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What can I do if I feel uncomfortable asking about sexual orientation and gender identity?

The following can help you become more comfortable:

• Educate yourself (see Resources).
• Become familiar with LGBTTTIQ resources in your area.
• Practice asking the questions in the guide.
• Role-play with a colleague.
• Consult with therapists/counsellors who have clinical experience in the area.
• Reflect on your own sexual orientation and gender identity to become more aware of feelings and biases that may help or inhibit discussion of sexual orientation and gender identity with clients. Deciding about whether to disclose your own orientation or identity to clients (if not already known) may be approached in the same way as deciding about sharing other personal information. Beyond your readiness or comfort in self-disclosing, would disclosure be helpful to the client and the counselling relationship, or might it have another effect? The client’s needs should always take priority over other interests.

What can I do to help alleviate clients’ concerns about discussing sexual orientation and gender identity?

Assess and counsel people in the context of their sexual orientation and gender identity. Be sensitive to (and reflect as appropriate) the language your client uses when referring to his or her identity and life.

When addressing transgendered or transsexual clients, use the proper pronouns based on their self-identity. When in doubt about the proper pronoun, it is fine to ask, “What is your preferred pronoun?” And then remember to use it. If you do slip up, apologize to the client and continue to use the preferred pronoun. For these clients, being seen as the gender that they are will greatly affect trust.

Increase your knowledge base, but avoid using clients as a primary source of your education about LGBTTTIQ people. Inviting additional information to better work with a client is appropriate; however, clients are there to receive your support, not to teach you.

Watch for unconscious bias or judgmental tendencies. Most of us have been socialized to “pathologize” LGBTTTIQ people.

Most of us are also raised to believe in binary thinking. Watch out for the “either/or” model of sexual orientation and the “either/or” model of gender identity — be careful not to push questioning clients to “choose.”

Try to balance between the extremes of:

• assuming that being LGBTTTIQ is the underlying reason for substance use or mental health difficulties
• ignoring sexual orientation and gender identity altogether
• showing excessive curiosity about a client’s identities.

Do not impose your values around if/when/where/how a client should come out. It is up to the client to consider what is involved in coming out.

Anti-LGBTTTIQ conversation or comments should not be tolerated in the treatment/counselling environment or client groups. Rather, therapists/counsellors should address these comments and create a culture of respect for diversity.

Ensure clients that all disclosed information will be kept confidential.

I am not LGBTTTIQ. How can I convey to a client that I am LGBTTTIQ-positive?

• Use this guide and create an atmosphere of acceptance. This can include placing LGBTTTIQ-positive posters, signs and reading materials in the agency or office. Offer appropriate support to clients who are exploring their sexual orientation or gender identity.
• Show that you accept the client’s sexual orientation and gender identity, and make the client aware of any anti-discrimination policies at your agency/service.
• Keep a non-judgmental attitude and be aware of your body language.

Client perceptions

“If someone calls me by the wrong pronoun, I don’t want to hear why they made the mistake. This has happened to me. They’ll say, ‘Oh, I’m sorry; it’s because your brow ridge or your shoulders or your waist or your hips.’ They’ll tell you all the reasons why you don’t pass. Shut up. I don’t want to hear why I don’t pass in their eyes or why any of us don’t pass in their eyes. I just want to hear, ‘I’m sorry.’”

“They didn’t say, ‘We’re going to be sensitive to gender and sensitive to sexual orientation and sensitive to mental health.’ If they had said those things, I might have known that I could expect support if others gave me a hard time. But because they just said, ‘Oh yes, we want to be supportive and we want to be inclusive of everyone,’ does that really mean that you are not going to think that I’m a freak?”

Therapist/counsellor perceptions

“Professionals shouldn’t wait to get a transgendered client to learn about what the needs of transgendered clients are.”

“The intake and assessment workers have gotten more comfortable asking all these kind of questions. Now, these kind of questions just sort of roll off their tongue, whereas they didn’t before.”

“Is it not worth asking about the impact of HIV on lesbian/bisexual women too? Especially if you are assessing the level of self-hatred and conflict. Many women who identify as lesbian have sexual relations with men.”

“One concern for clients around coming out to a therapist is judgment. Also, lack of appropriate treatment once disclosure has happened. Fear of having retribution in some form through the type of treatment you receive. As far as gay rights have come, there is still a whole lot of judgment, hatred, homophobia and stigma.”