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How School-Based Mental Health Providers Can Support LGBTQ Youth

A photo of students sitting in a hallway.
School-based mental health providers
– counselors, psychologists, and social workers – can often be some of the first adults that young people connect with regarding their LGBTQ identity. In fact, in the 2017 National School Climate Survey over half of LGBTQ students reported that they would feel most comfortable talking with school based mental health professionals about LGBTQ issues.  Unfortunately, a recent study shows that 76% of school mental health professionals received little to no preparation on working with LGBTQ youth (Supporting Safe and Healthy Schools). These providers can adopt some of the following best practices to best serve their students:

  1. Advocate with other teachers and administrators

LGBTQ students need to know that there is at least one adult who is supportive of them. This is, very importantly, a “show don’t tell” version of allyship. What this means is that it is not enough to simply say we are supportive of LGBTQ students, we need to show it through our actions. I recognize that because of different environments, locations, and administrations, we as mental health counselors might not have as much of a voice in our school system to be able to do some of these more public actions. However, take a look at this list and see if there are a few that you might be able to do, or alter to be able to fit within the bounds of your particular school. Here are several suggestions of public actions that you can take to show your support of the community.

a. Have pronoun buttons available in an obvious location in your office. Also, wear your own pronoun button if you’d like!

b. Display LGBTQ-affirming materials and signs while you work with youth. This can be done with books, safe space stickers, or posters to promote an inclusive space, or with notebooks or lanyards if you travel between spaces or schools.

c. Advocate for time and/or funding for your school to be able to have a GSA (Gender & Sexuality Alliance or Gay-Straight Alliance) group.

d. If a teacher or administrator is using bigoted language (whether in front of students or not), respectfully but firmly let them know that the language they are using is inappropriate.

e. If an adult or student in the school is using the wrong name or pronouns of a transgender student who is out publicly, correct them. Don’t make a big deal of it, as that can draw uncomfortable attention to the student. Instead, simply say the correct name or pronoun and then let the person continue speaking.

f. Find out from your school regarding their policies regarding bathroom use, and advocate strongly that your students can use the bathroom that matches their identity, or at the very least, for them to be able to use the gender-neutral staff bathroom. Refer to and share GLSEN’s Trans Model Policy for support.

  1. Explore LGBTQ-Community Resources

Take some time to do research in your own area regarding therapists and clinics that are LGBTQ-friendly, and compile a list of referrals for students who are looking for therapy outside of school. Granted, depending on where you are, those resources may be slim, but there are multiple vetted online support groups as well as national helplines for young people to be able to get support outside of school.

This need for referrals holds particularly true if you only have time to meet with students infrequently, or for short periods of time. Forgive yourself if you can’t be “The Person” that this student goes to for support regarding their LGBTQ identity. There are so many hats that a school mental health provider has to wear, and it is an honorable thing to recognize your limits. You can still have a positive impact, even if your primary role is connecting that student to an outside provider and being a safe space in the school environment for the time that you are able to give them.

  1. Be transparent with your students about what you can (or cannot) hold confidential

It is crucial when working with LGBTQ youth that we are forthcoming regarding what our obligations are regarding confidentiality. Every school is different regarding what is expected of their counselors in regard to sharing what a student has shared, be it with teachers, interns, administrators, or the student’s family members. In addition, it is important to be aware of how note-taking may happen after you see a student and of who might have legal access to those notes.

Personally, unless safety is a concern in any way, I believe thoroughly that it is our ethical duty as counselors not to share any information about a student’s sexual orientation, gender identity, or curiosity and exploration of gender expression, unless the student is ready to come out and wants some help with having those conversations. It is so important for young people to have a safe space, and have access to adults who value their privacy and respect their need to take their time with self-discovery. Remember that public school students have a right to privacy.  If this confidentiality is not possible due to the particular expectations in your school, you need to make that clear to any student who might want to share personal information with you regarding anything along the LGBTQ spectrum.

As LGBTQ youth are more likely to experience mental health concerns regarding suicide (YRBS 2017, Trevor Project), be very transparent with your students that you will have to break confidentiality if you are concerned about their safety either due to potential self-harm or harm from someone else. Depending on the situation, even with this necessary break of confidentiality, you may be able to keep the person’s LGBTQ identity out of the conversation if the student wants to keep that part of their identity private for the time being.

  1. Follow their lead with their coming out path

When we’re working in a school setting, we often have dual relationships with students. We see them privately in our offices, but we may also interact with them in other settings, such as in a group session, in mediation, in an Individualized Education Program (IEP) meeting, or even in classrooms. This can make it feel tricky to know how to keep confidentiality for a client while also respecting what they may have shared with you about their identity.

For example, let’s say a student comes out to you as being a transgender girl. Ask her how she would like for you to address her in public settings. It’s possible that she may, for now, ask you to continue to use her legal name or “deadname” and he/him pronouns in public, as she does not yet want others to know. You are not being disrespectful to then follow her wishes. When you are meeting with her alone, use her chosen name and her female pronouns. Furthermore, offer to help her facilitate conversations with her parents and/or the administration should she decide she is ready to come out publicly. Share GLSEN’s Coming Out Guide to help the student consider different aspects of this ongoing process.

There are myriad factors that play into a young person’s decision to come out or not, and potentially a student may feel that due to their individual circumstances it may not be safe for them to be out. All you can do is hold space for them, and allow them to safely explore their thoughts and feelings about their gender or sexual identity with you, without the pressure of feeling obligated to have to take everything to the next step of coming out.

  1. Remember that we will never be experts

One of the most important things I’ve learned as a therapist is that the moment we think we are an expert in something is the moment that we stop learning. Regardless of whether we may have decades of experience as a counselor, or if we are out and proud regarding our own gender identity and sexual orientation (I myself am as queer as a tea cozy!), that does not make us experts on a particular student’s experience. We have to do our own continuing education (on our own) to learn how the language is changing, and we have to do it enthusiastically. We have to allow our students to correct us, and not become defensive if we have made assumptions that are challenged.

More than anything, we have to hold an open, honest space where we allow each individual student to teach us about their specific experience. Just because I have worked with countless queer and trans teenagers does not mean that I automatically understand every emotion, hardship, or desire of a person walking through my door. What makes someone truly a professional is confidence in the acceptance of being wrong, and a genuine willingness to learn. You are here, reading this, which means that you already are on a solid path toward being the person that an LGBTQ student may need. In fact, you probably already are.

Kit McCann, LMFT, she/her, is a queer/gender therapist in Portsmouth, New Hampshire.