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Clinicians

How to Support LGBTQ Clients in Therapy: Advice from Five LGBTQ+ Therapists

Brandon Grill
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June 14, 2024
Learn effective strategies for supporting LGBTQ clients in therapy. Discover practical steps to create a safe and affirming environment for LGBTQ clients and to help them overcome struggles.

Supporting LGBTQ+ clients in therapy is unlike supporting any other type of client. There’s a lot of information that can be missed in therapy if you’re not familiar with LGBTQ culture. And that goes for therapists who are part of the LGBTQ community, too. It’s not a given that being an ally or being part of the LGBTQ community translates into effective therapy.

That’s why we asked five therapists who specialize in helping the LGBTQ+ community for their tips, tricks, and best practices. Their responses can help therapists like you create an inclusive and affirming space, help clients overcome their struggles and embrace their identities, and stay up to date with best practices.

Common Therapeutic Goals for LGBTQ+ Clients

We asked our five experts about what they're seeing in their day-to-day therapy practie. What are the common presenting concerns of LGBTQ+ clents?

Symptom Reduction

One of the primary goals in therapy for LGBTQ+ clients is symptom reduction. This includes addressing mental health issues such as depression, anxiety, PTSD, and substance use.

Dr. Michael Grey, PsyD, emphasizes the importance of symptom reduction, including the symptoms of depression, anxiety, PTSD, and substance use.

“Most times, people come to therapy in a crisis; having dealt with the pain for so long, they are looking for relief,” he said.

Therapists must be equipped to help LGBTQ+ clients manage these symptoms effectively, ensuring they receive the competent care necessary to improve their overall well-being.

Identity Exploration and Acceptance

A significant aspect of therapy for LGBTQ+ clients involves exploring and accepting their gender and sexual identities. This process often includes overcoming internalized shame and stigma.

Kristie Tse, LMHC, highlights the range of issues LGBTQ+ clients seek therapy for.

"LGBTQ+ clients seek therapy to address a range of issues, including self-acceptance, identity exploration, and coping with discrimination,” she said. “Therapy aims to help them build resilience against societal pressures and internalized stigma, enhancing their self-esteem.”

Therapists can assist clients in processing their gender and sexual identities, helping them navigate the complex emotions and experiences associated with these aspects of their lives.

Minority Stress

About working with LGBTQ clients, Tse added, “Managing stress and anxiety caused by minority stressors is another frequent focus. Therapy sessions help clients explore and set personal boundaries while also fostering a sense of community.”

Intersectionality is a big presenting concern in LGBTQ therapy. Clients may not just be LGBTQ, but in a minority race, a lower economic class, and more. It’s how each of these identities affects a client that needs attention and compassion from a therapist.

Relationship Concerns

LGBTQ+ clients often seek therapy to address various relationship concerns, including romantic, familial, and platonic relationships.

Effective communication strategies and boundary setting are crucial components of this process. Therapists must be adept at guiding clients through these challenges, helping them to build and maintain healthy relationships.

These are just a handful of the most common therapy goals of LGBTQ clients. Now what about the things that are often unique to this population when engaging in therapy?

Unique Challenges in LGBTQ Therapy

Being part of a misunderstood minority brings unique challenges. Here are a few unique concerns our experts have noticed when working with LGBTQ+ clients.

Access to Competent Care

One of the most significant challenges faced by LGBTQ+ clients is the lack of access to competent care.

This issue stems from the fact that many graduate programs do not offer specific training on LGBTQ+ mental health concerns. As a result, therapists may not be adequately prepared to address the unique needs of LGBTQ+ clients, leading to microaggressions and microinvalidations.

"The biggest issue that LGBTQ+ people face is access to competent care,” Dr. Grey said. “Most schools offer graduate students a generic education, the broad strokes to satisfy the licensing board's requirements.”

As such, not all therapists are sufficiently trained to help LGBTQ clients. So, what can you do as a therapist to remedy this?

Basically, you need to seek out specialized training outside of your graduate training. This can look like CEUs and supervision, as two examples.

Just make sure that the training is from a systemic lens and not too specific to one situation. The realities of systemic oppression of LGBTQ people make it that you’ll need a meta-level view, not a narrow view.

Being a Sexual Minority

Minority stress is another significant challenge for LGBTQ+ clients. This stress results from societal pressures and discrimination, which can exacerbate existing mental health issues.

