5 Ways to Provide Culturally Competent Care for LGBTQ+ Clients

The diversity among the LGBTQ+ community is something to be recognized and celebrated! Below are five ways therapists in private practice can provide culturally-competent care for members of the LGBTQ+ community.

1. Spend time intentionally reflecting upon your own sexual, romantic, and gender identity

The first step to providing culturally-competent care to the LGBTQ+ community is something of a nuanced one – it’s to do a bit of “soul searching” about your own gender and/or sexual identity.

Think of it this way. Due to social norms and constraints, folx from queer and trans communities are typically compelled to examine their gender and sexual/romantic identities far more often than people who identify as straight or cisgender.

And this discrepancy in self-reflection can be a primary barrier to our understanding, and clinical competence, with our LGBTQ+ clients. After all, much as race, economic status, ability, and other aspects of the clinician’s identity are present and influential in the therapeutic relationship, so, too, are the provider’s gender and sexual/romantic identities.  

So as clinicians – particularly those of us who identify as straight and/or cisgender – we can minimize the inclination to “other” our queer and trans clients, and develop a foundation for empathy and inclusivity, simply by spending intentional time observing our identities as worthy of questioning.

2. Spend time reviewing fundamental gender and sexuality concepts

Cultural competency is rooted in knowledge; so when working with clients from the LGBTQ+ population, make sure you’re not only up to date on fundamental concepts related to gender and sexuality, but you’re also fluent in them. The following are key points to get you started:

Sexual identity

Describes who we are sexually attracted to based on others’ and our own gender identities.

Romantic identity

Describes who we are romantically attracted to based on others’ and our own gender identities.

Sexual fluidity

The understanding that sexual identity, attraction and behavior can change within individuals over time and across situations.

Sex

Biological designation as male, female, or intersex based on genitalia, chromosomes, hormones, and other primary sex characteristics. Typically assigned at birth.

Gender identity

An individual’s internal sense of themselves, often defined in relation to maleness and femaleness, but in reality can be any combination of these dimensions, something in between, or something else entirely.

Gender expression

Ways in which we display our gender identity, through demeanor, clothing, hair, or other aspects of behavior. For example, a client might identify as a cisgender man, wear clothing bought from the “women’s section” at a store, and paint his nails.

Gender binary  

The widely held assumption that gender is dichotomous, i.e., includes only male and female.

Trans-inclusive feminism

A gender justice movement that includes and honors the lives and experiences of trans and non-binary individuals.

You may wish to further research these topics, and possibly discuss with colleagues where appropriate.

3. Continue to expand your gender and sexual identity vocabulary

Above, we discussed gender and sexuality concepts; but that is only part of the story. Diversity in gender and sexual/romantic identity is another.

Some identities your clients might have include:

Queer

Often used as an umbrella term to describe having any sexual identity other than heterosexual.

Pansexual

Attraction to people across the gender spectrum.

Asexual

Lack of sexual attraction or interest toward others; can still have romantic attraction.

Aromantic

Lack of romantic attraction or interest toward others; can still have sexual attraction.

Trans*, Genderqueer, Gender nonconforming

Often used as umbrella terms to describe a gender identity that does not adhere to the gender binary or assigned sex at birth.

Agender

Lack of identification with gender.

Remember that behind these labels are people – full of complexity and humanity.

4. Put yourself in your clients’ shoes so you can spot opportunities to make them feel welcome

Think of the series of steps involved in starting therapy: Searching for a provider online or through other referral sources; making the first call; completing intake paperwork; showing up to an office where vulnerability and disclosure are encouraged.

Each of these steps involves verbal and nonverbal communication to the client that can either promote, or minimize, our clients’ experience of belonging.

As clinicians, we can influence this verbal and nonverbal communication so that clients feel recognized and valued before we even meet them in person.

Here are three ways to communicate respect throughout the therapeutic process:

a) Update your intake forms to reflect inclusive language  

In intake forms, consider including some of the following information (this is not an exhaustive list). Make these questions voluntary. And when determining which questions to include, ask yourself, "Is this information about my client relevant to our therapeutic work?"

You can ask for the client’s legal name, which may be needed for insurance, billing, or other purposes. However, this could be listed after the client’s affirmed name, which conveys the importance of the client’s chosen name for the therapeutic relationship.

b) Enhance your office’s decor, and/or update its facilities

It can be helpful for clients’ identities and needs to be reflected in the physical space of therapy.

For example, I keep trans pride and POC pride flags in my office to convey, without overtly having to state it, that all clients are welcome in my office.

Ask yourself, what small but impactful changes can you make to your office to make it more inclusive? For example, if your office has a bathroom, is it accessible to all genders, or is it designated by the gender binary?

c) When therapeutically productive, acknowledge your identities

Finally, consider naming your identities to clients whose presenting concerns are, or could be, related to their identities.

As with any disclosure in a session, we clinicians can practice naming our identities with intention and consideration of the process and content of the session.

By naming our identities, clinicans who belong to the queer or trans community, as well clinicans who are allies to these communities, can empower their clients to examine and discuss with us the joys and challenges of moving through the world as queer and/or trans warriors.

Related: One Therapist’s Outlook & Advice for Disclosing Queer Identity in Therapy

Related: Benefit, Downsides, & Honest Advice for Self-Disclosing Queer Identity as a Therapist

5. Seek out additional training and resources, both online and in-person

There are many, many people and organizations working to educate the public about gender and sexual diversity! Take advantage of these resources, and share them with your colleagues.

Below is a short list of resources to get you started:

You can also do research for organizations in your area, or ask colleagues for recommendations.

Your office is a haven for clientele, including members of the LGBTQ+ community. By taking these small but impactful steps, you can convey the message – without having to explicitly, verbally state it! – that all aspects of their identity are not only accepted, but also respected and warmly welcomed.