Building an LGBTQ-Affirming Practice

By Sue Coyle, MSW

Delivering services that are effective and beneficial requires clinicians and practices as a whole to be genuinely inclusive and knowledgeable about the individuals and communities they serve. This is particularly true for those who work with individuals who identify as a part of the LGBTQ community.

“LGBTQ individuals face unique concerns and challenges when it comes to seeking services and connecting with their providers,” says R. Lane Forsman, PhD, LMSW, an assistant professor in the department of social work at Southern Illinois University Edwardsville.

“Because of the narrative in society that many LGBTQ people experience telling them that their status as a member of the community decreases their self-worth or excuses their experiences of discrimination and trauma, it is vitally important that LGBTQ persons seeking assistance from a social worker know that their identity is welcome in that space and considered as a valid and integral part of how they understand the world,” he says.

Social workers who serve the LGBTQ community must put effort into creating a practice that welcomes not only the community but the individuals within it as well.

Common Missteps
The first step in building an inclusive practice is recognizing the assumptions and mistakes many make. For example, it is not uncommon for clinicians to say they are LGBTQ affirming without putting in the effort it takes to actually be affirming. This is not necessarily due to carelessness but rather a lack of recognition about one’s own shortcomings.

“You may be an activist, educator, or ally to the community, but words do not mean much if policies and procedures are not in place to protect the LGBTQ community,” says J. Chandler Caldwell, MSW, LICSW, PIP, a psychotherapist and doctoral of social work student at the University of Alabama. “In an effort to connect words to practice, it is important to examine how your practice currently operates and how it can establish or strengthen its affirmative practices.”

Even when a practice has taken steps to go beyond talk and actually be affirming, an examination is necessary to make sure that the whole community, not just segments of it, is being welcomed and treated appropriately. Another common misstep is assuming that policies and procedures designed to cover some, cover all.

For example, Heidi P. Breaux, LCSW-R, program manager for online education at Tulane University School of Social Work and a doctoral of social work student, says, “Often clinicians may have an LGBTQIA+ affirming practice but also participate in harmful gatekeeping against the transgender and gender-diverse community.” She points to the need for individuals to get written documentation from providers before being able to have gender-affirming surgery. The process calls into question the individual’s own ability to attest to their identity and advocate for themselves.

“Requiring clients to take extra steps such as seeing a psychiatrist when it isn’t required, again to make the clinician ‘feel comfortable’ is also the same, medical gatekeeping,” she adds. “All of these can have very negative mental health consequences for your client. The NASW Code of Ethics requires us to go further than just affirming our transgender and gender diverse clients’ pronouns or names. Advocacy for trans equity is part of our ethical obligations.”

Becoming Affirming
Beyond recognizing errors and assumptions, clinicians must take the time to learn about the community they hope to serve. This means connecting with individuals who are a part of the community and who work within it.

Forsman and Caldwell recommend reaching out to a variety of individuals and organizations including colleagues, advocacy groups, and nonprofits to gain a better understanding of the community served.

“Just like working with any other group of people that we don’t share a lived experience with or who we are unfamiliar with in a practice setting, the first step is to educate ourselves. It cannot be the responsibility of that group to reach out and educate us. It must be an intentional action we take,” Forsman says.

He adds that when local resources are unavailable or minimal, social workers can look to national organizations for additional information and, ideally, connections. A number of organizations, such as SAMHSA and the NIMH, offer trainings on working with the LGBTQ community. For example, the Human Rights Campaign Foundation has partnered with the National LGBT Health Education Center to offer LGBT patient-centered care training. There are currently more than 50 webinars available for viewing, as well as a variety of other online learning opportunities.

Individuality
The most important lesson to learn, however, is that every person who identifies as a part of the LGBTQ community is a unique individual and must be treated as such.

“Making generalizations or comparing experiences of two people in the LGBTQIA+ [community] should never be done, even if you think they are similar or that the client would ‘want to know,’” Breaux says. “Oftentimes, providers use this tactic to qualify their experiences to an LGBTQIA+ client, but this is at a high emotional cost to the client and only serves the purpose to make the clinician more comfortable.”

“This goes for LGBTQ practitioners, as well,” Forsman adds. “I am a queer man and I have a lived experience because of that, and it allows me to empathize more with members of my community. But I am also still a cisgender white male. I will never know the lived experience of a Latinx lesbian or a black trans woman or a Muslim gay man.

“Never let your pride as a practitioner stop you from letting clients know you need more information about their experience to clarify their needs,” he says.

Taking Action
Once a social worker has begun to gain a better understanding, they should, as Caldwell advises, examine their policies and procedures to ensure they are LGBTQ+ affirming/inclusive. Education is the foundation, not the sole step, for building an affirming practice.

“It is best to take action when developing an affirming practice,” Caldwell says. “When a client calls and asks what your practice is doing to foster positive relationships with the LGBTQ community, you should be able to answer that with concrete evidence.”

On the simplest level, paperwork can be changed to reflect more gender diversity. Staff, regardless of their role in the practice, can be trained on LGBTQ affirming practices. And clinicians can make a conscious effort not to make assumptions before, during, or after sessions.

“[Do] not operate your practice from an assumption of heterosexuality/cisgender identity,” Forsman says. “For instance, during an assessment with a client or discussion of their home life, don’t make assumptions about the gender of their partner through heternormative language like ‘husband’ or ‘wife.’ Use more neutral language like ‘partner’ or ‘spouse.’”

Taking and maintaining these actions will in and of themselves prove to the individuals served that a practice is LGBTQ affirming. However, clinicians can do more to show their intention. Having an affirming practice is only beneficial if/when members of the LGBTQ community know that the practice exists.

Both Caldwell and Forsman recommend including information about training and experience with the LGBTQ community in the literature used to advertise services. This may be a clinician’s biography, pamphlets at the front of an office, or a website. Not only should training and experience with the community be included but the language used should be inclusive as well. Again, if advertising couples counseling, for instance, don’t shape your description of the service around a male and female. That will indicate to a potential client a lack of understanding and inclusivity.

“I also think it is important to support LGBTQ causes, remain open and honest about how your agency or practice welcomes all individuals, and advertise what the agency is doing to maintain affirming practices,” Caldwell says.

“As an LGBTQ person myself, I always look for clinicians that specialize in LGBTQ issues. [I look at] the agency’s social media to see what type of content they are sharing, and if there is any representation of the LGBTQ community on the agency’s website,” he notes.

Lifelong Learning
Finally, don’t be complacent. Gaining the foundational knowledge and taking the necessary actions to build an LGBTQ-affirming practice are not the final steps. They are the first steps. Being genuinely inclusive is an ongoing and ever-evolving process.

“Never assume expertise,” Forsman says. “The LGBTQ community is a vibrant and evolving one. If you can form partnerships with LGBT groups or organizations in your area, this can be a very good way to stay connected to growth and change in the community.”

He advises discussing service plans and other aspects/approaches with the organizations in the community. Form an advisory panel. Essentially, make the people you serve a part of creating the services.

“The more you invest into getting to know the LGBTQ+ community,” Caldwell says, “the easier it will be to maintain an affirmative practice.”

— Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs.