Working with Lesbian, Gay, Bisexual, Transgender, and Questioning People

Couple sitting at dinner table with two childrenMultiple studies show that LGBT+ individuals in the United States experience mental health concerns at high rates; thus, it is likely you will work with LGBT+ people at some point, if you do not already.

Like all other individuals, LGBT+ and questioning people may seek therapy for a number of reasons. They might want a safe space to express what they have realized or are coming to understand about their sexual orientation or gender identity or to address any challenges they may face in the process of coming out. Some may experience discrimination and harassment from people in their daily lives and seek counseling to address any mental health concerns (such as depression, stress, or anxiety) they might experience as a result of this lack of acceptance. But many LGBT+ people experience little to no difficulty or distress as a result of their LGBT+ identity and may seek therapy for unrelated reasons, such as family challenges or relationship issues.

It may be helpful to consider the following when working with LGBT+ individuals:

As you would with any person in therapy, be sure to conduct a complete and comprehensive interview. Individuals seeking therapy may have concerns completely unrelated to their LGBT+ identity, or they may be seeking therapy for reasons associated with this identity.

Are they out or have they begun the process of coming out? People may come out at different levels in different settings (e.g. family, friends, work, etc), and coming out is more of a lifetime process than a discreet event.  Be prepared to ask questions over time. Coming out may have positive effects for many, but many also face challenges when coming out. Some may choose never to come out.

LGBT+ people are at increased risk for mental health concerns. Various research studies indicate LGBT+ individuals experience depression, anxiety, and suicidality at higher rates. Members of the LGBT+ community may also be at increased risk for substance abuse as well as homelessness, risky behaviors, and lack of family support, all of which may influence the development of mental health concerns.

Clarify terms early. It may be a good first step to ask the person in therapy their pronouns and preferred name, if this name differs from their legal name, and use the correct pronouns and name consistently.

Many LGBT+ individuals do not seek services specifically related to sexual orientation. Most are likely to seek services because of other aspects of their life. These concerns may or may not develop in relation to identity, and it is generally a good idea to keep in mind that even when one’s identity and/or orientation does contribute to the development of mental health concerns, it is not necessarily the case that identity or orientation has caused that individual distress. Clarifying what has brought a person to therapy is an important early step in treatment.

Find the right professionals for the person. If the person in therapy needs medication(s), other medical care, or a psychological evaluation, it is generally best to refer them to a provider who has training and experience with LBGT+ people. Asking referral sources what makes them a good referral for a person in your care may be a good idea and in the best interests of the person you are treating.

Allow yourself to learn. No one is an expert automatically. People are likely to be more sympathetic to providers willing to learn and grow with them and respect their identity and orientation. This may include their partner(s), pronouns, and chosen name. Be open to supervision, outside agency consultation, research, and continuing education. It is a provider’s ethical obligation to explore their own beliefs about LGBT+ issues and decide how these beliefs may affect the care they provide.


  1. American Psychological Association. (2011). Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients. Retrieved from
  2. Broverman, Neal. (2016, March 18). How Our Intolerant Society Contributes to LGBT Mental Disorders. Advocate. Retrieved from
  3. Hart, T. A., & Heimberg, R.G. (2001). Presenting problems among treatment-seeking gay, lesbian, and bisexual youth.  Journal of Clinical Psychology, 57, 615-628.
  4. Martell, C. R., Safren, S. A., & Prince, S. E. (2003). Cognitive-behavioral therapies with lesbian, gay, and bisexual clients.  New York: Guilford Press.

© Copyright 2012 All rights reserved. Permission to publish granted by Andrew Mendonsa, PsyD, therapist in Sacramento, California

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Bettina S

    Bettina S

    January 12th, 2012 at 5:22 PM

    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?



    January 12th, 2012 at 11:33 PM

    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.

  • Lara F

    Lara F

    January 13th, 2012 at 5:41 AM

    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.

  • bryan


    January 13th, 2012 at 11:54 PM

    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.

  • rene


    January 15th, 2012 at 6:00 AM

    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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