In recent years, therapists, counsellors, life coaches and healers have all been challenged to provide safe and affirming spaces to help LGBTQIA+ people (lesbian, gay, bisexual, trans, queer, intersex, asexual and others). More recently, we have also been asked to consider how best to support people who identify as non-binary or gender fluid. A key reason for this is that people who identify as LGBTQIA+ or gender diverse’ have become more visible and many are seeking out therapy and healing. In addition, many parents of LGBTQIA+ and gender diverse adolescents are bringing their children in for assistance, especially since so many youths experience trauma for being different.  Sometimes our clients will come to see us for another issue or concern and, in the process, the issues of gender identity and expression will emerge. Given this situation, it is important for us to become more gender conscious and to have some understanding of how our clients identify themselves and the kinds of issues that affect them. Of course, many therapists, counsellors, coaches and healers may also be grappling with their own gender and sexual identities and behaviours.

What do the labels mean?

One of the most important things to understand is the importance of language. Although words and definitions evolve rapidly, people use labels to affirm who they are. It gives a sense of empowerment, validation, visibility and community. Learn’ing how different people use labels to create meaning is important, as is using inclusive language in conversation with others. Despite prevalent gender norms telling us how to behave as ‘men’ or ‘women’, more and more people are choosing to express themselves in ways which feel more authentic to their souls and, in South Africa, gender and sexual diversity is protected by the constitution and a number of democratic laws.

People tend to define themselves according to their sex, sexual orientation and gender. Although lots of people use ‘sex’ and ‘gender’ interchangeably, ‘sex’ refers to the legal status that was initially determined by biological attributes observed at birth; typically categorised as male, female or intersex. ‘Gender identity’ refers to one’s psychological sense of being a male, a boy, or a man; a female, a girl, or a woman; neither of these, or both of these. ‘Gender expression’ is the way a person expresses their understanding of masculinity, femininity, both, or neither, including their physical appearance, clothing choice, speech patterns, and behaviours. ‘Sexual orientation’ is a person’s romantic or sexual attraction to another person. An individual’s sexual orientation may be lesbian, gay, heterosexual, bisexual, queer, pansexual, asexual, or fluid; terms which we will define shortly.

The cultural expectation is that one’s biological sex, gender identity, gender expression and sexual orientation will align in stereotypical ways: That someone, for example, who is ‘male’ will identify as a boy/man, have a so-called masculine gender expression and be attracted to females/women. ‘Cisgender’ is used to refer to individuals who do have a match between the sex they were assigned at birth, their bodies and their gender identity. ‘Heterosexual’ (straight) refers to a person who is attracted to someone of the other sex. In many communities, cisgender and heterosexual are the only identities considered ‘normal’. But this does not reveal the truth about our diverse world and the myriad experiences of self that actually exist. Nowadays you may also here the following words:

Asexual identity or orientation: Includes individuals who do not experience sexual attraction to others of any sex or gender.

Bisexual: A sexual orientation that describes those who experience sexual, romantic, or emotional attractions to people of more than one gender.

Fluid: This term is used to describe those who experience shifts in their sexuality, sexual attraction, or sexual behaviour in different situations or throughout the course of their lifetime.

Gay: A term that describes individuals who experience sexual, romantic, or emotional attraction to people of the same or a similar gender. Some women prefer the term ‘lesbian’.

Gender dysphoria: Refers to strong, persistent feelings of identification with another gender and the presence of clinically significant distress.

Heteronormative language: Language that assumes everyone is heterosexual and cisgender (e.g., asking a girl if she has a boyfriend is an example of heteronormativity).

Homo/Bi/Trans phobia: Fear and/or hatred of people who are gay, bisexual or transgender. Often shown through mocking, prejudice, discrimination, intimidation or acts of violence.

Intersex: This refers to people who have anatomy or genes that do not fit the biological definitions of male and female. Most intersex people, however, identify as either men or women.

