Many providers claim they are queer-affirming, but what does this actually mean in practice? This Pride Month, all types of mental health clinicians must reflect on their own comfort, supervision, practice, and education around working with LGBTQIA+ clients in therapy or counseling.
Providing effective mental healthcare for queer folks requires more than just standard therapeutic techniques. In a 2020 study for the National Institute of Health, it was found that while psychotherapy with LGBTQIA+ patients often involves discussing universal human experiences like relationships, work, and social circumstances, the impact of providing more specialized psychotherapy when a client has identified a specific sexual orientation or gender identity should be in a therapist’s training toolkit. One’s orientation, identity, and interests are fluid over a lifetime, which makes it crucial to have a therapist with deeper knowledge regarding fluidity to normalize what a client may feel as they grow and change.
The Risk of a Therapist’s Lack of Comfort With Issues Facing LGBTQIA+ Clients
Comfort addressing sensitive topics including sexual and romantic experiences within the LGBTQIA+ community is absolutely paramount for all therapists and couples counselors. The same 2020 study by Drescher and Fadus states that the therapist’s own discomfort or lack of awareness can lead to missing key emotional and sexual aspects of a patient’s experience, causing clients to feel isolated and misunderstood. Mental health providers have historically reported little training in LGBTQ-specific issues and can sometimes unconsciously express biases.
A clinical example: A therapist assumes that their cis-female client discusses her relationship with a partner named “Kora”. The therapist assumes she is involved with another cis-gender woman and uses she/her pronouns to describe Kora, who uses they/them. While the client may inform the therapist that Kora does not identify as a woman, she may then feel anxious about explaining that her partner recently had top surgery to better affirm their gender non-binary identity. It also might inhibit the client from expressing the ambivalent feelings the surgery brought up for her including a combination of happiness for her partner, worry about her partner’s health, missing her partner’s breasts which she was erotically drawn to, and fear that she might lose sexual attraction to them. She might not feel that it’s acceptable to express the shame and guilt she feels for having all these concerns and that she should only feel positive about her partner’s ability to fulfill their dream of healing their gender dysphoria.
A lack of preparedness on the therapist’s part can also contribute to LGBTQIA+ clients anticipating discrimination and mistrust of other medical providers, leading to avoidance to getting mental healthcare, medical and sexual healthcare. To become more comfortable, clinicians should continue engaging in specialized education, training, and proper supervision surrounding clients’ sexuality, orientation, and behaviors.
What Specialized Therapist Training and Supervision Should Include
To provide the best care and improve patient outcomes, practitioners need specific sexuality related preparation. This includes training to become comfortable initiating discussions around sexual orientation(s), gender identity(ies), erotic fantasies and sexual practices. Training should cover basic knowledge of societal and medical challenges common in the LGBTQIA+ community, such as:
- Discrimination
- Homophobia
- Safer sex
- Sexually transmitted diseases
- Mental health diagnoses like Depression and Generalized Anxiety, which are experienced at higher rates in this population.
Without specialized training, providers risk losing the trust of their clients. In a recent peer-reviewed article titled “Cultural Competence in the Care of LGBTQ Patients”, authors Brittany Bass and Hassan Nagy clearly state different complications, slang used, medical treatment needed, and other aspects of the queer community that medical professionals should know. It is a great resource to get started on obtaining didactic education on how to best attend to queer clients.
Additionally, see what other continuing education courses are available for therapists to remain up-to-date on the latest evidence-based care. A 2022 NIH study showed that an online training in LGBTQIA+ affirming Cognitive Behavioral Therapy helped disseminate and improve evidence-based therapists’ care to queer folks. While AASECT Certified Sex Therapists and Counselors are required to receive education, clinical experience, and many hours of supervision about clients that identify as sexual minorities or on the LGBTQIA+ spectrum, not all therapists can afford the resources and time needed to invest in such training. There are other ways to gain training through certification programs and/or programs that offer AASECT CE eligible courses/webinars, along with supervision with a Certified Sex Therapist or specialist in the field.
How Clinical Supervisors Can Provide LGBTQIA+-Informed and Cultural-Minority Expertise to Therapists
The clinical concept of parallel process, suggesting that supervisor-therapist interactions can reveal or mirror what’s happening between therapist and client, has a deep-rooted history in psychodynamic and psychoanalytic education. In a 2017 study for the Journal of Counseling Psychology, 12 predoctoral interns were interviewed to see how they utilized clinical supervision when working with lesbian, gay, and queer clients. The findings showed that all participating trainees, both those identifying as heterosexual and LGQ, had significant benefits from supervision that positively influenced their therapeutic work with all clients, not just those from sexual minority groups. Heterosexual supervisees felt as though it helped ensure their heterosexuality didn’t hinder affirmative care. LGQ supervisees felt it assisted in managing overidentification and disclosure decisions. All stated that queer-affirming supervision offered support, fostered awareness of queer issues, and enhanced their overall competence and therapeutic skills.
This Pride Month, supervisors and psychotherapists should be working to broaden their knowledge on the LGBTQIA+ community. As trans and queer folks are coming under more pressure and at times violence leading them to hide their identities, it is of the utmost importance that all clinicians invest time in their own clinical skills and education to better serve the unique needs of LGBTQIA+ clients and supervisees. It is not enough to simply say that a therapist is an “ally” or “queer-affirming” if they have not done the work to back it up. To create a safe space for the queer community, we must be ready to work to make sessions as supportive and therapeutic as possible.
