At Rula, we’re proud to work with therapists who support diverse communities. In this Therapist Spotlight, we interviewed Dr. Judi Passy, LMFT, RN. She describes her decades of work researching and advocating for the therapeutic needs of the LGBTQ+ community. Judi sheds light on the unique challenges faced by LGBTQ+ people, details some best practices for working with diverse populations, and fills us in on how to provide competent care for LGBTQ+-identifying individuals.  

Content warning: This article discusses the AIDS epidemic and the effects of bias and homophobia on the LGBTQ+ community. Please read with care.

Why therapy? What drew you to work with LGBTQ+ clients?

My journey to becoming a therapist began with a series of unexpected circumstances during my early adulthood. I experienced widowhood and found myself needing to care for two children on my own. At the same time, I knew I needed to develop my career to support my family. 

The helping professions had always interested me and I started taking classes and working toward becoming a psychiatric technician. Over the next several years, I continued to advance my education and obtained my nursing license. Then in 1979 I transferred to the University of California, Irvine (UCI) Medical Center just before the AIDS epidemic took hold in the gay community.  

UCI Medical Center was one of the first hospitals to accept patients with AIDS in Orange County. At that time, little was understood about the cause of AIDS and the prognosis was disheartening. The public called the illness the “gay man’s disease” and I witnessed firsthand the lack of compassion and stigma that surrounded the gay community at that time.  

Seeing such widespread suffering and losing patients, friends, and colleagues to the illness affected me deeply. So I returned to school to study counseling and knew I wanted to provide mental health support for the LGBTQ+ community. 

Tell us about your career progression and research as a therapist to this point.

Within a week of attending classes in my counseling program, I realized there was an urgent need for peer-reviewed research that would make a difference for LGBTQ+ people. Existing research on the topic was scant and biased, and we received little training on working with transgender and nonbinary individuals.  

So, despite some outspoken criticism from a few fellow students, I committed myself to conducting research that would ultimately help counseling students learn to provide competent care for LGBTQ+ individuals. With the support of my counseling professors, my research continued over the next 20 years and culminated in my dissertation, Transgender Competencies in Counseling Programs, published in 2021. 

How did you start working with the LGBTQ+ population? 

During my counseling program, I interned at an LGBT center to gain experience working with the population I wanted to serve. The center was staffed by experienced supervisors who taught me about how stigma and microaggressions can lead to depression, anxiety, low self-esteem, and even worse, internalized homophobia, a factor that can lead to suicidal ideation. 

Being surrounded by LGBTQ+ co-workers, co-interns, and clients at the center and later — plus my work with transgender clients — helped me become the advocate and ally I am today.  

What’s something that you wish more people understood about working with LGBTQ+ folks?

Throughout my career, I watched the shift in cultural attitudes towards gay, lesbian, and bisexual-identifying people. Our society has become more open to embracing the LGB part of the LGBTQ+ community. But today, transgender, nonbinary and gender-nonconfirming people face the brunt of prejudice, stigma, and bias in many communities. This is in part due to a glaring lack of understanding, academic and otherwise, about this population. 

Many therapists are not sufficiently trained to counsel trans and nonbinary individuals because working with this population isn’t covered adequately in most counseling programs. So if you want to work with trans or nonbinary folks (or other members of the LGBTQ+ community) it’s ethically imperative to seek additional training, like the American Counseling Association’s Competencies for Counseling with Transgender Clients.  

It’s not up to trans clients to teach therapists about trans people. Rather, it’s up to us as society’s helpers to insist on more inclusive educational guidelines for training mental health professionals and to advocate for our clients both in and out of the therapy room.

What’s your treatment philosophy?

Because I work with LGBTQ+ individuals who frequently encounter negative experiences in their communities, mass media, and workplace environments, I lead with affirmation and position myself as an ally for my clients’ lived experiences.  

LGBTQ+ clients often struggle with depression, low self-esteem, and anxiety. But research has shown that these symptoms are not inherent to LGBTQ+ people. Rather, these are socially constructed due to the stigma and discrimination LGBTQ+ people frequently encounter. For this reason, therapists who work with the LGBTQ+ community must adhere to a treatment philosophy that includes an understanding of the impact of minority stress on their clients.

What’s your best advice for therapists who want to better meet the needs of their LGBTQ+ clients?

Providing quality care for LGBTQ+ clients starts with deepening your understanding of the challenging experiences your clients encounter each day. This can include microaggressions, trauma, and minority stressors like internalized transphobia, shame, and guilt. Of course, some clients may not experience all of these problems. But most LGBTQ+ people are, at one time or another, exposed to some of them.  

Another critical component of providing quality care to LGBTQ+ individuals is being aware of some important nuances. For example, sexual identity (i.e. gay or lesbian) and gender identity (i.e. transgender, nonconforming, nonbinary) are not the same thing. Be informed of the concepts, vocabulary, and terms that apply to the community and always refer to your clients using their chosen names and pronouns. 

Also, keep in mind that while they represent the “T” in LGBTQ+, transgender clients have unique needs, such as gender-affirming therapies, surgeries, and hormone replacement. While members of diverse communities often share experiences of stigma, each person has unique requirements and experiences that must be taken into account in the treatment environment.  

Lastly, be aware of your own underlying biases when treating members of the LGBTQ+ community. No one is immune to bias. But it’s up to you to examine your own implicit biases related to LGBTQ+ people (and other diverse clients you serve) so that you can check them at the door or make a referral when necessary.

What’s the most rewarding part of your work? 

As a therapist who works with the trans community, I’ve been involved in helping my clients with the documentation required to secure insurance coverage for various gender-affirming surgeries such as mastectomies, orchiectomy, and hysterectomies. 

I’ve had the honor of supporting my clients during their transition and witnessing the pure joy and excitement that occurs when their bodies become congruent with their identity. The most common phrase I hear is: “For the first time in my life, I have hope!”  

I’ve also walked with my LGBTQ+ clients as they become self-accepting and recognize that friends and family openly love them. When this happens, their self-esteem improves, and their depression declines. Witnessing their happiness and resilience as they navigate their therapeutic journey is indescribable! 

What’s something on the horizon that you’re optimistic about regarding the treatment of LGBTQ+ clients?

I’m optimistic about efforts to increase diversity in sex education, making Pride a holiday to be observed by all, and an increase in mandatory diversity workshops for professors.

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