The intersectionality of various identities, such as race, socioeconomic status, and sexual orientation, can further complicate the mental health of LGBTQ+ individuals.

Jeremy Henderson-Teelucksingh, LPC, explains the concept of minority stress.

"Minority stress is the additive stress that LGBTGEQIAP+-identifying people experience above and beyond the average stressors experienced by the majority population,” he advised. “From coming out to family and friends or at work and at school to internalized oppression, minority stress appears to be the underlying concern that many within the LGBTGEQIAP+ population experience as a result of the political and social determinants of health."

Effective therapy with LGBTQ+ clients must address minority stress.

Social Rejection and Isolation

Social rejection and isolation are common experiences for LGBTQ+ clients, particularly when family or friends do not accept their sexual orientation or gender identity.

This rejection can lead to feelings of loneliness and exacerbate mental health issues. It is crucial for therapists to help clients find and connect with supportive communities.

"Social rejection is hard for LGBTQ people, especially since the rejection is because of their LGBTQ identity,” said Brandon Simpson, AMFT. “When a patient tells me about social rejection, I help them process if they want to maintain those social connections and how they can be mentally and emotionally safe in those interactions.”

Sometimes, the best thing for an LGBTQ client to do is to leave harmful relationships.

“If they wish to disconnect from those social connections, I help them find more socially inclusive groups,” added Simpson.

Therapists must be aware of these unique challenges and provide the necessary support to help LGBTQ+ clients navigate them effectively. This involves continuous education and a deep understanding of the complex interplay between various identities and the societal pressures that LGBTQ+ individuals face.

Strategies to Support LGBTQ+ Clients

How can you support LGBTQ clients more effectively in therapy? It starts with understanding the LGBTQ+ culture, offering an affirming space, connecting clients with resources, and using various modalities.

Creating a Safe and Affirming Space

Creating a safe and affirming space is fundamental for supporting LGBTQ+ clients in therapy. This involves using affirming language, incorporating visual inclusivity, and ensuring that the environment feels welcoming and safe for all clients.

"Ensuring a welcoming environment for LGBTQ+ clients involves incorporating visual inclusivity, such as pride flags and diverse literature, prominently in the practice,” Tse contributed. “Inclusive intake forms with varied gender and relationship options acknowledge and respect clients from their initial contact.”

But being an inclusive therapist extends beyond the therapy room. Truly comprehensive care offers a network of resources with support groups and healthcare providers.

You can also share your identity as a minority with clients. Tse tells clients about her experiences as a minority to increase rapport and trust, when appropriate.

Therapeutic Techniques

Using effective therapeutic techniques is crucial in addressing the unique needs of LGBTQ+ clients. Narrative therapy and cognitive-behavioral techniques (CBT) are particularly useful, along with mindfulness exercises and grounding techniques.

"I start by creating a trusting and affirming therapeutic space where clients feel safe to explore their feelings without judgment,” Tse offered. “Often, I incorporate narrative therapy, encouraging clients to share their personal stories, which helps them reframe their experiences positively.”

Just like with any client, you may need a few modalities to best serve your LGBTQ clients. Tse, for example, uses CBT and mindfulness exercises to alter negative thought patterns and manage anxiety, respectively.

“My goal is to empower clients to embrace their identity with pride and self-compassion,” Tse said.

Support Networks and Community Resources

Connecting clients to support networks and community resources is another key strategy for supporting LGBTQ+ clients.

Building a strong support network can help mitigate feelings of isolation and provide a sense of community.

Simpson emphasized, “Many LGBTQ+ people have their chosen families and communities, and I will help my patients connect to local LGBTQ+ support groups, sports, special interests, etc.”

Having a community around you is important because rejection can lead to isolation. With LGBTQ+ people already at higher risks for pathologies and substance use, people mustn’t feel like they are an outcast.

“Connecting them to local community resources is important,” Simpson continued. “So many people have this experience, and when you finally meet others like you, it’s wonderful."

By focusing on these strategies, therapists can create a more inclusive and supportive environment for their LGBTQ+ clients, helping them to navigate their unique challenges and achieve their therapeutic goals.

Addressing Specific Issues

For more advice on addressing specific issues in LGBTQ therapy, check out these call-outs from our experts.

Sexual Orientation and Gender Identity

Helping clients navigate their sexual orientation and gender identity is a crucial aspect of therapy for LGBTQ+ individuals.

