Tag Archives: LGBTQ Issues

LGBTQ Issues

Making schools more inclusive for LGBTQ+ students 

By Stephanie Opiela  August 15, 2023

child in denim t-shirt with rainbow symbol, wearing an orange backpack outdoor, standing outside


In working with children and families who have experienced trauma, I have accompanied a diverse range of LGBTQ+ clients on their healing journeys. Sometimes their challenges arise from a single significant event, and other times, a collection of circumstances and support system failures contribute to their struggle.  

When a person mentions a “support system,” the first thing that often comes to mind is one’s family or peer network. However, support systems can also include organizations, and when it comes to children, especially those in the LGBTQ+ community, schools can serve as additional and vital systems of support.  

It is a well-supported fact in mental health research that LGBTQ+ individuals are at greater risk for mental health challenges than those from other groups. According to the National Alliance on Mental Illness, those who identify as LGBTQ+ are nearly three times more likely to develop a mental health disorder such as depression or anxiety and are significantly more likely to attempt suicide and abuse substances. The risks are especially high for adolescents and young adults, with LGBTQ+ youth ages 10–24 being four times more likely than their peers to attempt suicide. 

Because many students in districts across the nation are part of the LGBTQ+ community and use mental health services, schools can play an important role in creating an inclusive and trauma-informed environment to prioritize mental health prevention and intervention. In this article, I share one student’s story and offer advice on how counselors and schools can create a supportive environment for all students.  

One student’s experience as an LGBTQ+ individual  

CJ (a pseudonym) is a high school senior who began receiving mental health services primarily to address ongoing challenges with anxiety and depression. CJ acknowledged that while a lot of progress has been made when it comes to creating a sense of inclusivity for LGBTQ+ people in their current community, they “have never truly felt included.” 

Although CJ is comfortable and confident in their gender and sexual identity, they expressed that their emotional safety is challenged on a daily basis living as an LGBTQ+ individual. CJ described the deep hurt that accompanies the perpetuation of stereotypes, saying, “There is this constant stream of negative feedback on who I am as a person.”  

CJ found it particularly hard to trust anyone. CJ believed that some teachers and students will “treat them as a completely different person” after learning CJ is an LGBTQ+ individual, despite having previously welcomed them into their social and physical spaces.  

CJ further described the unmistakable discomfort that others display when they are outed in conversations: “There is always that pause — that deafening pause. Conversations shut down when they learn that about me. They try to escape it as quickly as possible.”  

Inevitably, anger, confusion, a sense of shame and feelings of rejection accompany these all-too-frequent interactions with peers and adults. CJ explained that other LGBTQ+ students on campus tend to “stick together” for social and emotional support, but this does not diminish the challenges that accompany identifying as an LGBTQ+ person. CJ described the mental energy they must spend distinguishing safe people and spaces at school, and the crushing disappointment and loss that come with learning that someone is nonaffirming. “I wish everyone here was super welcoming, but that is too much to expect. There are people here that want nothing to do with someone like me, and it hurts,” CJ said. 

CJ shared that when they came out to their family, they felt a renewed sense of freedom and happiness, but they quickly realized that sense of freedom did not translate to their school and community environments. CJ’s confidence and comfort began to crumble as they consistently found that they could not out themself unless they had determined a person or group was safe, which proved difficult to do.  

Constant disappointment can take a toll on even the most resilient of individuals. “I’ve told many people in your line of work [mental health] that I’ve become less and less comfortable telling people that I am gay,” said CJ. “I’ve even gone out of my way to try and make people more comfortable by avoiding that topic.”  

This transition — from being open and free to being guarded and cautious — was a significant loss that CJ continues to grieve, all while carrying the burden of other people’s discomfort with who they are. Like many others who belong to the LGBTQ+ community, CJ knew from early on that they were “different” from many of their peers. Their identity was not something that they “chose or created” but just who they were.  

CJ shared one instance when their class engaged in a discussion about whether people were “born gay.” The consensus among the teacher and most students was that this was not possible but rather that homosexuality was something people chose. CJ described feeling outnumbered, unsafe and angry that a group with an entirely different set of beliefs and experiences was explaining CJ’s identity as a choice, without having any degree of understanding of who CJ was, what their life experience had been or the hurt that the conversation was causing them in that moment.  

Just as many individuals who struggle with anxiety are constantly operating on high alert, many who identify as LGBTQ+ must scan for indicators of safety and inclusion, and negative experiences further reinforce a lack of trust in others and a decreased sense of safety. For this to be happening at school — where students spend most of their daily lives with the expectations of safety and support — has concerning implications. This becomes even more serious when one considers students who already struggle with anxiety and depression because of other factors. 

Despite continuing support from mental health and medical professionals, CJ struggled with ongoing invalidation and oppression, and at more than one point, this bright, funny and engaging student was hospitalized because they had become suicidal. While psychiatric hospitals are a crucial part of mental health care system, they are not usually the warm, supportive and healing environments that we would like to believe they are. On multiple occasions, CJ spent days away from loved ones, with no contact with the outside world and surrounded by other patients who carried their own horrific traumatic experiences.  

This is the cycle that many of our most vulnerable students endure when they do not have safe, supportive and affirming environments to be who they are while they spend their mental and emotional energy connecting with others, tackling academic demands and navigating the stress of adolescence. They survive until the weight of all their turmoil becomes too much and they fall apart. Most of the time, counselors are fortunate enough to pull them back to safety, but sometimes, these students slip away. 

Steps to creating an inclusive environment 

Providing and promoting an inclusive, welcoming and trauma-informed school environment is more critical than ever for ensuring that all students, including LGBTQ+ students, can experience the sense of safety and belonging that they deserve. How can this be accomplished?  

