LGBTQIA+ counseling: The importance of inclusive counseling services

Challenges Faced by the LGBTQ+ Community

Many LGBTQIA+ community members face constant stigma, not only in the form of hate, but also in society’s heteronormative (straight-centered) expectations and implicit judgment from others surrounding their very existence. 

Common challenges that those within the LGBTQIA+ community face include:

• Having their identities ridiculed or unfairly questioned by those outside their community or social circle.
• Homophobic comments, physical assault, and other hate-based attacks that threaten their bodily and emotional well-being, as well as the weight of worrying about their safety.
• Gender roles that may feel (or be) forced onto them, creating internal and external conflict that feels unresolvable, especially if they aren’t ready or interested in coming out.
• Dealing with constant confusion from others about their sexual orientation or gender identity. This can create unresolved feelings of anger and frustration that may affect their ability to trust others.
• Family problems that may arise from relatives’ lack of understanding or acceptance of their identity, lifestyle, or self-image.
• Little to no access to proper care and resources (i.e. medical, mental health, etc.), making it difficult or even impossible for them to have their basic needs met and cared for.
• Lack of self-esteem or low self-worth, which may be caused and exacerbated by all of the above issues.

Each of these challenges affects LGBTQIA+-identifying people in unique ways, and each of them needs individualized emotional support to help them manage the impact they have on their mental health.  

How Can the Stigma and Hate Experienced by LGBTQIA+ Individuals Affect Their Mental Health?

The negative experiences LGBTQIA+ people have can affect their mental health in various ways, causing a number of different mental health conditions. Examples of common mental conditions seen in LGBTQIA+ individuals include: 

• Depression
• Anxiety 
• Suicidality
• Identity issues (borderline personality disorder or floating identity, trauma)
• High stress

These conditions are highly prevalent in LGBTQIA+ communities, especially in youths. Many LGBTQIA+ people find it difficult to fit in and often get bullied for who they are and how they express themselves. 

Mental Health Disparities Within the LGBTQIA+ community

There are huge mental health disparities that disproportionately affect the LGBTQIA+ community. Consider a few statistics from Mental Health America:

• LGBTQIA+ individuals are 3x more likely to develop a mental health condition.
• LGBTQIA+ teens are six times more likely to experience depression.
• LGBTQIA+ kids and teens are twice as likely to experience suicidal thoughts and four times as likely to attempt suicide. 
• About 27% of trans individuals, and 8% of LGBTQIA+ individuals overall, say they have been outright denied necessary health care.

According to NAMI, LGBTQIA+ adults are more than 2x as likely as heterosexual adults to experience a mental health condition, and transgender individuals are 4x as likely. What’s even more troubling is that 39% of LGBTQIA+ adults reported being cut off from a family member after coming out, as Pew Research data indicates. 

Counseling can help the LGBTQIA+ community to address these challenges, from the mental health conditions they may struggle with to other life issues like building relationships with others and talking to loved ones about their sexual orientation and identity.

How Can the Right Counselor Help LGBTQIA+ Individuals? The Importance of Specialized Counseling

The mental health disparity mentioned above begs the need for proper mental health care in the LGBTQIA+ community. Fortunately, more and more counselors understand the challenges these individuals face. 

Specialized counseling is the most equipped to deal with the above problems in a nonjudgmental and trauma-informed manner, meaning that clients will not have to deal with their own concerns while teaching their provider about their LGBTQIA+ experience and how it might differ from the heterosexual or cisgender experience. They can also provide clients with a sense of safety and security, something that doesn’t happen in many spaces.

Often, LGBTQIA+-affirming counselors will start by getting to know the individual, including their unique presentation of issues as well as their life goals. If you are a member of the LGBTQIA+ community and you decide to pursue counseling, your counselor might ask the following to get to know you better:

• What are your interests?
• Are you currently in a relationship—and if so, how does your relationship seem to impact your mental health? 
• What is your living situation like?
• Are you happy with your life right now?
• What long-term or recent issues are you struggling with?
• In what ways has your identity shaped your experience and interactions with others? 

Depending on whether one’s LGBTQIA+ identity is a central point of therapy, therapists may discuss the client’s openness about their sexual or gender identity, and perhaps help them come out to themselves through guided introspection and consistent positive regard. This is a very important part of the process of self-acceptance and love that therapy strives to foster.

It’s also important to note that it’s not always wise to lump people with gender identity experiences and sexual identity experiences together. Though they are technically part of the same community, transexual, non-binary, gender-fluid, and other individuals with gender identity experiences will often have very different struggles and concerns than gay, bisexual, asexual, and other people with sexual identity experiences. As such, their provider will specialize and individualize treatment depending on the client’s unique experiences.

Common Approaches to LGBTQIA+ Therapy

Depending on your story and journey, you may find a counselor who uses a specific counseling approach, such as cognitive behavioral therapy (CBT), solution-focused therapy (SFT), dialectal behavior therapy (DBT), or more. More specifically, a counselor who identifies as LGBTQIA+ or specializes in working with the community can help you address the damage and impact of: 

• Trauma: Whether you’ve experienced turmoil or adverse experiences in the past or present, an LGBTQIA+-affirming counselor can help you resolve and start to heal the damage and impact of trauma on your daily life. 
• Family conflict: If coming out, your lifestyle choices, or arguments over your identity have caused rifts in your relationships with relatives, your counselor can help you to learn how to better navigate these connections, minimizing the negative effects that may rebound on you. 
• Relationship difficulties: Whatever the nature of your romantic relationship, an LGBTQIA+ counselor can help you and your partner stay connected, grounded, and aware of each other’s needs and goals. 
• Anxiety: Whether you’ve come out or aren’t interested or ready, talking with a counselor can help you manage the anxiety that may arise from concerns over how others will respond to your truth. 

The bottom line with LGBTQIA+ counseling—and any kind of therapy or counseling—is that clients will lead with their own goals. The provider is there for support and guidance, not to give specific direction or set goals for the client.

This is especially related to LGBTQIA+ counseling when considering therapy goals and identity. Though one’s identity in the LGBTQIA+ community can have a great impact on their life and goals, not every LGBTQIA+ person will center their therapy goals around their LGBTQIA+ identity—this is only one facet of their life, and therefore it can’t be assumed that their identity is the cause of their concerns.

If a provider feels that even more specialization is needed to give a client the care they need, they can also offer references to specialists in specific LGBTQIA+ issues (body dysmorphia, gender dysphoria, gender-affirming care, trauma, etc.).

The right provider can help ensure their LGBTQIA+ client’s resilience and freedom of expression remain intact, even while navigating potential discrimination and unjustified hatred.

Thriveworks Approach to LGBTQ Counseling: Work with an LGBTQIA+ Counselor to Navigate Your Journey

Again, it’s important to know that counseling often focuses on more than just the problem at hand. A counselor’s ultimate mission is to help their client live an overall happier, healthier, and/or more successful life and, perhaps most importantly, to be a safe, nonjudgmental person for LGBTQIA+ individuals to talk to and lean on for support.

This often means that one’s counseling sessions will involve discussing and working toward their goals, in addition to making positive changes to best benefit one’s mental health and well-being. That said, no one counseling journey is the same: Your counselor will design treatment based on all of the information they gather in your initial sessions. The end goal, though, is always the same: to help you live better.