This process often involves internal and external acceptance, role-playing scenarios, and practicing coming out in a safe environment.

Dr. Grey explains his approach to helping clients with their sexual orientation and gender identity:

"As a psychodynamic therapist, I dive into early experiences and interactions and help patients get to the root cause of their struggle,” he said. Together, Dr. Grey and his clients analyze the messages they’ve received and internalized about what it means to be LGBTQ.

Unlearning old beliefs is a powerful way to help LGBTQ client. As is helping them navigate shifting identities.

“From my interactions, many people don’t struggle with accepting themselves; they struggle to accept that their life may change, people may treat them differently, cut them off, or they may be removed from the church; in some cases, it has nothing to do with their sexual or gender identity, and more with their other identities as a family member, member of a religious organization, or group,” Dr. Grey sagely added.

Making room for the full expression of all your client’s identities is a key way to help LGBTQ clients.

Managing Minority Stress

Minority stress, resulting from societal pressures and discrimination, is a common issue for LGBTQ+ clients. Effective therapy must include techniques to help clients cope with these pressures and empower them to embrace their identities.

Aaron Martin, LMFT, provides insight into managing minority stress, which is often due to systemic oppression: 

"Systemic oppression is not unique to Queer folks, as Queer folks of color often feel the impacts of multiple systems of oppression. As heterosexual (non-LGBTQ+) clinicians, you can sometimes pull from your own experiences of systemic oppression to better empathize with queer clients."

It’s also important to “bloom where you’re planted,” as the saying goes. Henderson-Teelucksingh has noticed a trend with clients where they may idealize a move to a big city where it’s an LGBTQ safe haven, only to realize later that discrimination is present regardless of geography.

By addressing these specific issues, therapists can provide targeted support that helps LGBTQ+ clients navigate the complexities of their identities and the societal pressures they face. This comprehensive approach ensures that clients receive the care and support they need to thrive.

Creating an Inclusive Practice

How can you communicate verbally (and nonverbally) to clients that you’re an inclusive therapist? That you understand them and won’t judge them?

Intake and Documentation

Creating an inclusive practice starts with the intake process and documentation. Inclusive intake forms and assessment tools are crucial for respecting and acknowledging clients' diverse identities, ensuring they feel seen and validated from their initial contact with the practice.

"My intake paperwork has space for diverse gender expressions, pronouns, relational constructs, sexual identities, and expressions,” said Dr. Grey. “My website is affirming to all the diverse populations that I serve within Sexual and Gender Minorities, encompassing LGBTQ+, sex workers/adult content creators, polyamory/consensual non-monogamy, and BDSM/kink."

Therapists who want to better serve the LGBTQ+ community can use their intake paperwork and website copy to connect with LGBTQ clients. It’s the little things that tell potential clients you’re a safe person to open up with.

Continuous Education and Awareness

Staying informed about the latest research, best practices, and issues affecting the LGBTQ+ community is essential for providing competent care.

Therapists must engage with the community and continuously educate themselves to ensure their practices remain inclusive and effective.

Dr. Michael Grey emphasizes the need for continuous education, saying “I have alerts on my email to let me know when a new article is published that fits my niche.”

This allows him to be as up-to-date as possible, and pass that along to the next generation of therapists.

“I gave a talk to a group of therapists on Harnessing the Power of BSDM for Trauma Recovery,” Dr. Grey noted. “The talk was set for May 17th; on the 14th, a new journal article was published about this topic, and I incorporated it into my lecture.”

If you want to stay up to date, consider setting up Google Alerts for new research, books, and online presentations.

Engaging with the LGBTQ+ Community

Engagement with the LGBTQ+ community involves more than just staying informed; it also includes actively participating in community events, supporting LGBTQ+ organizations, and consulting with peers to stay connected with the evolving needs of the community.

Tse offered, "Queer culture is constantly changing, and it can be overwhelming, but I stay as up-to-date as possible, and if I don’t know something, I consult with my queer peers."

Perhaps the worst thing we can do when working with a unique population is to assume we know what they’re going through. Tse sidesteps this by asking her queer peers for their perspectives and input.

By focusing on these aspects, therapists can ensure their practices are genuinely inclusive and affirming, providing a supportive environment for all LGBTQ+ clients.

Planning for Coming Out

One big reason LGBTQ folk come to therapy is for support in “coming out” to friends and family. It can be truly terrifying, and as a therapist, you can help them make progress. Below are some insights about how best to do that.

