10 Ways to Create an Affirming Space for LGBTQ+ Clients

Jun 20, 2019

By William Hua, PhD

Love is Love. Loud and proud. Born this way, born this gay!

Happy LGBTQ+1 Pride Month! Pride can mean so many things to different people. Pride is sharing in community with friends, loved ones, and allies. Pride is remembering and honoring the heroes who risked and lost their lives fighting for LGBTQ+ equality. Pride is living one’s authentic self and creating a space for others to do the same. Pride is bold, courageous, and fearless. Pride is all of you and pride is all of us.

But Pride and its many meanings should not end with Pride Month. And for clinicians who work with LGBTQ+ clients, the spirit of Pride is to consider and honor these identities year-round. A clinician’s work in providing LGBTQ+ affirming care with humility is an ongoing process and requires intentional effort and growth.

The American Psychological Association (APA) has developed two helpful resources on this topic: the Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients and the Guidelines for Psychological Practice for Transgender and Gender Nonconforming People in Everyday Practice. In addition to these practice guidelines, consider implementing the following 10 practices to help promote an affirming, safe space for clients who identify as LGBTQ+.

1. Show visual signs of being an LGBTQ+-affirming clinician.

Wear, or include in your office, symbols that represent or promote a safe space for LGBTQ+ clients. This might include a rainbow healthcare pin or buttons and signs that say LGBTQ+ “ally”, “equality”, “pride”, or “safe zone”. If you have books, posters, brochures, and other materials in your office, make sure these items include representation of LGBTQ+ people and communities. If you’re able to, post signs for gender-neutral bathrooms.

2. Avoid assumptions about LGBTQ+ identity and sexual practices

Don’t assume that a client’s sexual or gender identity equates to specific sexual practices. Ask permission or invite the client to discuss their sexual health. Don’t assume that LGBTQ+ clients are engaging in riskier sexual practices. If risk behaviors are present, invite dialogue and discuss without judgment.

3. Recognize and validate the impact of stigma and discrimination on the client’s health disparities and experiences.

Your LGBTQ+ clients may experience minority stressors in ways that can have a significant impact on their physical and mental health. These stressors can involve individual and larger contextual factors that influence health – things like bullying, homophobic and/or transphobic attitudes, legal discrimination as it relates to health insurance, employment, and marriage, and a lack of access to health care or care providers who are knowledgeable about LGBTQ+ health. In addition, LGBTQ+ adolescents and adults may have elevated cumulative risk factors for suicidality. It’s crucial to understand these health concerns and validate the impact that they can have on your clients.

4. Focus on strength, resilience and pride.

Knowing and internalizing the reality that your LGBTQ+ clients are strong, powerful, and whole is an important foundation that can help you foster an affirming space for them. Focus on their strengths, honor their resilience, and join them in celebrating their pride! Avoid the assumption that LGBTQ+ clients are struggling to manage the stressors they experience. Recognize the positive impact that LGBTQ+ affirming communities and support networks can have on your clients.

5. Strive to understand a client’s LGBTQ+ identity within their intersection of identities.

We all have many cultural identities that overlap and intersect. These identities can be influenced by race, ethnicity, gender, age, religion, spirituality, physical attributes, political beliefs, personal values, and life experiences, to name a few. A sole focus on one identity can rob a person of their full story. Similarly, avoid assuming that your client has a specific stance on religion or political beliefs based on their LGBTQ+ identity. Seek to honor the multiple influences on your clients’ lives. Similarly, don’t assume that your client’s LGBTQ+ identity is the most salient aspect of their identity or that they want that identity to be the focus of their work with you.

6. Learn what you can about LGBTQ+ culture, including history and movements.

Learning about moments in history that impacted the fight for LGBTQ+ rights is useful in providing context for the struggles and oppression that some of your clients may have experienced. This knowledge is important regardless of your LGBTQ+ clients’ age. Three examples of such events are mentioned below.

Often referred to as Compton’s Cafeteria Riot, in August 1966, a group of mostly trans women of color stood up against persistent police harassment and abuse.

Though this historic event is considered one of the first acts of resistance for queer liberation and occurred three years before the Stonewall Riots, the riot at Compton’s is not as well-known and the trans women are given much less credit for sparking the ensuing fight for LGBTQ+ rights.

AndDon’t Ask, Don’t Tell, the military ban that prevented LGBTQ+ service members from serving in the military, was not officially repealed until September 2011.

7. Don’t expect your clients to educate you on LGBTQ+ experiences but be ready to actively listen if they choose to share.

Some clients may not want to feel as though they have to share their experiences of being LGBTQ+ to yet another person. Conversely, some clients may never have had spaces where they could freely share their story and identities. Collaboratively create a space for both, and let your client be the guide on what feels most useful to them.

8. Ensure that intake forms, screening measures, and any documents you use in your practice are affirming to LGBTQ+ clients.

Make sure that your intake forms are inclusive and allow for the full gender and sexual expression of your LGBTQ+ clients. Include a space for your clients to state what pronouns they use (and be sure to use them!). Be sure that any behavioral health screeners you use incorporate inclusive language around gender and sexual identity.

9. Consider your own biases and privileges.

Proactively work to identify and understand how your own biases, experiences, and perspectives shape and influence the way you navigate the world, and thus intersect with the way in which you interact with your clients. Recognizing your own privileges and biases can be uncomfortable, but you can use this discomfort to better ally and advocate for your clients. Organizations such as the National LGBT Health Education Center offer helpful resources around learning to address these biases.

10. Seek additional training and consultation in LGBTQ+ affirming and client-centered care.

Develop the mindset that working with clients, regardless of background, involves a continual process of openness, self-awareness, and self-reflection. Seek guidance, training, and ongoing consultation in LGBTQ+ affirming care. Keep learning, keep growing, and keep cultivating a safe space for your LGBTQ+ clients.


1 LGBTQ+ is a term that is used to inclusively represent lesbian, gay, bisexual, transgender, queer, and other communities and identities under the queer umbrella, such as pansexual and two-spirit. The author would also like to state recognition that this is a very broad term used to discuss the spectrum of gender and sexual identity expression. While this label may be convenient, it is not meant to generalize the unique needs and experiences of individuals within the LGBQT+ community.

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DISCLAIMER:

The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

ABOUT THE AUTHOR

William Hua, PhD is a clinical health psychologist and associate clinical professor who practices and teaches in San Francisco, CA. He has a passion for integrated behavioral health, Acceptance and Commitment Therapy (ACT), and applying diversity, equity, and inclusion practices to his work with clients and in his approaches to teaching.