Out On The Couch

Working With LGBTQIA+ Clients: What Therapists Should Know

Posted: 3-30-22 | Andrew Kravig

Two masculine presenting clients sit on a sofa facing a therapist. The image represents the importance of affirmative care when working with LGBTQIA+ clients.

As a therapist, your first priority is understanding your clients’ needs. This is no less true when working with LGBTQIA+ clients. Many therapists have distanced relationships with the LGBTQIA+ world.  Some clinicians do not feel the need to explore LGBTQIA+ experience and identity. This lack of exposure threatens to hinder your work with members of the LGBTQIA+ community. This can further damage the wounds these clients are seeking treatment for. Luckily, there are many ways to educate yourself and expand your practice so that you can offer the best possible treatment for your queer clients. Here are just some of the things therapists need to know about working with LGBTQIA+ clients.

Educating Yourself

The first thing a therapist needs to keep in mind when working with LGBTQIA+ clients is the importance of education. When providing therapy to the LGBTQIA+ community, an understanding of the history of societal oppression that queer folk have experienced is essential. Without knowledge about topics like minority stress, microaggressions, political gatekeeping, or internalized queerphobia, it will be impossible to fully grasp your clients’ lived experience. In order to provide effective treatment, you will need to develop a deep understanding of experiences unique to the LGBTQIA+ community, including both experiences your client is dealing with in their everyday life as well as the impact of historic events or generational trauma. Even our ethical standards expect us to have a certain level of education in working with LGB and trans clients.

Celebrating LGBTQIA+ Life and Community

But it is also important to extend your education beyond an awareness of the hostility, disenfranchisement, and trauma experienced by this community. LGBTQIA+ folk have built a beautiful world for themselves that includes new approaches to politics, embodiment, learning, growth, community building, gender identity, sexuality, language, and culture. Educating yourself on different gender identities, pronouns, cultural terminology, significant historical figures, and political projects will also be essential to your therapeutic work. Get to know the nuances of LGBTQIA+ life and community so that you can properly see and contextualize the joys and struggles of your queer clients.  Bottom line is: take in as much knowledge as you can about the things that directly affect your clients, and continue educating yourself every day.

 Avoiding Assumptions and Prejudices

Avoiding assumptions and challenging your own prejudices are also crucial for therapists working with LGBTQIA+ clients. The LGBTQIA+ community has dealt with oppression for generations due to the impact of homophobia and not fitting into heteronormative societal structures. The field of psychology is no exception to this history of discrimination, and has remained a major site of trauma for queer folk, even into the 21st century. In years past, members of the LGBTQIA+ community were routinely subjected to “conversion therapies,” ranging from talk therapy denigrating same-sex attraction all the way to electroshock therapy in an attempt to curb “deviant” behavior. Sadly, these are practices that remain legal in many states, or have taken on new names to escape oversight or public scrutiny.

Even therapists who refrain from these aggressive, damaging approaches often practice therapy steeped in their own prejudices about what it meant to live a queer life. For this reason, it is no surprise that members of the LGBTQIA+ community have not always found solace in the world of psychotherapy. This makes it all the more necessary to work intentionally to challenge assumptions and prejudices when treating LGBTQIA+ clients. Luckily, there are many resources available for continuing education, LGBTQ-Affirming consultation and trainings, supervision, or community support from agencies dedicated to this work. Therapists need to come from a place of openness, understanding, and respect when speaking with clients. The quality of the therapeutic work will depend on your clients not feeling judged, dismissed, or overlooked when sharing their experiences.

Creating a Safe and Welcoming Environment

The third thing therapists need to know about working with LGBTQIA+ clients is the importance of creating a safe, welcoming environment. After enduring years of systemic oppression, many queer folk have deep distrust for medical, governmental, and religious spaces, and may feel that these places are unsafe for them. To allow your clients to open up and feel safe enough to be vulnerable, it is all the more important that they feel your office environment is a welcoming one. Never underestimate the importance of initial rapport building!

  • When your clients walk into the office, do the resources, decorations, amenities, and signage include them and speak to their needs?
  • Is your office located in a part of town that might feel hostile to members of the queer community?
  • Do your clients have access to gender neutral restrooms?

As a therapist, it is crucial to build a space where your client feels they can trust you. And even when your queer clients are through the door, in the office, and sitting across from you, are you able to speak about their identities and lived experience with ease? Stumbling over pronouns, misgendering or deadnaming a client, and other microaggresions will impede the process of building rapport. The therapeutic process will be stymied if you are unable to utilize inclusive language and proper gender pronouns when communicating with your clients. The LGBTQIA+ community deserves to feel safe and respected in all spaces, especially therapeutic ones, just like everyone else. You won’t regret putting in the necessary effort to ensure your clients receive the best experience at each appointment.

From Awareness to Practice

Now is the time to start (or continue!) your educational adventure into the world of LGBTQIA+ health and wellness! The first step is awareness, and now that you’re aware of some of the things therapists should know about working with LGBTQIA+ clients, you can begin implementing these strategies today. And luckily, you’ve come to the right place! Check out some of the articles, courses, and trainings offered here at The Affirmative Couch, and discover more ways to make your practice an affirming, welcoming environment for your LGBTQIA+ clients. 


Learn more from our CE courses

"Gender Minority Stress in Adolescent by Melissa Dellens, MA, AMFT 6 CE Course" underneath an image of a child crossing a street with a rainbow colored crosswalk         "Identity development around sexuality, gender, and relationships presented by Cadyn Cathers, PsyD 5 CE Course" under a rainbow image of several silhouettes with a magnifying glass to denote identity development in LGBTQIA+, CNM, and kink communities      Geometric heart with infinity symbol in front. Underneath "Polyamorous Clients in Therapy: What You Didn't Know You Needed to Know Presented by Stephanie M. Sullivan, MS, LLMFT, 3 CE Course"


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