Queer Therapists Practicing in Their Own Cultural Community: Proactive Ethical-Decision Making Suggestions


“If you are ever at the local drag show and you see me there, do not worry. I will not approach you and say hello. If you acknowledge me first, I will wave. I will not come up and start a conversation with you. This action is not me ignoring you, but it will allow us to maintain a healthy therapeutic relationship. We can chat about the show at the start of the following session if you would like. Does this boundary make sense, and are you comfortable with it?”

Suppose you have ever had a similar conversation during an intake session. In that case, you might be a queer therapist (for the purpose of this article, queer refers to any person who identifies on the LGTBQIA+ spectrum) who specializes in working with the queer community in a smaller city. You might have learned through trial and error the ethical-decision making that you are constantly navigating. You might have realized that this type of ethical-decision making was not discussed in your training program.

This article aims to provide the reader with the common ethical dilemmas that a therapist who works within their queer cultural identity may encounter and steps to take to be proactive and minimize any negative impact.

Ethical decision making

Ethics is about doing the “right thing” when working as a marriage and family therapist. An ethical dilemma includes any situation in which the welfare of clients may be at risk (Hecker & Murphy, 2016). Therapists must provide services that benefit the client and do not cross any professional boundaries to inhibit therapeutic progress or the therapeutic relationship. Therapists are expected to practice benevolence, which may take on a new meaning while practicing within the therapist’s cultural community.

Currently, numerous ethical decision-making models have been proposed for psychotherapy. Most ethical decision-making models assume that the therapists across community types share similar dilemmas and the number of occurrences (Gonyea, Wright, & Earl-Kulkosky, 2014; Hecker & Murphy, 2016; Pope & Vasquez, 2011). Many of the current ethical decision-making models provide the following for the resolution of the ethical dilemmas: be aware of potential ethical issues, understand and state the problem clearly, know and practice the core competencies of the ethical codes, stay up-to-date with research, be aware of ethical and legal pitfalls, gather all relevant information from multiple sources if possible, respect the client’s autonomy, and seek supervision as needed (Hecker & Murphy, 2016; Pope & Vasquez, 2011). Lastly, therapists must document the process, take responsibility for their decision and its consequences, and understand the effect of their decision on the future of their client and themselves (Hecker and Murphy, 2016; Pope & Vasquez, 2011).

Cultural communities

As a queer therapist who works in their queer cultural community, it is essential to understand potential ethical dilemmas that may arise. Therapists must know that these dilemmas are most likely to occur, and the most prominent ethical dilemma includes the potential for dual relationships (Addison, 2019; Everett, MacFarlane, Reynolds, & Anderson, 2013; Heins, 2013). As queer cultural communities can be small, especially in smaller cities, there is a higher risk of interacting with clients outside the therapy room. For example, as a queer therapist in a smaller city, Author Thomas (he/him) makes the ethical decision not to attend the weekly “Queer Nights” at the local coffee shop. His decision includes ensuring that his clients have a safe space outside of the therapy room to connect with other queer community members. Within himself, he has decided that the queer event can be more impactful for his clients than for him because he has the privilege of building his queer community through his networks outside of the city in which he practices. This decision works best for him, and he worked with his clinical network to make this ethical decision. This is an example of navigating a potential ethical dilemma following the steps of being aware of the potential ethical issue, understanding the problem clearly, understanding the ethical codes, and making the best choice that allows for client autonomy (AAMFT, 2015). 

Suggestions for practice

The best method for maintaining ethics includes being proactive and normalizing potential ethical dilemmas, especially the potential for dual relationships. Following are specific steps to take to stay proactive, inclusive, and ethical.

1. Be open and honest about the likelihood of running into each other.

Discuss the potential dilemma during the first session. Work with your client to be proactive rather than reactive, which allows for a more ethical relationship. The narrative shared at the start of this article is an example of being open and honest. At first, it might seem uncomfortable sharing with your new client that you like to attend drag shows (or any other queer community space/event), but in the long run, it will allow for ethical boundaries to stay firm.

2. Offer clients referrals to an alternate affirming therapist if they become less comfortable.

Start the therapeutic relationship by normalizing the option to terminate services if the boundaries become uncomfortable. A potential narrative to address this problem could mirror: “While we are working together as a therapist and client, please do not hesitate to inform me if you feel as though we know too many of the same people or enjoy too many of the same social events and spaces. This is due to the ethical codes that I have to abide by, and you might realize that we are in the same social circle before I do. Specifically, I am not legally allowed to disclose that you are my client. This means that I am not sharing your name with anyone. You are more than welcome to share that I am your therapist. This dynamic might allow you to realize before I do that we know the same people.” This exact scenario has happened a few times to one author, and all clients were able to ask for a referral comfortably. In addition to encouraging clients to inform you if they become uncomfortable, it is your responsibility to elicit feedback occasionally to ensure continued therapeutic safety. It is important to normalize this process and provide a list of referrals that includes therapists who are not queer but are allies to the community.

When clients are comfortable with shared community spaces, negotiate how each of you will navigate these spaces. Collaborate with your clients about what spaces you can share and which spaces should be separate. This could depend on the importance of spaces to your clients, and the degree of blurred boundaries.

