Practical Suggestions for Providing Competent Treatment

How can a counselor self-monitor when treating LGBT clients? The first issue is what counselors and agencies, via construction of psychosocial histories and intake forms, ask or do not ask clients at intake. If clients are routinely asked about partners or significant others, but this question is omitted with LGBT clients, LGBT clients lose the opportunity to tell their counselor who they really are. Some LGBT clients may not want to reveal their sexual or gender orientation, but if counselors do not ask, they may treat the client’s “false self” (Winnicott, 1965), that is, the self that is presented to the world to protect the identity that is repressed and stigmatized. Treating the false self, by not asking about sexual orientation in an accepting and nonjudgmental way, is acting unethically and does a disservice to the client.

Following are some guidelines, or “do’s and don’ts,” for counselors who are or who wish to be sensitive to the needs and feelings of their LGBT clients and improve their own treatment and counseling skills.


• Do create safety for LGBT clients. This can include clearly stating what you can and will hold in confidence and what you will share with your team or your supervisor; assuring clients of your own supportive attitudes; and protecting LGBT clients from others’ homophobia.

• Do know the population. Read about LGBT people. Get to know LGBT people, especially those in self-help groups and nonclients. Know what LGBT resources are available for clients and how to access them. Recognize that it is easy to shame LGBT clients because of their internalized homophobia and their substance abuse.

• Do create an atmosphere that is supportive. On forms and in all verbal interchanges, use inclusive language. For example, instead of asking about marital status, ask who the partner or significant other is. Instead of asking for the names of next-of-kin in case of emergency, ask for the name of the responsible party and that person’s relationship to the client.

• Do acknowledge clients’ significant others and encourage their participation in the treatment. Hang pictures and posters of known LGBT people (e.g., athletes, historical figures); have books about LGBT subjects on tables and in waiting rooms; post lists of LGBT-friendly Alcoholics Anonymous/ Narcotics Anonymous/Al-Anon/Adult Children of Alcoholics meetings in visible places.

• Do be guided by your LGBT clients. Listen to what they say is comfortable for them. Support them in making decisions about coming out, self-disclosing, or accepting their identity.

• Do get training to help you become less heterosexist and increase your knowledge and understanding.


• Don’t label your clients. For example, when a client says he is in a long-term relationship with another man, do not say, “Oh, then you must be gay.” It is for the client to label himself or herself.

• Don’t pressure clients to come out. Respect their sense of where they are in this process and their need to feel safe.

• Don’t ignore significant others and family members. Don’t assume because people are not related by blood or marriage that they are not extremely important to the client.

• Don’t interpret on behalf of the client by saying “It must be hard being a lesbian,” or “You must be angry because your parents don’t accept your being a person of transgender experience.” Follow the client’s lead. A comment that is empathetic in one context may be invasive in another.