There has been growing discussion within our profession about the need for competent counselors to work with lesbian, gay, bisexual, transgender, queer, questioning and intersex (LGBTQQI) clients in an affirming manner. Largely, the discussion has focused on the inadequate training many counselors receive related to counseling these populations.

The purpose of this article is to discuss three pertinent issues counselors might encounter in session with LGBTQQI clients and to provide pragmatic, affirming strategies to facilitate successful therapeutic outcomes. We chose to focus on the deleterious consequences of heterosexism and transphobia and coming out because almost all LGBTQQI individuals have experienced these two issues. We also discuss bullying because, as we have recently seen, the consequences can be fatal.

Healing the consequences of heterosexism and transphobia

Significant changes have occurred in the past 20 years in terms of quality of life for LGBTQQI individuals. Despite these changes, LGBTQQI communities continue to experience discrimination and oppression, much of which is socially and legally sanctioned. For clinicians to work effectively with LGBTQQI clients and treat some of the mental health consequences associated with heterosexist oppression, it is important to understand the nature of this discrimination and hostility. In 2009, Gregory M. Herek and colleagues hypothesized that children internalize the ideals of heterosexuality during early socialization processes and are expected to grow up to be heterosexual. During school-age years, many children are apt to have strong, negative reactions to other children who are perceived to be LGBTQQI. This can cause LGBTQQI youth to be more vulnerable to homophobic harassment and victimization. Additionally, research has shown that these experiences contribute to psychological, behavioral and academic problems ranging from substance abuse to high-risk sexual behavior and suicide.

Herek and colleagues described sexual stigma as the view that any sexual behavior that is not heterosexual is inferior, relegating individuals who engage in non-heteronormative behavior or whose gender expression transgresses traditional boundaries to a “less than” status. Oftentimes, to avoid being stigmatized, many LGBTQQI individuals censor the things they say and modify their behaviors so as not to be identified as LGBTQQI. These modifications can manifest in a number of ways, such as a gay man talking about a fictitious girlfriend with coworkers, a lesbian teen dating someone of the opposite sex to avoid being “discovered” by family or peers, or a transgender individual being forced to use a restroom that is not gender appropriate for the individual. These actions can lead to feelings of anxiety, guilt, depression and fear.

Although much of the research examining the influence of heterosexism on LGBTQQI folks has focused on Caucasian populations, the mental and physical health consequences are even greater when sexual orientation and gender identity intersect with race and ethnicity. Consequently, LGBTQQI individuals of color become double or triple “minorities” depending on which oppressive “categories” are applied to them. Studies have shown that LGBTQQI identities in combination with racial or ethnic identities have an additive, as well as interactive, effect and can lead to even more extreme negative psychological effects and high-risk behavior. As counselors, we should be dedicated to improving the quality of our LGBTQQI clients’ lives. Therefore, it is vitally important that we not only assess and reassess our own biases, but that we consider and understand the experiences of those who are culturally different from us.

When working with LGBTQQI clients, it is important to maintain an affirming position that normalizes and validates their identities because many of these clients have experienced various forms of oppression and discrimination. Competent counselors should not be afraid to ask clients about those experiences. At the same time, competent counselors should not assume that a client’s presenting issue is necessarily related to the client’s sexual orientation or gender identity.

Additionally, due to living in a heterosexist and transphobic (negative attitudes and oppression toward transgender individuals) society, LGBTQQI clients regularly hear and internalize negative messages about themselves, which can lead to feelings of shame and depression. Clinicians should work with clients to process and replace those negative messages with positive affirming messages. This usually can be done with cognitive behavioral strategies and by providing clients with accurate information about LGBTQQI communities and values. For LBTQQI clients affected by heterosexism and transphobia, culturally competent clinicians should explore the client’s feelings of isolation and loneliness because discrimination can result in a person feeling no sense of belonging. To remedy this, counselors should work with clients to identify a support network.