  • Create a culture shift. School staff must first be willing to take responsibility for all students in the school. This necessitates learning from one another through communication, collaboration and professional development opportunities. Great strides have been made through the use of multitiered systems of support teams, in which staff from various departments and specialties come together to develop appropriate interventions for students who exhibit academic, behavioral or mental health needs.  
  • Become trauma informed. Establishing a safe and inclusive school setting requires that staff be trauma informed. Staff must be willing to recognize their own implicit biases and understand that everyone has their own story. All staff — not just teachers and administrators — need to be educated and equipped to recognize basic signs and symptoms of mental health challenges and know who to contact if they have concerns about a student’s well-being.  
  • Provide resources. Students and families need to be aware of the resources available to them on and off campus. All staff should be familiar with key resources, including local mental health authorities, LGBTQ+ organizations, crisis hotlines and bilingual providers. In addition, posters with inclusive language celebrating diversity and addressing the stigmas surrounding mental health challenges need to be visible throughout campuses. 
  • Make time for connection. Staff should make an effort to learn the names of all their students and use their correct names and pronouns. This will allow each student to feel valued. It also models respect and acceptance for all students. To create or strengthen students’ support systems, staff should also establish regular contact with families to develop trust and build a successful partnership. 

Inclusivity and equality are not new concepts, but there is still much work to be done. Our work as counselors matters because our students matter. My hope in sharing CJ’s story is for school counselors, administrators and staff to recognize the potential impact they can have in the lives of all students by being an advocate and resource on campuses and in their communities.  


headshot of the author, Stephanie Opiela, standing beside a tree

Stephanie Opiela is a licensed professional counselor-supervisor with over 14 years of experience serving clients with histories of adversity. Most of her career has been dedicated to serving children and families affected by abuse, first in a therapist role and then as a program director and clinical director for local children’s advocacy centers. Her work with medical professionals, law enforcement, child and family protective services, and district attorney’s offices continues to fuel her passion for promoting trauma-informed care in systems that are designed to protect children. She currently serves as a school-based therapist for a campus of 2,500 students. Contact her at stephanie.opiela@dsisdtx.us. 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

ACA and SAIGE co-host webinar on LGBTQ+ advocacy and allyship

By Samantha Cooper June 26, 2023

two hands form a heart; one has a rainbow bracelet on the wrist


On June 7, the American Counseling Association and Society for Sexual, Affectional, Intersex, and Gender Expansive Identities co-hosted a webinar, Speaking in Support of LGBTQ+ People Through Advocacy and Allyship, on how counselors can support LGBTQ+ clients.

Dominique Marsalek, ACA’s state government affairs manager, began the webinar by introducing some of ACA’s legislative priorities for the year and discussing two types of advocacy counselors can use to support queer clientele:

  1. Issue advocacy promotes a particular position supported by interest groups and focuses on policies that could affect this position (such as gender-affirming care) on all levels.
  2. Legislative advocacy involves acting to support or discourage the passage of a certain kind of legislation.

Gene Dockery and Valeo “Leo” Khan-Snyder, the two other presenters, continued the conversation on advocacy by discussing how counselors can become advocates for the LGBTQ+ community in the wake of the homophobic and transphobic laws being introduced around the country.

“Right now, we have more than 520 anti-LGBTQIA bills in various states. We also have several at a national level — and this is the highest number we’ve ever had,” said Dockery, chair of SAIGE’s Public Policy Committee and a doctoral candidate in counselor education and supervision whose research focuses on trans and queer liberation, advocacy and disability justice. “This is a deadly issue for trans people. A lot of what is happening is a concerted effort by conservative groups. These are bills that are prepackaged with nearly identical language being sent from state to state.”

The speakers discussed how Senate Bill 1580, which Florida Gov. Ron DeSantis recently signed into law, allows Florida health care providers and payers to decline care or payment for certain services if they “conscientiously object” for any reason. This means that those in health care can deny transgender individuals gender-affirming care without repercussions.

As a transgender man, Khan-Snyder said he has seen firsthand the harm this legislation has done.

Khan-Snyder, a SAIGE Public Policy Committee member, and Dockery stressed that counselors need to become advocates for their clients to prevent more laws like this from being passed. But they also caution that this work can take a toll on counselor as well.

“The advocacy work we’re doing is inherently traumatic,” noted Khan-Snyder, a clinical mental health counselor who works with marginalized populations, particularly LGBTQ+ clients in rural communities. “This isn’t just impacting our clients; it is also impacting our advocates.”

So much of counselors’ focus tends to be on the clients that the counselors often neglect their own safety and mental health, added Dockery, who is nonbinary. Dockery explained they face a lot of risks since their name and gender identity are publicly available. Same with Khan-Snyder, who shared that he had to create a plan to leave his state in case his personal information got leaked.

The speakers told the audience that cis and straight counselors can help advocate for their clients by meeting with legislators, connecting with LGBTQIA+ organizations and creating support networks.

“Make it known to other people that you are here; you are doing the work. Show up to events that are legislatively focused, show up to school board meetings … to the extent that it is safe for you,” said Khan-Snyder. “Be visible and active in doing the work.”

Part of doing the work, he continued, is to learn more about the queer community and its individual members as people. This way, we can take their desires and needs into account when we advocate on their behalf, Khan-Snyder noted. He stressed that an advocate’s job is to uplift people’s voices.

Both speakers also discussed how advocates can keep up to date and in touch with the queer community: They can follow local news sources as well as queer and trans journalists, connect with LGBTQIA+ organizations and reach out to teaching unions. Dockery added that teaching unions can be useful resources because many teachers are concerned about the educational restrictions resulting from these bills.

“You have to hold space for people publicly, but you also have to stand up for us privately,” Dockery said. “What are you saying [and] what are you doing when we’re not looking? Because if you’re not doing this when we aren’t looking, you’re not actually an ally.”


Samantha Cooper is a staff writer for Counseling Today. Contact her at scooper@counseling.org.

