According to psychiatry.org, individuals in the LGBTQIA+ community are more than twice as likely as people who are heterosexual to have a mental health disorder in their lifetime. They are 2.5 times more likely to experience depression, anxiety, and substance misuse compared to heterosexual individuals because of the stigma and discrimination they face. Despite their clear need for mental health help, LGBTQIA+ individuals also face significant barriers when seeking treatment for mental health conditions and can struggle to find mental health specialists who can help them properly.
Seeking therapy can be difficult for all patients, and it’s unfortunately all too common for them to have a bad experience that can put them off further treatment after an initial outreach. This is especially true when treating patients who face discrimination and stigma. Sometimes, even when people mean well and seek to offer help and care, they might not realize they’re committing micro-aggressions or hurting patients. That’s why it’s important for therapists who help patients in the LGBTQIA+ community to keep some best practices in mind to offer compassionate care and a safe space.
1. Educate Yourself and Your Staff
Just as the field of mental health is ever evolving, so too is our understanding of gender and sexuality. Language changes and things your staff might have learned could be outdated. Consider the word “queer”. It’s been reclaimed by the LGBTQIA+ community, particularly for younger people, but older people might still remember when it was a slur. Don’t try to label your patient; let them define themselves. It’s important to consider your patient’s perspective, how their mental health is affected and how you can treat them effectively and without prejudice.
It can also be exhausting for patients to continually have to be the source of information regarding their gender or sexuality. They might not want to spend the first fifteen minutes of their limited session time explaining what the difference between being pansexual and being bisexual means. They might think their provider does not have the knowledge to properly treat them.
Education is also very helpful when helping patients who are questioning or queer. They’re often overlooked and are looking for answers during a confusing time in their life. While you might be thinking questioning patients are teens, that’s not always the case, so be sure to develop a plan for questioning individuals who are older as well.
Education can also be helpful to reduce stereotypes and micro and macro aggressions. People sometimes make assumptions about LGBTQIA+ patients that can make them feel alienated or viewed as a collection of stereotypes rather than a human being.
2. Practice Affirmative Mental Health Care
Affirmative therapy validates and advocates for the needs of LGBTQIA+ clients. Affirmative care affects all facets of treatment, including verbal communication, environmental cues, and even intake questions. Affirmative care is positive, helpful and uplifting. A major factor in worsening mental health is the feeling of isolation that comes with many conditions. Affirmative care can help lessen the feeling of isolation, which in turn helps the patient form healthy relationships, take part in communities, and continue their treatment.
In addition to helping LGBTQIA+ patients feel safe and supported, affirmative therapy enables patients to be able to be completely honest with their therapist, who can then provide better care. It’s not uncommon for patients (including heterosexual patients) to omit some things from their therapists or provide incomplete information. Seeking mental health can be a very painful and difficult thing to do, and patients can struggle to fully “open up”, especially if they underwent traumatizing events. Whether it’s shame, PTSD or fear, your client might be conflicted about telling you everything. If they’re not treated in a positive, affirmative way, they might withhold information to feel safe or because they’re scared to be judged.
3. Be Inclusive and Intersectional
Whether it’s the way you advertise, or the language used in questionnaires or forms, a little bit goes a long way to make people feel accepted. Consider using terms like “partner” instead of “husband” or “wife”, or “caregiver” instead of “parent”. Ask people if they have preferred pronouns or if they have a name they prefer to their given name. These practices need to be followed in all documentation. For example, a therapist might remember their teen patient’s chosen name, but if the paperwork only has the legal name, that patient could have a receptionist or paperwork use the wrong name.
Make sure you have strong policies against discrimination, and that they are available to patients who might be browsing your site. It can be difficult to confront bias and ignorance. Sometimes, people mean well but don’t realize they say things that are hurtful, outdated, or ignorant. It’s important to create a healthy response and process for learning new things and be open to them instead of closing up or feeling personally attacked. Besides being helpful for client relationships, this emotional toolset can be useful in group sessions or therapy that happens in more public locations, where someone could be aggressive towards a patient.
It’s important not to dodge the fact that some clients might belong to the LGBTQIA+ community. While it might be tempting for some practitioners to ignore it altogether, a person’s sexuality and gender identity affects their mental health. Avoidance can be a sign that a therapist is uncomfortable when dealing with LGBTQIA+ patient, and the client might feel they’re not going to be treated properly because the therapist is unable to realize the way their identity and mental health intersect.
Of course, LGBTQIA+ patients don’t go to therapy solely because of their sexuality or identity, but they do affect mental health, and it would be reductive to avoid the topic. At the same time, don’t make the mistake of thinking their belonging to the LGBTQIA+ community is the reason for the mental health problems. Don’t make assumptions about your clients based on their gender or sexuality; for example, if a patient wants to treat their depression, don’t assume they’re depressive because of the gender or sexuality. Be willing to listen to them without judging them.
Intersectionality is not limited to patients who belong in the LBGTQIA+ community or to patients of color. Rather, it’s a way to recognize that the many traits that define us all play a part in the way we move through systems and how they benefit or burden us. Two patients might suffer from anxiety, but a black patient might experience more discomfort due to microaggressions at work than a white patient. It’s not the main reason they have an anxiety disorder, but it affects their mental health.
4. Be Prepared for Difficult Conversations
While many therapists help patients who face traumatic and violent experiences, people in the LGBTQIA+ community face increased risks. Hate crimes are on the rise, and people of color, particularly transgender people, are disproportionally affected. Some states are particularly unfriendly towards people in the LGBTQIA+ community and often pass laws that can have a considerable impact on their lives, ranging from their ability to join the military to allowing discrimination based on religious grounds. Some people can find themselves rejected by friends or family, or face hostility in the workplace because of their mental health, sexuality, or gender identity. Therapists who treat patients in the LGBTQIA+ community should be well-versed in trauma-informed care and identity-based trauma, as well as their impact on mental health.
5. Offer Resources and Referrals
Your staff can pass on some resources to their patients, such as groups for trans women, tools to help LGBTQIA+ teens or safe spaces outside of your clinic. In addition, as any therapist knows, therapy does not end after the session. Patients need work on themselves even outside of their sessions. It’s paramount for therapists to have access to resources that help patients work on their mental health between sessions. You might have some resources on managing anxiety or stress, so consider making specific resources available for members of the LGBTQIA+ community.
Just as you should also have a strong referral system for resources like homeless shelters, substance use recovery or other types of care outside of the scope of your practice, make sure you can refer LGBTQIA+ patients to referrals that can help them, such as gender affirming care facilities or sexual health facilities.
Proper mental health treatment should be inclusive, affirming and offer a safe space for patients. Doing a little extra work and research goes a very long way towards making marginalized people feel valued and cared for. Your practice and your mental health treatments will be stronger for it.