How and Why to Use LGBTQ+ Inclusive Language in Psychology
Reviewed by David Alonzo, chair of GLSEN Greater Kansas City Chapter
About 10.1 million Americans, or 4.1% of the country’s population, identify as LGBTQ+, according to the Pew Research Center.Those numbers have been steadily rising. It’s unlikely that more people are being born LGBTQ+; instead, people are coming out in higher numbers as cultural attitudes shift. However, according to the American Psychiatric Association (APA), LGBTQ+ individuals are more likely to grapple with anxiety, depression, gender dysphoria, and other challenges listed in the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Being LGBTQ+ does not mean one is mentally ill; the APA states that the LGBTQ+ community’s disproportionate levels of mental health issues can often be traced to issues with societal and self-acceptance—and if you look at the cultural climate that the community has long endured, it’s not hard to understand why.
Though this is no longer the case, the APA classified homosexuality as a mental illness until 1973, and it wasn’t until 2003 that the U.S. Supreme Court struck down laws that made it illegal for men to have consensual sex with other men in their own homes. Although the LGBTQ+ community in the U.S. is living in an age of unprecedented acceptance, freedom, and media representation, there are still the ever-present realities of homophobia, bigotry, discrimination, and even violence against them. As a result, they’re more prone to mental health crises.
Because the language surrounding the topic is highly sensitive, this page was designed to guide mental health professionals through the often-murky waters of discussing LGBTQ+ issues.
How Can Inclusive Language Improve LGBTQ+ People’s Mental Health?
You’ll likely have members of the LGBTQ+ community or loved ones thereof as clients, even if LGBTQ+ issues are not your specialty. Understanding sensitive language that’s unique to the community is critical both to your success and to the mental health of those you serve.
Kevin Watson, M.D., is a board-certified psychiatrist with OU Medicine, the largest multispecialty physician practice in Oklahoma. He spoke at last year’s Oklahoma City Pride Parade about issues that affect the LGBTQ+ population, including mental health.
– Kevin Watson, board-certified psychiatrist
“Inclusive language is important because many LGBTQ+ people worry they may not be accepted and may not disclose their LGBTQ+ identity for fear of rejection,” Watson says. “Making it clear that a provider is LGBTQ+ affirming can put a client at ease and allow them to be more fully honest, which can improve care.”
Shauna Lawlis, M.D., a board-certified pediatrician who runs the OU Medicine LGBTQ+ clinic and specializes in adolescent medicine, concurs.
“Inclusive language helps to build a safe space where a patient feels comfortable and will be able to engage in important conversations around their medical and mental health concerns,” she says.
Sara Stanizai is a Licensed Marriage and Family Therapist (LMFT), trainer, consultant, therapist, and the owner of Prospect Therapy, an LGBTQ+ affirming psychotherapy practice in Long Beach, California. She says there’s a direct correlation between language and mental health.
– Sara Stanizai, LMFT
“Inclusive language reduces the microaggressions that marginalized communities experience on a daily basis on an institutional, environmental, interpersonal, and internal level,” she says. “To many people, [a pronoun is] ‘just a word,’ but to those who use those words to describe themselves, it’s an affirmation of their identity. In other words, it’s critical to not use language that is painful, invalidating, and dismissive.”
Kryss Shane is a dual-licensed mental health professional with 25 years of experience as an activist and educator in the field of LGBTQ+ mental health. As the author of The Educator’s Guide to LGBT+ Inclusion, she’s regarded by the New York Times and other top publications as one of the country’s foremost experts. Like Stanizai, she stresses the significance of inclusive language.
– Kryss Shane, mental health professional and educator
“LGBT+ inclusive language isn’t important, it’s crucial,” she says. “Just like calling someone by the wrong name, using language that is not inclusive alienates people and lets them know that you do not value them, which undermines any opportunity for trust-building or attainment, which is vital when working together toward goals. By using inclusive language, you let LGBT+ people know that they are valued, a foundational need that all people have in order to feel calm and safe in any spaces or interactions they are in.”
In considering the language you use in your practice, be aware that many serious mental health issues disproportionately affect the LGBTQ+ population. It’s important to note, however, that being LGBTQ+ is not the root cause of any of them. The This, according to the APA, can lead to “internalized homophobia,” which may trigger the mental health struggles most common to the community, including:
You must be proactive in learning how to discuss these sensitive issues by familiarizing yourself with the concepts and language surrounding them. The organization Screening for Mental Health Inc., for example, developed the suicide treatment protocol ACT (acknowledge, care, and treatment). The Trevor Project outlines some of the prime causes—like bullying and family rejection—behind the shockingly high suicide, homeless, and addiction rates in the LGBTQ+ community.
How Can I Make My Language More Inclusive?
Developing inclusive language skills starts with disposing of preconceived notions.
“Don’t assume anyone’s sexuality or gender—ask,” Watson says. “Then make sure they know that they’re truly accepted, valued, and supported as they are. LGBTQ+ people are just like anyone else, so talk to them and about them just like anyone else.”