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Legislative bills increase fear and trauma in transgender community 

By Samantha Cooper  June 9, 2023

A transgender flag being waved at LGBTQ+ gay pride march

Ink Drop/Shutterstock.com

Fear, anger and anxiety — these are just some of the feelings Jessica Jarman’s transgender clients are dealing with right now. And for good reason. 

Thus far in 2023, nearly 500 anti-LGBTQ+ legislative bills have been introduced at the state level. This includes a bill introduced in Jarman’s state of South Carolina that would force teachers to report any child who is trans and “out” students to their parents. 

Jarman, a licensed professional counselor (LPC) in South Carolina who specializes in trauma, has previously had to report a father to the state’s Department of Social Services because he became abusive after finding out his child was transgender. According to Jarman, police arrived at the home and blamed the child, telling her that if she would just stop pretending to be a girl, then her father wouldn’t get angry and they wouldn’t need to come back. Jarman worries that situations like these could become the norm should the bill pass. 

“Those poor kids are terrified,” Jarman says, “because right now they’re the ones being targeted most by our government. So they’re watching their ability to live being stripped away. … [It’s] just a very scary time.” 

Other states have introduced more severe legislation. For example, Florida Gov. Ron DeSantis recently signed into law several anti-LGBTQ+ bills, including a bill (SB 254) that bans gender-affirming medical care for minors and would allow the state to temporarily remove a child from their home if they receive gender-affirming treatments or procedures and a bill (HR 1069) that restricts teachers, faculty and students from using their pronouns of their choice in public schools and prohibits teaching about sexual orientation and gender identify through the eighth grade.  

According to a study by the Trevor Project, around 86% of trans and nonbinary young people in the United States say that listening to lawmakers debate transgender rights has negatively affected their mental health. This population is more likely to attempt suicide and to develop anxiety, substance use disorders and eating disorders than are their cisgender peers. 

Demographic differences 

Transgender individuals of all ages will face negative repercussions because of these laws. Several states are seeking to pass laws that would imprison doctors for providing any form of gender-affirming care — regardless of the patient’s age.  

“If you are trans and you have undergone a medical treatment that involves removing your testes or removing your ovaries and now they’re not going to let you have hormone therapy, … what’s that going to look like? Your body can’t go back to producing the hormone that you’re born with, and what’s that going to do?” asks John Thomas, an LPC located in Virginia who specializes in gender identity and sexual development. 

The Williams Institute estimates that approximately 1.6 million people age 13 and older identify as transgender in the United States, with trans adults making up about 0.5% of the country’s population. With laws that prohibit doctors from giving gender-affirming care, many of these people will no longer have access to hormone therapy, which can have a negative impact on their physical health and force them to make extremely painful decisions. 

Jarman, who is genderqueer, mentions having some difficult conversations recently with transgender clients during counseling sessions. Jarman says they ask, “Is now the time to go back into the closet? I’m not very far out. Is this safe?”  

“[It’s] a devastating conversation to have because as much as I want to say there’s a good answer … there’s not,” Jarman says. 

Other factors also can affect someone’s decision to come out. Transgender people of color face extra struggles when navigating the world compared with white transgender people. The Williams Institute reports that about 0.5% of white people identify as transgender. Meanwhile, adult persons of color who identify as transgender make up 0.5% to 1% of their race’s population. 

“We live in an incredibly racist society,” says Okichie Davis, a LPC with a private practice based in Philadelphia. “There is a certain power and access that comes from being white that shifts the experience that white trans people [have] in relationship to trans people of color.” 

For example, Black trans women face some of the highest levels of intimate partner violence in comparison with trans people of other genders and races. All trans people of color are more likely to experience extreme poverty in comparison with their cis or white peers, says Davis, who holds a certificate in affirmative therapy for transgender populations. 

These factors can play into a client’s desire or ability to seek gender-affirming care. Of course, the most prominent issue that many trans people struggle with when seeking care is location. 

Accessing care 

It is important for counselors to recognize that the issues facing transgender and nonbinary people are unique and real, Davis says, especially now that states are passing more anti-trans legislation.  

Professional counselors can tackle some of the issues transgender people are facing by using the same tools they would with other clients dealing with trauma. At the same time, there is a severe shortage of LGBTQ+ affirming and knowledgeable counselors. So gender-affirming counselors often have extensive waiting lists. And these counselors are typically located in major cities, which means people living in more rural areas can’t easily access their services, Jarman adds.  

Then there is also the issue of the cost of care itself. 

“The lack of universal health care in this country is an incredible barrier … to seek[ing] mental health care,” Davis says. They explain that trans and nonbinary adults are more likely to experience poverty than their cis peers, so they have less money to seek out care in the first place. “As long as that financial barrier exists, everyone who is marginalized in this society is going to have a harder time accessing care,” they add. 

Davis, a nonbinary woman, says it has only been in the past few decades that mental health care for transgender individuals has become more affirming, rather than pathologizing trans identities. It is important that the profession doesn’t take a step back, they assert. 

Davis adds that the providers doing the most affirming work tend to be transgender or nonbinary themselves. It’s often a struggle for them to get into the field in the first place, they explain, because they face systemic barriers such as cost and stigma regarding their gender identity. 

When working with transgender clients, all the rules that clinicians use with other clients still apply. But there are additional things to keep in mind. “The counselor may be the only witness to a client’s truest self, and in that space, the counselor can help them explore how they can balance authenticity with safety,” Thomas says. 

Of course, there are obvious actions that counselors shouldn’t take, such as engaging in conversion or reparative therapy, which denies a person’s identity and gender. Being transgender is not a mental illness, Davis emphasizes. It is not something that needs to be “fixed.” What these clients need instead is support in dealing with the trauma inflicted on them by society, Davis says. 

Whether it is with cognitive behavior therapy, dialectical behavior therapy, existential therapy, person-center Rogerian therapy or any other approach, counselors should aim to focus on all facets of their clients’ lives, Davis adds. 

