LGBTIQ+ affirming practice

LGBTIQ+ affirming practice is important for working with all young people, regardless of whether they have identified as LGBTIQ+. Some clients may not be comfortable to identify as LGBTIQ+ when they first meet clinicians or other adults; they may not be aware themselves; or they may feel shame.

As part of person-centred clinical practice, listen to and validate your client's experience of the world and their mental health by:

• using LGBTIQ+ affirming language to build a culture of safety around these identities and normalise experiences, helping to dismantle stigma and discrimination
• believing and supporting your client as the person they know themselves to be – this may change over the course of their time accessing your service, and it may be different from the way their family or school describes them
• affirming your client’s gender, sex and sexual identity by using their preferred name, pronouns and sexuality descriptors
• respecting your client's choices about disclosure of any intersex variations.

Affirming gender

For trans and gender diverse people, having others know and use correct pronouns and chosen names is an important part of their gender affirmation.

Using pronouns

LGBTIQ+ young people say it’s important for clinicians to learn about and use their preferred pronouns as part of affirming practice. People may choose gendered pronouns (e.g. she/her), gender-neutral pronouns (e.g. they/them) or neo-pronouns (e.g. xe/xem/xyr).

• Gendered pronouns
• Neutral pronouns
• Neo-pronouns
• Mixed pronouns

To model best practice when using pronouns:

• understand that using correct pronouns is important for the client’s dignity and identity, and approach each situation with empathy and respect
• set a positive example by consistently using correct pronouns and modelling respect for a client’s identity
• correct yourself if you make a mistake when using pronouns, and don’t place the burden of emotional labour on the client to make you feel better
• embed pronoun use in your daily life and practice to help build cultural safety – use them when introducing yourself in conversations, meetings, emails, email signature and on name badges
• be patient, as it may take time for people to get used to new pronouns – ongoing reminders can help.

Some trans and gender diverse people use different pronouns interchangeably to describe their gender experience. For example, a client whose pronouns are she/they wants to be addressed by either she/her/hers or they/them/theirs. You can either use one of their pronouns or a mix of pronouns, but you don’t need to use a mixture every time.

So if Dee identifies as she/they/xe, you can say:

• “Dee missed her bus this morning, so she will be late for her appointment”
• “Dee missed their bus this morning, so they’ll be late for their appointment”
• “Dee missed their bus this morning, so she’ll be late for her appointment.”
• “Dee missed xyr bus this morning, so xe’ll be late for her appointment.”

You don’t need to say:

• “Dee missed her/their/xyr bus, so she’ll/they’ll/xyr’ll be late for her appointment.”

Asking a client about pronouns

Even if someone has accessed your service before, or their pronouns were noted in a referral, ask the client about their pronouns, their chosen name and how they’d like to be addressed, e.g:

• “Hi, I’m AJ, I’m a case worker and my pronouns are they/them, what are yours?”
• “We need to double check some personal details: which pronouns do you use, and what name do you go by?”
• “Which pronouns would you like me to use when I refer to you?”
• “I want to confirm which name you'd like to be addressed by.”
• “I know you accessed our service a little while ago, but I want to make sure our records are up to date. Which pronouns do you go by, and what name do you like to use?”
• “Thanks for letting me know about your preferred name and pronouns; are you happy for me to make a note of these in our records? Is there anyone that you don’t want me to use they/them pronouns and your preferred name with?"

Correcting pronoun use

In the course of your work, you and others will ‘misgender’ people and use the wrong pronouns – this is normal.

When you or someone else makes a mistake with a client’s pronouns

• Stay calm and positive, then correct the error calmly and move on – don’t dwell on the error or be defensive.
• Encourage learning and, if appropriate, provide resources or guidance on pronoun use.
• Reinforce that correct pronoun use demonstrates respect.
• Foster a culture where learning from mistakes is valued.
• Encourage open dialogue about pronouns and identities.

Correcting yourself

• When you realise you’ve used the wrong pronoun, take accountability and correct yourself promptly, e.g: “I’m sorry, I meant they,” or “Apologies for the oversight in my last email, River uses they/them pronouns".
• Keep the correction brief to avoid drawing excessive attention to the client or putting them in a position where they need to console you for misgendering them.
• After correcting yourself, continue to use the correct pronoun in your subsequent references to reinforce respect and help to establish the correct usage moving forward.
• Make a mental note of the correct pronouns and be mindful to use them in future interactions.

Correcting someone else

• Address the person’s misuse of pronouns in a respectful manner, in a private conversation or message, e.g: “Just a quick note, River uses they/them pronouns”.
• Frame corrections in a way that focuses on your perspective using ‘I statements’ rather than placing blame, e.g: “I’ve noticed that River uses they/them".
• Provide gentle reminders in a non-intrusive way, where appropriate, such as: “Remember that River prefers they/them”.

Using chosen names

Many trans and gender diverse people don’t go by the name they were given at birth. Being addressed by their chosen name rather than the name they were given at birth (or deadname) is essential to feeling safe and affirmed.

