NB: In this article, the term ‘LGBTIQ+’ is used as an umbrella term to refer to lesbian, gay, bisexual, intersex and queer people and other people with diverse genders and sexualities. The acronymn ‘LGBPTTQQIIAA+’ is also commonly used (click here for a comprehensive glossary of terms by UC Davis’ LGBTQIA Resource Center).

Diverse genders and sexualities are becoming more common and visible in the mainstream, affecting how people identify and understand themselves and each other. 

To work effectively with a range of clients, it is important for therapists to understand the concept of diverse genders and sexualities and to reflect upon what these concepts mean in the context of their own practice and the client-therapist relationship.

This article offers some definitions, explores brief case studies, and provides general tips for therapists to work effectively – and compassionately – with LGBTIQ+ clients.

Diverse genders

‘Transgender and gender diverse’ is an umbrella term used to describe people whose gender is different to the sex that was assigned to them at birth. Beneath this ‘umbrella’ are a diverse range of terms used to describe people’s gender identities.

Non-binary (also referred to enby) people identify as neither a man or a woman, or they identify as more than one gender. Genderfluid people do not consistently identify with a single gender. Gender questioning people are unsure about their gender identity. MTX is a genderqueer or gender expansive person who was assigned male at birth. FTX is a genderqueer or gender expansive person who was assigned female at birth. AFAB / DFAB is a person who was assigned as female at birth / designated female at birth. AMAB / DMAB is a person who was assigned male at birth / designated male at birth.

The lived experiences of transgender and gender diverse people challenge traditional Western views of gender. They demonstrate that gender is not always a simple binary (man / woman), nor an inevitable outcome of one’s biological sex.

Case study

Matt’s eldest child, Jay, is 15 years old and identifies as non-binary. Jay wants to be referred to as ‘they / them.’  Matt has sought counselling to help him better adjust to and understand Jay’s needs. “I don’t really even know what non-binary means,” Matt says to his counsellor. “Does that mean he wants to become a woman?”

Diverse sexualities

The growing list of terms used to define and describe different sexual orientations reflects an increasingly nuanced and complex understanding of human sexuality. 

Aromantic (ARO) is used to describe a person who does not experience romantic attraction. Asexual (ACE) is used to describe a sexual orientation characterised by a lack of sexual attraction. Demisexual is used to describe a sexual orientation to people with whom you have an emotional connection.Gray asexual / Gray Ace is used to describe a person who experiences sexual attraction rarely. Pansexual is used to describe a person who is attracted to all genders, including cisgender, transgender and non-binary.

Diverse sexualities challenge the traditional Western belief that a person’s sexual orientation is limited to three possibilities: straight, gay or bisexual.

Case study

Tai is a 33-year-old nurse. He came out as bisexual in high school but has since realised that the term pansexual is a more accurate reflection of his sexual orientation. Tai has come to counselling to talk about a range of issues, including a budding relationship with a woman he is dating.

“She’s great, she’s such a great person,” Tai says as he describes his girlfriend. “It’s just, she’s pretty conservative. She’s assumed that I’m straight and at some stage I’ll need to tell her I’m not. But people have a hard enough time understanding what it means to bisexual, let alone pansexual so… it’s going to be interesting.”

Gender and sexuality

Sexual orientation and gender identity are distinct characteristics.

  1. Sexual orientation is a pattern of enduring romantic or physical attraction to another person
  2. Gender identity is a person’s innermost sense of themselves as a man, a woman or other gender (e.g. non-binary).

Although it seems obvious to point out, someone can be gay, lesbian, bisexual or queer without being transgender, and someone can be transgender without identifying as gay, lesbian, bisexual or queer. Making this distinction is important because it was once commonly assumed that gay men were women ‘trapped’ in men’s bodies and lesbians were men ‘trapped’ in women’s bodies. This assumption was based on the heteronormative idea that the only people who could (or should) be attracted to men are women, and the only people who could (or should) be attracted to women are men. 

Michael Bronski and his colleagues (2013) argue that conflating sexual orientation with gender identity undermines the diverse and complex lived experiences of LGBTIQ+ people. For example, many gay men and lesbians report gender non-conformity in childhood, but not everyone who is gender non-conforming as a child will later identify as transgender. Similarly, conflating sexual orientation with gender identity often leads to the assumption that transgender people are gay. In fact, transgender people can identify with any sexual orientation along the continuum – gay, heterosexual, bisexual, pansexual and so on.