A counselor’s responsibility 

The important thing to remember is that the issues trans clients are bringing into session are real, Davis stresses. Davis says they have often had clients whose previous providers would not recognize the severity of what the clients had gone through. 

“They [the counselors] are telling them to think more positive thoughts, and there’s a sense of detachment from the very real fact that a lot of our clients who are marginalized are directly under attack,” Davis says. “Their physical lives, their physical safety are in jeopardy.”  

“If you are not acknowledging the realness of the attack on trans clients right now, you are not in a position to really support them,” Davis stresses. 

Aside from asking more counselors to become openly gender-affirming providers and offering their services pro bono or for a discount (if possible), Davis and Jarman advise counselors to get politically involved. 

Offering crisis management services for LGBTQ+ organizations that are protesting transphobic laws or involving themselves visibly during these events is a good way for counselors to show their support, Jarman says. She adds that she rarely sees other counselors who say they are gender-affirming and serve transgender clients show up to public protests, which she finds disheartening. 

“I think the biggest thing I would ask from any therapist would be [to] be an ally,” she says. “Any therapist that uses the terminology affirmingly, please show up. At the state house, please show up. At the community events, please show up.” 


Samantha Cooper is a staff writer for Counseling Today. Contact her at scooper@counseling.org.  

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Addressing intimate partner violence with LGBTQ+ clients

By Lisa R. Rhodes June 1, 2023

Two men sit side by side across from a woman


It has been a long-held belief that intimate partner violence (IPV) happens primarily in heterosexual relationships and that straight, cisgender women are most likely to be the victims of abuse.

“Domestic violence theories have historically been gender based,” says Susan Holt, a licensed marriage and family therapist (LMFT) and an associate director of the Mental Health Department at the Los Angeles LGBT Center. Domestic violence or outreach materials, research and media often talk about IPV from this heteronormative perspective and refer to victims of IPV using the pronoun “she” and perpetrators of IPV as “he,” Holt notes. And domestic violence shelters and support groups are often designed for and cater to straight, cisgender women.

This belief that IPV happens only or mainly to straight, cisgender women prevents many LGBTQ+ people from recognizing that they may be in an abusive relationship and that they have the right to seek protection from their abuser.

“LGBTQ+ intimate partner violence has been relatively invisible to not only members of the LGBTQ+ community but our society in general,” Holt says.

The pervasiveness of abuse

IPV in the LGBTQ+ community is more prevalent than commonly believed. The Centers for Disease Control and Prevention’s report National Intimate Partner and Sexual Violence Survey: 2010 Findings on Victimization by Sexual Orientation found that domestic violence occurs in LGBTQ+ relationships at rates similar to or higher than those in the general population.

According to the 2020 report Finding Safety: A Report About LGBTQ+ Domestic Violence and Sexual Assault, published by the Los Angeles LGBT Center, 4.1 million LGBTQ+ people in the United States have experienced physical IPV, partner rape or partner stalking in their lifetimes. When LGBTQ+ people do reach out for help in an abusive relationship, they are often mistreated and disrespected. The Finding Safety report notes that 70% of the LGBTQ+ individuals surveyed said that when they sought assistance from service providers, which included mental health counselors and physicians, they experienced “prejudice and/or negative responses to their gender or sexuality” and were often dismissed and shamed. They also reported homophobic, transphobic and sexist treatment, as well as violence, when they attempted to report the abuse to the police.

According to the report Intimate Partner Violence and Sexual Abuse Among LGBT People: A Review of Existing Research, published by the Williams Institute in 2015, studies suggest that “transgender people may confront similar levels, if not higher levels, of IPV as compared to sexual minority men and women and cisgender people,” with findings of lifetime IPV among transgender people ranging from 31% to 50%.

“The LGBTQ+ population has not been commonly studied. This is especially true when it comes to domestic violence and intimate partner violence,” says Holt, founder and director of the STOP Violence Program at the Los Angeles LGBT Center. “Rather, information that applies to other populations without the unique, and often complex, aspects of the LGBTQ+ population [is] extrapolated and applied to the community.”

Holt says that both historically and currently, bisexual female survivors of IPV have been overlooked or misclassified as either heterosexual or lesbian based on their partner, and they report higher levels of severe violence, such as choking, than do lesbians or heterosexual women.

“Bisexual females are often believed erroneously to be hypersexual and depicted as sexual objects, or more sexual than others, and hence subject to objectification and violence,” she continues. “They are also more often controlled by their partners because the partner fears that they cannot be trusted [and] are prone to affairs and infidelity.”

Unlike male survivors of IPV, Holt says bisexual and heterosexual women tend to be more willing to disclose the abuse they have experienced and are open to seeking assistance, which may account for their higher numbers in studies.

Patriarchal and systemic oppression

Patriarchal norms and systemic oppression make LGBTQ+ people more susceptible to IPV. Tristyn Ariyan, a licensed professional counselor (LPC) in Texas who specializes in trauma and relationship issues and violence-informed care for the LGBTQ+ population, says society’s patriarchal view that only men are entitled to exercise power and control “complicates the understanding and recognition of sexual minority or intimate partner violence.”

Ariyan says the patriarchal assumption that men are perpetrators of abuse comes from the idea that sex assignment plays an integral part of social and intimate power dynamics: People assume that men inherently have a right to power and will therefore be socialized to be aggressive and strong, whereas women are raised to be compliant and docile. “This patriarchal perspective skews the view of same-sex and transgender relationships with both societal and internalized beliefs such as men cannot be victims, women are not violent, and LGBTQ+ and intimate partner violence [are] reciprocal, which often prevents reporting and intervention,” she adds.

Society’s patriarchal construct creates myths and expectations about LGBTQ+ relationships so that a partner’s role in the relationship is decided by factors such as their gender expression (based on societal constructs), says Eric Sullivan, an LPC and LMFT who specializes in working with the LGBTQ+ community.

