Intake Interviewing with Lesbian, Gay, Bisexual, and Transgender Clients: Starting from a Place of Affirmation

Initial interactions between lesbian, gay, bisexual, or transgender (LGBT) clients and psychotherapists can reveal existing biases from both parties. LGBT clients may have previous experiences with the mental health establishment and legitimate concerns about being pathologized. Psychotherapists may approach clients with openness and acceptance, but are likely to have little training in working with LGBT individuals. In this article, we discuss affirmative practices as a framework for clinicians beginning the intake process with LGBT clients. Through a brief history and overview of LGBT mental health, we provide mental health professionals with an appreciation of the multiple influences on LGBT individuals’ well-being. We then discuss the intake interview process in relation to each subgroup of the LGBT acronym, as each of these four populations face different (yet inter-related) challenges. While there is clearly no “formula” for working with LGBT individuals, in keeping with the principles of multicultural competency (Sue, The Counseling Psychologist, 29:790–821, 2001), our goal is to encourage therapists to reflect on their existing biases and to gain knowledge and skills for working with this diverse population. Overall, we hope this article demonstrates to therapists how to conduct an affirmative intake interview that minimizes heterosexual and dualistic gender assumptions that remain so pervasive in our society and in therapeutic practice.