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

Multiple 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.

References: 

1. American Psychological Association. (2011). Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients. Retrieved from http://www.apa.org/pubs/journals/features/amp-a0024659.pdf
2. Broverman, Neal. (2016, March 18). How Our Intolerant Society Contributes to LGBT Mental Disorders. Advocate. Retrieved from http://www.advocate.com/health/2016/3/18/how-our-intolerant-society-contributes-lgbt-mental-disorders
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.

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