Affirmative approaches to social work validate LGBTQ clients’ identities and help to create an inclusive space for all.  

Compared to their heterosexual peers, members of the LGBTA community are 2.5 times more likely to suffer from depression, anxiety and substance abuse. They're also the victims of a rising number of hate crimes taking place in communities and schools across the country. 

Undergirding these risks are a number of social determinants of health and safety, many of which are based on a history of discrimination and stigmatization. To combat the effects of LGBTQ marginalization, the social structures perpetuating this phenomenon requires an integrated approach to create support systems that comprise protective policies, increased access to health and social services, advocacy, and awareness efforts. Social workers can play a significant role in advancing this mission.

“Some LGBTQ individuals grow up in families and communities that are very accepting, but many others grow up in homes or communities in which it may be unwise or even unsafe for them to come out. And feeling unaccepted for who you are may beget lasting trauma,” said  William Feuerborn, clinical assistant professor at the USC Suzanne Dworak-Peck School of Social Work. “Social workers can combat discrimination and promote greater social equity by practicing not merely tolerance, but true validation of LGBTQ clients’ identities and experiences.”

Feuerborn, who specializes in relational and childhood trauma, provided the following guidelines for practicing identity-affirming clinical social work to create an inclusive, safe space for all:

1. Stay curious. Feuerborn emphasizes the importance of asking questions and remaining engaged. “It’s important to maintain an attitude of respectful curiosity, especially if you’re a heterosexual and/or cisgender social worker serving LGBTQ clients,” he said. “Don’t be afraid to ask questions and encourage clients to open up about whatever they feel comfortable sharing.”

2. Make eye contact. “Simply employing nonverbal cues such as attentive eye contact can signal to clients that they are being heard, respected and validated,” Feuerborn said. “Offer a welcoming handshake and always be intentional about maintaining eye contact.”

3. Watch your body language. In the same vein, Feuerborn emphasizes the importance of retaining a welcoming presence. “Be aware of your disposition and monitor your facial expressions,” he said. “Crossing your arms or legs could convey disapproval or that you are unreceptive to what the client is saying, even if that’s not your intention.”

4. Use open-ended language. Feuerborn warns against using gendered questions before you’re 100 percent positive of a person’s identity and sexual orientation. “Use inclusive language, don’t make assumptions, and don’t be afraid to ask what gender pronouns a client uses,” he said.  

Extending the benefits of affirmative therapy

Through affirmative therapy that validates the identities and experiences of LGBTQ individuals, social workers can help reduce peer and family rejection, ease stigma and combat feelings of isolation, providing them with a reliable source of support.

The benefits of affirmative therapy extend beyond the patient, often yielding positive impacts on the social worker as well. According to recent studies, training in LGBTQ-affirmative psychotherapy can enhance therapists’ attitudes, knowledge and skills. With this in-depth knowledge in hand, social workers are better equipped to serve and promote the well-being of LGBTQ clients throughout their careers.

“To create systemic change toward greater LGBTQ equality and affirmation throughout society, social workers should take on the mantle of this fight by setting a standard of care, ensuring LGBTQ people feel not only safe and tolerated, but valued and celebrated for who they are,” Feuerborn said.

Browse the following resources for affirmative therapy options and additional support services:

• TrevorChat: a free, confidential instant messaging service for LGBTQ youth that provides live help from trained volunteer counselors
• Trans Lifeline: a grassroots hotline and microgrants organization offering direct emotional and financial support to trans people
• National Queer and Trans Therapists of Color Network: a list of therapists across the country who are LGBTQ and/or people of color
• The Gay, Lesbian, Bisexual and Transgender National Hotline: an organization offering three hotlines and a private, one-on-one online chat service for LGBTQ people
• GLMA (previously known as the Gay and Lesbian Medical Association) and The Association of LGBTQ+ Psychiatrists: national listings of queer and queer-affirming mental health professionals