Self-reflection is a key part of supporting rainbow clients and is an ongoing process. As mental health professionals, we are just as influenced by societal discourses and attitudes as anyone else, and it takes an active effort to unlearn our own buried beliefs and assumptions that are unhelpful to rainbow clients.

We don’t always take time to reflect on our own identities and beliefs related to sex, sexuality, and gender, especially if we’re part of the majority group. Before you read further, take a few moments to consider these questions. You might want to brainstorm or note down your reflections as you go:

• What words would you use to describe your sex, sexual orientation, and gender?
  

• How might your own identities or views impact on your work with rainbow clients?
  

• What messages have you been given over the course of your life about biological sex, sexual orientation, and gender? This might be from formal education, family, friends, the media, religious teachings, or society more broadly.
  

• How comfortable do you currently feel working with rainbow clients? What do you need to do to increase your confidence and knowledge?
  

• Do you have the opportunity to reflect on these topics during clinical supervision? What do you know about your clinical supervisor’s beliefs and knowledge about sex, sexuality, and gender diversity?
  

• Has any information in this resource surprised you so far? What has been new, and what did you already know?

Affirmative therapy is an approach that embraces a positive view of rainbow identities and relationships and considers the impact of stigma and discrimination on the lives of sex, sexuality, and gender diverse clients.

Central to affirmative therapy is affirmation and validation of rainbow identities.

Affirmation and validation can come in different forms. For clients just beginning to understand their identity, mental health professionals can discuss rainbow identities as part of natural human diversity, and counter societal views that say otherwise. For clients already comfortable in their identity, affirmation may simply be the absence of a surprised look from their mental health professional when they mention their rainbow identity.

Some mental health professionals wonder whether there is a need for affirmative therapy – after all, isn’t all of our therapy affirmative?

Research with rainbow people shows that standard therapeutic practices can maintain societal silence around sex, sexuality, and gender diversity. Mental health professionals rarely initiate conversations about sex, sexuality, and gender in therapy, instead leaving it up to their clients. Although this is usually done with the intention of being client-centred, rainbow clients often take this silence to mean that mental health professionals have assumed their identity. Silence around sex, sexuality, and gender can also signal that these topics are off limits for discussion, especially when the mental health professional asks about all other important aspects of life.   

There are many different ways that mental health professionals can challenge the societal silence about sex, sexuality, and gender. Perhaps the most obvious way is to ask clients how they identify during an assessment, or the ‘get to know you’ part of the session.

Asking about sex, sexual orientation, and gender is a contentious issue. For some clients, it shows that their mental health professional hasn’t assumed their identity, and creates a space for them to talk about identity.

For others, being asked about how they identify in a mental health setting can feel confronting.

An alternative to directly asking about identity is to bring up sex, sexuality, and gender as a potential topic the client might want to talk about, without pressure to do so at a particular time. For example, you could say, ‘Is sex, sexuality, or gender something you want to talk about here?

Expansive Language

One of the easiest and most helpful things we can do to signal to clients that we are rainbow friendly is using expansive language. Expansive language refers to any language that is deliberately open or vague so as to not assume someone’s identity or narrow their experiences. For example, rather than asking if a client has a boyfriend or girlfriend we can ask:

Using expansive language means referring to anyone using they/them pronouns (known as gender-neutral pronouns) or a person’s name until we hear more about them or learn the pronouns they prefer.

Maintaining Privacy

When talking to rainbow clients about their names and pronouns, be sure to check in about whether they have a preferred way of being publicly contacted or addressed, for example when being called in the waiting room or sent any official communications. You should also ask what name and pronouns clients use around their family/whānau, at school or work, and in other important areas of life.

Sharing and Checking Pronouns

A great rainbow-friendly practice is to share our own pronouns when we introduce ourselves and ask our clients what pronouns they use. Some might never have heard of pronouns, and this is a great opportunity to spread the word. When asking about pronouns make sure to ask all clients, rather than only asking clients that you think might be rainbow - when pronouns are asked of some people and not others, clients may feel they have been singled out as trans.

Alternatives to directly asking about pronouns in person include asking clients how they would like to be referred to or including a pronoun question on intake or registration forms. Just make sure you have some examples of pronouns (e.g. he/him, she/her, they/them) to make it clear what you’re asking, and leave an open box. You can also share your pronouns by including them in your email signature, or on ID cards and name badges.  

When sharing and checking pronouns, let your client know that they can update you any time their pronouns change. You can also update your clients’ gender on the National Health Index to reflect their identity, even if their legal name or gender marker has not been changed (if you do not have access to make these changes, ask your administrative staff or contact the Ministry of Health). This can be particularly useful for refugees, asylum seekers, or other migrants who cannot amend these details on official NZ documents until they are permanent residents.

Creating a friendly space for rainbow clients must be done at a wider institutional/organisational level, as well in our personal practice. This inclusivity can make a big difference in how comfortable rainbow clients feel meeting a mental health professional for the first time.

Bathrooms

Every mental health service should have at least one accessible all-gender or gender-neutral bathroom that anyone can use. This acknowledges that not all clients are men or women, and is important for those who may not feel safe or comfortable using either the men’s or women’s bathrooms. Often this can be as simple as changing a sign.

Forms

Any form used in your service should ask about gender in an inclusive way. This means providing more flexibility than two tick boxes marked male and female. The easiest way to do this is with a single open-ended box, but if you must use closed boxes, include options like ‘gender diverse’, ‘trans man’, ‘trans woman’, ‘takatāpui’ and ‘nonbinary’. Make sure there’s at least one write-in space, and that people can tick multiple options.

You should also consider whether you need to know about clients’ gender, the sex marked on their birth certificate, or both. Make this clear to help clients fill out forms easily and accurately.

Visual Signs

Many rainbow people find visual signs of support helpful. This could be a rainbow and/or trans flag in your waiting room, or posters and flyers that include people of diverse sex characteristics, genders, and sexual orientations.

For some people, their rainbow identity will be a central focus in their sessions with you but for others, it may not be relevant to why they’ve accessed support. Supporting rainbow clients is about finding a balance between creating space to talk about identity, but only making it the focus when relevant.

Rainbow clients are generally happy to be asked about whether they see their identity as impacting on their mental health, or whether they want to talk about sex, sexuality, or gender in therapy. It is important to think about how to approach questions surrounding identity. There’s a difference between suggesting that someone’s identity caused their mental health difficulty and questioning whether the stress that can come with discrimination and exclusion is having an impact on their mental health and wellbeing.

Background Knowledge

Having background knowledge about sex, sexuality, and gender diversity is essential. It’s just as important to balance that with getting to know the client in front of you. If we rely on our background knowledge too much, we can make incorrect assumptions about what’s happening for our clients.