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What are some of the specific needs, concerns and/or experiences of LGBTTTIQ people of colour or other queer people from marginalized communities?

Coming out and finding support is harder for people who are doubly or triply marginalized.

For example, a deaf lesbian may experience discrimination from the deaf community around her sexual orientation and discrimination around her disability from the LGBTTTIQ communities. She may not find appropriate supports from either the LGBTTTIQ services or agencies for deaf people. She may need to develop connections in a deaf LGBTTTIQ community. This unique type of support is available in large cities, but it may not exist in other places. The Internet may be one resource for people looking to meet others with similar experiences.

LGBTTTIQ people of colour often face a similar double marginalization — it may be challenging to be “all of who they are” in the various LGBTTTIQ and racial communities to which they belong. LGBTTTIQ people of colour experience racism from a predominantly white queer community. However, the ethnospecific communities from which they originate may have been places of support and shelter from racism in general society. Coming out carries the risk of losing this important support.

When working with LGBTTTIQ people who belong to marginalized communities (other than the LGBTTTIQ community), clinicians need to be aware of the additional challenges and should ask clients about this experience.

Where possible, provide a list of groups and services specifically for LGBTTTIQ people of colour, LGBTTTIQ people with disabilities and LGBTTTIQ people from other marginalized communities.

Can the questions in the ARQ2 guide be used with clients who have severe mental health problems?

Sexual orientation and gender identity are basic information that therapists/counsellors need to know about all clients. Often, people with severe mental illness (e.g., schizophrenia, psychosis) must cope with having their sexual orientation and gender identity go unrecognized. Faulty assumptions are often made that these people are not sexual. A prevailing social myth is that people become lesbian or gay because “something bad” happened to them, such as the idea that sexual abuse “caused” their sexual orientation. Counsellors/therapists working with survivors of childhood sexual abuse will need to be aware of this myth and help the client expose and debunk the myth as part of their healing work. For example, it is helpful for a client to hear a clinician say, “There is no correlation between the abuse and your sexual orientation.”

In emergency and crisis situations, we recommend that clinicians use their best judgment in deciding when, how and if the ARQ2 guide is to be used. Clinicians should consider that in some crisis situations, sensitive questions regarding sexual orientation and gender identity might help the clinician and the client to better understand and resolve the causes of the crisis. For example, an LGBTTTIQ person who is coming out or transitioning may present to an emergency department with suicidality after being rejected by a family member.

Client perceptions

“There’s all of that internalized oppression within the ‘crazy’ community too, where, ‘She’s crazier than I am therefore, she’s lower on the totem pole.’ Or, ‘I’m only depressed; she’s schizophrenic.’ There’s so much of that. ‘I’m only schizophrenic; she’s schizophrenic and gay.’ And then you go lower and lower. ‘She’s schizophrenic, gay and black.’ This multiple piling on of marginalizations, and you get lower and lower.”

“I had a nervous breakdown and I told this girl on the ward that, ‘If they tell you I’m gay, don’t believe them.’ That just started an uproar. I thought eventually that they were trying to kill me. It was horrible. I was having these delusions and hearing voices that they were coming for me, and it’s a very scary experience. It was mostly fabricated in my head, because of the symptoms I was having. But because of the homophobia and abuse that I have had to deal with, it makes it even scarier and more threatening.”

“I came out to my psychiatrist. He says, ‘It’s good to be a lesbian. Just don’t have sex with women.’ I had abuse issues with my mother and he thinks if I have sex with women, it will trigger. Many, many, many straight women are abused by men. So, is the advice, ‘You shouldn’t have sex with men because it will trigger’?”

Therapist/counsellor perceptions

“There is a huge stigma associated with coming out in the black community. So I rarely get black clients who identify as LGBTTTIQ, although I do have clients who are black. And what that often means is they don’t feel they can access culture-specific programs, especially within the LGBTTTIQ communities, because there’s a possibility that there will be somebody there who knows the family or whatever.”

“I have one client who is a refugee claimant and he’s gay. When a person presents with those multiple layers — the cultural thing, the religious thing and sexual orientation — it takes on a different degree and intensity, because of all of those layers of isolation and estrangement.”