Working with the LGBTQ+ community

I have worked as a psychotherapist for the LGBTQ+ community for a number of years, and I am also part of that community, so I wanted to share with you ten top tips for working with us.

1. Do not assume that homophobia, biphobia and transphobia sit safely in the past.  The LGBTQ+ community experiences power imbalances and discrimination every day, and you may not even see it. High numbers of LGBTQ+ youth experience rejection by their family, and the Ali Forney Center reports that 75% of LGBTQ+ youths that come to them ‘have been assaulted or abused in their homes for being LGBTQ+’.  And this is just in the US.  When I was a therapist at an LGBTQ+ charity in London (England), I sometimes worked with asylum seekers who had been fleeing persecution in Uganda and Pakistan.  Their own family members and friends wanted them dead simply because they identified as gay.  This was hard work, as they struggled to make sense of their identity as a gay man, a Muslim, and a loving son, brother and friend.
2. Do not underestimate the impact of discrimination.  According to the Ali Forney Center, ‘LGBTQ youth comprise 40% of the homeless youth population in New York’, and this is largely due to rejection from their families.  According to the Hetrick-Martin Institute, LGBTQ+ youth who report family rejection are ‘8.4 times more likely to attempt suicide, 5.9 times more likely to have high levels of depression, 3.4 times more likely to use drugs, and 3.4 times more likely to engage in unprotected sexual intercourse’. Discrimination can leave an imprint for years, and it can significantly influence someone’s interpersonal skills.  They may be less inclined to trust or accept things at face value, and they may have had few people to share their feelings about their emerging sexual or gender identity.  Addiction, anxiety and depression may have fuelled this despair, especially if they felt isolated from the rest of society. 
3. Maintain awareness of developments in the political and legislative arenas.  There are too many powerful people who want to strip the LGBTQ+ community of their right to work, right to marry, right to have children, and right to be served by a business.  In the majority of US states someone can lose their job simply by identifying as a member of the LGBTQ+ community.  There is a similar lack of legislative support for members of the LGBTQ+ community who want to adopt or foster children.  Consider the impact this has on the psyche, being treated as second-class citizens
4.  Be sensitive to privacy and safety.  Just because you know the person’s sexual or gender identity, does not mean it is safe for anyone else to know.  When I worked at the LGBTQ+ charity in London, I was conscious that the clients might not want to take the paperwork home as it had logos that could be linked to the LGBTQ+ community
5.  Know your local LGBTQ+ organizations.  There are many decent, and local, LGBTQ+ organizations, but each one is not for everybody. I have known of LGBTQ+ walking groups, coffee meetings, an LGBTQ+ creative writing group, a Jewish LGBTQ+ group, a Christian group, and a Muslim LGBTQ+ group
6. Consider your conversations, documentation, policies and procedures.  Whether you are having a conversation, writing an email, creating a document, a policy or procedure, are you assuming that a married couple consist of a man and a woman, and two parents of children are a man and a woman?  Do you make assumptions about sport (football for men and ballet for women), colors (pink for girls, blue for boys), and even the family structure (a female as the caregiver and the male as employed).  Do you have expectations about what a ‘man’ and a ‘woman’ should look and sound like?  Maintain awareness for gender-normative and hetero-normative assumptions in our conversations, documents, policies and procedures
7. A cultural and historical perspective check – Understand where that LGBTQ+ person is coming from in terms of their culture.  Are they surrounded by family members and/or friends who are homophobic or transphobic?  Some cultures view the LGBTQ+ community as evil, or a sickness to be ‘cured’.  It is a tough decision to make between your sexual or gender identity, and the family and friends you have always known.  In addition, consider the history of that member of the LGBTQ+ community.  Older members have grown up in a time when society was a great deal less accepting, and so they may have a different perspective of their gender or sexuality than someone who grew up more recently
8.  Do not confuse gender and sexuality.  For example, if someone is transitioning from male to female, this does not make them gay.  Being transgender is about the gender they identify with, and being gay is about who they are sexually attracted to (their sexuality).  A transgender man transitioning to be a woman will not necessarily be attracted to men
9.  If you are unsure, ask.  We all have different perspectives, so a person-centred approach would be to start with the individual and the meaning they attach to terms such as LGBTQ+, trans, etc.  If you are working with someone who identifies as transgender, you may stumble over whether to refer to them as ‘her’ or ‘him’.  A common approach to this is to refer to them as ‘they’, and, the best approach is to ask them how they would like to be addressed
10.  ​Failing that, here is a quick list of some common terms.  However, each term is the subject of debate, so these should not be viewed as definitive definitions –
11. LGBTQ+ = Lesbian, Gay, Bisexual, Transgender, Queer.  I tend to use the + to be all-inclusive, because some say the correct term is LGBTTQQIAAP (lesbian, gay, bisexual, transgender, transsexual, queer, questioning, intersex, asexual, ally, pansexual)
12. Transgender = An umbrella term for anyone whose gender identity or expression is not in line with the gender they were assigned at birth
13. Transsexual = Some argue there is no real distinction between the term transgender and transsexual, whereas others argue that the term transsexual focuses on those who have the desire to transition to wish to have gender affirmative surgery
14. Non-binary = Someone who does not identify solely as a man or woman
15. Cis-gender (cis-male or cis-female) = Someone who identifies with their birth gender (so cis-male is someone who identifies as male and who was born male)
16. Gay, or homosexual = Someone attracted to someone of the same sex
17. Bisexual = Someone attracted to men and women
18. Asexual = Not sexually attracted to anyone
19. Lesbian = A female homosexual
20. Queer = This is an umbrella term for anyone whose sexuality or gender does not identiy as heterosexual and the gender they were born with (cis-male or cis-female)
21. Intersex = Someone who cannot be distinctly identified as male or female because of their sex characteristics (genitals, etc)

Chris Warren-Dickins is a Licensed Professional Counselor in Ridgewood, New Jersey.  He specializes in psychotherapy for couples, adolescents, men, and the LGBTQ+ community. 
Sessions are available in-person at 162 E Ridgewood Ave, Ridgewood NJ 07451, or via the internet or telephone. Book a consultation today www.exploretransform.com
​

---