Lesbian, gay, bisexual, transgender and queer + (LGBTQ +) people are marginalized and are often at risk of discrimination on the basis of sexual, gender and loving minority orientations. While queer people experience heightened prejudice, research by the American Psychiatric Association has shown a lack of appropriate counseling for LGBTQ + groups who would benefit greatly from increased services.
This need for adequate queer counseling is compounded by the growing percentage of self-identifying LGBT people. The Washington Post recently published results from a Gallup poll that showed LGBT adults grew 1.1% from 2017 to 2020, and that 1 in 6 people ages 18-23 identify as LGBT. In view of a growing queer population and the increased need for advice, there is a clearly recognizable gap for qualified offers.
Queer-competent advisors can help. Unfortunately, many practitioners lack queer competence, perhaps due to the small number of LGBTQ + courses and training opportunities available to advise PhD students. Even when proactive and eager graduates seek committed academic performance, internships, and training experiences in queer environments, viable options are limited. The cycle of limited to non-existent queer-accessible counseling resources is continued without available training experience. How can we become LGBTQ-competent counselors when there are so few opportunities for training and practice in this area?
The queer experience
We live in a society that prefers white, Christian, male, cisgender and heterosexual people. In order to retain power, both intentionally and not, these dominant identities often suppress any divergence. Adolescents are often indoctrinated that a deviation from socially recognized normative standards, such as same-sex attraction or non-binary sex, is deviant or wrong. This belief system often strengthens with age and can lead to discrimination and suppression of queer people throughout life. To stay safe in today's heteronormative and cisnormative society, many queer individuals hide their identities. This is often the only way for them to be put on an equal footing with their heterosexual, cisgender counterparts.
The researchers Laura S. Brown and David Pantalone showed that the nature of constant secrecy, dissonance and the struggle to adapt negatively affects mental health. The Drug Abuse and Mental Health Agency found that sexual minorities who are excluded from society are more likely to have mental disorders, major depressive episodes, and substance abuse. The data from the Trevor Project even indicate that queer youth have higher rates of suicidal ideation.
Darrel Higa et al. from the University of Washington found that LGBTQ + individuals who share their identities with their parents, guardians, schools, and workplaces often encounter rejection and discrimination. This is reflected in higher homelessness rates and higher unemployment compared to heterosexual people. Although LGBTQ + people suffer from increased mental health differences, queer clients often find unsupportive counseling services.
Consultant competence
LGBTQ + clients benefit from counselors and psychosocial institutions that offer acceptance and validation through queer counseling skills. The Society for Sexual, Affectional, Intersex and Gender Expansive Identities (formerly known as the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling) set up a task force in 2012 that outlines queer-competent counseling behavior. The competencies touch on queer human growth and development, social and cultural foundations, helpful relationships and more. The same group released skills for counseling transgender clients in 2009. These resources, while important to agencies, have not been updated for a decade and would benefit from incorporating more recent relevant queer research.
Having queer-knowledgeable counselors in all areas of mental health is critical to foster open discussion and disclosure of LGBTQ + client identities. A survey by the Center for American Progress shows that there is a lack of trust in health systems within the LGBTQ + community. It is likely that counselors must continually win the trust of queer clients because of their historically negative health care experiences and trauma. To achieve such trust, counselors should provide LGBTQ + clients with adequate services, determined by the queer counseling skills and ethical obligations of the American Counseling Association for charity and non-harm.
Paper guides on LGBTQ + literacy exist, but the field is bound by the same values to offer more than the predominant “self-taught” approach. When queer competence is effectively implemented, the resulting safe spaces, open dialogue and unconditional positive appreciation will encourage more LGBTQ + clients to be authentic. Findings from Edward Alessi et al. showed that a queer-affirmative counseling approach resulted in a stronger therapeutic alliance and increased well-being for LGBTQ clients. There is a great need for PhD students and current practitioners to better learn queer counseling skills.
Missing academic achievements
In order to acquire LGBTQ + competence, doctoral students and practitioners must take part in courses and advanced training courses on queer theory. In addition, they must take part in appropriate training experiences. Many students and practitioners encounter obstacles in their search for such offers. The following describes our experiences (Jonah Friedman and Megan Brophy) as we tried to find suitable training in this area.