Lesbian: a woman or female-identified person who experiences sexual, romantic, or emotional attraction to people of the same or a similar gender.

Misgendering: This occurs when you intentionally or unintentionally refer to a person, relate to a person, or use language to describe a person that does not align with their affirmed gender. For example, referring to a woman (including a trans woman) as ‘he’ is an act of misgendering. Misgendering can have negative consequences for a person’s self-confidence and overall mental health.

Non-binary: Describes people who understand their gender in a way that goes beyond simply identifying as either a man or woman. Non-binary people can identify as both male and female, neither male nor female, or identify with no gender type at all.

Pansexual: A term that describes individuals who can experience sexual, romantic, or emotional attraction to any person, regardless of that person’s gender, sex, or sexuality.

Queer: An umbrella term that describes individuals who are not exclusively heterosexual. The term queer acknowledges that sexuality is on a spectrum as opposed to a collection of independent and mutually exclusive categories. People who are genderqueer often experience their gender as fluid, meaning it can shift and change at any given time.

Sexism: Prejudice or discrimination based on sex or gender norms. Systemic sexism can affect anyone and can foster sexual harassment and violence.

Trans: Thisis short for transgender. Trans is a broad term that describes people whose gender identity is different from the sex they were assigned at birth. While some transgender people are non-binary, most transgender people have a gender identity that is either male or female. Trans is inclusive of a range of identities including a trans woman and trans man; a trans woman is a woman regardless of her biology. Not all trans and gender diverse people want gender affirming surgery.

What kinds of issues might our clients need help addressing?

Being a member of the LGBTQIA+ community comes with many challenges. Despite South Africa’s progressive laws which include marriage equality, research shows that this community still face exhausting micro-aggressions and discrimination on a regular basis. Schools, for example, continue to impose patriarchal gender norms, including restrictive dress codes, on learners. So-called masculine and feminine attributes are still being dichotomised, with boys/men being expected to be ‘masculine’ and girls/women being expected to be ‘feminine’. LGBTQIA+ people and youth who do not conform to the gender norms, are vulnerable to bullying, violence, prejudice and shame.

In some instances, teachers notice homophobic bullying but fail to do anything about it, or actually engage in bullying behaviours themselves. Some teachers interviewed by researchers even justify the victimisation of youth who are, or appear to be, ‘gay’, ‘lesbian’, ‘bisexual’, ‘sexually confused’ or ‘transgendered’. This is dreadful, as studies have found that this prejudice and discrimination adds an additional layer of risk on top of biological, social, environmental and psychological factors. These youths are more likely to experience loneliness, isolation, identity crises, alienation, depression, high levels of anxiety, extreme hypervigilance, self-loathing and other mental health concerns. They may even turn to drugs or alcohol; become delinquent; play truant; suffer from poor academic performance and eating disorders, become homeless or try to prove somehow that they are ‘normal’. When supported by their families and teachers, however, many LGBTQIA+ youth will grow up to live extremely well-adjusted, resilient lives. According to the Trevor Project’s research: “Even just one accepting adult in an LGBTQ kid’s life can lower their likelihood of attempting suicide by 40 per cent.”

Our own biases and views                                  

Based on your understanding of gender, as well as your personal gender identity, be careful about how you bring your assumptions around gender into the room and acknowledge and unpack your own biases before seeing LGBTQIA+ identifying clients, so as not to further stigmatise or invalidate their experiences. Understanding your own ideas about sexuality and gender will help make sure your space is supportive and validating for gender exploration.

As we know, many in the LGBTQ community have been rejected by family, friends and religions, which have belittled their lifestyle, tried to convince them to change, or even suggested conversion therapy. In addition, many experience microaggressions, which are subtle slights that serve to derogate, invalidate, or shame members of marginalised groups.

Dr Ruben Hopwood, a gender-affirming psychologist, presents a few ways we may (knowingly or unknowingly) commit microaggressions:

Backhanded compliments

“You look so good; I never would have known you’re trans.”

