Serving the LGBT Population in Therapy

When working with clients from the LGBT community, it's important to remember your professional values and act ethically. This means following a code of conduct that respects each person's rights and treats everyone fairly. Being ethical when providing therapy to LGBT clients is an important part of helping them feel safe, seen, heard, and understood. So how do we actually enact these ideas into our practice? Let's talk about it. 

- How can therapists ensure ethical practice when working with LGBT clients?

Therapist can ensure ethical practices in their own practice by observing and adhering to the American Counseling Association's Code of Ethics, Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling (ALGBTIC) Competencies for Counseling as well as the World Professional Association for Transgender Health Ethical Guidelines. Seriously--between all three codes you're going to ensure that you're doing the best by your clients.

- What are some of the ethical considerations for therapy with LGBT clients?

When serving the LGBT population ethical considerations include;

Language--are you as a professional up to date in the current language and definitions used within the community? With the understanding that language is a living entity and therefore constantly changing, it is still imperative that you do your due diligence in reading up on what terms and phrases are being used currently.

Theoretical Frameworks--it is no surprise that counselors need to be considerate of the theoretical framework being used in session with LGBT clients. A particular example that is been among the discourse in the profession is the use of CBT when working with LGBT clients. CBT, for all the good that is can offer, does not take into consideration the experience of folks who exist in minority/marginalized identities. We cannot ask an LGBT client to simply "reframe" their understanding of an inherently discriminatory world and its patterns.

Accessibility & Equity--does your practice allow for sliding scale clients? Does your practice create a welcoming environment for clients to feel safe? What sort of language do you use in your intake paperwork? These are questions that will promote examination of how you are serving the LGBT community and ways to improve access to your practice.

- What are the laws or legislation in place that could interfere with LGBT folks pursuing counseling?

This image identifies the status of Conversion Therapy Laws throughout the United States (source). When discussion laws related to therapy it is integral to understand the damning, harmful nature of Conversion Therapy. Per the Human Rights Campaign, "Reparative" or "conversion" therapy is a dangerous practice that targets LGBTQ youth and seeks to change their sexual or gender identities." The American Counseling Association supports all legislation that promotes banning the practice and acknowledges that is goes directly against the ACA Code of Ethics. No therapist should be practicing Conversion Therapy.

Currently, a major topic of contention is gender affirming care for transgender youth. Depending on how the legislation is worded therapists can be included in these bans and it can become criminal to serve and affirm transgender youth. It is imperative that therapists remain watchful of this legislative actions and do their part to help politicians understand the harm they cause (try writing a letter to your legislator or going to your capital to speak on behalf of the folks your serve)

- How can a therapist deal with judgement and stigma when working with LGBT clients?

With regards to therapist's own judgement and stigma it is crucial to consistently evaluate and be aware of any biases that exist towards LGBT clients. How can therapists do this?

Through pursuing Continuing Education directly dealing with LGBT topics

Consultation with other practitioners who serve the LGBT community

Supervision with a seasoned clinician who serves the community

This, obviously, is not an exhaustive list of all that you can do as a practicing mental health professional but it at least gets your mind headed in the right direction. It is not enough to be an ally in the therapy setting. You must also be informed and competent to serve the LGBT population. Enjoy the journey of expanding your understanding of the human condition through these intentional exercises!