Creating a Safe Plan

When clients are considering coming out to family, friends, or at work, it's essential to develop a detailed and safe plan. This involves assessing the client's safety and support systems to ensure they have a solid foundation before taking this significant step.

Simpson helps his clients plan for coming out ahead of time. “We go over the location they will be at, the people they want to come out to, and what they will say,” he said. “We create the most predictable situation as we can.”

Coming out is already very painful for many LGBTQ members. As therapists, we can help them control whatever variables we can so that they are as comfortable as possible.

“We also go over support, who are trusted people, and trusted organizations who have 24/7 support, and I even make myself available as a line of support,” said Simpson. “I also reinforce that not everyone deserves their whole story, which helps alleviate the pressure of needing to come out if the person does not need to know my client's story or does not deserve it."

If you’re helping a client come out, start with a plan.

Ongoing Support

Coming out is not a one-time event but an ongoing process that requires continuous support. Therapists must be prepared to provide ongoing assistance to clients as they navigate the complexities of coming out in different aspects of their lives.

Martin elaborates on the continuous nature of coming out.

"Coming out is gigantic for Queer folks. I like to think of ‘coming out’ as allowing people into our lives, and I will explicitly label it as such with clients. Who deserves to be let into this facet of our life?”

The truth is that not everyone needs to know about your client’s status as a sexual minority. Also, coming out isn’t a one time thing, but a daily occurrence as clients seek to live authentically.

“It’s also not a one-and-done event,” Martin echoed. “Queer folks come out all the time in our lives, and it can be exhausting! We come out to some, and stay in the closet to others, and this is okay. Our clients know what is best for them.”

Coming out is a big life decision, and it may help to address this “bigness” with your LGBTQ clients. 

“Maybe they’re feeling anxious, excited, worried, all of the above. What do they think will change in their life by coming out? How might it stay the same? Are there people who already know they’re queer? How can we use those folks as a support network during this complex time? What is going on in their bodies as we are talking about it in therapy?,” Martin elaborated.

In helping clients talk through (and feel through) the different potentials of coming out, both positive and negative, we can help clients gain clarity and resolve.

Emphasizing Personal Agency

It's crucial to empower clients to make their own decisions regarding coming out. This process should be client-led, with the therapist providing support and guidance without pushing them towards any particular outcome.

"With caution, I need to make sure that my patients can be safe and have supportive people in their lives, especially if their family isn’t affirming their identity or they are in a place that isn’t safe,” Dr. Grey said. 

Safety is a primary concern for therapists working with LGBTQ clients. Many clients need to consider if coming out is safe for them, and to think about the potential for harassment, discrimination, and other concerns.

Overall, “It’s an ongoing process, one that doesn’t happen overnight,” said Dr. Grey. “I let my patient lead, and I follow, I am not here to gatekeep them from living their life."

By focusing on creating a safe plan, providing ongoing support, and emphasizing personal agency, therapists can effectively assist clients in the complex and personal journey of coming out.

On the Importance of Supportive Therapy for LGBTQ+ Clients

Supportive and affirming therapy is vital for the mental health and well-being of LGBTQ+ clients. By understanding and addressing the unique challenges they face, therapists can create a safe and inclusive environment that fosters healing and growth. From reducing symptoms of mental health issues to exploring and accepting identities, building healthy relationships, and managing minority stress, effective therapy can make a significant difference in the lives of LGBTQ+ individuals.

In conclusion, the journey to becoming a competent and empathetic therapist for LGBTQ+ clients is ongoing. It involves continuous learning, self-reflection, and a dedication to fostering an environment of acceptance and support. By doing so, you can help your clients overcome their struggles, embrace their identities, and lead fulfilling lives.

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This blog post is provided for informational purposes only and is not intended as legal, business, medical, or insurance advice. Laws relating to health insurance and coverage are complex, and their application can vary widely depending on individual circumstances and state laws. Similarly, decisions regarding mental health care should be made with the guidance of qualified health care providers. We strongly recommend consulting with a qualified attorney or legal advisor, insurance representative, and/or medical professional to discuss your specific situation and how the laws apply to you or your situation.

About the Author
Brandon Grill

Brandon Grill is a mental health copywriter and marketer based in Las Vegas, NV. He loves helping mental health professionals build fulfilling businesses. You can find Brandon going on a walk with his adorable nephews.