Creating a Safe Space for LGBTQ+ People in Therapy

“It takes no compromise to give people their rights…

it takes no money to respect the individual.

It takes no political deal to give people freedom.

It takes no survey to remove repression.”

~Harvey Milk

by Gavin Hannegan, Cal Poly, San Luis Obispo undergraduate intern, supervised by Dr. Hannah Roberts

Therapy can be an incredibly rewarding experience, so it is important to create a comfortable environment for your clients. For LGBTQ+ folk, it is even more important. The therapist-client relationship can offer a safe space for LGBTQ+ individuals to be able to freely express themselves without judgment. But this community may feel overwhelmed trying to find a therapist that affirms them. You might explicitly state that you welcome people of all backgrounds, which is a great start, but how can you follow this statement up with action?

Here, we will be offering a few tips to help you better affirm your LGBTQ+ clients. As you read, keep in mind that the process of building that trust with your client may take time. Some clients may be more receptive to you than others. But with enough time, the relationship you build with your LGBTQ+ clients can become a valuable resource for that community.

Be Open to Learn

A common misconception is that to be an LGBTQ-affirming therapist, you have to also identify as a  member of the LGBTQ community, but practicing empathy with your clients can help bridge any gaps. One theme that emerged in interviews with SLO County residents who attended therapy is that positive experiences with therapists occurred when the therapist were willing to learn more about LGBTQ identities, regardless of if the therapist identified as LGBTQ or not (Bettergarcia et al., 2021). You might ask your clients some questions about their identities to better understand your perspective. Here are some examples:

• “Tell me more about this.”
• “I’m not sure I fully understand where you’re coming from. Could you help me understand?”
• “What makes you feel most affirmed?”

Allow your clients to educate you too. They should feel comfortable enough to correct you and explain how that made them feel. However, it is not their job to teach you everything about how to effectively work with the LGBTQ+ population; you may need to do some homework and develop your knowledge outside of the session.

Actively Validate Their Identities

An active effort with your LGBTQ+ clients is key. In their research, Anzani et al. (2019) distinguish between passive forms of affirmation towards trans people (i.e., not using microaggressions) and active forms of affirmation (i.e., encouraging gender exploration). While both forms can be helpful, Anzani et al. (2019) recommend that therapists strive to be actively affirming in order to help their clients navigate the cisnormativity that exists within society. Active validation looks like:

• Connecting your clients to local groups and resources
• Using your client’s correct name and pronouns before, during, and after transitioning
• Treating your client’s identities as normal and authentic

In other words, an affirming therapist should do more than the bare minimum. The work that you do with the LGBTQ+ population can create positive change both in and out of a session. Take some time to reflect on how you approach LGBTQ+ issues with your clients. Do you simply acknowledge homophobia or transphobia or do you work with your clients to develop tactics to combat these prejudices? 

Treat Your Clients as Individuals, Rather Than as Representatives of A Group

The ways in which one client experiences their identities might not be the same ways that other queer folk experience their identities. If you generalize these experiences by saying something like, “All gay people experience…,” then that could harm your connection with your clients. Remember that the label of LGBTQ+ encompasses many different identities. In one survey, mental health clinicians reported that even though they might be affirming of lesbian, gay, and bisexual clients equally, they actually perceive themselves to be more competent when treating lesbian and gay clients compared to bisexual clients (Ebersole et al., 2018). Each of these distinct identities can bring unique experiences–on top of the unique experiences that each individual already has! If you feel unfamiliar with some of the identities within the LGBTQ+ label, it may be best to do some research on your own time. You can also ask your clients for clarification, but do this sparingly. You might also need to adopt a multicultural approach and to consider the interplay of multiple identities. Keefe et al. (2023) found that racial and ethnic minorities who also identified as LGBQ responded best to mental health programs that emphasized the minority stress model, compared to those that did not implement this model. In other words, racial and ethnic minorities may be subject to discrimination based on race and discrimination based on LGBTQ+ status, so you should account for each of these influences when they apply. 

One last note: a client’s reasons for attending therapy might not even be related to their gender or sexual identity. While you should not outright ignore their identities, it may not be necessary to always attribute certain topics to their gender identity or sexual orientation. These identities are just a few aspects of who someone is. Remember that this is your journey, and you deserve to feel respected and affirmed in the ways that feel most comfortable to you. 

Feel like you want your clients to have more information? Here’s a blog post that features the same tips, but directed specifically towards potential clients seeking LGBTQ-affirming therapists.

Have more questions or feel like you need supportive therapy? Schedule a session with one of our therapists today! You can schedule online here!

We hope you enjoyed this blog post! Have more topics you’d like us to blog about? Contact us and we’ll be sure to include your topic in a future post!

References

Anzani, A., Morris, E. R., & Galupo, P. (2019). From absence of microaggressions to seeing authentic gender: Transgender clients’ experiences with microaffirmations in therapy. Journal of LGBT Issues in Counseling, 13(4), 258-275. https://doi.org/10.1080/15538605.2019.1662359

Bettergarcia, J., Wedell, E., Shrewsbury, A. M., & Thomson, B. R. (2021). “There’s a stopgap in the conversation”: LGBTQ+ mental health care and community connection in a semi-rural county. Journal of Gay & Lesbian Mental Health, 26(1), 48-75. https://doi.org/10.1080/19359705.2021.1900973

Ebersole, R. C., Dillon, F. R., & Eklund, A. C. (2018). Mental health clinicians’ perceived competence for affirmative practice with bisexual clients in comparison to lesbian and gay clients. Journal of Bisexuality, 18(2), 127-144. https://doi.org/10.1080/15299716.2018.1428711

Keefe, J. R., Rodriguez-Seijas, C., Jackson, S. D., Bränström R., Harkness, A., Safren, S. A., Hatzenbuehler, M. L., & Pachankis, J. E. (2023). Moderators of LGBQ-affirmative cognitive behavioral therapy: ESTEEM is especially effective among Black and Latino sexual minority men. Journal of Consulting and Clinical Psychology, 91(3), 150-164. https://doi.org/10.1037/ccp0000799