What you don’t say, however, can be just as important as what you do say.
“Avoid saying that LBGTQ+ is a ‘lifestyle,'” Watson says. “Being LGBTQ+ is an immutable personal characteristic, not chosen. Try to avoid stereotypes, such as ‘gay people like decorating and are flamboyant.’ There is diversity among LGBTQ+ people and not everyone fits a stereotype. As many LGBTQ+ people have had negative experiences with religion, try to avoid religious language which may seem to connote moral judgment.”
Since “the list of inappropriate words, terms, and beliefs is ridiculously long,” Shane suggests that only an immersive education into LGBTQ+ culture and issues—a list of resources at the end of this article is a good place to start, but it is not all-inclusive—can prepare you to navigate the minefield of potentially damaging language.
A brief summation by Lawlis reinforces this point.
“I try to avoid the term ‘preferred’ for names or pronouns,” she says. “It implies choice and many of those in the community as well as those who have studied gender identity and sexual orientation believe it is an innate characteristic. Obviously avoid slurs. The term ‘transsexual’ is in general outdated and most prefer ‘transgender,’ though some members of the community may use it to mean someone who has transitioned with sexual reassignment or gender affirmation surgery. Saying someone is a ‘he/she’ or ‘it’ is not respectful. The term ‘queer’ is considered controversial. Many younger people may be using it to ‘take back the word’ or use it as an inclusive term for the community; however, those of slightly older generations may remember when it was used as a slur.”
Inclusive Language in One-on-One Interactions
One-on-one sessions are the most personal of all therapy environments—and the one where the choice of language is most consequential. This setting is where you’ll establish guidelines for intimate issues like pronoun use.
“After introducing oneself, start the conversation with how the patient would like to be addressed,” Lawlis says, referring to the following hypothetical scenario. “‘My name is Dr. Lawlis and I use she/her pronouns. What name do you use? What pronouns? How would you like for me to address you?’ Use terms that the patient used. Ask for clarification if you don’t know what a term means or if you have heard it used in different contexts, such as ‘I’m not familiar with the term ‘aro.’ Can you explain what you mean by that? Can you spell that for me?'”
Stanizai agrees.
“Share your own pronouns in conversation, introduction, in writing, on business cards, in your email signature,” she says. “Use neutral terms like spouse or partner, sibling, child, relative, person, etc. Try using neutral language whenever possible. It reduces the ‘spotlight’ on LGBTQ+ people having to explain themselves.”
Normalizing the sharing of pronouns (or agreeing to refer to someone by name, with no pronouns at all, if that’s their request) acknowledges that gender is important and that you recognize that there are more identities than male and female—an especially important topic to young people.
One-on-one sessions are also where you’re most likely to encounter people going through the life-defining process of “coming out.”
“Listen, encourage, and acknowledge the gravity of the event,” Watson says. “Make sure they know that it’ll be okay even if they are not accepted by important people in their lives. Let them know that they’re normal and will lead normal lives.”
For Stanizai, language selection is incredibly important when a patient is “coming out,” which in and of itself can be a problematic turn of phrase.
“When a patient is coming out, I prefer to use the term ‘being open about’ their identity,” she says. “It reduces the idea that they were hiding something previously. Like many people, just because you don’t know something personal about me, doesn’t mean I was hiding it. But if I choose to share it or be open about it, that’s a different story.”
Inclusive Language in Small Groups
Although less personal than one-on-one therapy, small groups allow for the exchange of ideas in a setting that is still intimate. It could involve families talking through their feelings, members of the LGBTQ+ community sharing their experiences, or bullies reconciling with their victims in school. Organizations like Identity House provide resources for group therapy, as do The Center and the American Counseling Association.
In small-group therapy, it’s critical for the leader to state the ground rules and norms, and to establish the time together as a safe and constructive environment. A typical process for developing that structure includes the following steps:
- Have participants fill out pre-assessment forms and assign them a code but ask them not to put their names on the questionnaires.
- Introduce yourself and state your gender pronouns. Discuss the purpose of the group and ask group members to share their names, gender pronouns, and, if they’re comfortable, a little bit about their backgrounds. Don’t insist they share things they are not comfortable sharing.
- Explain how group therapy functions—it’s a time to share thoughts and feelings in a non-judgmental space and it’s normal for these conversations to cause intense or uncomfortable emotional responses. It’s critical at this point to discuss confidentiality and any exceptions to confidentiality.
- Encourage group brainstorming and solicit input about what the rules should be and the best way to create a safe, constructive environment. This might include showing respect, allowing one person to speak at a time without interruption, etc. Then, ask what the members are hoping to learn, gain, or accomplish.
- Consider splitting the group into pairs to interview each other and share what each learned about the other.
- Conclude by thanking each group member for sharing and reminding them when the next session will take place.
Inclusive Language in Large, Mixed Groups
Large, mixed groups are the least intimate setting, but they offer the best opportunity to educate broad, diverse audiences. GLSEN provides a wealth of educator resources that can prepare you for presenting to large groups. Although the environment is not as personal, language choice remains critical, and the subject matter is no less sensitive. You might, for example, speak to educators, parents, members of the LGBTQ+ community, or some combination thereof about safe sex issues that are unique to this population. This requires you, as a speaker, to know the language the population uses, even if it’s uncomfortable for or unfamiliar to some attendees.
