ARQ2: Counsellor competence

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We already conduct a lengthy assessment at our agency. Why is it necessary to add this extra piece?

Part A will only take a few minutes to be filled out by the client.

Sexual orientation and gender identity are basic information that therapists/counsellors need to know about clients to develop appropriate treatment/counselling plans. Sometimes, therapists/counsellors will make incorrect assumptions about a person’s sexual orientation or gender identity. For example, they may assume a transsexual person is gay, or that a bisexual woman is a lesbian.

Clients might not volunteer information about their sexual orientation and gender identity at assessment or during counselling. Bisexual clients might only discuss their opposite-sex relationships. Transgendered clients might minimize their gender identity issues. Clients may not even necessarily disclose this information to LGBTTTIQ staff. They might assume staff members are straight.

During assessment, some LGBTTTIQ clients will look for indications that they can be open about their sexual orientation or gender identity during the treatment/counselling process. Some clients will wish to disclose this information, but may not have the opportunity. This guide provides this opportunity and the context for framing the assessment interview.

Will clients feel uncomfortable being asked about sexual orientation and gender identity at assessment?

Some clients, especially those who have had negative experiences following self-disclosure of sexual orientation or gender identity, may not feel comfortable answering the items in Part A during an initial assessment. However, these items will let the client know that the therapist/counsellor or agency is aware of LGBTTTIQ identities. This may facilitate disclosure of sexual orientation and gender identity later during treatment/counselling.

When we field-tested the guide, participants reported that it was okay to discuss sexual orientation and gender identity issues during assessment. Some of the responses were:

“No problem answering the questions.”

“Didn’t bother me at all. The more they know about me, the better they can place me.”

“I’m really open, so I am fine to discuss these things at any time.”

“Good to get it out in the open so that you can discuss things. Sexual orientation and drug use are probably intermingled.”

“Fine for me. Didn’t mind being asked. I’m at a point where I am ready to talk about it.”

“Made me think about things I wouldn’t have considered much, so it was good in making me realize those things.”

“It was fine, great to have a place to go where you don’t have to hide your sexual orientation.”

“Even though it’s not my main concern, it was okay.”

Therapists/counsellors who administered the guide during the field test made the following comments:

“I’ve used it and had a good response from clients. I feel it opened up dialogue.”

“During the assessment, when I moved to this sheet, there was an immediate shift—the presence in the room—there was more comfort. It was more comfortable for the client and it was more comfortable for me.”

“Clients were pleased to be asked. Some had never been asked before and they were struggling with their sexual orientation. No one was offended.”

“I think this new assessment piece is really needed. I am glad to have this. I am sure we have missed a lot of clients who do not identify themselves as LGBTTTIQ at assessment. Unfortunately the assumption that everyone is straight is very prevalent.”

Client perceptions

“My mother had just died and I started attending a bereavement support group. And I didn’t come out to them about being trans because I didn’t want it to influence the other members of the group’s opinions of me, my experience as a part of a group, or my experience with the facilitators as part of a group. And then I started to realize that there was a tremendous number of things I couldn’t address in a bereavement support group about what I was feeling about my mother’s death. I couldn’t talk about how the funeral was when I hadn’t seen all these family members since before my transition. I couldn’t talk to the facilitators of the group about what it was like to wonder whether or not my mother could accept me, never knowing now if she ultimately did.”

“Being out and open about being gay, I don’t have to tell any lies. I don’t have to be secretive. I don’t have to be part of a group that’s exclusively straight and macho. I can be myself by being out.”

Therapist/counsellor perceptions

If someone doesn’t feel safe enough to be honest with who they are, they are not going to feel safe enough or feel comfortable to address any issue, in terms of counselling. If that trust isn’t there, it’s a waste of their time to be coming to see you, because they’re not really going to present their real situation and there’s never going to be a good rapport, so therefore, there won’t be a good working relationship.”

“Before going into that whole section of questions, you should have a piece that is said to normalize things, like ‘we recognize that there are lots of different sexual orientations, and sexual orientation can be fluid, and given that reality, we need to ask the following questions,’ or something that sets the stage.”

“You may have gone through family relationships, intimate relationships and social connections with the client, but they didn’t disclose their sexual orientation or gender identity. Later, if they do disclose, those issues then need to be re-visited because there’s a piece that wasn’t discussed before that impacts on all those issues like family and intimacy. You didn’t get the whole picture.”

“I make sure clients know, ‘We are not here to turn you into something. We’re not here to corrupt you. We’re not here to tell you that you are. You’re the only one who knows who you are. You’re the only one who’ll have a choice in who you become. So, it’s up to you.’ Labels, when they’re assigned by other people to us, become limited and limiting. When they’re assigned to us by ourselves, they’re empowering.”

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Asking the Right Questions 2

• Acknowledgments
• Introduction
• Using the manual
• Background information:
  • Part A — Client Questionnaire
  • Part B — Conversation Guide
• Counsellor competence
• Resources
• References
• Appendix

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