Although there is a clear distinction between gender identity and sexual orientation, people with diverse sexualities and people with diverse genders have a common social and political history. Both communities have been subject to violence, discrimination and stigma and there are myriad examples of the communities working together to advocate and fight for the rights of LGBTIQ+ people.

“The relationship between gay and transgender people is one of social and political survival. Gay and transgender people have sought one another’s support because they could not find it in environments, such as schools and workplaces, that are hostile to those who deviate from heterosexual gender norms” (Bronski et al, 2013, p. 128).

Case study

Li is 17 years old. She identifies as a trans woman. Li lives in a regional area with a loving and supportive family however she confides in her counsellor that she sometimes feels isolated and lonely.

“There’s a few gay kids at my school and they’re great, we all get along really well and we band together when someone’s getting bullied or harassed. But I’m the only trans woman in the group and even though I have heaps in common with the gay kids, being trans is not the same as being gay. I just wish there a few more trans people around who I could talk to, you know?”

Working with LGBTIQ+ clients

Affirmative approaches

One of the barriers to help-seeking among LGBTIQ+ people is fear of discrimination. For example, a recent report by the National LGBTI Health Alliance (2020) reported that 71% of LGBTIQ people aged 16 – 27 did not use a crisis support service during their most recent personal or mental health crisis and, for a significant proportion (32%), their reason for not seeking help was “anticipated discrimination”. 

It is important that therapists are aware of the subtle and overt signs that may convey homophobia, transphobia or a limited understanding of LGBTIQ+ clients’ needs in a counselling session. These include:

  1. Stereotypical assumptions about a client based on their sexual orientation or gender identity
  2. Assuming that sexual orientation or gender identity is the cause of the client’s presenting problem
  3. Avoidance or minimization of the client’s sexual orientation or gender identity
  4. A limited understanding of diverse sexualities or diverse genders
  5. Judgmental attitudes or discomfort discussing sex, sexual orientation or gender identity.

In contrast, affirmative approaches to diverse genders and sexualities are characterised by:

  1. An understanding of diverse genders, diverse sexualities and LGBTIQ+ communities
  2. Awareness and acknowledgment of discrimination, prejudice and stigma
  3. A positive view of LGBTIQ+ lives
  4. Sensitivity and respect for same-sex relationships
  5. An assumption that LGBTIQ+ clients have the internal resources and creative capacities to manage the challenges they experience.

Case study

Zakiah works as a counsellor in a community-based health service. One way she makes sure that she is not making assumptions about a client’s sexual orientation is by using gender neutral phrases. So, when working with a new client, Zakiah will ask, ‘Are you in a relationship at the moment?’ or ‘Is there someone special in your life?’ If Zakiah asked her client ‘Do you have a girlfriend / boyfriend at the moment?’, she would be assuming that the client is heterosexual.

Reflecting on privilege

Peter Finnerty and his colleagues (2017) argue that mere tolerance of diverse genders and sexualities is not sufficient for counsellors who want to work with clients in an affirmative way. They argue that an affirmative approach to LGBTIQ+ clients requires:

  1. Understanding and
  2. A willingness to resist and defy:
    • Heterosexism: beliefs, values and practices which imply that heterosexual relationships are the only natural, normal and legitimate expressions of sexuality and relationships,
    • Hender binaries: the classification of gender into two categories (man or woman) based on biological sex and
    • Heterosexual and cisgender privilege. 

To develop these qualities, counsellors – including those who identify as LGBTIQ+ – need to identify their own biases and privileges and assess how these factors influence their work with clients.

Reflecting on heteronormative privilege

Heteronormative privilege is the unconscious or taken for granted benefits afforded to heterosexual people. Here are some examples of heteronormative privilege developed by Sam Killerman (the full list is available here). 

  1. Receiving public recognition and support for your intimate relationships
  2. The ability to express affection in most situations without expecting a hostile reaction
  3. The ability to move into any neighbourhood without worrying whether your neighbours, local service providers, schools etc. will accept you and your family
  4. Having the choice to belong to a religious denomination without worrying what the leaders of that religion say or believe about your sexual orientation
  5. Not having to ‘come out’ (pronounce or explain how your sexual identity).

