Selecting LGBTQIA+ Competent (and Celebratory!!) Providers
If you or someone you know identifies as a sexual, affectional, or gender minority, you probably know how hard it can be to find medical and mental health providers who understand LGBTQIA+ people and the unique challenges they face. Even well-meaning providers often fall short, expressing their lack of information and experience by making assumptions that further enforce stigmas and assumptions that exacerbate mental health struggles, or in some cases overtly or covertly blaming client problems on their identity. Negative experiences such as these often cause LGBTQIA+ people in these populations to distrust mental health professionals or avoid seeking help when they need it.
So how can LGBTQIA+ people select providers who do not simply offer competent services but also help them to celebrate their lives and truly thrive despite the difficulties they face? Below are a few tips to help prospective clients and their loved ones with this challenge.
Know Your Rights: The Very Basics
In an ideal world, providers who can provide competent and celebratory care to LGBTQIA+ clients would be numerous. However, this is not reality, and further, there are providers who either knowingly or unknowingly use discriminatory practices. Many clients do not know their basic rights or know how to access the resources available to them. In order to establish a baseline of “do no harm”, there are three things clients should know when establishing their expectations for the very baseline requirements for services.
Conversion therapy, or therapy that attempts to change someone’s queer or transgender identity, is dangerous and is not supported by the American Counseling Association, the American Psychological Association, or the National Association of Social Workers. It is currently illegal in 26 states, Washington, D.C., and Puerto Rico; hundreds of municipalities; and activists continue to work toward a nation-wide ban.
The ethical codes of the American Counseling Association, American Psychological Association, and National Association of Social Workers explicitly state that providers cannot refuse to serve clients based on their beliefs about sexual orientation, gender, or other identity factors. However, in some states, these ethics are at odds with state laws or even some agency practices, and/or providers may state other reasons to justify denying services. It is up to each client to determine what to do if that occurs. Luckily, the advent of teletherapy often gives clients a wider geographical range to seek affirming, competent care.
In the event of a mental health emergency, there are crisis hotlines that specifically serve LGBTQIA+ individuals. These include:
The Trevor Project: 1-866-488-7386 www.thetrevorproject.org
Trans Lifeline: 1-877-565-8860 www.https://translifeline.org/hotline/
Others: https://pflag.org/resource/support-hotlines/ A list of resources that includes those for homelessness, domestic abuse, and chemical dependency. Many of these hotlines can also provide referrals to outpatient providers.
Finding A Competent Provider: Before Your First Appointment
In the internet age, there are many ways to screen potential providers for their competence addressing LGBTQIA+ issues. The following are some questions you might consider when looking for providers – keeping in mind that none of these guarantees your provider’s competency or lack thereof – it just gives you information to work with. At the end of the day, you will have to determine for yourself who you would like to work with.
The Provider’s Website and Social Media:
Do the providers discuss diversity and LGBTQIA issues in their biographies? It’s easy to say these things and another to actually provide affirming care, so also look for examples of their experience. What certificates, professional association involvements, or other workshops/research are mentioned?
Do the providers list their own pronouns on their profile? This may be a huge clue that they understand the importance of pronouns and are therefore at least somewhat savvy to principles of inclusivity.
Do the website materials use gendered language such as “he/she” or make assumptions such as that all romantic relationships involve two people of opposite genders? Existence of this type of language may reveal biases on the part of the agency or the providers themselves as to what constitutes a typical client.
Does the website feature pictures of diverse families, such as those with same gender couples, blended families, people with disabilities, and mixed race families? While some of these may not directly speak to the LGBTQIA+ experience, they may be indicators that the providers recognize the diversity of experiences among their clients.
Is the practice religiously affiliated? If they are, it may not mean anything – maybe just a reference to who founded or funded them – but it might be best to look up the beliefs of that religion and look at the mission statement of the agency to see how those values are reflected in practice.
Check out any online reviews, but be careful. People who complete online reviews may be doing so because they had outlier experiences – either positive or negative. That said, if reviewers speak to a trend or a specific experience speaks to you, this may help you make your decision.
Interaction with office staff and completing paperwork.
How do office staff address you? Do the office staff ask about pronouns and preferred names? If you state your pronouns, do they remember to use them?
What questions are included in intake paperwork? Even if you don’t feel comfortable answering, see if and how they go about finding out your preferred name, pronouns, sex and gender, orientation, or other aspects of client’s identities.
When you get to the office, what visual cues exist that you are in a safe place? Are there symbols such as a triangle or pride flag? What kind of families/clients are shown in any pictures on the walls and/or the magazines in the waiting room?