Some clients struggle with whether their LGBTQQI identity is “right” or “wrong” and might request reparative/conversion therapy. Counseling professionals should consider how being raised in a heterosexist and transphobic society might contribute to the client’s struggle, whereby messages of a less-than status and abnormality may be internalized. Competent counselors must remember that the American Counseling Association Governing Council adopted a resolution in 1999 opposing the promotion of reparative therapy for use with LGBTQQI clients. Additionally, effective clinicians should never label, categorize or define a client’s identity. The competent counselor will support and empower clients through the process of self-discovery. With the help of affirming counselors, the experience of self-empowerment and the process of self-discovery will lead most LGBTQQI clients to come out.

Coming out

One of the most important life tasks many LGBTQQI individuals face is coming out. Coming out is a process of acknowledging same-sex feelings, attractions and/or gender identity or expression to one’s self or others. For some LGBTQQI individuals, the initial awareness of same-sex feelings or struggles related to gender identity might cause feelings of shame, guilt, fear and self-hatred, leading them to seek counseling services to assist with the coming out process. What follows are general guidelines that might foster a meaningful and empowering coming out experience for clients, as well as help forge an affirming, therapeutic relationship.

On average, people come out between the ages of 19 and 23, although LGBTQQI individuals are increasingly coming out at even younger ages. Coming out is not a onetime event; it is a lifelong process of negotiating when and to whom to disclose. A common belief exists that if a person comes out, that individual will be happier and more satisfied with life. This might ultimately be true for most people, but counselors must understand that during the initial phases of coming out, self-esteem, happiness and life satisfaction decrease, while feelings of loneliness increase. Therefore, it is crucial to identify what stage the client is at in the coming out process because this will help determine which counseling tools will be most beneficial. Is the client just beginning to come out to himself or herself, or is the client preparing to disclose to significant others? For clients just beginning to recognize their own LGBTQQI identity, counselors should process the meaning of those feelings as they relate to the individual’s self-concept.

One of the most valuable things a counselor can do is to assess the multiple identities of clients who are coming out. This includes exploring how a client’s race, ethnicity, age, relationship status, social and economic status, ability, spiritual beliefs and so on intersect with the individual’s sexual orientation and/or gender identity/expression and how these intersections influence the coming out experience. For example, the counseling needs of a 14-year-old Mexican lesbian who is coming out will be very different than the needs of a heterosexually married Southern Baptist male who is coming out as gay.

As a culture, we love labels. Sometimes, counselors with the best of intentions unknowingly push away clients who are coming out by forcing them to self-label, asking questions such as, “Are you gay? Do you think you might be bisexual?” What is most helpful for clients is to provide validation and support, which might mean encouraging them not to adopt labels at this stage. Similarly, effective counselors should not advise or push clients to come out. This is often a challenge for some LGBTQQI counselors who have gone through their own coming out process. Most important, culturally sensitive counselors should not pathologize clients who are coming out by recommending sexual orientation change therapies. As mentioned previously, ACA “opposes the promotion of reparative therapy to cure homosexuality.” The counseling environment should be a safe escape from the heterosexism, homophobia and transphobia that LGBTQQI people experience.

For clients deciding whether to disclose, counselors can utilize a decision matrix listing the pros and cons of coming out. If a client decides to come out, a counselor can assist by helping to plan the disclosure. Counselors might role-play with clients about what to say and how to say it. Together, they can explore the most effective time to disclose. Counselors must also ensure that clients have mechanisms in place to handle either positive or negative reactions.

It is imperative to assess risk of potential harm once disclosure is made because it is not uncommon for some individuals to be assaulted after coming out. For clients who do not receive the positive response for which they had hoped, counselors should explain that this could be a normal part of the coming out process and that significant others might be going through a grieving process. Supporting clients during the coming out process is a unique opportunity for counselors to empower LGBTQQI individuals to recognize their own truth and to share that truth with others.

LGBTQQI bullying

Media attention to recent teen suicides has highlighted a phenomenon long known about within LGBTQQI communities: anti-LGBTQQI bullying in schools. Although the media primarily focused on the deaths of several young men in late 2010, there are other stories of LGBTQQI bullying and harassment leading to suicides that have received little or no media attention. In addition, media attention usually focuses on a specific subsection of our community: White gay males. Although this group certainly represents one face of this issue, countless others have also experienced bullying and other types of harassment leading to negative academic, personal/social and career-related outcomes.