“For example, if you’re in a gay male relationship, there’s this myth that if you’re the ‘top’ [the one who gives penetration] in the relationship, then you’re supposed to be more in control, more dominant, more ‘masculine,’” Sullivan says. Myths such as this perpetuate “constructs of gender norms that aren’t true … even in heterosexual man [and] woman relationships,” he explains.

How a person decides to exert power or control over another person “isn’t connected to a person’s gender or sexuality,” says Ariyan, owner of Luna Therapy Solutions in San Antonio, and “doesn’t line up” with stereotypical notions of masculinity.

Moshe Rozdzial, an LPC and owner of Glow Counseling in Denver, says another harmful consequence of patriarchy is the concept of ownership and that men have the right to “own” or control their partner and children. No one, including LGBTQ+ people, is immune from having been indoctrinated by this social construct, he stresses.

“The dynamics of power and position in LGBTQ+ relationships are not outside of patriarchy,” says Rozdzial, a certified sex therapist and national co-chair of the National Organization for Men Against Sexism. This is why some gay men and lesbian women believe they have the right to control their partner, he says.

“No relationship is purely equal. Someone in the relationship has rank, position or power based on financial standing, education or social status,” he adds. “No relationship is free of power dynamics.”

How these power dynamics play out between two people is what differentiates an abusive relationship from an egalitarian relationship, Rozdzial notes. This reality is not unique to LGBTQ+ relationships; it is a broader understanding of IPV, he says.

Not only is patriarchy an adverse influence in LGBTQ+ relationships, but the systemic oppression against LGBTQ+ people can be detrimental to their sense of self. “We have unique forms of discrimination and prejudice that we experience in the world that are added pressures and stressors in relationships,” says Sullivan, who is part of the LGBTQ+ community and owner of a virtual private practice, Proud Counseling.

LGBQT+ people often internalize a lot of the oppression they experience, which is a form of complex trauma that can show up in relationships and other areas of their lives, Sullivan notes.

Individuals who identify as LGBTQ+ grow up hearing negative social messages that their existence is wrong, sinful or perverted, and these messages are pervasive throughout society’s institutions, such as the media, schools, the workplace, religious institutions and even family systems, says Rozdzial who has been counseling LGBTQ+ people for more than 20 years.

“People hear those messages and come to feel they are damaged or broken or worthy of abuse, punishment or shame, rather than seeing [the messages] as tools of systemic oppression and ‘othering’ that are inherently outside of themselves,” he says.

Sullivan says these negative messages lead some LGBTQ+ people to feel that their personal relationships are judged by others. This often makes them uncomfortable to tell others they are in an LGBTQ+ relationship. It’s already hard to navigate a personal relationship but being a queer couple “makes it that much harder,” Sullivan says. And fear of judgment for being LGBTQ+ can make it more difficult for someone to report IPV, he adds.

Rozdzial uses psychoeducation to educate his clients about the harmful impact of internalizing these oppressive messages. “I want my clients to understand that what they are experiencing [in regard to abuse] is not their fault,” he explains, noting that heterosexuality and society’s assumptions about its inherent superiority means that LGBTQ+ people are often seen as “outsiders.”

He also works to reinforce clients’ strengths and self-determination. Rozdzial says he helps clients develop affirmative statements such as “This is not about me,” “I am not shame worthy” and “This is not my doing,” which help them externalize systemic oppression.

“I want them to realize that they deserve a life free of fear and discrimination, both at home and in society,” he says.

Rozdzial advises clinicians who work with LGBTQ+ survivors of domestic abuse to invest time in unearthing any biases and assumptions they may have about the LGBTQ+ community before developing the therapeutic relationship.

“The therapist is in a power position that can be used against the client if they are not aware of systemic oppression,” he says. “Counselors can harm the client in the clinical setting if they unknowingly align themselves with patriarchal constructs or heterosexist, anti-gay beliefs.”

Holt says it is critically important for counselors to be properly trained to treat LGBTQ+ survivors of IPV. “Because domestic violence and intimate partner violence can cause emotional trauma [and] physical injuries and is potentially lethal, it is imperative that counselors, when faced with a domestic violence case, make sure they have been sufficiently trained to intervene safely and effectively,” she stresses.

Assessing for domestic abuse

Because LGBTQ+ clients may not be aware that they are in an abusive relationship, clinicians must be diligent to correctly assess for IPV. The counselors interviewed for this article recommend that clinicians who are working with couples assess one client at a time and in private. That way, if abuse is present, then the client who is being mistreated might feel more comfortable giving honest answers during the intake.

Ariyan uses the Danger Assessment-Revised questionnaire to screen clients for trauma as part of the intake process. Although the questionnaire was designed to assess abuse in female same-sex relationships, she says that counselors can revise the questions to use gender-neutral language in session with LGBTQ+ clients. The questionnaire includes questions such as:

  • Is she [your partner] constantly jealous and/or possessive of you?
  • Does she [your partner] try to isolate you socially?
  • Does she [your partner] constantly blame you and/or put you down?

To better assess for IPV, Sullivan also suggests counselors ask the following questions during intake:

  • In general, how does your partner treat you?
  • Do you feel safe and comfortable in your living environment?
  • Are there times when you fear your partner?
  • Has your partner ever called you a disparaging name?
  • Has your partner ever threatened you or struck you?
  • Has your partner ever forced you to have sex when you didn’t want to?

Sometimes clients may be hesitant to answer these questions out of concern for how the information will be used. If this happens, Sullivan recommends clinicians normalize the intake process by saying something such as, “It seems like you are hesitant to answer some of these questions. That’s perfectly normal. I’m here to help. You can share only what is comfortable for you. The information that you share can be helpful to you and for me, so that I know what’s going on, and so we can decide what we will work on together in therapy.”

Sullivan, who consults with businesses to help them become LGBTQ+ inclusive, also suggests counselors let clients know during the intake process if they are a member of the LGBTQ+ community or if they identify as an ally of the community. This is important, he says, because clients may be concerned that the clinician has a judgment or bias against LGBTQ+ people or same-sex couples.