3. Negotiate ethical dual relationships.

When clients are comfortable with shared community spaces, negotiate how each of you will navigate these spaces. Collaborate with your clients about what spaces you can share and which spaces should be separate. This could depend on the importance of spaces to your clients, as referenced earlier, and the degree of blurred boundaries. For instance, you may jointly decide that attending city pride parades is acceptable, but not drag events due to the number of attendees. It would be best to discuss what boundaries and interactions are required for each setting to ensure confidentiality and comfort. Should there be a verbal greeting, a nonverbal greeting, or no greeting? How might you handle situations when you sit near each other at an event? What should happen when shared acquaintances try to introduce you to each other? Your client should drive the decision-making car with you in the passenger seat, providing suggestions and considerations. These discussions can be held at the beginning of treatment, as well as throughout treatment when events arise.

4. Telehealth can be your friend.

During the global pandemic, telehealth has become more frequent and normalized. Telehealth can be an excellent asset for queer therapists because it allows them to work outside of their community network. It opens up the entire state they are licensed in, which lowers the possibility of dual relationships and interacting with clients at queer community events in the city where they live. For Author Nedela (she/her), who provides telehealth services in a separate state from which they reside, this provides a clear separation of the local community and clinical treatment for the therapist and clients. Do not be afraid to market yourself as a virtual therapist, and abide by the telehealth guidelines set forth by your state and the state in which you practice. As a private practice owner, this is extremely important, and it allows you to be a resource to the queer community in your entire state. Working with clients outside of your city or state will enable you to lower the likelihood of navigating the aforementioned scenarios.

These guidelines are simply suggestions for queer therapists to be proactive when working in smaller queer communities. These guidelines could potentially be translated for other cultural minority therapists who work in their own cultural community. Dr. Sheila Addison provided a webinar for AAMFT’s Queer and Trans Advocacy Network on Multiple Relationships in Small Communities & Subcultures that further discussed this situation. The webinar is available in Teneo for further training. Training programs need to include discussions of multiple relationships in small communities, such as queer communities, in their ethics courses. Cultural minority therapists are an asset to their community and navigating potential ethical dilemmas proactively can ensure that these therapists provide the best services they possibly can. This topic might be overlooked, but as our field increases in diversity (race, ethnic, sexual orientation, and cultural), it is essential to adjust the ethical training conversations.

M. Evan Thomas, PhD, LMFTA (he/him), is an associate professor, department chair, and program director of the Master’s in Marriage and Family Therapy Program at Converse University. He is an AAMFT Professional Member and holds the Approved Supervisor designation. He is the current chair-elect for the QTAN AAMFT Network. His research focuses on Appalachia mental health and the opioid epidemic. He owns a private practice in Greenville, SC where he specializes in working with queer clients. evan.thomas@converse.edu

Mary R. Nedela, PhD, LMFT(she/her), is an associate professor and clinical coordinator in the Department of Counselor Education and Family Therapy, Marriage and Family Therapy Program at Central Connecticut State University. She is an AAMFT Professional Member and holds the Clinical Fellow and Approved Supervisor designations. Her clinical and research expertise is in the health and well-being of queer and trans relationships. Most recently, Nedela was awarded the AAMFT Research Foundation Dissertation Award on her dissertation titled, “Bisexual Relationships: Investigating the Impact of Attitudes Regarding Bisexuality on Relationship Satisfaction Among Female Same-gender Couples.” mnedela@ccsu.edu


Addison, S. (2019, May 10). “Small world, isn’t it?” Multiple relationships in small communities & subcultures [Webinar]. AAMFT, Queer & Trans Advocacy Network. https://networks.aamft.org/qtan/events/event-description?CalendarEventKey=60a842fa-8e67-40cc-8889-31fc4d4133d1&CommunityKey=0656c32b-e37a-41d5-b175-eadc9e4b2d6b&Home=%2fqtan%2fevents%2fcalendar

American Association of Marriage and Family Therapy. (2015). AAMFT code of ethics. Retrieved from https://www.aamft.org/imis15/Documents/Legal%20Ethics/Board%20Approved%20Code%20for%20Web%20Secured.pdf

Everett, B., MacFarlane, D. A., Reynolds, V. A., & Anderson, H. D. (2013). Not on our backs: Supporting counsellors in navigating the ethics of multiple relationships within queer, two spirit, and/or trans communities. Canadian Journal of Counselling and Psychotherapy, 47(1), 14–28.

Gonyea, J. J., Wright, D. W., & Earl-Kulkosky, T. (2014). Navigating dual relationships in rural communities. Journal of Marital and Family Therapy, 40, 125-136. doi:10.1111/j.1752-0606.2012.00335.x

Hecker, L.L., & Murphy, M. (2016). Ethics and professional issues in couple and family therapy (2nd Eds.). Taylor & Francis Group.

Heins, N. (2013). Queer predicaments: Dual relationships in sexual minority and gender variant clinicians who practice within their communities [ProQuest Information & Learning]. In Dissertation Abstracts International: Section B: The Sciences and Engineering (Vol. 73, Issue 10–B(E)).

Pope, K. S., & Vasquez, M. J. T. (2011). Ethics in psychotherapy and counseling: A practical guide. John Wiley & Sons.

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