What Is Culturally Competent LGBT Therapy?

It is no measure of health to be well adjusted to a profoundly sick society.  -Krishnamurti

Lesbian, gay, bisexual and transgender people seek therapy for the same reasons anyone does. In addition, they are impacted by living in a homophobic and transphobic world. Understanding the issues presented within that context is where the LGBT culturally competent therapist comes in.


I’d like to first share the definitions I operate from when working with LGBT clients and issues.

Sex– What we are assigned at birth. Believed to be binary (male or female) and to dictate gender expression. In reality, many are born intersexed, and/or experience a gender that is different from their birth-assigned sex.
Gender– Socially constructed, learned via culture. In Western culture typically binary: men (who are masculine) and women (who are feminine). Behavior, appearance, and societal roles are differently defined for each gender. For most people, gender is their sex made visible. For transgender, gender variant or gender non-conforming people this is not the case.
Sexual Orientation – A person’s sexual/romantic attraction to members of the same and/or opposite sex. Includes gay, lesbian, bisexual and heterosexual.
Gender Identity – A person’s inner sense of self as male, female or other gendered. Gender identity may not corresponds to the sex you were assigned at birth.
(People often confuse sexual orientation and gender identity. Your gender, whether it is man, woman, transgender, says nothing about your sexual orientation.)
Gender Expression– The way people communicate their gender identity to others through behavior and appearance. Transgender people may desire to make their gender expression match their internal identity, rather than their birth-assigned gender or sex.
Transgender– An umbrella term that can be used to refer to a variety of identities that do not conform to the gender role expectations of their birth-assigned sex. It may include people who identify as transexuals, female-to-male (FTM), male-to-female (MTF),  genderqueer or other gendered. Transgender people may or may not choose to alter their bodies hormonally and/or surgically.

For further definitions of many sexual orientation/gender identity related terms see: Glossary or Trans Basics: Glossary of Terms (note: terms are constantly evolving. The only way to be certain which terms an individual prefers is to ask!)

Why seek a therapist with awareness of/expertise in LGBT culture and issues?
LGBT culturally competent therapists get that you are more than your sexual orientation/gender identity. Certainly not everyone LGBT is seeking therapy for issues related to their sexual orientation and/or gender identity! At the same time, it is crucial for the therapist to “get” the many ways societal prejudice and discrimination create problems that LGBT clients may seek to address in therapy. As a trauma therapist I understand the individual within the context of multiple levels of oppression (and privilege). Many institutions and individuals within our culture continue to hold anti-LGBT biases such that growing up LGBT often is a stigmatized and traumatic experience. If you have felt stigmatized because of your sexual orientation or gender identity, the last thing you want is to have to spend valuable time educating a therapist about your orientation or identity, or talking about your sexuality/gender because your therapist considers it to be a “problem.” You have a right to a therapist that is affirming and educated about the LGBT communities.

What are some issues LGBT clients might want to address in therapy?

1. Coming out issues: Coming out refers to the process of recognizing your own sexual orientation or gender identity and deciding whom to share it with and how to do that. Coming out is a life long process for most LGBT people. Do you need a safe place to explore your sexual orientation? Are you struggling with internalized shame or fear about what it means to be LGBT? You may be comfortable with your identity but fear rejection by important people or discrimination on the job. Parents of LGBT children might seek therapy to understand how to support their child in this process. You may also be wondering what it means about your identity if your choice of partner changes, or your partner transitions form one sex/gender to another.

2. Relationship issues: Stigma impacts our ability to have healthy relationships and sexuality. Are you struggling with your ability to form and maintain healthy relationships? Are you wondering if your sexual behavior is compulsive? Too much? Too little? Are you questioning whether monogamy works for you and thinking about exploring other options? Do you identify as polyamorous and fear this being pathologized? Are you kink identified? Are you wanting to discuss the differences between bdsm and abuse? If you are bisexual, are you tired of explaining that this does not always equal nonmonogamous?

3. LGBT-related trauma
: LGBT clients experience all the same traumatic events as heterosexual individuals. In addition, they may also experience traumas related to their sexual orientation or gender identity. You may have experienced bullying as a child or teen related to your presumed sexual orientation or gender expression. You may have experienced physical or sexual assault (gay bashing). You may experience same-sex domestic violence, which carries with it additional stigma and barriers to treatment. You may have expereinced prior therapy that focused on trying to “cure” your sex orientation or gender variance or defined it as pathology. You may have been traumatized by cultural institutions that still stigmatize LGBT individuals and identities. Where you rejected by your faith community? Discharged from the military? Shunned by friends or family? Fired from a job? If you are bisexual, are you dealing with misconceptions from straight and queer culture alike? All of these are traumatic events that may be addressed in therapy.

4. Accessing community support
: We often here talk about the LGBT community, as if there is only one! In reality there are many sub-communities and finding your niche can be difficult. Therapists with awareness of the communities locally and at large can help guide you in seeking support and a place where you fit. LGBT affirming churches, support groups, recreational activities are all out there if you know where to look.

Kathleen Young, Psy.D.

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7 Responses to What Is Culturally Competent LGBT Therapy?

  1. Patricia Wilcox says:

    Hi! I was glad to discover your blog and your work through Twitter. You might be interested in my blog about treatment for children and families. My work is in the area of helping child and adolescent treatment programs become trauma informed. Glad to connect with you!
    Patricia D. Wilcox
    Klingberg Family Centers
    http://traumatreatment.blogspot.com

  2. Pingback: LGBT Therapy - Sharon Sanquist

  3. Pingback: “Hey hey, ho ho, homophobia’s got to go!” – National Equality March™ « Dr. Kathleen Young: Treating Trauma in Chicago

  4. WG says:

    Howdy,
    Best post I have read on this topic. No offence intended but many therapists/psychologists/counsellors are sadly lacking in real understanding in this area and think that basically being “open and accepting” should be enough to work with all people irrespective of gender/sex/orientation. Its a good start of course! but its not what I would call real understanding.. Or a strong enough basis upon which to build trust. Reading this made me both sad and happy. Oh dear now I may have to “talk” about this…😉
    Thanks. Dr K.
    X

  5. Pingback: Treating Trauma… in Tucson | Dr. Kathleen Young: Treating Trauma

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