You are here: Home > Publications > Resources for professionals > Asking the right questions 2

What are the barriers to discussing sexual orientation and gender identity?

Many factors create barriers to discussing sexual orientation and gender identity. Therapists/counsellors often lack training, or believe:

• It is intrusive to ask.
• The client will be upset.
• Sexual orientation and gender identity are not relevant in treatment/counselling.

Staff and other clients, regardless of sexual orientation or gender identity, may lack understanding or have biased attitudes toward people whose sexual orientation or gender identity differs from their own.

Some staff may be concerned that clients will ask about the sexual orientation or gender identity of the therapist/counsellor. LGBTTTIQ staff working in predominantly heterosexual or mainstream settings may fear the professional consequences of self-disclosure. Therapists/counsellors of every sexual orientation and gender identity may be concerned about the impact of self-disclosure on the client or counselling relationship.

LGBTTTIQ clients may feel discomfort, anxiety or fear of negative consequences. They may fear being misunderstood by therapists/counsellors and other clients. Therapists/counsellors should remember that clients have probably had previous homophobic, transphobic or biphobic experiences in health or social service agencies.

I am only conducting the assessment and will not be involved in the treatment/counselling. Should I be asking about the client’s sexual orientation and gender identity? Will this only “open up a can of worms” or bring up a lot of unrelated issues I won’t have time to deal with?

Sexual orientation and gender identity, along with other topics that are considered sensitive, including domestic violence, child abuse, family substance use and use of mental health services, have a tremendous impact on clients. Basic information about these topics is necessary to develop appropriate treatment/counselling plans.

At assessment, you may not need to get deep into issues related to sexual orientation and gender identity. However, it is important to identify these issues and determine whether they need to be addressed during treatment/counselling. Clients struggling with their sexual orientation or gender identity will be reassured that they can discuss and be open about their concerns during treatment/counselling. When developing a treatment/counselling plan, the criteria you use (e.g., the Admission and Discharge criteria in Ontario) could indicate a particular level of service, but you may find that, locally, that service is not sensitive to LGBTTTIQ issues. This may mean you have to deviate from the criteria for the treatment/counselling plan and referrals.

The client’s responses to Part A will help therapists/counsellors make the best referral possible.

Why discuss the issues in Part B?

The issues in Part B will help you:

• collect information to help formulate an appropriate treatment / counselling plan
• maintain an effective relationship with clients by showing that you are aware of their issues.

Client perceptions

“Some health professionals can be very biased and have really difficult attitudes. For example, there was one therapist that I was out to as a transwoman and I stopped seeing him simply because he tried putting words in my mouth. I said to him, 'I want children and I would love to have been able to have my own.' So, he sits up, looks at me and says, 'Oh, so you want to be a father, do you?' That immediately shut me right down. I lost trust in him.”

“My experiences were very much that the clinical staff and the nursing staff had just a tremendous amount of tolerance for other people hurling slurs at me. I think it’s ignorance. I think it’s lack of information and lack of training, but I also think that it’s a really touchy subject for some. I think that a lot of people don’t like conflict on that type of level. It’s not that they think it’s okay. They think it’s a hard conversation to have with someone. In a clinical setting, someone might be afraid to stick up for the queer girl because they are afraid of how they will be perceived.”

Therapist/counsellor perceptions

“Changing our intake has had an impact on the numbers of clients who are identifying as LGBTTTIQ. Initially, when we started, we thought, well, what do we know? We know probably 10 per cent. Now, since we have implemented the ARQ questions, it’s a 100 per cent increase. Now, our stats are telling us 20 per cent. It’s probably more.”

“A few things will make it harder for a client to come out. Their assumptions about me as the therapist would make it harder. I think their initial interaction with me. I think the language I use. I mean, I’m pretty deliberate in saying, ‘Do you have relationships with men or women?’ That’s not accidental. So, if I just ask my female clients about any relationships with men, it might make it harder for them to come out.”