Do any of these privileges apply to you? If so, how might these privileges influence your work with clients?

Case study

Giancarlo is a tolerant and open-minded person and he regularly applies those principles to his counselling work. During a recent professional development course, Giancarlo and his colleagues were asked to reflect upon their heteronormative privilege.

Giancarlo reflected on the multiple places he had lived: he grew up in Italy, then moved to the United States, where he met his wife. They lived in Dubai for a few years, then Singapore, before migrating to Australia.

“The travel itself is a privilege, of course,” Giancarlo explains to the group of people at the workshop. “But not having to worry was a form of privilege as well. I never had to worry that I wouldn’t be accepted in a different country because I was in love with and married to a woman.”

Reflecting on cisgender privilege

Cisgender privilege is the unconscious or taken for granted benefits afforded to cisgender people. Here are some examples of cisgender privileges (also developed by Sam Killerman, click here for more information).

  1. Being able to use public toilets and access changing rooms without fear of confrontation
  2. Not having to put up with people asking you what your genitals look like or how you have sex
  3. Your validity as a man or woman is not based on how much surgery you have had
  4. Not having to remind people to use the correct pronouns when referring to you
  5. Not having to worry that people might assume you’re confused, troubled or misled because of your gender identity

Do any of these privileges apply to you? If so, how might these privileges influence your work with clients?

Case study

When Nat’s colleague gives her an article to read about cisgender privilege, Nat reflects on the fact that no one has ever questioned her right to use the women’s toilets or the women’s changing room at her gym. She imagines what it’s like to have to remind people to use the correct pronouns when referring to her. 

As a woman, Nat has an understanding of gender-based discrimination. However, it is not until she consciously reflects on being cisgender that she begins to understand the privileges associated with that identity. A person whose gender corresponds to the sex they were assigned at birth (a person born female who identifies as a woman, and a person born male who identifies as a man) is cisgender.


Most LGBTIQ+ Australians live happy and fulfilling lives. They face the same challenges as other Australians in their relationships, family and working life and demonstrate remarkable resilience in the face of stigma and discrimination.

Counsellors can play an important role in ensuring the health and wellbeing of LGBTIQ+ people. To fulfill this role, counsellors need to have an awareness and understanding of diverse genders and sexualities, a commitment to affirmative practice, and the ability to reflect upon their own privilege.


  1. American Psychological Association. (2012). Guidelines for Psychological Practice With Lesbian, Gay, and Bisexual Clients. Retrieved from: Website.
  2. Australian Institute of Family Studies (AIFS). (2019). LGBTIQA+ communities: Glossary of common terms. Melbourne: Australian Institute of Family Studies. Retrieved from: Website.
  3. Bronski, M., Pelligrini, A., & Amico, M. (2013). You can tell just by looking and 20 other myths about LGBT life and people. Boston: Beacon Press.
  4. Finnerty, P., Kocet, M. M., Lutes, J., & Yates, C. (2017). Affirmative, Strengths-based counselling with LGBTIQ+ people. In M. M. Ginicola (Ed.), Affirmative Counseling with LGBTQI+ People (pp. 109-125). American Counselling Association.
  5. Killerman, S. (2012a). 30+ Examples of Heterosexual (Straight) Privileges. Retrieved from: Website.
  6. Killerman, S. (2012b). 30+ Examples of Cisgender Privileges. Retrieved from: Website.
  7. Lytle, M. C., Vaughan, M., Rodriguez, E. M., & Shmerler, D. L. (2015). Working with LGBT Individuals: Incorporating Positive Psychology into Training and Practice. Psychology of Sexual Orientation and Gender Diversity, 1(4).
  8. National LGBTI Health Alliance. (2014). Working therapeutically with LGBTI clients: a practice wisdom resource. Newtown, NSW. Retrieved from: Website.
  9. National LGBTI Health Alliance. (2020). Snapshot of mental health and suicide: Prevention statistics for LGBTI people. Retrieved from: Website.
  10. PFLAG. (2020). PFLAG National Glossary of Terms. Retrieved from: Website.
  11. Weir, C., & Piquette, N. (2018). Counselling Transgender Individuals: Issues and Considerations. Canadian Psychology, 59(3), 252-261.