One question I always ask clients who are new to my practice is to tell me about their past therapy experiences -- what was helpful and not helpful; what worked and didn't work. The #1 unhelpful thing people tell me about their past experiences in therapy goes something like this...
"I tried to come out when I was seeing my last therapist, and they tried to help me, but I dunno...They didn't know a whole lot about what I was going through."
I would guess that 99% of clients coming into therapy aren't aware that there is a Spectrum of Competency. And not just for queer-focused specialties, but for all specialties. I've illustrated this Spectrum in the graphic above to help you visualize what I mean as it relates to therapists who work with that LGBTQ+ community. So let's dive into what's behind it...
Most therapists who advertise as LGBTQ+ Friendly have totally pure intentions in using this tagline. And I know a lot of great therapists who are very cordial toward the queer community. They have open, warm, and accepting practices, and are willing to help clients from all walks of life. However, many Friendly therapists are general practitioners -- they know a great deal about a lot of things, and can help with many different concerns, but they don't necessarily have a specialty in helping clients with sexuality and gender concerns. On the other hand, many Queer Friendly therapists have a specialty in something more related to mental or behavioral health -- depression, anxiety, stress management, anger, trauma, etc. Typically, this means that what they help best with are issues that aren't rooted in gender or sexuality stuff. Sometimes these are therapists who are relatively new out of grad school and are gaining experience in the field. Or sometimes these are seasoned therapists who want to add a queer specialization to their work and are just starting that process. However, Friendly therapists may or may not be seeking a change in the way they work; they might be just fine with staying Friendly and not moving toward Aware or Knowledgeable on the Spectrum. Whatever is the case, every therapist who works with LGBTQ+ clients should start here -- at being friendly, warm, and open.
If we look at the other end of the spectrum, we have Queer Knowledgeable therapists. These are the therapists who have decided to gain as much information as possible to be a true specialist or expert in working with the queer community. They will have understandings of cultural forces that impact your life as a queer person, concepts like heteronormativity and cisgenderism. These therapists have a strong understanding of minority stress. They will keep up with (or may even be doing) research that is being published about queer people and their therapy needs, as well as therapy practices that work best for the queer community. They typically will have dedicated lots of time and probably even lots of money in learning about the issues that impact you as a queer person. Perhaps they have some certification(s) in queer mental health, though not always (There are only a few of them offered and recognized nationally/internationally). Or they might at least be professional members of ALGBTIC and/or WPATH (or similar organization for their particular discipline). They will more than likely be willing to write HRT and Surgery Referral Letters for trans* clients. They will mostly already know the terms you use to describe your identity (I say 'mostly' because the lexicon is changing so rapidly that it's hard to keep up with everything right as it happens). They might even be the therapists that are training other therapists (the Friendly and Aware ones) to help them gain more knowledge.
And speaking of the LGBTQ+ Aware therapists, let's circle back to them. They do important work, and I don't want to leave them out! Many times, Aware therapists are on their way to becoming knowledgeable. These are the therapists who know a quite a bit about working with queer clients on queer issues, but perhaps still need some consultation or supervision with an already Knowledgeable therapist. Aware therapists know of local resources for the queer community, or at least know how to find the resources. They have likely attended some trainings and are planning to attend more. Perhaps they have read some books and have a stack waiting to be read, or an Amazon cart full of ones to buy (speaking from personal experience!) They might be working on a certification or higher degree related to working with queer clients. They are great resources because if you come in with a queer issue they don't fully understand, an Aware therapist is likely to dig into learning, but without you having to be their main/sole source of education.
One therapist type that I didn't place on the Spectrum are UN-friendly therapists. Those who are anti-queer and don't work with queer clients at all. You've met anti- people, I'm certain (and I'm sorry 💔). You know what they're like. It's hard for me to wrap my head around queer unfriendly therapists, but they are out there. I just don't happen to think they deserve to tarnish a spot on my beautiful rainbow graphic, so there... 😉
If you are curious to explore this idea a little more, I first learned about this concept in this video from therapist Dara Hoffman-Fox. They do a great job explaining their notion of the "tiers" of gender therapists, in particular.
I have enjoyed every step of my journey from Friendly to Aware to Knowledgeable! If you've worked with a therapist or even a few different therapists in the past, can you recognize where you'd place them on the Spectrum?
Wishing you well,