Jonah started a master's degree in consultancy training in August 2020. In an early academic counseling session with the faculty, he expressed an interest in LGBTQ + counseling. While searching for courses in homosexual affirmative therapy and related theories, Jonah was informed that the college he was attending had no courses available. An institution that emphasized its core tenet of multicultural competence did not have specific LGBTQ + counseling courses. While this is unfortunate, it is the case at most universities that offer a Masters in Counseling and Related Degrees. This made it possible to forego such courses or to credit corresponding optional services from one of the few programs with queer counseling services. Eager to receive such training, Jonah began looking for other CACREP-accredited graduate programs that offer courses in theoretical approaches to LGBTQ +.
New Jersey has 12 CACREP-accredited universities offering graduate counseling degrees in a variety of programs. A review of these programs and their course directories found that only four clinical mental health programs regularly offer electives on sexual issues in counseling or gender issues. None of these courses were explicitly dedicated to working with LGBTQ + clients. The remaining programs did not list relevant electives or offered any form of LGBTQ + counseling course. This absence can be attributed to the fact that CACREP does not require the integration of LGBTQ + counseling training in order to obtain accreditation for clinical programs on mental health.
Jonah applied to Southern Methodist University (SMU) in Dallas to take courses in this area. The school has a counseling program that pursues positive therapy with LGBT clients. Jonah has since enrolled as an unenrolled student in two electives: Affirmative Therapy with LGBTQ + Individuals: Advocacy Across the Lifespan and Affirmative Therapy with Transgender and Gender Non-Conforming Clients. Although the experiences were insightful and enabled exploration of sexuality and gender through a deeper and more critical lens, it was a difficult and arduous process to receive this theoretical training. The time, cost and effort required to attend these courses at a second institution only add to the difficulties caused by the lack of an initial course offer.
In addition, Jonah was only able to take online and remote courses at SMU due to COVID-19 guidelines. During regularly structured semesters, such courses are personal and not accessible to foreign students. In addition, Jonah has proactively enrolled in these courses; Students who do not seek queer counseling courses will have minimal exposure to these crucial theories. If such courses are not offered or requested, it means that queer theory is not important to CACREP or our practice as consultants.
Lack of clinical experience
Even if LGBTQ + courses are secured, counseling students must then have queer-relevant training experiences in order to build up practical skills. This approach follows the logic of the formative development in the consulting field: first learning the theories through courses, followed by application during clinical experience.
Megan Brophy's experience of finding an LGBTQ + -based internship as a PhD student proved to be challenging. In the states of New Jersey, New York, and Pennsylvania, Megan found only four websites that exclusively offer LGBTQ + counseling. In order to secure competitive internships at such locations, students often start with applications and interviews up to six months before the start of their studies. At one location in Philadelphia, the application window was only open for a month. Many other locations only accept one to three interns a year. This very selective approach to interns significantly increases the already difficult endeavor to find a suitable apprenticeship position. The limited financial and logistical barriers to hiring interns and licensed practitioners at these locations prevent counseling students from gaining the clinical experience necessary to become queer-literate counselors. Students struggle to structure their degrees to receive these queer-oriented internships while they work to stay on the path to graduation.
In her search for internships, Megan called a number of LGBTQ + community centers in New Jersey to check for internship availability. She found that most of the service providers were limited to support groups supported by unlicensed professionals. In part due to a lack of funding and resources, the services tended to be more related to social gatherings, legal transfers, and Pride celebrations. As a result, queer young people have very limited access to suitable counseling services. Accordingly, PhD students attending CACREP-accredited programs cannot receive internships in such locations that meet the accreditation requirements for supervision without licensed clinicians.
Even when qualified services are available, they are often niche and not representative of the larger queer community. One such counseling facility is a residential program for queer, homeless youth in Ewing, New Jersey. While homelessness is crucial, it is an extreme situation that LGBTQ + youth find themselves in. We also need to consider queer youth who have not been evicted and are still looking for mental health services.
