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Research uncovers considerable differences in what therapists know about LGBTQ+ issues
Many queer people experience being overlooked, misunderstood, or having to educate their providers during healthcare visits.
Both healthcare workers and members of the LGBTQ+ community report low competence among psychologists, healthcare workers, and others working in mental health services.
This is shown by new research from the Norwegian Research Centre for Sexual Health (CENCE) at the University of Oslo.
The two reports summarise knowledge from Norway and Scandinavia, and also draw on international data. They reveal inadequate guidelines and procedures related to queer people seeking mental healthcare.
Assume that a partner is of the opposite sex
Researcher Jacob Evje has contributed to the report that examines queer people’s experiences of seeking mental healthcare.
He says education about LGBTQ+ people is inadequate both during training programmes and within individual treatment institutions.
“Teaching and training are most often introduced by individuals who are passionate about the topic and feel that someone must take on the task,” says Evje.
He believes many therapists are afraid of making mistakes and therefore avoid addressing the possibility that someone may be queer.
“It can mean the therapist automatically assumes the patient or client who comes to the first session is heterosexual. If it's a woman who talks about her partner, the therapist will often assume the partner is of the opposite sex,” he says.
Evje also points out that people with gender incongruence – the experience that one’s gender does not match the gender assigned at birth – are often referred to as ‘he’ or ‘she,’ even though the person may prefer the gender neutral ‘they.’
Long experience of being overlooked
“For LGBTQ+ people using health services, it's important to be seen as who they are. If this goes wrong from the outset, it's easy for someone seeking help for mental health problems to lose confidence in the system and to feel overlooked,” says Evje.
He emphasises that queer people are a patient group with a long experience of being overlooked and also of being harassed.
Both Evje and his colleague, researcher Anna Ivanova, stress that the new research uncovers the same problems.
Therapists and other healthcare workers generally lack the necessary knowledge.
According to the researchers, this must be addressed on three tightly interwoven levels:
- Individual level: knowledge, attitudes, and skills
- Organisational level: routines, training, and managerial support
- Structural level: legislation, funding, and culture
Patients have to teach their therapist
“A common strategy among mental healthcare providers is to choose not to talk about gender identity or sexual orientation. Many do not know how to ask. Some are also afraid of offending patients who identify as heterosexual by raising such questions,” says Anna Ivanova.
She emphasises that many therapists' and other healthcare workers' apprehension can have serious consequences for queer people. These are individuals who are already more vulnerable to depression, mental health problems, suicide, and violence than the rest of the population.
Jacob Evje stresses that many LGBTQ+ people are also exposed to exclusion, prejudice, and discrimination.
“Someone seeking mental healthcare is often worn down and exhausted. If they then have to spend a lot of time explaining to a therapist what it's like to be queer in Norway these days before they can talk about their own mental health problems, it becomes an extra burden and may be enough to lose faith in the therapist,” he says.
He believes it would be a great advantage if everyone working in mental healthcare had basic knowledge of LGBTQ+ people’s vulnerable situation from the outset.
The right to equal healthcare
Jacob Evje reminds us that equal healthcare for all is a statutory principle in Norway and other countries. Therefore, the varying level of competence encountered by LGBTQ+ people in mental health services, as revealed in the reports, must be addressed.
Anna Ivanova agrees. Both she and Evje stress that knowledge and competence are not the sole responsibility of individual therapists or healthcare workers.
“Knowledge about meeting LGBTQ+ people must be included as a compulsory component in training programmes. There must be common procedures in hospitals and clinics. Continuing education for existing clinicians must also be mandatory,” says Evje.
The two researchers find it particularly interesting that Rosa kompetanse reports that it's the mental healthcare workers who already have competence about LGBTQ+ people that ask for more knowledge. Rosa kompetanse is the national competence-raising programme on gender and sexual diversity.
“It's the same people at the clinics that also try to share expertise or acquire expertise from outside. Paradoxically, Rosa kompetanse finds that therapists with little or no competence often perceive that they have sufficient knowledge on the subject,” says Anna Ivanova.
Standard intake forms
Jacob Evje and Anna Ivanova call for national standards for all clinics.
One suggestion is to introduce standard procedures before the first consultation in mental health services, which have been successfully used in Sweden.
“Intake forms that allow people to tick boxes for gender identity, sexual orientation, who their next of kin are, etc., will prevent the therapist from making mistakes at the first meeting with their client," Ivanova believes.
Both she and Evje stress that mental healthcare providers need to learn to ask questions that make LGBTQ+ people feel seen and heard.
It's particularly important that the patient feels safe enough to talk about what is troubling them. Their mental health is often affected by being queer in a heteronormative society.
Don't beat around the bush, and don't probe excessively
“Once you've practiced, it isn't difficult to ask the right questions as a provider. Just start with fairly open questions such as: Is it important for you to talk about sexuality and gender? Is this something that would help you if we spent more time discussing it?” says Evje.
He has little time for therapists who beat around the bush and play guessing games.
“If the answer is no, you have at least asked. If the answer is yes, you can simply continue,” he says.
Evje does, however, advise against digging and asking very detailed questions that arise mostly out of curiosity.
“It's important to be professional in the role of a therapist,” he says, adding that overly forward therapists are in the minority.
The problem is usually that clinicians ask queer people too few questions, according to the researchers.
Jacob Evje and Anna Ivanova believe a standardised approach will make things far more predictable for queer people seeking mental healthcare.
“Feeling certain that a mental health provider and the healthcare system understand their situation will increase trust in health institutions, which is crucial for LGBTQ+ people. Hopefully this will lead to many more people in need to seeking mental health services and feeling seen and understood,” says Jacob Evje.
References:
Evje et al. Skeives helsesøkende atferd (PDF) (LGBTQ+ health-seeking behaviour), CENSE, 2025. ISBN: 978-82-569-3000-5
Ivanova et al. Skeives psykiske helse fra tjenesteyteres perspektiv (PDF) (Mental healthcare providers' perspectives on providing care for LGBTQ+ individuals), CENSE, 2025. ISBN: 978-82-569-3001-2
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