Abusive tactics

In addition to the common manifestations of IPV, which include physical, sexual, emotional and economic maltreatment, abusers in LGBTQ+ relationships may use harmful psychological tactics that target their partner’s gender identity or sexuality to degrade and humiliate them.

Because LGBTQ+ people and survivors of IPV internalize being abused, there is often an expectation that being abused “is their lot in life,” Rozdzial says. Therefore, they may not recognize these destructive LGBTQ+ specific tactics, which include the following:

  • Threatening to “out” a partner to their family, friends, employer or other social connections. Ariyan says outing a person in the LGBTQ+ community who is not ready or willing to do so themselves can cause them to lose their job, housing or place of religious worship or create a rift in their family and other support systems that may be difficult to heal.
  • Using derogatory slurs. Sullivan says an abuser may use name calling or mockery that’s related to a partner’s queer identity to shame them.
  • Exploiting a partner’s insecurities around their gender identity or sexuality. Abusers may use a partner’s emotional vulnerabilities against them. For example, Sullivan says that an abuser may tell a transgender woman in transition, “You’ll never be a ‘real woman,’ and you are lucky that I’m with you because nobody else is going to want to date you.”
  • Limiting a partner’s support system by isolating them from family, friends or other social connections. Sullivan says an abuser may try to elevate their position in the partner’s life over all other people. For example, an abuser may tell their partner, “Your friends don’t support you. Your family doesn’t support you, but I accepted you right away.”

The nature of generalized or LGBTQ+ specific abusive tactics in a relationship “may provide insight into [the] overall dynamics of monitoring and controlling behaviors by one partner over another, even as sex, gender identity or gender expression may not be defined through a traditional heteronormative lens,” Rozdzial says.

Healing trauma and affirming the self

The counselors interviewed for this article agree that LGBTQ+ survivors of IPV often struggle with anxiety, depression, posttraumatic stress disorder and suicidal ideation. Therapeutic modalities such as skills training in affective and interpersonal regulation (STAIR), somatic experiencing, mindfulness and LGBTQ+ affirmative identity therapy can help clients process trauma, reframe their thoughts, heal their emotions and repair their sense of self-esteem.

It’s important for clinicians to help clients experiencing IPV feel safe so they can share their experiences without fear of being judged or shamed for who they are. A critical part of therapy with LGBTQ+ people, Rozdzial says, is to “name and acknowledge the level of abuse they are experiencing” and help them to understand that the negative behavior is a result of external systemic factors, rather than as “a personal or individual internalized expression of self.”

Ariyan says she honors the client as “the expert of their own experience” and “allows them to lead the discussion [to] increase their self-agency.”

She says that because survivors have often received mixed messages from their abusers, they learn to assign meaning to nonverbal behaviors to help them receive information beyond what is being spoken or told to them. Because of this, “many survivors are highly adept at reading nonverbal cues, so clinicians must work to be genuine, congruent and explicit,” she notes.

Ariyan uses STAIR to help survivors process trauma. STAIR, which was originally developed to help people who have experienced childhood abuse and have a history of posttraumatic stress disorder, is a skills-based approach that “can be modified for use with clients that have a history of intimate partner violence,” she notes.

“The primary focus of STAIR is reframing cognitions that are impacted by traumatic experiences, allowing individuals to develop and practice adaptive emotion regulation and increase interpersonal functioning,” Ariyan says. “STAIR facilitates meaningful change with clients as they become aware of the impact of interpersonal violence schemas and how it can influence their emotional and social functioning, while also increasing their resiliency through somatic awareness strategies and cognitive restructuring.”

Processing and discussing traumatic events can be stressful, so counselors should ensure that clients have the coping skills needed to address any potential emotional dysregulation that comes up. Ariyan finds somatic experiencing helpful when working with survivors of IPV because it helps clients address physiological dysregulation of traumatic experiences. “By learning to reconnect body sensations with the mind, clients are able to communicate to their nervous system that the perceived threat is over, facilitating a sense of safety and increasing their window of tolerance, or functional range, when activated by stressors,” she explains.

One somatic experiencing self-soothing intervention that Ariyan suggests counselors use is resourcing (i.e., the practice of having the mind/body attuned to sensations of safety). Counselors, for example, could ask the client to imagine a place they find beautiful or comforting and think about the details of the places — the sights, smells and sensations — they are noticing. Counselors can then ask about the emotions (e.g., happy, relaxed) and body sensations (e.g., warmth) they are experiencing and where in their body they feel these sensations.

“If a client begins to experience distress during a session, it can be useful to pause for a moment, bring awareness to a positive and calm resource, then proceed once they have returned to a safe state,” Ariyan says.

Clients can also use this exercise of concentrating on a calming location and the pleasant sensations associated with it outside of session whenever they feel the need to create safety and calm within their environment, she adds.

Sullivan uses mindfulness and grounding exercises such as deep breathing and body scanning to help clients develop the coping skills they need to manage the stress that may result from exploring their traumatic experiences.

He also uses LGBTQ+ affirmative therapy to foster empowerment and acceptance of a client’s queer identity, which amplifies their confidence and sense of self and counters negative messages they may have heard from an abusive partner.

Sullivan notes that it’s important for counselors to provide psychoeducation about heterosexism, homophobia, transphobia and other biases to help clients understand that systemic oppression is a form of complex trauma that needs to be processed and that the abuse they have suffered is not their fault.

Even if LGBTQ+ people have experienced a complex level of trauma, they are not “damaged,” Sullivan stresses. Instead, he says clinicians can help these clients recognize the strengths and resiliency they have developed from their experiences and use these qualities to rebuild their self-esteem and live an empowered life.


