Work with clients in the LGBTQIA+ community

One of the main topics often discussed in the therapy room is shame. It takes on many forms and we work often over a period of time to hold space and develop awareness around the shame. This could include style, identity, hobbies, expression and more. I’ve been honoured to work with many clients over the years from various countries and this I can say is the big elephant in the room. Often similar to when we work with other minorities and their distress.

Psychoeducation and normalising the clients experience can be so helpful and often it feels like we need to do “magic” in the session, but what I’ve found is when we hold space, and acknowledge a clients lived experiences – this makes the work flow easier. There’s more reflective space and we can then deal with some of the additional layers of the work.

Useful model GENDER formulation 

Gifted to me by an amazing supervision whom I won’t name, but they’ll know who they are. This formulation has been a very helpful tool that I’ve used with clients who’s contemplating or going through their transition. This is helpful to be used as a starting point and I often use it flexibly with clients, exploring these issues in 6 domains.

The acronym GENDER is used to explore different aspects of the treatment plan 

G – Gender:  here we explore gender identity, explore where a client is now, where they may want to go. Topics of shame or gender norms are also discussed. Often the shame theme is present here too and we can unpack and make sense of feelings and thought to increase sense of self and build on esteem.

E – Express Concern: Naturally as with any client they may have concerns and worries about  things – here we make sure to keep an open door to explore the obvious but also unspoken concerns.

N – Necessary Action: sometimes this may be coming out stories, it may be staying in the closet. Any emotional actions are taken into account here – we can also explore physical health and well being. Sometimes that’s visiting a GP, a gender specialist and more.

D – Distress Management: more often than not clients coming in from the LGBTQIA+ community experience distress and worries. Here we hold space for homophobic slurs and attacks. Often I check on anxiety, depression, low mood, risk and so forth. 

E – Ecologies of Support: This can be both fun and daunting for some clients. We can now explore people, places and services they can find affirmations in. Sometimes this can be parents, friends, community groups and peer groups. 

R – Reinforcement + Resilience: Affirming care is so essential within the community and through the work we do within the community it never stops to amaze me how when we provide care that’s affirming, open and reflective. We build resilience, reinforce a truly client-centred approach and work toward a reduction of some of the challenges that has brought clients in.

Naturally I can go on and on on this topic but I’ll keep it brief. If you or anyone else’s you know would like to work with the amazing LGBTQIA+ community, I’ll recommend finding yourself an affirming and well trained supervisor. This has been instrumental in my own growth.

I’ll now leave you with a powerful quote from Dominique Jackson in her role as Elektra “You think I just woke up one day and poof, I look like this? No. It takes drive work, drive and sacrifice to be a woman”. 

References and resources 








Written by: Alex Koen

Registered Art Psychotherapist and Specialist Wellness Counselor

MA AThR, B.A.Psy.(Hons),

B.A. Psy.Soc. Cert. Counselling,

Advance Cert. Gestalt Play Therapy