Using a deadname that a client no longer uses, or sharing it with others without consent, is disrespectful and not affirming of their identity.

If a client is deadnamed without their consent, they may:

• feel they have not been listened to or respected by the health system, causing them to lose trust in the support offered and compound their mental health distress
• be ‘outed’ as trans, which is a risk to their mental and physical health
• be triggered, as deadnaming is a common form of transphobic bullying and emotional abuse that many young people experience in their families, schools and community spaces.

Using a client’s chosen name can be complicated in health settings like CAMHS services, because their legal name is required to access government services like Medicare or Centrelink. Despite this roadblock, your practice can still be affirming to the individual, while meeting administrative requirements.

Safety and confidentiality

There are many places where clients do not feel affirmed and where using their chosen name and pronouns can increase the risk of them experiencing bullying, or domestic and family violence.

To ensure you are balancing the need for a client’s affirmation of pronouns and names with their safety and confidentiality, ask for consent and make agreements that respect their needs.

If a client has shared their chosen name and pronouns with you and these are different from their legal or referral information, clarify when it is comfortable and safe to use their chosen name and pronouns and when it is not.

Make a plan about how to address your client:

• in conversation with family or community who don’t affirm their identity
• in conversation with the treating team
• when introducing them to new people.

More about affirming data collection.

Affirming sexuality

It is always a client’s choice whether to disclose their sexuality in a clinical setting. The way that someone describes their sexuality, and who they invite into their understanding of self, may change over time.

Ways to show respect and support for a client in your practice

• Make it clear from first contact that your service is inclusive and supports diverse sexual identities, e.g: “Here, we routinely ask about sexual identity, behaviour, and attraction to ensure we provide the best support possible. This helps us understand and respect your individual experience".
• When first discussing relationships or sexuality, use gender-neutral language to avoid making assumptions and respect privacy, e.g: “Are you seeing anyone?”
• Ask about their preferred terms and use those that are respectful and consistent with their understanding of self, e.g.: “What terms or labels do you use to describe your sexuality?”
• When they are open about their sexuality, keep responses positive and neutral without focusing on it too much or making them uncomfortable, e.g: “Thank you for sharing that with me”.
• Acknowledge when they seem to be struggling to share, and respond positively and supportively, e.g: “I appreciate you sharing this with me. It’s important to me that you feel comfortable and supported".
• Invite them to share more about experiences related to their sexuality, both positive and negative, e.g: “If you’d like, I’m here to listen to your experiences and how you feel about your sexuality. It’s important to understand what’s going well and any challenges”.
• Do not conflate sexual diversity and mental health concerns, or assume that being sexually diverse is inherently problematic or the source of mental health issues. Approach their experiences with an open mind and focus on their overall wellbeing.
• Respect privacy and build trust by ensuring that any information about sexuality is kept confidential, unless they explicitly consent to sharing.
• Provide access to supportive resources and information about sexual identity and wellbeing if they would like to explore these, without imposing them.
• Be open to feedback on how you can better support them regarding their sexuality, to improve your practice and show commitment to respect and inclusivity.
• Promote understanding and a supportive environment by educating staff and peers about LGBTIQ+ inclusivity; diverse experiences of sexuality; and the importance of respecting clients' sexual identities.

Affirming experiences of clients with intersex variations

A client with an intersex variation may not want or need to disclose or explore their variation with a mental health clinician. Some clients and their families may not have much information about their variation, or even be aware of it.

Affirming care for a client with an intersex variation involves respecting their choice to disclose or not, and how they would like to explore their experience. It can also include working with them to access information about their variation if they want to, and understanding their right to bodily autonomy.

Ways to show respect and support for a client in your practice

• Respond supportively and with empathy if they choose to share, e.g: “Thank you for sharing that with me, I’m here to listen and understand what’s happening for you".
• Provide person-centred care by being curious and respectful about what they may or may not want to explore, including more information about their variation, e.g:
  • “You don’t need to talk more with me about your variation or medical experiences unless you want to.”
  • “Would you like my help to find out more about your variation?”
  • “Would you like me to find out more about people with similar experiences for you to connect with?”

• Be aware they may have experienced medical trauma throughout their lives, making health spaces triggering to access and health professionals difficult to trust.
• Don’t assume everyone with an intersex variation has the same experiences. For example, some may identify as LGBTQ+ while others may be cisgender and heterosexual.
• If you make a mistake in how you discuss or refer to their experience, acknowledge it promptly and apologise, e.g: “I’m sorry if I made any mistakes in our conversation. I want to acknowledge and thank you for your patience and letting me know”.

• Respect privacy about personal details of a variation, e.g: “I understand that discussing personal experiences is sensitive. You only need to talk about and share what’s comfortable for you”.
• Encourage them to advocate for their own needs and preferences, e.g. supporting them to access their health information and learn more about their experience.
• Undertake research, education and training about relevant issues as part of your practice, including the importance of using respectful language, and the role of health systems in causing harm for young people with intersex variations.
• Promote awareness within your organisation or community about experiences of people with intersex variations.

More about people with intersex variations and resources