Finding A Competent Provider: Your First Appointment
Depending on what you’ve seen when considering the above questions, your first meeting may be the interaction that matters the most, and so you might ask yourself similar questions regarding how they introduce themselves, what kind of questions they ask you, and/or look for language that may reveal biases. Know that you have the right to ask about any concerns you have, talk about past positive/negative therapeutic experiences, and correct your counselor if they misstate or misunderstand something you communicate to them. LGBTQIA+ persons have a diverse range of experiences, and no provider can know everything. So what they know about LGBTQIA+ people is important, but sometimes what is more important is how they react when encountering something they don’t know. If a provider is not willing/able to take clarification/correction from you, that may be something to consider.
Here are some ideas about questions you might ask your provider before or after your intake session. Each may or not be applicable to your specific situation, but they address some issues that regularly come up in therapeutic relationships:
Find out what kind of training they have with regard to working with people in LGBTQ+ populations.
Some preparation programs have courses that specifically address issues related to sexuality and gender. Some discuss these factors within broader diversity courses. Just remember that their training may have a lot more to do with the program offerings than the provider. If they haven’t had training at their school, providers may have taken additional training in continuing education workshops, so you are welcome to ask about them too.
It may be important to see if provider’s have training around the specific identities you hold. There is a wide range of identities and experiences under the LGBTQIA+ umbrella, and the issues faced as a result of these differences vary a great deal. Just as with all clients, it’s important that your provider recognizes and/or is willing to learn about the unique issues you may face.
If you are seeking services specifically related to clearance to undergo medical gender confirmation (aka transition) procedures such as hormone therapy or surgery, find out in advance what your insurance provider requires in order for you to undergo those treatments. Make sure your provider is aware of these requirements and is qualified/willing to do their part.
If you are not a legal adult or are undergoing mandatory treatment, discuss with your counselor whether or not you have disclosed that identity to your parents/guardians or others who may have access to your health record. Find out what they would be required to reveal if that person asked for an update on your therapy process. In some states, the law may not require providers to keep certain aspects of your record private if asked, although their ethical mandates may require that they disclose as little information as is necessary.
If you have a history of self-harm or symptoms that may ever require you to enter a higher level of care such as a hospital or treatment program, make sure you discuss with your provider what institutions you would go to. At the end of the day, guaranteeing your physical safety may mean bypassing preferred sites, but if there is a choice in the matter, you and your provider should discuss places that have reputations for being LGBTQIA+ affirming, where your preferred name and pronouns will be respected, and where you can discuss your concerns, including medical and romantic concerns, openly.
If you are in the LGBTQIA+ population, you probably already know that sexual, affectional, and gender minorities experience disproportionate levels of anxiety, depression, trauma, substance abuse, and suicide. While this is true, it is important that your provider recognizes that your identity is only one fact about you. You can and should feel free to discuss other aspects of your life such as career, education, health, religion/spirituality, family, hobbies, and history, noting that your identities are contextual but should not be seen as the problem. That said, it is also important that your provider does not dismiss your identity as irrelevant by implying or directly stating that things should be as easy for you as it may be for those who hold more privileged identities. Something as simple as navigating a new job may be difficult due to fears that you rightfully may have about discrimination. An affirming provider will never tell you these fears are not warranted, although they may work with you to engage your fears in the interest of other goals.
Queer Joy: Celebratory Providers
It’s not a secret that living as an LGBTQIA+ person can feel like a constant uphill battle, and while it is important that you discuss stressors in your counseling session, make sure you also get a chance to talk about the things that are going well in your life, both specific to you and the things that happen in your world. These strengths may lie outside traditional sources. For example, the family that raised you might not fully understand or even support your LGBTQIA+ identities, so it may be even more important to focus on your “family of choice” or peers and role models in your community, in popular media sources, or in educational or occupational arenas for guidance or social support. Similarly, your provider should help you identify ways you have been resilient in the face of discrimination and help you celebrate the many joys in your life, so you have them to remember on difficult days. Working against external stigmas can be hard, but what is often harder is identifying ways in which those stigmas may have been internalized. Having concrete, positive examples of people who you believe offer quality social support has been shown to provide an important buffering mechanism against those stressors.
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Dr. Elisa Woodruff (she/they) has specific training in working with diverse populations, with a passion for helping LGBTQIA+ clients and their partners and families. They are Past-President of the Illinois Society for Sexual Affectional Intersex and Gender Expansive Identities and regularly present and teach counseling trainees and professionals on topics related to LGBTQIA+ identities, sexual normativity, gender identity, and related topics. They recently were awarded the 2023 Quantitative Article of the Year Award by the Journal of LGBTQ Issues in Counseling, and their dissertation has received accolades for being the first to quantitatively describe asexual-identified people from a strengths based perspective. Elisa is currently taking new clients. Call (630)-297-7559 to request an appointment today!!
