I was recently assigned a new client who is a gay male in his 40’s. He called for services because of depression after a relationship breakup. In his intake interview he requested a gay male therapist and was told the agency would try to honor his request but couldn’t guarantee it. I am a straight female but I am very close to my gay brother, his husband and their two kids. I also have a number of gay friends, both men and women. What should I tell the client to help him feel at ease with me?

Your question raises two related issues that are present when working with a client whose cultural identifications are different from ours: cultural competence and therapist self-disclosure. This blog will discuss the issue of cultural competence and the next one will discuss self-disclosure.

Cultural competence refers to having the necessary knowledge and skill to treat a member of a particular cultural community. You have identified two areas of cultural difference: gender and sexual identity. Being able to provide competent treatment to this client requires knowledge about the influence of his gender and sexual identity on his psychological development and functioning. You can acquire knowledge related to culturally competent treatment of a gay male client through a combination of academic courses, clinical training, personal research and personal relationships. Your skill in applying this knowledge comes from clinical experience and guidance in supervision.

Cultural competence also requires an attitude of openness and the absence of bias or assumption when working with a member of a cultural minority or non-dominant group. As you anticipate working with this new client, give thought to any areas of knowledge or skill that you may need to develop, and be aware of the potential bias that is present in any cross-cultural therapeutic relationship. Your personal experiences with gay men and women are useful but not sufficient to providing cultural competent treatment.

Assuming that you have the knowledge and skill to provide culturally competent treatment and that you can approach your client with openness and awareness of potential bias, let’s turn to the question about your new client. He is a gay male who requested a gay male therapist, which you are not. You don’t know the meaning of his request or his feelings about working with a female therapist, straight or gay. You have the same task with him that you have with all clients at the beginning of treatment, which is to establish a therapeutic alliance. Your question assumes he will be uncomfortable with you, and you have developed an agenda of putting him at ease. If you can let go of that agenda, you will be better able to establish a therapeutic alliance based on understanding and responding to the concerns that are leading him to seek treatment as well as his desire to see a gay male therapist.

You can open the issue of his request in your first session by saying “I know you requested a gay male therapist, and I’m a female. Can you tell me more about your request and how you feel seeing a woman?” If the client raises the issue of his request when you contact him to schedule the first appointment, see if he is willing to come in for an initial appointment so you can discuss his concerns in person rather than by phone.

Once your client tells you about his concerns and feelings, you should respond to them with honesty and empathy, acknowledging his need to make a decision about working with you based on what he believes to be in his best interest. It may help to remind him that clients are often unsure at the beginning of treatment whether it will be helpful and that getting to know you over the first few sessions may help him decide. If he decides to continue in treatment with you, the gender and sexual identity differences between you may remain a prominent issue throughout the treatment or they may recede as you work together. Most important is that you approach this client knowing that the differences between you are one factor among many that will influence the development of your therapeutic relationship.

I hope you found this helpful in thinking about culturally competent treatment. Please email me with comments, questions or suggestions for future blog topics.