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Fundamentals and Ethical Considerations of Clinical Practice with LGBT Populations: Assessment and Therapy Guidelines

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1.  What is the difference between sex, sexuality, and gender? Sex refers to biological characteristics, such as genitalia and chromosomes; sexuality is the cultural and social aspects of sexual attraction and behavior; and gender is the roles and expectations society assigns based on perceived sex. Sexuality pertains to biological characteristics, such as genitalia and chromosomes, while gender encompasses the cultural and social aspects of sexual attraction and behavior. Sex is the set of roles and expectations society assigns based on perceived sex. Sexuality encompasses biological characteristics, such as genitalia and chromosomes, while gender is the cultural and social aspects of sexual attraction and behavior. Sex refers to the set of roles and expectations society assigns based on perceived sex. Sexuality is the set of roles and expectations society assigns based on perceived sex, while gender pertains to biological characteristics, such as genitalia and chromosomes. Sex encompasses the cultural and social aspects of sexual attraction and behavior.

2.  What are 3 proximal/internal stressors experienced by LGBT individuals as conceptualized by Minority Stress Theory? non-disclosure, non-affirmation, victimization depression, anxiety, suicidal ideation non-disclosure, internalized homo/transphobia, negative expectations discrimination, rejection, non-affirmation

3.  What is the best way to authenticate the name of a patient before you have confirmed preferred name and pronouns? Skip the authentication process and use gender-neutral language to avoid any potential discomfort. Avoid using honorifics or first name and use gender-neutral pronouns until you can assess for preferred name and pronouns. Use the name and pronouns specified in the patient’s medical record. Ask the patient for their full legal name as it appears on official identification documents.

4.  Which of the following best describes the DSM-5 criteria for gender dysphoria? Persistent distress related to the incongruence between one's experienced gender and assigned gender. Persistent distress related to a strong desire to be rid of one’s primary/secondary sex characteristics because of incongruence between one’s experienced and assigned gender. Persistent distress related to a desire for the primary/secondary characteristics of another gender. A psychiatric diagnosis applied to anyone who identifies as transgender.

5.  What would be the best way to ensure confidentiality when assessing for preferred name and pronouns? Use preferred name and pronouns both when speaking with family members and when documenting in the medical record. Use preferred name and pronouns when speaking with family members but use the legal name when documenting in the medical record. Use preferred name and pronouns when communicating with the patient but use the legal name when speaking with family members and when documenting in the medical record. Ask the patient which name and pronouns to use when documenting in the medical record and when speaking with family members.

6.  A transgender patient presents with depression. How would you go about determining the link between their gender identity and their presenting concern? If the patient does not mention any distress related to their gender identity, focus on their depression only and do not discuss their gender identity. Explore with the patient how their depression may or may not be related to their gender identity and to the effects of minority stress. Work with the patient to identify the links between their gender identity and their depression. Provide psychoeducation on the direct effect of transgender identity on mood.

7.  In which of the following scenarios would you NOT want to refer an LGBT patient? Your religious views do not align with the LGBT patient’s identity, and you have identified significant negative bias toward the patient. The patient presents for a letter for gender-affirming surgery and you do not have experience performing gender-affirming surgery readiness evaluations. A patient presents to discuss sexual concerns related to their hormone therapy and you do not have training in transgender healthcare or in sex therapy. A patient presents to discuss exploring their gender identity, and while you have training in working with LGBT populations, you are a cisgender clinician who does not have much personal experience with the trans community.

8.  Choose the best answer: How do you navigate performing a hormone readiness evaluation for a transgender individual with active psychosis? Having active psychosis should not change the way that the individual is treated; proceed with the evaluation as usual. Utilize the informed consent model for assessment, taking special care to assess whether the individual’s psychosis limits their ability to consent. An individual cannot be diagnosed with gender dysphoria when actively psychotic, therefore, they are determined to not be eligible for hormone therapy. Determine whether gender dysphoria is a direct effect of the psychosis and proceed based on that assessment.

9.  Which of the following are commonly-used terms to describe sexual identities? non-binary, agender, Two-Spirit bisexual, cisgender, questioning demisexual, polyamorous, biromantic asexual, queer, lesbian

10.  What would be the best practice for treating a lesbian patient with depression related to rejection from her family? Use an evidence-based protocol for treating depression integrated with an evidence-based protocol for minority stress. Use an evidence-based protocol for treating depression. Do not use evidence-based protocols as they are not adapted for lesbians; instead, create your own intervention for this particular patient. Prioritize working with the family to minimize rejection of the patient’s identity.