Featured Article: Creating an LGBT-inclusive environment as a therapist

Creating an LGBT-inclusive environment as a therapist

For LGBT people, each day presents the possibility of exposure to name-calling, anti-LGBT jokes and stereotypes, nonrepresentation, subtle and overt discrimination, and threats of violence or assault.

As a result of this context and their prior experiences, sexual and gender minorities are acutely attuned to signs of prejudice or exclusion. For clinicians and psychotherapists who wish to treat LGBT people, it is critical that they present an environment of respect and inclusion from making the first impression to engaging the individual in therapy.

The belief that LGBT people will feel welcome in a clinic environment in which sexual orientation and gender identity are ignored until the patient raises these issues is patently false. LGBT people may be especially sensitive to heterosexist language, attitudes, and actions by psychotherapists, including being excluded or not represented in the clinic environment.

Making a good first impression:

  • Be seen in the community – participate in pride events, transgender day of remembrance activities, find local LGBT-focused community centers and fund-raisers.
  • Advertise a willingness to see LGBT people – note it on business cards, consider placing an ad in local LGBT papers or magazines. If a non-LGBT therapist is using any of the popular symbols – the rainbow flag, transgender symbol – these should be accompanied by a phrase such as ‘LGBT ally’.
  • Recognise LGBT people in your office – what is your office environment saying? What kinds of people are represented in images on the walls? Consider including LGBT-inclusive material in the waiting room.
  • Use inclusive assessment questions – Typical intake forms ask for ‘sex’ instead of ‘gender’, and ask for the name of the patients ‘husband or wife’. Inclusive forms will ask for ‘sex assigned at birth’, ‘gender identity’, and replace ‘marital status’ with ‘relationship status’.
  • Train staff to be welcoming and professional –Using the name and gender preferred by the patient (regardless of legal name or birth sex) can help to promote an inclusive atmosphere. Establishing and posting a personnel and patient non-discrimination policy can communicate these expectations to staff and patients.
  • Provide unisex or single-occupancy restrooms – but if only gendered restrooms are available, allow people to use the room they feel most comfortable using. If other people are upset by an LGBT patient using the restroom, support the patient’s right to use the facilities consisted with their gender identity.

 Providing affirming services:

  • Ask about the individual’s preferred name and gender – this communicates respect and can be particularly meaningful to transgender individuals. If you slip when first using a new preferred gender pronoun, sincerely apologise and promise to do better – people will appreciate sincerity and effort.
  • Self-disclosure requires rapport and trust – patients may not disclose sensitive information on the intake form, or during initial visits; they need to feel they trust their therapist before disclosing. Therapists who understand this will periodically review identity-related information, which allows the patient to comfortably disclose information at their own pace.
  • Listen to and mimic patients’ language – active listening promotes rapport. Listen to how patients refer to themselves and their relationships. For example, the absence of pronouns when talking about relationships may suggest concern around being judged for same-sex experiences.
  • Be open to different ways of being - Variety in human experience and relationships is really the norm. Therapy should be a safe place to explore different identities and different kinds of relationships. Be prepared by learning the subtle differences used in terms describing open relationships, such as polyamory, nonmonogamy, monogamish, and polyfidelity.
  • Become educated on LGBT issues – therapists should not expect their patients to be their teachers. By talking to LGBT friends, going to events, and attending LGBT-themed community lectures, as some examples, you can develop awareness and gain foundational knowledge about the community.
  • Know when the issue is not about LGBT status – Sometimes in an attempt to be supportive and welcoming, therapists can become too focused on a patients LGBT status. There will be times when this status is not salient to the presenting problem.