Creating a Safe Environment for your LGBTQ Clients and Why it Matters

Yep, you guessed it! It is time to talk about cultural sensitivity and our never-ending quest as clinicians to practice it. I use the term cultural sensitivity rather than cultural competence because an important distinction between the two indicated in Carissa D’Aniello’s (2016) article. In the article, Hardy & Laszloffy (1995) define cultural sensitivity as a “state of attunement” and an “empathic resonance and the capacity to not only understand another’s perceptions and feelings, but the ability to moderate one’s own behavior to adjust to the other” (p. 235). For me, this is where the therapeutic alliance begins, with how I am being with my clients more than what I am doing with them. 

Why it Matters 

As a lesbian who has been out for 13 years and married for 8, I entered this MFT grad program knowing I would be coming out again multiple times. The fear surrounding repeatedly coming out is significant regardless of where, when and how it happens or how many times one has already done it. It is about safety. It is about being accepted. It is about having the coming out experience without judgment or surprise or approval. Yes, you read that right. Approval is the one of the oddest responses. ‘Good for you!’ or ‘I’m totally cool with that!’ are not uncommon, nor are they culturally sensitive responses to a woman mentioning or introducing their wife. Unfortunately, they are very real responses that LGBTQ individuals must deal with on a regular basis throughout life. This is just a glimpse at my own personal experience, there are so many others and coming to therapy for the first time is no exception. 

LGBTQ folx continue to face discrimination even in bubbles that may seem like safe, unprejudiced, inclusive communities. McGeorge (2020) provides a long list of statistics demonstrating that LGBTQ folx experience higher rates of mental health problems and suicidality, specifically for transgender and nonbinary people. McGeorge (2020) also defines and describes how cisnormative and transnormative assumptions, cisgender privilege and institutional cissexism impact our ability as clinicians to provide affirmative and culturally sensitive therapy. You may be thinking, ‘Of course I am culturally sensitive!’ or ‘I would never offend someone because of their gender identity or sexual preferences, race, ethnicity, etc.!’ While those are great intentions, we all have implicit biases that cause us to react in ways that can be uncontrollable if we are not aware of them. So how do we become aware and go about creating a safe, culturally sensitive, affirmative environment? The following is a beginner’s list of ideas to ponder and resources to access as we all work on the lifelong journey of becoming the therapists we wish to be. 

Ideas for practice: 

  • Ever revolving self-of-the-therapist work – become aware of your implicit biases and what they mean 

  • Use gender neutral language (spouse/partner instead of husband/wife, parent/caregiver instead of mother/father) 

  • Learn gender identity terms, and familiarize yourself with cisnormative assumptions, transnormative assumptions, cisgender privilege and institutional cissexism. The McGeorge (2020) article poses many excellent questions for self-reflection. 

  • Learn more about the lived experiences of LGBTQ individuals and the barriers they face 

  • Share your pronouns when you introduce yourself and ask what other folx prefer to use.  

  • Attend a LGBTQ affirming training or workshop for professionals wishing to create and identify their business as a safe space for LGBTQ members – see what the University of Iowa offers by clicking here 

  • Consider the level of inclusivity and diversity in your office, bathroom space, waiting room, etc. 

Resources for more in-depth exploration:  



D’Aniello, C., Nguyen, H., & Piercy, F.P. (2016). Cultural sensitivity as an MFT common factor.  

The American Journal of Family Therapy, 44(50), 234-244. 


Diversity, Equity, and Inclusion. University of Iowa.  

Knudson-Martin, C., McDowell, T. & Bermudez, J.M. (2019). From knowing to doing:  

Guidelines for socioculturally attuned family therapy. Journal of Marital and Family Therapy, 45(1): 47-60. doi: 10.1111/jmft.12299  


McGeorge, C.R., Coburn, K.O., & Walsdorf, A.A. (December 15, 2020). Deconstructing  

cissexism: The journey of becoming an affirmative family therapist for transgender and nonbinary clients. Journal of Marital and Family Therapy. DOI: 10.1111/jmft.12481 

NYC Health + Hospitals Pride Health Advisory Council. Creating an LGBTQ Affirming Clinic: A Guide for Practice Managers and Providers.  

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