A Guide for Mental Health Clinicians

The Importance of Mental Health Clinicians Becoming LGBTQ+ Competent

Without LGBTQ+ competency, LGBTQ+ patients can be retraumatized by providers who:

  • Question the validity of patients’ identities.
  • Make inaccurate assumptions about patients’ sexual orientations and gender identities.
  • Invalidate LGBTQ+ patients’ life experiences.
  • Are blind to their own cultural biases surrounding gender identity and sexual orientation.
  • Fail to create and maintain a safe space.
  • Overly attribute patients’ problems to their identities OR underemphasize the importance of a patient’s identity.
  • Engage with LGBTQ+ patients’ family members without preserving patients’ privacy.

How to Work with Bi+ Clients: A Guide for Mental Health Clinicians

  • Include space for clients to write in pronouns on your intake forms. This expands beyond the gender binary of “she” or “he” and assures that you, as the clinician, know their pronouns before the first session.
  • Understand the difference between sexual orientation, gender identity, and sex. While these are all intersecting parts of identity, bi+ identity refers to sexual orientation, or who one is attracted to. Gender identity refers to who a client understands themselves to be internally in regards to their gender and gender expression (how they present to the world). Sex refers to genetalia—the parts they were assigned at birth. For example a client could be Gender Non-Conforming (Gender Identity), Bisexual (Sexual Orientation), and assigned female at birth (Sex).
  • Develop a foundational understanding of common bi+ labels:
    • A bisexual is a person who can be attracted to more than one sex, gender or gender identity. 
    • The most popular definition of bisexual comes from veteran bisexual activist Robyn Ochs: “I call myself bisexual because I acknowledge that I have in myself the potential to be attracted – romantically and/or sexually – to people of more than one sex and/or gender, not necessarily at the same time, not necessarily in the same way, and not necessarily to the same degree.” 
    • Pansexual is defined as someone who has the potential for emotional, romantic, or sexual attraction to people of any gender. Please note that bisexuals also define their sexuality as encompassing an attraction to any gender as well and some find it offensive that pansexuality is seen as more inclusive. The term pansexual is sometimes more popular with younger people because they feel the label is more inclusive of those with expansive gender identities. The most important thing is to learn what the client’s chosen label means to them as these definitions can be subjective and evolve over time.
    • Fluid is defined as attraction to various genders that changes—or might fluctuate—over time.

  • Understand that bi+ can be used as an umbrella term that encompasses all sexual orientation labels for people who are attracted to more than one gender, including but not limited to pansexual, fluid, queer, etc. Sometimes bi+ people use more than one term to define their sexual orientation. For instance, “I’m bisexual, pansexual and queer”.

  • Language is important in building an affirmative therapeutic relationship. Use inclusive terms like, “same-sex couple” instead of “Gay couple” or “Lesbian couple.” Say “LGBTQ+ community” instead of “Gay and Lesbian community”. Know that terms like “different-sex partner” don’t contribute to erasure like “opposite-sex partner” has the potential to.

  • Bisexuality is valid and real. Be aware of common stereotypes, biases, and myths such as that bi+ people are promiscuous, confused, greedy, incapable of monogamy, “need both to be happy,” or that their bisexuality is a phase.

  • Educate yourself about the health disparities faced by the bi+ community. The client shouldn’t have to educate you about statistics. You can learn more on this website and from other bi+ organizations/platforms if you need to expand your knowledge-base.

  • If your client is in a committed relationship, don’t assume their sexual orientation based on the gender identity of their partner. The client’s bisexuality is valid regardless of their partner or partner’s gender identity. They haven’t chosen a side. Even if a client has not sexually and/or romantically been with a partner or partners of the same gender identity, their bisexuality is real based on their own internal experience of their attractions.

  • The client is the expert on their own experience. Don’t assume bi+ people are confused or don’t know who they are—or that their sexuality is a passing phase. Meet each client where they are at. Chances are, they’ve given their sexual orientation a lot of thought before coming out to you.
  • Don’t ask bi+ clients which sex (male or female) they prefer. This continues to operate under the restrictive gender binary and doesn’t account for all the complexities of sexuality and gender identity. Some of us prefer a sex and/or gender identity. Some of us don’t. Be curious about what it means to the client to be Bisexual. While you’ve understood basic definitions under the Bi+ umbrella, each client will have a unique relationship to whatever label most resonates.
  • Don’t assume bi+ clients are not monogamous. Some of us are. Some of us aren’t—just like people of every sexual orientation.
  • Understand that bi+ people are often objectified or fetishized in their dating life. Understand that cisgender bisexual women have the highest rates of sexual assault and intimate partner violence in part because bisexuality is sometimes viewed as implied consent for sexual interaction.
  • Understand that bisexuals face an almost equal amount of stigma from gays and lesbians as they do from straight people, and many are closeted within relationships because they can’t gain acceptance from partners as their authentic selves. For this reason, bi+ people are less likely to be out than their gay and lesbian peers with only 19% out to the most important people in their lives. Additionally, 88% of bi+ people are in relationships with people of a different sex, while 12% are in a relationship with someone of the same sex. This doesn’t make their bisexuality any less valid or mean they have “chosen a side.”