Resources for LGBTQ+ domestic violence survivors

Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Helping LGBTQ+ individuals — One story at a time

By Luke Romesberg August 12, 2022

“I came across your article. I’m in a desperate situation. I need help. I wasn’t sure who else to turn to.”

No matter how many times I receive email messages such as this, it is always somewhat of a surprise for me. My previous Counseling Today online exclusive “Conversion therapy: Learning to love myself againhas led me to receive a consistent array of messages from folks of all ages and geographical locations who are struggling with their sexual orientation and gender identity.

Some of the emails contain positive messages: folks who commend me on my bravery to tell my coming-out story. Many of those same people are also shocked I was able to navigate the situation in a manner that led to me having what most would consider a successful personal and professional life. However, the majority of emails I receive are from folks who are in dire need of support and are living in situations and communities where they do not have support or are unable to find support that is confidential. Without appropriate resources, many of these people are at their wits end. The struggles include being trapped at home with unsupportive, homophobic and transphobic family members; being stuck in a marriage in which one’s partner has no idea the other partner is hiding their sexual orientation; being bullied in school; or living one’s entire life with unaddressed trauma stemming from being forced to repress one’s sexual identity. (Please note that the stories and emails I share in this article have been altered to protect the privacy and confidentiality of those who have reached out. All identities remain 100% confidential.)

Conversion therapy throughout the world

First, let’s explore the current state of conversion therapy. Several places have bans against this practice. According to a Stonewall.org article on conversion therapy bans, Brazil led the charge by introducing a ban on conversion therapy in 1999. This ban on therapy relating to sexual orientation was considered groundbreaking at the time, and it helped to set the standard for other countries to follow. In 2000, Norway issued a similar ban, and Samoa banned “registered health professionals from practicing conversion therapy” in 2007. These types of bans continued in places across the world, including in Argentina and Fiji in 2010, Ecuador in 2014, Malta in 2016, and Uruguay in 2017. In 2021, Chile introduced a medical ban and India issued “directives to prohibit conversion therapy.” This year, France and New Zealand also passed laws banning the practice.

Canada initially started banning conversion therapy practices in various provinces and territories, including Ontario, Nova Scotia, Prince Edward Island, Quebec and Yukon, and in December 2021, it banned conversation therapy entirely. The United States has had taken a similar approach. According to the Movement Advancement Project, California was the first state to pass a ban on conversion therapy in 2012, followed by New Jersey in 2013; District of Columbia in 2014; Oregon and Illinois in 2015; Vermont in 2016; Connecticut, Nevada, New Mexico and Rhode Island in 2017; Delaware, Hawaii, Maryland, New Hampshire and Washington in 2018; Maine, Massachusetts, New York, Colorado, and Puerto Rico in 2019; Utah and Virginia in 2020; and Minnesota in 2021. In addition, Michigan, Minnesota, North Carolina and Wisconsin have all partially banned the practice and signed an executive order prohibiting the use of state funding for conversion therapy for minors. And roughly 100 other U.S. counties, municipalities and communities have also issued ordinances banning conversion therapy practices. Please note that some states and districts may only have partial bans, meaning some aspects of conversion therapy may still be legal or eligible for state funding.

The good, the bad and the ugly

Although as a society we have made progress toward the expulsion of conversion therapy, we still have a long way to go, which is evident by the range of emails and stories I received after writing my online exclusive in 2017. And it is important that we do not forget those who may have been left behind or who have not had the opportunity to benefit from the successes of dismantling conversion. We must continue to recognize everyone’s unique experience in dealing with conversion therapy and other methods of identity repression. The following two stories represent a very small margin of the emails I have received from folks reaching out for guidance.

Feeling alone, scared and unsupported  

I received an email from a young person who described themselves as trans-identified and stated they had recently come out to their parents. They were met with pushback and were encountering consistent transphobic and homophobic verbal abuse. They mentioned many of the issues I had previously written about in my CT online article such as feeling as if they had no outlet to be themself. They expressed fear for their future and wondered if they would even have a future. They said that when they purchased clothing that aligned outside of their assigned sex, their parents would find the clothing and throw it in the trash. They were literally and figuratively being stripped of their transhood.

When receiving a message such as this, it is nearly impossible to not immediately feel a sense of darkness and heartbreak — not simply for this individual but also in a grander sense. Homophobia and transphobia are issues that are plaguing queer youth, and they are not issues that simply end as one gets older. Eventually the negative messages they are constantly being fed consume their thoughts, and in turn, it begins to affect their mental health, physical health and any healthy sense of self-identity they may have one once held. The lack of familial support and downright abuse day after day after day will eventually break someone down, and this theme will often continue into one’s adulthood.

After reading this email, I knew this young person was in dire need of any support and genuine kindness, and they were purposefully being kept in an environment that didn’t provide or allow for that. It is important to note that the idea of being able to provide virtual support to a minor, who needs to keep everything a secret from their family, is incredibly challenging. It can also be dangerous for the younger person as they attempt to secretly navigate the situation. This youth put themselves at risk with every email correspondence with me. They were guarded in their emails and left out descriptors such as their specific age and geographic location, which made locating exact resources impossible. However, given the description of their small town, it seemed as though these potential resources likely did not exist.

I drew from my own experience and thought of the outlets I had used when I was under the age of 18 and dealing with conversion therapy in a small town without many LGBTQIA+ resources. I turned to my honors English teacher; she was the first adult I came out to aside from my parents. At the time, I was still living in an environment where I had to be secretive about my sexual orientation. Even after coming out, I was forced to maintain the façade of being heterosexual. My teacher was one of few adults I could trust, and I genuinely enjoyed taking her class. One of our assignments involved creating a CD of songs, along with a description of each song and an explanation of how the songs applied to our life. I used this assignment as my coming out story to her. This project resulted in my teacher giving me 100 bonus points (which meant I was guaranteed an A+ in her course), but more importantly, it also gave me confidence and the knowledge that coming out would not necessarily always be met with a negative response. Even in a very conservative area with seemingly no LGBTQIA+ supports, there were still folks out there who held compassion, understanding and positive regard for those whose identity falls under the queer umbrella.

