Clinical Intersections: The Intake Process Is Sacred When Serving LGBTQ Folks - What Social Workers and Other Clinicians Need To Know
by Biany Pérez, M.Ed., MSS, LSW
Whether you are a social worker, psychotherapist, counselor, or any other helping professional, it is important to think about your first contact with new patients or clients. The first session or appointment with a person who identifies as LGBTQ requires that you think carefully about the questions, the setting, and the person’s sense of safety.
As the Intake Coordinator at Walnut Psychotherapy Center, I work with every new client that comes to us. I believe that my role as an intake clinician is sacred, and it’s one I hold with tenderness and pride. It is truly an honor to be the one who listens carefully - with compassion and empathy - to someone’s stories, their reason for seeking treatment, their history, and holding these individuals until I match them with one of my colleagues for long-term therapy.
It has been our experience that LGBTQ folks are bursting at the seams to tell or share their stories with someone who has earned the right to hear them and one who is able to hold space for their unique voices and life journeys. Sometimes LGBTQ folks have waited a very long time to sit with someone who can understand their experiences without explanation or having to educate someone. It is critical that you consider this as you prepare to meet or introduce a potential client into your agency, organization, or institution.
Consider the steps someone goes through to become a client at your organization. At each step, there are ways to ensure that LGBTQ people will have a positive experience. Who takes calls from new potential clients? What questions do they ask? Are these questions trauma-informed, caring, and LGBTQ-affirming? Is the potential client given clear and concise information about agency services and expectations?
New calls and email communications are welcomed by our front desk administrator. My colleague Kara Koser (she/her) is kind, compassionate, caring, and curious about those who are interested in our services. In addition to the typical questions about scheduling and insurance, there are several other questions she asks that are designed with the LGBTQ community in mind.
First, we distinguish between preferred name and legal name. For many queer (and especially trans) people, the name on their insurance card or ID isn’t the name they use, so while we need the legal name for insurance purposes, we are careful to ask for the person’s preferred name and legal name.
We also ask everyone, “What pronouns would you like us to use?” We ask absolutely everyone who calls, because there is truly no other way to find out what pronouns to use for someone. Their name, the sound of their voice, whether they are queer or trans, will not tell you what pronouns they use. We don’t use the phrase “preferred pronouns,” because someone may prefer different pronouns in different contexts - for instance, a trans person who is not yet out to their family. What we really need to know is what pronouns WE should use, so that’s exactly the question we ask.
And finally, while these questions are not required, we believe it is important to capture demographic data for the folks who express an interest. It helps answer the larger question: Who are you serving? What can we do to serve those who are historically underrepresented? Please be sure to let potential clients know that these latter questions are optional and that they are not required to answer them. The questions are: How do you identify racially and ethnically? How would you describe your gender and sexual orientation?
After the initial contact, what’s the next step at your organization? Does the next person to interact with the new client continue to be LGBTQ-affirming? It’s important that a client’s experience is consistent throughout the intake process. If one person is affirming and the next person isn’t, that’s going to damage the new client’s trust and attachment to the organization, making it less safe for them, and decreasing the chances that they’ll keep coming back.
At our practice, I’m the next person to interact with new clients after they speak to the front desk. The information that has been gathered by my colleague helps me to consider this person’s interest, reasons for engagement, and their potential needs. I introduce myself via phone or email by sharing my preferred name, pronouns, and my role at the agency. I thank them for their interest in our services and invite them in for our intake appointment. I explain the purpose of the appointment, the length of time, and remind them that this time with me will help us to determine the therapist who would be the best fit for them.
In the intake appointment itself, there are further ways to be LGBTQ-affirming. For one, don’t make any assumptions about what your new client will look like based on how they sounded over the phone, or what their name or pronouns are. It is still important to ask them in the intake appointment their preferred names and pronouns, even if they answered this in the initial contact.
Before beginning the intake appointment, I let new clients know what to expect in our time together. I walk them through the appointment by informing potential clients what questions or themes will be covered. Again, it is important that clients are not surprised by questions and that they are prepared and can anticipate the themes that will be covered. Another thing to consider is that it is important that clients are comfortable during this session and that they do their best to answer questions based upon their comfort level. Try to consider them as a whole person, and if they are not comfortable answering a question, just move on to the next question. Try not to take it personally, and consider their safety. Don’t pry or push your line of questioning - just go to the next one. The goal is to make them feel comfortable and safe enough to share their selves.
One topic I’m sure to cover in every intake is whether the client has any preferences about the therapist they see. For LGBTQ people, the identity of their new therapist is often very important to them. Many queer people want to see someone who is also queer, for instance. Also, knowing that many LGBTQ people are also trauma survivors, it’s often important to be matched with someone with whom they can really feel comfortable. It’s important to take these preferences seriously. I always ask new clients what they want in a therapist so I can be sure to make an appropriate match.
Finally, new clients are matched to long-term therapists. When presenting a case to a therapist, I’m careful to include name and pronoun preferences, as well as any history or identity labels that a person informed me of during the intake. I share what this client outlined as their goals for therapy and serve as an advocate for the client and their needs for treatment.
On the whole, the intake process is an important opportunity to welcome and affirm the humanity of our LGBTQ folks. We do this by creating space to honor their stories, use their preferred names and pronouns, and to listen carefully and attentively to their needs with the goal of meeting them where they are on their journey. The intake process is more than just collecting information on a new client for the purposes of connecting them to services. To minimize the role of the intake process is to forget the importance that the first engagement offers to new clients. It is cultivating a safe enough space for them to articulate their needs, share their story, feel heard and seen, to have someone hold the parts of their lives that feel sacred and tender as they prepare for their journey inward with their new therapist.
Biany Pérez, M.Ed., MSS, LSW, is the Intake Coordinator at Walnut Psychotherapy Center and the secretary of the board of directors at the Walnut Wellness Fund. She achieved her MSS from Bryn Mawr and her master’s in education from Temple University. In her role as Intake Coordinator, Biany oversees the process of becoming a client at Walnut. Her aim is to provide her clients with a friendly, respectful, and supportive environment. She specializes in working with adolescents, college students, women, and the LGBTQ community. Biany believes the therapeutic relationship is essential to the process of wellness and improving one’s life. She is a queer-affirming, trans-affirming, and culturally sensitive therapist.