Recognizing when your therapist lacks the cultural competency to effectively work with Black LGBTQ+ clients can save you from ineffective treatment, re-traumatization, and wasted time and money. Cultural incompetence in therapy can actually worsen mental health symptoms and create additional trauma. Here are the warning signs to watch for and steps to take when you encounter them.
Major Red Flags in Initial Sessions
Identity Rejection and Pathologizing
Suggesting Your Identity Is the Problem
- Implying that your sexual orientation or gender identity causes your mental health issues
- Recommending conversion therapy or suggesting you can change your orientation
- Focusing on your identity as pathology rather than addressing discrimination and minority stress
- Suggesting that accepting your identity is giving up or taking the “easy way out”
- Framing therapy goals around changing or suppressing your identity
Minimizing Discrimination Experiences
- Dismissing accounts of racism, homophobia, or transphobia as “just perception”
- Suggesting you’re being “too sensitive” about discriminatory treatment
- Focusing on your response to discrimination rather than validating the trauma of discrimination itself
- Claiming that discrimination is “less common now” or “not as bad as you think”
- Encouraging you to “just ignore” or “not focus on” discriminatory experiences
Religious or Moral Objections
- Expressing personal religious beliefs that condemn LGBTQ+ identities
- Referring to your identity as sinful, unnatural, or morally wrong
- Suggesting prayer or religious conversion as treatment for mental health issues
- Inability to separate personal beliefs from professional practice
- Recommending religious counseling instead of evidence-based therapy
Language and Terminology Issues
Outdated or Offensive Language
- Using outdated terms like “homosexual lifestyle” or “sexual preference”
- Refusing to use your chosen name or correct pronouns
- Using pathologizing language about gender identity or sexual orientation
- Making jokes or casual comments about LGBTQ+ identities
- Using terminology that feels clinical and dehumanizing
Lack of Basic Knowledge
- Not understanding common LGBTQ+ terms or concepts
- Confusing sexual orientation with gender identity
- Asking invasive questions about your sexual or romantic life unrelated to treatment
- Requiring you to educate them about basic LGBTQ+ issues
- Demonstrating surprise or discomfort when you discuss your identity
Cultural Insensitivity and Bias
Racial Stereotyping and Assumptions
Making Assumptions About Black Culture
- Stereotyping Black families as inherently more homophobic or transphobic
- Making assumptions about your religious beliefs based on race
- Assuming economic status or educational background based on race
- Speaking about Black culture as monolithic without understanding diversity
- Using phrases like “your people” or “in your community” inappropriately
Minimizing Racism
- Suggesting racism is less prevalent now or not a major issue
- Claiming to be “colorblind” and not see race
- Focusing only on individual factors while ignoring systemic racism
- Dismissing experiences of workplace or institutional racism
- Suggesting that focusing on racism is counterproductive
Intersectionality Misunderstanding
- Treating racial and LGBTQ+ identities as separate, unrelated issues
- Unable to understand how racism and homophobia/transphobia interact
- Focusing on one identity while ignoring others
- Not understanding the unique experience of being Black and LGBTQ+
- Suggesting you should prioritize one identity over another
Inappropriate Personal Disclosure
Oversharing Personal Beliefs
- Discussing their own religious or moral views about LGBTQ+ issues
- Sharing personal struggles with acceptance of LGBTQ+ identities
- Talking about their own family members’ LGBTQ+ identities inappropriately
- Expressing their personal journey of learning to accept LGBTQ+ people
- Making the therapy session about their own growth rather than yours
Boundary Violations
- Asking personal questions unrelated to treatment goals
- Sharing details about other LGBTQ+ clients (even without names)
- Attempting to connect you with their other LGBTQ+ clients
- Discussing your case with others without proper consent
- Using your experiences as learning opportunities for themselves publicly
Treatment Approach Red Flags
Ineffective or Harmful Therapeutic Techniques
Ignoring Minority Stress
- Focusing only on individual pathology while ignoring external stressors
- Treating anxiety and depression without addressing discrimination trauma
- Using standard treatment protocols without cultural adaptation
- Not understanding how oppression impacts mental health
- Suggesting individual solutions to systemic problems
Inappropriate Family Work
- Pressuring you to reconcile with rejecting family members
- Not understanding chosen family concepts
- Insisting on including unsupportive family in treatment
- Minimizing the impact of family rejection
- Not recognizing the validity of chosen family relationships
Lack of Trauma-Informed Care
- Not recognizing discrimination as traumatic
- Pushing you to discuss trauma before establishing safety
- Not understanding complex trauma from ongoing oppression
- Using re-traumatizing techniques or approaches
- Focusing on individual resilience without addressing systemic causes
Poor Understanding of Intersectional Issues
Failure to Address Multiple Identities
- Focusing on only one aspect of your identity in treatment
- Not understanding how different forms of oppression intersect
- Treating you as if you can separate your racial and LGBTQ+ identities
- Not recognizing the compounding effects of multiple minority stresses
- Unable to adapt treatment for intersectional experiences
Limited Community Understanding
- Not understanding LGBTQ+ community dynamics and culture
- Lack of knowledge about Black LGBTQ+ history and contributions
- Not recognizing the importance of community connection and chosen family
- Unable to help you navigate different communities and spaces
- Not understanding the role of community in healing and support
Communication and Relationship Red Flags
Poor Therapeutic Relationship
Lack of Warmth or Connection
- Seeming uncomfortable or awkward when you discuss your identity
- Not showing genuine interest in your experiences and perspectives
- Appearing judgmental or disapproving despite trying to hide it
- Creating an atmosphere where you don’t feel safe to be authentic
- Making you feel like you need to educate or convince them of your worth
Power Dynamics Issues
- Not acknowledging their privilege and its impact on the therapeutic relationship
- Becoming defensive when you point out cultural insensitivity
- Not taking feedback well or refusing to acknowledge mistakes
