Developing a Queer-friendly Health Practice: Supporting Sexual Minority Clients

by Heron Saline, CHT CMT ©2007

These days with more and more freedom for people of sexual minority status to live safely "out of the closet," it is more likely that they will bring those aspects of themselves to a session with a health professional. I’m referring to those who self-identify, for instance, as lesbian, gay, transgendered, bisexual, intersexed, queer, or even "questioning"! For two reasons I imagine that sexual minority clients might find their way to you at some point: (1) many have had a disproportionately challenging life responding to biases against them, and really need skilled support, and (2) they are likely more willing than most people to try new things to improve their life (as the challenges of heterosexism and xenophobia have strengthened them in character and creativity through their years).

One way in which people of sexual minorities are often more vulnerable than other minorities is that they very likely grew up in a family which did and does NOT share their minority status, unlike people of religious or racial minorities, for instance. They may have grown up for decades experiencing themselves as an outsider, right in their very own home. It’s important for practitioners to understand some basics in order to really meet the client as an individual and set aside any judgments, projections of shame, or other dynamics which marginalize the client or block healing.

Here are five things you can do to work effectively with a sexual minority client:

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  1. When a client comes to you and discloses a self-identification as a sexual minority, it is tremendously important to honor their individual experience. Even if you are comfortable and familiar with other queer-identified individuals or subcultures, you will be better equipped to help them by being clear on exactly who they are and what they want for their life. Just like anyone, they are individuals first!
  2. While some stereotypes may have a basis in reality, you need to check out your guesses with the person to verify information that pertains to what you will be working on together. This can apply to just about anything, such as what they want socially and romantically (monogamy, polyamory, …?), health status issues (HIV negative or positive?), spirituality or religious beliefs (Christian, Pagan, Atheist, something else…?), political values, sexual behaviors, level of education, financial status, on and on…
  3. If you think you know something about them or are not sure, then ask! And ask open questions which allow the person to take the lead in cuing you in to their reality. While yes/no questions confirm or deny your prior understanding and guesses, you may be "asking the wrong question" so to speak! So instead of asking a transperson "Are you "male to female" (MTF) ?", you might want to instead ask "Would you tell me about your gender?": (some transfolk are multi-gendered rather than directional on a binary male/female-only system). Or instead of "Have you had any surgery?" you could ask "What is your plan for body modification, if any?" Until the person tells you about her or himself, you don’t know and can’t safely assume anything. Very likely being asked in a respectful, open way will lay the foundation of trust and confidence for an effective working relationship with you. It’s ok to not know everything; it’s not ok to act as though you do!
  4. One aspect of really meeting this person in a manner conducive to healing work is to reflect back the language they use about their life. Sometimes shades of meaning and nuance about how they see themselves and choose to be known in the world show up in word choices. Note in your intake summary the words and phrases they use, and use them yourself in the conversation. This can include the pronoun that they prefer used to refer to them (he/him, she/her — even ze/hir, which are gender neutral variations coming into common usage currently), using (or NOT using) the labels such as "queer" or "gay", etc., which to some people are offensive and to others liberating! Again, if you don’t know, ask the person’s preferences, ask what those choices mean to them, and honor their choice. With that respect you’ll see them open up to you and more fully engage in the work!
  5. If you are unable to work with the client as they are — really showing up to meet them in the work free of judgments and your own blocks — then you can recuse yourself from working with them as an act that is respectful of you both. Almost any one of us, having grown up with the broad homophobia of society, may have internalized value judgments around sexuality in general, and gender expression and sexual behavior in particular. If you notice blocks coming up in you, they will likely be either known consciously, or energetically felt, by your client as well. For instance, if you "just don’t believe" that a person can change genders when working with a transgendered client, or that "homosexuality is wrong" with someone who is in a same-sex relationship, those beliefs are yours and don’t belong in their session.

If you are able to work with hir for health and wholeness, for self-actualization and authenticity in the world, then you and your client have a win-win situation on your hands, and you will be able to truly and effectively support a unique person using your gifts and training!

Best wishes in contributing to the healthy biodiversity of true life in the world and in your clients!

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