Finally, we need to consider how the lack of availability and accessibility of LGBTQ + sites directly affects our customers. The long journey to the nearest LGBTQ + counseling center is a privilege that many do not have. We cannot expect or require our queer clients to travel as far as to seek psychological services. Queer-identifying youth almost never have this opportunity without the help of a supportive friend or family member. In addition, due to school and homework obligations and participation in extracurricular activities, they may not have the time to travel long distances for services.
While the recent influx of online mental health services due to the COVID-19 pandemic has made counseling more widely available, online counseling in an unsupportive home setting can be detrimental to LGBTQ + clients. In such situations, queer clients may not be able to securely disclose information about their sexual or gender identity. This underlines the work still to be done in the field of counseling in order to create more queer-inclusive spaces with queer-competent counselors.
Understanding queer identity
As consultants, it is our duty to be multicultural and competent. The counseling skills for multicultural and social justice developed by the Association for Multicultural Counseling and Development describe the levels that lead to more inclusive counseling: self-awareness of the counselor, the client's worldview, the counseling relationship and advocacy interventions.
While our field has made advances in integrating diversity, there is still more work to be done to help queer clients. In order to train and maintain queer-competent consultants, we must commit ourselves to better understanding the diverse aspects of queer culture, identity and relevant terminology. In addition, counselors can participate with the community in additional research and relevant literature, including resources provided by leading queer organizations (e.g. The Trevor Project, GLSEN). Understanding queer identity and worldview is fundamental to effectively working with LGBTQ + clients and empathizing with their unique experiences.
Active representation of interests
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ACA has a non-discrimination policy in place that prohibits all forms of harassment, including protection for transgender, gender-nonconforming, and LGBTQ + people. We as a profession need to overcome this passive protection and evolve as active advocates. Practitioners can act with and on behalf of their queer clients on the micro, meso and macro levels of advocacy.
At the micro level, counselors can work with queer clients to continually confirm their identity. At the meso level, lobbying could include working with local school systems to organize LGBTQ + support groups or to arrange professional development for staff. At the macro level, practitioners can get involved in legislation that supports LGBTQ + people and communities. All three levels of advocacy are required to make a difference in our current climate.
Degree programs for graduates
Reg. Phil Murphy of New Jersey recently signed a law for LGBTQ + inclusive curricula following the states of California, Colorado, Illinois and Oregon. Out of 50 countries, only five have recognized the importance of a queer-inclusive approach to education. Education boards across New Jersey have begun to incorporate accurate portrayals of queer people and history into curricula.
So many of the accredited colleges in the same state have yet to accept similar academic achievements. These schools, which are training the counselors of the future, need to offer more courses on queer theory. All graduate counseling students are familiarized with the basic LGBTQ + terminology and culture. This integration of the queer curriculum will lead queer counseling skills beyond specialization.
LGBTQ + -oriented websites
While it would be ideal to open queer-focused counseling centers in each state, a more realistic plan for existing agencies would be to introduce LGBTQ + services. For example, the High Focus Centers in New Jersey, known for their outpatient substance abuse programs, recently added an LGBTQ + track that addresses substance abuse, queer wellbeing, self-esteem, empowerment, and relationship skills. Other websites may commit to adding queer tracks to their programs to provide more internship opportunities and training in queer-literate counseling. In return, websites for queer customers become more inviting.
A better future
By acquiring basic queer counseling skills, advocating for all LGBTQ + people, improving the queer-inclusive counseling curriculum and integrating queer support services in all facilities, our area of expertise can significantly improve counseling for LGBTQ + people. We all need to become queer-competent advisors and agents of change in our increasingly progressive field.
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Related reading: See June cover story of Counseling Today, "Listening to voices of color in the LGBTQ + community"
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Jonah Friedman is a Master of Arts degree in clinical psychosocial counseling from the College of New Jersey. He completed his undergraduate studies at Tulane University, where he first discovered his passion for helping others and the value of counseling. Inspired by his current work with the Trevor Project, Jonah hopes to eventually work as a practitioner with an LGBTQ + affirmative approach. Contact him at [email protected].
Megan Brophy (she / she / she) is a graduate of the College of New Jersey. Her work is guided by a passion for social justice and advocacy for marginalized communities. Contact them at [email protected].
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Opinions and statements in articles appearing on CT Online should not be construed as the opinions of the editors or guidelines of the American Counseling Association.
