Counselor Competence in Treating LGBT Clients

Counselors will encounter and provide treatment to lesbian, gay, bisexual, and transgender (LGBT) clients in all treatment settings: residential, intensive outpatient, outpatient, crisis intervention, and the criminal justice system.

The Center for Substance Abuse Treatment (CSAT) published a Technical Assistance Publication (TAP) in 1998 titled Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice, in which the professional addictions counseling field, represented by leaders of national counseling organizations, identified eight practice dimensions. The dimensions are (1) clinical evaluation, (2) treatment planning, (3) referral, (4) service coordination, (5) counseling, (6) client, family, and community education, (7) documentation, and (8) professional and ethical responsibilities. Proficient knowledge and skill in each of the dimensions is necessary for effective practice (CSAT, 1998b). The development of effective counseling practices in the field of addictions depends on the presence of attitudes in which openness to alternative approaches, appreciation of diversity, and willingness to change are present and consistently practiced (CSAT, 1998b).

In the counseling competencies model, a counselor needs to respect the client and his or her frame of reference; recognize the importance of cooperation and collaboration with the client; maintain professional objectivity; recognize the need for flexibility and be willing to adjust strategies in accordance with client characteristics; appreciate the role and power of a counselor as a group facilitator; appreciate the appropriate use of content and process therapeutic interventions; and non-judgmentally and respectfully accept the client’s cultural, behavioral, and value differences. These best practice methods are critical when working with LGBT clients.

The most important ethical issue in counseling is the protection of clients’ well-being and safety, based on an “ethos of care” and a “covenant of trust” between clients and counselors (Peterson, 1992). In this capacity, counselors acknowledge and manage the power accruing to them so that they can use that power constructively and ethically (Gartrell, 1994). Thus, counselors need to be aware of how clients who have been or are being discriminated against may respond to others’ power. Clients who have been traumatized may be overly passive and accepting or very oppositional. These behaviors are important information for the counselor, and an aware counselor will provide a safe environment for the client in which to work through his or her feelings. Counselors need to be aware of and monitor their use of authority so that they do not push or force clients to do something they are not ready to do. In the case of LGBT clients, Counselors should not “out” or push a client to share his or her sexual orientation or gender status in the name of honesty and good treatment.

At the same time, the counselor should help create a safe environment for clients who are ready to come out in treatment to do so. Counselors need to use their authority to ensure their LGBT clients’ safety when it is necessary to protect LGBT clients from overt expressions of homophobia (or biphobia or transphobia) by other clients or staff. Most clients who present for treatment have to deal with the shame and guilt of their drug-using behavior. It is important for counselors to remember how their words can activate clients’ shame; this is especially important when working with LGBT clients, who have been traumatized by both their alcohol or drug abuse and the heterosexist attitudes and behavior they must deal with.