To People Who Identify as Straight and Cisgender
It’s also important to consider language when helping straight/cis people who are working through LGBTQ+ issues in their own families.
“Be firm and confident in advising that their family member is not making a choice and should be accepted as they are,” Watson says. “You’re in a position of authority, and you may not get another chance. Be an advocate for the LGBTQ+ person while certainly acknowledging the well-meaning fears of the family member.”
The best therapists treat these interactions as a valuable opportunity to educate straight/cis individuals about the critical role they play in their LGBTQ+ loved ones’ mental health.
“Explain to the family member that you are trying to respect the individual’s pronouns and name that they have asked you to use and that studies show affirming one’s identity improves mental health outcomes,” Lawlis says. “Discuss that family support for LGBT youth has been shown to be protective for mental health as well as improved condom use, decreased substance abuse, lower risk of STDs, decreased suicide rates, etc. It’s normal to have questions. It’s normal to grieve and take time to adjust to new information. Discuss these concerns and get them set up with groups that are affirming like PFLAG and other parent/family support groups. Family therapy may also be helpful.”
When speaking to groups like this, it is also essential to address the concept of “deadnaming.” Many, though not all, trans people choose to change their names as part of their transitions. “Deadnaming” occurs when a person, intentionally or unintentionally, refers to a person by their previous name. This can cause distress, as it may feel like their identity is not accepted. Explain why it is essential to use a person’s current name and apologize when and if they mess up.
In some cases, you might find yourself in the uncomfortable position of dealing with straight/cis family members who are biased, hostile, or unaccepting.
“Acknowledge and validate the client’s perspective while not agreeing with them or condoning their viewpoint,” Watson says. “Assume the client with bias is well-meaning and try to understand where they’re coming from. Once rapport is strong enough, gently challenge their bias. As a leader, the therapist should stick up against bullying or antagonistic language by simply saying they disagree or don’t appreciate such language.”
Lawlis concurs.
“Try to address where this is coming from,” she says. “For example, do they not want their child to transition because they are worried about their safety? I always start with, ‘All I want for you is to have a happy, healthy child/patient/person.’ Talk about respect.”
How Can I Become More Comfortable Using Inclusive Language?
For Shane, your degree of comfort is directly proportionate to your level of education on the importance of using inclusive language.
“Counselors must prioritize understanding the full identities of their clients as people and as people within their environments. Language inclusion is only a piece of the care that LGBT+ clients deserve.”
Also, never promote yourself as an expert on this subject until you truly are.
“Counselors should seek education before claiming to be qualified to fully care for LGBT+ people,” Shane continued. “When you set up your profile on websites, do not include the LGBT+ community if you are not receiving ongoing training in this group’s specialized needs and experiences.”
This is especially true for professionals who are not members of the community themselves.
“It’s important for straight/cisgender therapists to educate themselves, and whenever possible go to another clinician with lived experience with that identity,” Stanizai says. “LGBTQ+ people are the experts on their own experiences. Also, keep in mind that LGBTQ+ people are just as capable of perpetuating oppressive and offensive practices. We are not a monolith and there is still some phobia within communities.”
If you are uncertain about or uncomfortable with your level of preparedness, it might be better to refer the patient to a more qualified therapist who specializes in LGBTQ+ issues. You might then speak with similar specialist colleagues yourself and seek guidance on how you could better prepare for working and talking with LGBTQ+ clients.
LGBTQ+ Related Resources for Psychologists and Counselors
Quick Glossary of Terms
There are literally hundreds of terms associated with the LGBTQ+ community. While terms like “gay,” “straight,” “lesbian,” and “in the closet” are commonly understood in the mainstream vernacular, others are less familiar. While this list is far from exhaustive, the following are a few terms defined by PFLAG that are newer, more complex, or commonly misunderstood—but ones you’ll have to understand to deal effectively with this subject matter nonetheless.
Meet the Expert
David Alonzo
David has been the chair of the Greater Kansas City chapter of GLSEN for about eleven years. He is a GLSEN certified professional development facilitator and a member of the GLSEN National Race & Privilege Committee, as well as a member of the GLSEN National Accreditation Review Committee. He retired from public school teaching in 2012 and taught instrumental music (strings) for 31 years, the last fourteen of which were in the Kansas City Kansas Public Schools. He has represented the school district as a delegate to the National Representative Assembly of NEA four times. He is a native of Kansas City, MO and graduated from Westport High School in 1972. He has a bachelor’s degree from William Jewell College and a master’s degree from the University of North Texas with additional work (ABD) at Texas Tech University. He has played in symphony orchestras in Texas and New Mexico. An ironic fact in his educational journey is that he started kindergarten at Frederick Douglass Elementary School in Kansas City and the first high school where he taught orchestra was Robert E. Lee High School.