- Insisting they know better than you about your own experiences
- Not recognizing you as the expert on your own life and identity
Communication Problems
- Interrupting or talking over you frequently
- Not listening carefully to your experiences and concerns
- Giving advice that shows they haven’t understood your situation
- Focusing on their agenda rather than your goals
- Not checking in about whether their approaches are working for you
Inadequate Crisis Response
Poor Safety Planning
- Not understanding the unique safety concerns of Black LGBTQ+ individuals
- Failing to create appropriate crisis plans for discrimination-related trauma
- Not recognizing signs of minority stress-related mental health crises
- Inadequate understanding of suicide risk factors in LGBTQ+ communities
- Not having appropriate referrals for LGBTQ+-affirming crisis services
Emergency Response Issues
- Not understanding when hospitalization might re-traumatize LGBTQ+ individuals
- Failing to advocate for you in medical or crisis settings
- Not understanding the importance of LGBTQ+-affirming crisis services
- Inadequate follow-up after crisis situations
- Not preparing you for potential discrimination in emergency settings
Systemic and Institutional Red Flags
Practice and Office Environment Issues
Non-Inclusive Environment
- Intake forms that don’t include options for diverse identities
- Waiting room materials that don’t represent diverse identities
- Staff who seem uncomfortable or unfamiliar with LGBTQ+ clients
- Policies that don’t account for chosen names or family structures
- Physical environment that doesn’t feel welcoming to diverse identities
Billing and Insurance Problems
- Not understanding insurance issues related to LGBTQ+ care
- Billing practices that might out you to insurance companies
- Not protecting privacy around LGBTQ+ identity in billing
- Lack of sliding scale or financial assistance options
- Not understanding the financial impact of discrimination
Referral and Network Issues
- Unable to refer you to other LGBTQ+-affirming providers
- Not connected to LGBTQ+ community resources and organizations
- Referring you to providers without checking their cultural competency
- Limited network of culturally competent medical and mental health providers
- Not understanding specialized services you might need
What to Do When You Encounter Red Flags
Immediate Response Strategies
Trust Your Instincts
- If something feels wrong, pay attention to that feeling
- You don’t need to give therapists the benefit of the doubt if they’re causing harm
- Your comfort and safety are more important than their feelings
- Remember that you’re the consumer and have the right to quality care
- Don’t minimize red flags or convince yourself they’re not important
Address Issues Directly (If Safe)
- Point out problematic language or approaches if you feel safe doing so
- Ask for clarification when something doesn’t feel right
- Request changes in approach or language
- Give specific feedback about what’s not working
- Set clear boundaries about acceptable treatment
Document Concerning Behavior
- Keep notes about problematic sessions and specific incidents
- Save any written communications that demonstrate incompetence
- Document any harm or re-traumatization you experience
- Keep records of any promises for improvement that aren’t kept
- Note patterns of behavior over time
Longer-Term Response Options
Seek Consultation
- Talk to trusted friends or family about your concerns
- Consult with other mental health professionals about the situation
- Contact LGBTQ+ organizations for guidance and support
- Seek second opinions about your treatment from other providers
- Connect with others who may have similar experiences
Find Alternative Care
- Begin searching for a more competent therapist immediately
- Don’t wait to find alternatives if you’re being harmed
- Use referral resources specifically for LGBTQ+-affirming providers
- Interview multiple therapists to find better cultural competency
- Prioritize your safety and well-being over convenience or cost
File Complaints When Appropriate
- Contact state licensing boards for serious ethical violations
- File complaints with professional organizations
- Report to insurance companies if billing or coverage issues are involved
- Contact facility administrators if therapist works for an organization
- Document formal complaints thoroughly with specific examples
Protecting Yourself During Transition
Safety Planning
- Ensure you have crisis support during therapist transitions
- Don’t terminate therapy until you have alternatives in place if you’re in crisis
- Build additional support systems while searching for new care
- Create safety plans for managing symptoms during the transition
- Know emergency resources and contacts
Self-Care During Search
- Be patient with yourself as you search for appropriate care
- Practice extra self-care during this potentially frustrating time
- Lean on friends, family, and community for additional support
- Remember that finding good cultural competency may take time
- Don’t blame yourself for therapist incompetence
Building Better Screening
- Use the experience to develop better screening questions
- Trust red flags earlier in the process with future providers
- Develop your own checklist of essential competencies
- Practice advocating for your needs more assertively
- Build a support network to help evaluate potential therapists
Finding Culturally Competent Care
Improved Screening Process
- Ask direct questions about training and experience with Black LGBTQ+ clients
- Request specific examples of how they’ve addressed similar issues
- Ask about their understanding of minority stress and intersectionality
- Inquire about their ongoing cultural competency development
- Trust your gut instincts during initial consultations
Using Specialized Resources
- Seek referrals from LGBTQ+ community organizations
- Use directories specifically focused on LGBTQ+-affirming providers
- Ask other Black LGBTQ+ individuals for recommendations
- Contact professional organizations focused on cultural competency
- Work with providers who specialize in minority stress and trauma
Building Support Network
- Connect with others who can help evaluate potential therapists
- Build relationships with people who understand your experiences
- Create chosen family and community support systems
- Engage with LGBTQ+ organizations and cultural groups
- Develop multiple sources of support rather than relying solely on therapy
Remember: you deserve therapy that affirms your full identity and addresses your concerns with competency and respect. Cultural incompetence in therapy is not just ineffective—it can be harmful and re-traumatizing. Trust your instincts, advocate for yourself, and don’t settle for inadequate care.