How is working with the LGBTQ community different from working with the general community in counseling?

How is working with the LGBTQ community different from working with the general community in counseling?


Although mental health conditions do not discriminate based on a person’s Sex, Race, National Origin, Gender Identity, Religion, or Sexual Orientation, unfortunately, people do. As such, LGBT client’s may face more negative outcomes, due to prejudices and other biases of the treating clinician conscious or unconsciously.

Knowing what challenges a member of the LGBTQ community face, such as, but not limited to internalized homophobia from years of hate messages from family and Society, can help ensure more positive outcomes.

I recommend clinicians ask themselves “Am I being GENE?” Genuine, Empathetic, Non-Judging and Empowering?” with all client’s, but especially with LGBT individuals. Be sure to ask LGBT clients about their history of suicidal and self-harm ideations as well as behavior on the first session.

How Do Mental Health Conditions Affect The LGBTQ Community?

LGBTQ individuals must not only confront the stigma of mental health but also prejudice based on their sexual orientation or gender identity. Some report concealing their sexual orientation from providers in the mental health system for fear of being ridiculed or rejected.

Due to the discrimination and prejudice factors, LGBTQ individuals are three times more likely than others to experience a mental health condition such as depression or generalized anxiety. The fear of coming out and fear of discrimination can lead to depression, thoughts of suicide and substance abuse to name a few.

Prejudice & Stigma

The effects of this double or dual stigma can be particularly harmful, and often prevent some LGBTQ individuals from seeking mental health treatment.

Due to the variety of external homophobic disparities toward the LGBTQ community including social stigma, prejudice, family rejection, social exclusion and denial of civil and human rights over days, and years, can have a profound effect on a person’s mental health and often leads to conscious and/or unconscious “internalized homophobia” by LGBTQ individuals.

As a result, the LGBTQ community is at higher risk for suicide, self-harm and substance abuse/addiction behaviors.


For LGBTQ aged 10–24, suicide is the second leading cause of death. LGBTQ youth are 4 times more likely and questioning youth are 3 times more likely to attempt suicide, experience suicidal thoughts or engage in self-harm than their straight peers. Approximately, 38%-65% of transgender individuals experience suicidal ideation.

Family support or lack of, plays a very critical and important role in the likelihood of suicide. Someone who faced rejection after coming out to their families were more than 8 times more likely to have attempted suicide than someone who was accepted by their family after revealing their sexual orientation.

Substance Abuse

The LGBTQ community reports higher rates of drug, alcohol and tobacco use than that of the general community. Wonder why? Prejudice, discrimination and stigma or “externalized homophobia”.

An estimated 20-30% of LGBTQ people abuse substances, compared to about 9% of the general population and 25% of LGBT people abuse alcohol, compared to 5-10% of the general population.


LGBTQ youth face discrimination, hatred and prejudice in school, with friends, in the community and at home, which can lead to higher risks of self-harm and thoughts of suicide. LGBTQ teens are six times more likely to experience symptoms of depression than the general population. Additionally, LGBTQ youth struggle to come out to family members, friends, classmates and teachers, especially of those that are not accepting of the LGBTQ community.

Early intervention, comprehensive treatment and family support are the key to helping LGBTQ youth on the road to recovery from a mental health condition. There are many resources available to help teens and young adults, including the It Gets Better campaign and The Trevor Project, which operates a national, 24-hr, toll-free confidential suicide hotline for LGBTQ youth at 866-488-7386. The Trevor Project also provides an online chat and confidential text messaging—text “Trevor” to 202-304-1200

GLSEN, the Gay, Lesbian and Straight Education Network has developed an annual report called the National School Climate Survey, which reports on the experiences of lesbian, gay, bisexual and transgender youth in U.S. schools.

Tips For Talking To Your Provider

  • Ask questions about the provider’s experience working with LGBTQ individuals.
  • If you feel comfortable, come out to your provider as soon as possible.
  • Be open about your thoughts and feelings of depression, suicide, anxiety, fear and self-harm.
  • Be confident about disclosing relevant information about your sexual orientation and/or gender identity.
  • Ask for more information about any health-care-related referrals, including to other therapists and psychiatrists.


About the Author:

Yvonne Schilling, LPC-S
Yvonne has over 18 years of experience in the mental health field in a variety of settings including community college, Employee Assistance Program, community psychiatric emergency services, and juvenile justice system to name a few. She enjoys working with family’s, adolescents, adults, and couples in both traditional and nontraditional or blended families.