Mistakes to Avoid when Working with LGBTQIA+ Clients

By Kristie Overstreet on May 20, 2019

As clinicians, we often learn something new every day. Education comes from experience in the clinical setting and our quest for continued learning in the field. One area that many clinicians need to continue to grow is working with LGBTQIA+ clients.

I use LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, plus) acronym because I feel like it is more inclusive. Often you will see LGBT, LGBTQ, LGBTQI, and other acronyms for the community. As a clinician, advocate, and ally, I wanted to share a few mistakes that some providers make when working with the community.

Mistake #1: Assuming You Know What the Client Needs

It can be easy for you to assume what you think the client needs before even meeting with them for the first time. For example, a new client schedules an appointment with you. They state that they are transgender and want to start counseling.

Don’t assume that they want to transition, come out, or only discuss transgender-related topics in the counseling session. Sure, they may wish to discuss these areas. However, you don’t want to assume that you ‘know’ what they need before the session even starts.

Meet the client where they are at the first session, by asking them what they want to work on in counseling. Listen to the goals they want to achieve by working together. Don’t start with an assumption of what they need.

Mistake #2: Overinflating or Underinflating Identity

Just because your client wants to discuss their sexual identity in a session, doesn’t mean it is all that they want to focus on. Clinicians can easily get caught up in overinflating or underinflating areas of interest.

Overinflating is when a clinician blows up an issue or overly maximize an issue more than it needs to be. For example, your new client who happens to be a transgender female, wants to discuss her goal of applying for a new position at her current job. She begins to describe her anxiety about her ability to handle time management with the potential new position. The clinician then focuses on how her gender identity affects the new position. As the client further discusses her anxiety, the clinician focuses only on her gender in relation to the job versus the client’s anxiety about time management.

Underinflating is when a client states they want to discuss their readiness for a letter of referral for Hormone Replacement Therapy (HRT) and the clinician avoids discussing this. The clinician focuses on other issues the client has versus discussing readiness for a referral letter. The clinician isn’t listening to what the client needs.

Mistake #3: You Determine When a Client Should Come Out

This may seem like an obvious mistake that can be avoided. However, some clinicians may not realize that they are putting their opinions on when a client should come out. Even though the clinician may not think it, there is a power dynamic between themselves and the client they work with. Clinicians need to understand the unique circumstances of the power dynamic they have with each of their clients.

The client may see you as having the answers they need, knowing what next steps they should make, and looking at you for guidance. This is why clinicians have to be very aware of the effect they can have on a client, especially those within the LGBTQIA+ community. For example, a clinician can imply that their client should come out to their parents or partner. If the clinician tells the client to stop worrying and come out, they may be putting their client in danger.

As clinicians, it’s not our place to tell a client when they should come out. It is our responsibility to work with the client and support them as they plan to come out if it is their decision. Regardless, if we as clinicians think that their anxiety may decrease if they can be true to themselves, it’s not our place to tell a client to take this step. We can’t ensure their safety, but we can help support them through the process.

The majority of clinicians working with LGBTQIA+ clients want to be helpful and supportive. However, it is crucial that we continue to attend training in the area of LGBTQIA+ counseling to ensure that we are providing the best service for our clients. This is why mentoring, supervision and continued education can help us continue to be better clinicians, which can provide better outcomes for our clients.


Dr. Kristie Overstreet is a clinical sexologist, certified sex therapist, licensed professional clinical counselor, author, speaker, and consultant. She holds a Ph.D. in Clinical Sexology, Master of Arts in Professional Counseling, and a Bachelor of Science in Biology. She is a licensed counselor in California, Florida, Georgia, and Louisiana. She is also a Certified Sex Therapist and Certified Addiction Professional. She has over 12 years of clinical experience specializing in sex therapy, transgender healthcare, relationships, and helping counselors build their private practice. She is president of Therapy Department, a private practice that provides counseling, training, speaking, and consulting services across the United States.  For more information about Dr. Kristie's work visit www.KristieOverstreet.com.


Add new comment

The content of this field is kept private and will not be shown publicly.

Plain Filter