I shared this story with the youth who was emailing me. We explored potential adults at school they felt they could trust. We also discussed the possibility that someone they thought would be supportive may not be. It is impossible to predict how somebody will react even if you feel you know them very well. And as queer people, we truly do not know how somebody will handle our queerness. Sometimes the benefits of coming out outweigh the risks, but sometimes they do not.

Understanding this risk, the young person decided to reveal their identity to a trusted teacher. Luckily, their music teacher was supportive and has managed to be a consistent outlet for them to express themselves and receive kindness and support in return. Obviously, this does not fix this youth’s entire situation as they are still under oppressive and transphobic control by their parents, but it does help to lighten this hardship. My English teacher was a major saving grace for me. Without her support, I fear that I would not be typing this today. I can only hope that the youth’s music teacher is as strong of a support system as my English teacher was for me.

Although my advice for this youth may seem simple or generic, it is important to remember that even in what seems to be the darkest hour, one can still find a light, no matter how big or small. Even in an area where LGBTQIA+ resources may be nonexistent or inaccessible, there are still folks out there who possess compassion and a willingness to go above and beyond to support someone who is in need. Sometimes we must go through the incredibly difficult process of attempting to trust another person with a secret — one we have already faced so much backlash for revealing. Being met with negativity when coming out just makes the process of coming out to someone else even more difficult. The story illustrates a common theme I have seen in the majority of emails I have received: folks who feel alone and unsupported.

The struggle of coming out

I also have gotten emails from people who haven’t come out yet. I received one at 3:04 a.m. I don’t often sleep much, so I was wide awake, and I read it immediately. The email was full of desperation. The man described himself as Muslim and said that he was attracted to men. He claimed his wife had no idea and they had been married for over three decades. He said that he was on verge of losing his marriage and children, and he was desperate to make things work with his wife. He had stumbled across my CT Online article and was able to relate to it because he remembered feeling stifled as a child. However, unlike me, he had never come out to anybody. He noted that this email was the first time he had expressed his feelings.

He described himself as a “frilly” child, which I interpreted as feminine. This had caused him to be bullied at school and at home, especially by his brothers, and it led to others making assumptions about him. He didn’t include many overt details regarding his school experience aside from stating that he did not have many friends — just one other boy with whom he had sexual relations when he was about 13-15. At one point, his brother walked in on them and discovered this sexual relationship, which resulted in him being physically beaten by not only the brother who discovered them but also his two other brothers. He was beaten so badly that he spent over two weeks in the hospital, and then he returned to the same home where the abuse occurred. His parents sent him to another school in a different neighborhood, and he said that he never saw his friend again. To this day, he has no idea what happened to him. These traumatic events resulted in an immense fear; one that has spanned the course of his entire life resulting in a fruitless marriage and the need for him to hide his true identity.

I will be honest and admit that it took me a long time to respond to this email. I even wrote several drafts before finally sending my response. This was a new situation for me: Most of the folks who reach out to me are in the middle of dealing with homophobic or transphobic issues, but his situation was different because he was still struggling with his sexual orientation. I researched affirming counselors in his area and provided him with a list of folks whom he could reach out to. I was also able to find an LGBTQIA+ support group in his city. And I did my best to provide kind words. I stressed that he was not a mistake and was actually a victim of his situation. It was clear he was holding a lot of guilt about keeping this secret from his wife and that it was eating away at him and his marriage. It was important for him to realize that his options at the time of his marriage were few and far between given the immense cultural and family pressure that was put on him to marry and have a family. That pressure mixed with the severe trauma and physical abuse he faced as a child pushed him deep into the closet.

I emailed him these resources and words of encouragement, and he responded almost immediately, saying, “Thank you for everything you have brought to this world.” This statement brought tears to my eyes. I am happy to be a voice for those who cannot speak up. However, my simple response to his very complex problems hardly seemed like enough. I left this interaction feeling discombobulated. I had provided him with resources, but I was in no way equipped to provide anything further regarding his marriage. That was something he would have to work on himself. Was there more that I could have done? Probably not. Did I wish there was more I could do? Definitely.

Trudging forward and making progress

I write this update to share a very small portion of some of the stories I have encountered since openly discussing my experiences with conversion therapy. It crucial that more people gain the courage to share their experiences so the gravity of the impact of conversion therapy can be fully understood. The more folks share their story, the more we are all able to connect and support each other. We are moving in a direction that is positive, but we must continue on this path to dismantle this harmful, dangerous and potentially life-destroying practice.

I had no clue the impact that my story would have on others. It is heartwarming yet terrifying that so many people are able to connect with and relate to such trauma. It became incredibly clear that I had accidentally distanced myself from the overall desperation one feels when trapped in a similar situation. Writing my previous article helped me to relive my experiences in a way that was healing, and the responses to that article serve as a brutal reminder of how much more severe one’s situation can be. These responses also remind me that many folks are not as lucky as I am to have parents who were willing not only to admit their wrongdoings but also to work through those mistakes and come out as loving and supportive parents on the other side. They are a testament to personal growth and willingness to understand. These are qualities that we need more of in humanity, and ultimately, these are the qualities that will help end conversion therapy.


Benjavisa Ruangvaree Art/Shutterstock.com



For more on laws relating to conversion therapy, see stonewall.org.uk/about-us/news/which-countries-have-already-banned-conversion-therapy and lgbtmap.org/equality-maps/conversion_therapy.



Luke Romesberg

Luke Romesberg is a licensed professional counselor and certified alcohol and other drug counselor. He is a doctoral candidate in the counselor education and supervision program at the Chicago School of Professional Psychology. Currently, he works as the director of youth homelessness services at Center on Halsted and as a home study worker for the Adoption Center of Illinois at Family Resource Center.




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.