“I thought you were a real [wo/man]. You look great!”

 “But you’re so attractive, why would you want to become a [wo/man]”.

 “You are so lucky you won’t ever have to experience ___ (e.g., PMS, menstrual cramps, pregnancy, prostate problems, erectile dysfunction)”.

“You are very masculine for a gay guy”.

“I though all lesbians are butch. You are quite feminine for a lesbian”.

According to Dr. Hopwood, more insidious microaggressions can include outing a client to another practitioner when it is not a necessity for the consultative support needed, and implicitly leading clients to tell a socially acceptable stereotyped narrative of their own gender identity development.

The importance of understanding clients

Being gender conscious and sensitive to sexual diversity means that we need to avoid applying generalisations or stereotypes to a client, or assuming similar experiences apply to another client who may use the same word to describe themselves. We can initiate discussions about gender and sexual diversity to fully understand how our clients identify. Be aware of their use of pronouns and do not misgender them. Not everyone uses the pronouns ‘she/her/he/his’ despite what we might assume based on their appearances. Some people prefer to use the gender neutral pronouns ‘they/them/their’ to reflect gender identity. Check what pronouns are used by the person, remembering that ‘they’ can refer to a singular client. The same applies to their titles and names: Simply use the ones a person asks you to use and, if a client uses a term you are not familiar with, ask for clarification: “I am not familiar with (that term).  Would you be willing to share with me what that means to you?” Similarly, it is important to ask how partners or other important individuals should be described. If it has not been made clear if or whom a client is interested in dating, do not jump to conclusions based on their gender presentation or expression. “Who’s the man in your relationship?” can actually be a hurtful question. Rather use neutral terms, or if it seems relevant and important to the session, consider asking in open-ended, nonjudgmental questions.

As we explore in our interactive workshops, a client’s experience must always be considered in its totality. Psychologist, Justin Martino-Harms, shares the following: “Because I have base knowledge of how oppression shows up in my client’s lives, I’m then able to focus on exactly what the client is looking to work on, but also be keenly aware of how oppression might relate to the work we are doing. For example, we might be working on depression, but then it becomes clear that the client is isolated because social connection is being hampered by sexism, homophobia or transphobia.”

You can you help your LGBTQ+ client by establishing rapport, safety and trust within your sessions, ensuring that the client recognises that there is nothing ‘wrong’ with them and finding out what assistance they need to live their best lives. Be a sounding board for the client to discuss the thoughts and questions they have about themselves and, where appropriate, make space in your sessions for your client’s doubt, uncertainty and insecurity, for the discomfort that comes with this often scary inner exploration.

Depending on your focus and expertise, you could help them develop self-esteem, better emotion regulation skills, improved confidence, the ability to handle messy family relationships and better coping mechanisms. This may involve helping the client identify and challenge internalised negative beliefs regarding their identity and relationship with the Divine, building positive self-talk, assertiveness training and helping the client process their feelings and ideas while healing from any painful experiences of judgment, rejection, grief, guilt and trauma. You could also provide spiritual resources to deepen their experiences of trust, self-esteem, hope, joy, self-love and love of life, while helping them understand their soul’s purpose for incarnating in this biological body with this gender and sexual orientation. Additional training is available to assist you with enhancing your gender consciousness.

Eric Richardson-Freese is the founder of the Gender Consciousness Project. He offers gender diversity sensitisation talks and workshops in schools and companies, and presents online seminars focused on self-healing through understanding and utilising the mind-body-spirit connection. A former lecturer, his latest book chapter appears in the Oxford Research Encyclopedia of Education. Connect with Eric at

His husband, Devin Richardson-Freese, is a free-spirited yoga instructor specializing in Hatha and Vinyasa styles of yoga, meditation and breathing techniques based in Benoni.  He currently is the owner and founder of the ‘Yoga East Rand’ brand, and offers multiple classes during the week that are suitable for all levels. Connect with Devin at