Barriers to LGBQ- and TGNB-affirmative clinical training in psychology doctoral programs.

Abstract

Affirmative training for lesbian, gay, bisexual, or queer (LGBQ) and transgender and gender nonbinary (TGNB) communities is needed within clinical and counseling psychology training programs. While recommendations have been published, barriers in implementation may prevent students from receiving the training needed to effectively work with LGBQ/TGNB clients. The purpose of the current study was to examine doctoral-level psychology students' perceived barriers to their program's LGBQ/TGNB-affirmative training. As part of a larger study, participants (N = 115) completed two open-ended questions online about barriers to affirmative training for clinical work with LGBQ and TGNB clients. Using Consensual Qualitative Research as a framework, an analysis was conducted to identify domains and subdomains based on participants' responses. A total of seven domains emerged across groups. Overall, statements about Uninformed and Negative Faculty and Inadequate Course Work appeared most often (Typical), along with comments about Insufficient Clinical Training and Insufficient General Training (Frequent). Comparison of participant subgroups revealed that LGBQ/TGNB respondents were more likely to report barriers related to Uninformed and Negative Faculty, as well as Poor Quality of Materials in relation to Inadequate Course Work and Insufficient General Training. Heterosexual/cisgender participants were instead more likely to address Lack of Preparation and Lack of Opportunities to work with these populations (Insufficient Clinical Training domain). Though few differences emerged between domains and subdomains regarding affirmative training for the LGBQ community and the TGNB community, results indicated that students receive less training about TGNB populations compared with LGBQ. Strategies to overcome identified barriers are discussed. Public Significance StatementFindings from this study suggest that student-perceived barriers to affirmative training for lesbian, gay, bisexual, or queer (LGBQ) and transgender and gender nonbinary (TGNB) clients persist despite published guidelines. Clinical and counseling psychology doctoral students most frequently identified uninformed and negative faculty and inadequate course work as barriers to LGBQ-and TGNB-affirmative training. Suggestions for training programs include faculty members furthering their multicultural competence via open-access resources, a designated committee to review course syllabi for inclusion and integration of current sexual and gender minority (SGM) content and working in collaboration with knowledgeable faculty and consultants to train informed, competent clinicians.

Cultural humility, counseling alliance, and counseling outcome among LGBTQ+ clients

“…Furthermore, the participants who identified with more excluded identities (McCormick & Barthelemy, 2021), such as gender fluid, genderqueer, queer, or asexual, had worse counseling outcomes than participants who identified with less excluded identities, such as cisgender, bisexual, gay, and lesbian. LGBTQ+CC training for counselors may focus more on the more mainstream identities (Soulliard et al., 2021), whereas more excluded identities are insufficiently covered in such training; for example, existing training tends to be more LGBQ‐oriented than TGNC‐oriented (Fitterman‐Harris et al., 2022). As a result, counselors may have insufficient LGBTQ+CC with regard to the more excluded identities, which in turn could impair the counseling alliance and explain the worse outcomes seen among these clients.…”

“…LGBTQ+CC training for counselors may focus more on the more mainstream identities (Soulliard et al, 2021), whereas more excluded identities are insufficiently covered in such training; for example, existing training tends to be more LGBQ-oriented than TGNC-oriented (Fitterman-Harris et al, 2022). As a result, counselors may have insufficient LGBTQ+CC with regard to the more excluded identities, which in turn could impair the counseling alliance and explain the worse outcomes seen among these clients.…”

Workplace experiences of LGBTQIA+ trainees, staff, and faculty in academic psychology, psychiatry, and neuroscience departments

“…LGBTQIA+ topics, use of respectful language, and promoting active allyship that could improve climate without putting the burden on LGBTQIA+ individuals to educate their peers. This extends to enhancing official curricula, e.g., how to engage LGBTQIA+ people as research participants or patients (Fitterman-Harris et al, 2022), and confronting homophobic, heteronormative, gender essentialist content within curricula.…”

Microaggression Detection in Psychotherapy: Expanding Affirming Care for Transgender and Nonbinary Clients

“…Psychologists in training programs continue to cite barriers to receiving adequate training in lesbian, gay, bisexual, queer and TGNB affirming care, including inadequate classroom training, uninformed faculty, inadequate clinical training, negativity among peers, and lack of supportive learning (Fitterman-Harris et al, 2022). This gap likely contributes to a dearth of inadequately trained therapists (Whitman & Han, 2016) and makes it more difficult for TGNB people to find care.…”