LGBTQQI bullying is an insidious issue. A 2009 national survey by the Gay, Lesbian and Straight Education Network found that 84.6 percent of responding LGBTQQI students reported being verbally harassed, 40.1 percent reported being physically harassed and 18.8 percent reported being physically assaulted at school because of their sexual orientation. In addition, 63.7 percent reported being verbally harassed, 27.2 percent reported being physically harassed and 12.5 percent reported being physically assaulted at school due to their gender expression. Understandably, a majority of these students (61.1 percent) felt unsafe in school because of their sexual orientation, while more than one-third (39.9 percent) felt unsafe because of their gender expression. Researchers noted that increased levels of reported victimization were related to increased levels of depression and anxiety and decreased levels of self-esteem for reporting students. In addition, grade-point average, school attendance and reports of continuing their education were lower among students who had been harassed.

How can we help students be successful if they don’t feel safe in schools? First, counselors should validate the feelings and experiences of victims of bullying. A great deal of research has been performed on microaggressions and how marginalized groups often feel invalidated and reoppressed when others do not recognize the challenging situations that they face on a daily basis. This often happens in bullying situations when counselors ask questions that challenge the students’ perceptions of their experiences and the chronology of the events. Counselors need to recognize how difficult it is for students to report bullying and recognize their need for validation and support.

Second, counselors should consider systemic interventions as opposed to working only with individual students. By focusing solely on the LGBTQQI student, counselors may inadvertently pathologize the student or label the victim. This approach also does little to address the larger bullying environment in the school. Instead, psychoeducational programming for all students about bullying might better address this issue. This could be accomplished by training peer mediators and working to empower other students to intervene if bullying behavior is witnessed. This might be the most powerful intervention school counselors can introduce in their schools.

Finally, it is important to recognize the need for advocacy on behalf of all students, including at the district and state levels. Policy documents should be reviewed to ensure LGBTQQI students are identified and protected, and bullying policies should include sexual orientation and gender identity/expression. Counselors should also use their skills to act as educators and consultants for administrators and teachers, who might be contributing — consciously or unconsciously — to a hostile school environment for LGBTQQI students.

Although LGBTQQI bullying is classified as a school phenomenon, it should be known that all counselors, and not just school counselors, have the ability and responsibility to intervene for our youth. The ACA Advocacy Competencies articulate the need for all counselors to speak for the needs of historically and culturally marginalized communities. A somewhat recent movement in school counseling, School Family Community Partnerships, addresses the need for school personnel to consult and collaborate with family members and community stakeholders, as well as provide a role and place for community members (including professional counselors) to work with and for the needs of all students. All counselors have the ability and potential to utilize their individual and group development skills to consult, collaborate, educate and intervene to ensure the success of all our students, including those who identify as LGBTQQI. The question is, given all that we know about the risk factors and concerns faced by this population, why haven’t we all done this yet?

The need exists for knowledgeable and skilled counselors to work effectively with LGBTQQI clients. Clinicians will see LGBTQQI populations seeking counseling in greater numbers as these individuals are discriminated against, come out or are bullied. No longer will it be acceptable to refer LGBTQQI clients out. Rather, counselors need to acquire appropriate training and accurate information concerning how to best meet the needs of LGBTQQI clients. The aforementioned strategies are a starting point from which counselors might work. We encourage counselors to implement the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling Competencies for Counseling LGB Individuals and Transgender Clients (

Our LGBTQQI clients are ready to be helped. Are you ready to help?

Michael P. Chaney is president of ALGBTIC and an associate professor in the Department of Counseling at Oakland University in Rochester, Mich. Contact him at

Joel M. Filmore is a doctoral student at Northern Illinois University.

Kristopher M. Goodrich is an assistant professor in the Department of Individual, Family and Community Education at the University of New Mexico.

This article was written on behalf of ALGBTIC’s LGBTQQIA Affirmative Counseling and Social Justice Task Force. All authors contributed equally.

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