012 by Dr. Andrew Mendonsa, Psy.D., therapist in Sacramento, CA. All Rights Reserved.
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5 Comments | Click here to leave a comment.
Comments
Maybe I come from a small town and don’t get it, but there seems to be an awful lot of this “questioning” going around that you never see where I live, or that I ever experienced when I was growing up.
When I was growing up and in school, everyone just dated who we thought we were supposed to. And it is not that I am against this group, because I guess you love who you love and sometimes you have no control over that, but I still find my mind closing from time to time when I have to think about it too much.
I am still not sure how I would feel if my own child came to me and told me he was confused about this. I want to think that I could live with it, but could I?
Well,treat them like any other patient right??
And I am well aware that their problems could be a little different and maybe they are more prone to mental health problems.But if we try and separate them as a different group,its only going to get worse.
You are going to know in an instant if the office invites you in. This is what those who are seeking help need, someone loyal that they can trust and that they know they can count on no matter what issues they could be facing.
I think a lot of understanding and professionalism is required of a therapist while dealing with clients from the LGBTQ community..Their needs are a little different and so is the reason for the problems..But a little modification can not only help them but also provide a lifeline to a community that faces discrimination and unsuited-ness in most areas of life.
Just like with being a teacher it is going to take a very special sort of therapist to work with this community. These are part of society that needs a lot of understanding but also a lot of answers to questions that they may have about themselves- who they are and what they want to be. They may also some help and guidance with how they could better let others know about their situation as well as giving them the voice to speak up for themslves. None of this is destined to be an easy task, so it would be a whole lot better if they are working with someone who understands the specifice issues that the LGBT community experiences and is willing to listen to listen and love and support open mindedly.
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