Expert Advice on Supporting Clients in Coming Out

“Hi, I’m Crystal. You can call me Dr. Beal, Dr. Crystal, or Crystal.”

Disclosure moments like this happen all the time. We continuously divulge details of our public and private lives through our conversations, body language, and personal expression. Our jewelry, clothing, hairstyles, and body modifications like tattoos and piercings all say something about us. Some of these disclosure moments are simple. 

And some aren’t. Your transgender and gender diverse clients navigate multiple layers of disclosure on a daily basis that your cisgender clients don’t. 

“I’m the founder and CEO of QueerDoc. At QueerDoc, we provide queer and gender-affirming telemedicine from LGBTQ+ identified healthcare providers.” 

I’m queer. It’s an integral part of me, and I’ve chosen to be very noticeably queer. The company I own has “queer” in the name. Everyone at QueerDoc identifies as LGBTQ+ and most have lived experience as gender diverse, which is part of our brand. We are out as a business. 

Weighing the Risks of Coming Out

Gender diverse, transgender, and sexual minority people constantly calculate their “coming-out” moments when in mixed company. These decisions can fall anywhere from no sweat to terrifying on the “how risky is this?” scale. All too often, the risks can be life-changing or fatal. And the statistics indicate that discrimination impacts multiple foundational facets of life.

Housing
One in five transgender people in the United States has been discriminated against when seeking a home, and more than one in ten have been evicted from their homes because of their gender identity.

Employment
More than one in four transgender people have lost a job due to bias, and more than three-fourths have experienced some form of workplace discrimination. One in eight become involved in underground economies–such as sex and drug work–in order to survive.

Violence
More than one in four trans people has faced a bias-driven assault, and the rates are higher for trans women and trans people of color. 44% of reported hate murders in 2010 were committed against transgender women. In 2017, there was the equivalent of one homicide of an LGBTQ+ person in the U.S. each week. This was an 86% increase from 2016. This number has continued to rise. There were 57 known homicides in 2021.  57% of transgender people feel unsafe calling the police for help.  

Healthcare
56% of LGBTQ+ individuals have confronted discrimination while seeking medical treatment. One in four queer people have reported encountering medical discrimination in the last year. Nearly 1 in 5 (19 percent) reported being refused care outright because they were transgender or gender non-conforming. Transgender people reported very high levels of postponing medical care when sick or injured due to discrimination and disrespect (28 percent). 28 percent of transgender people reported harassment in medical settings.

In light of all this data in all areas of peoples’ lives, coming out can put an individual at serious risk. But despite increasing legal protections in some states and at the federal level, there are also increasing legal risks in other states and emboldened private and public animosity everywhere. 

How to Help Clients Come Out With Intention

Your gender diverse and transgender clients face different risks in their daily lives than your cis ones do—and navigating these risks can be a significant source of distress and anxiety. As a mental health provider, you have a unique opportunity to support clients having these experiences. The decision to divulge should come from the individual’s own needs and values, and a safety assessment is a vital part of that process. 

LGBTQ+ individuals should never be expected nor required to come out to anyone. We don’t owe anyone that information. Nor should autonomy in these decisions be negated. Coming out should be an intentional act. The individual should control the whens, wheres, hows, and whos. Coming out should never be forced, and outing someone is a violation of autonomy and consent. 

As a mental health provider, your existing skill sets and practice modalities can help your clients prepare for their coming out moments. Here are a few steps you can take in these conversations: 

• Ask your client’s interest in discussing coming out with you. Get their consent before proceeding further.
• Ask about your clients coming out plans, if they have any. 
• Discuss the pros and cons.
• Role play.
• Help build resilience/coping strategies for negative reactions. 
• Help them develop backup plans for resources. 
• Offer a safe space, emotional support, and allyship. 
• Be prepared to connect your clients with appropriate resources. 
• Be prepared to connect your clients with community/peer supports. 
• Be prepared to admit when your skills are insufficient, and be able to refer your client to another provider who might be a better fit.

Preparing Your Clients For Different Scenarios

These steps are a good starting point to make sure you’re taking a holistic approach to helping your clients come out, if they want to. To dive even deeper into specifics when discussing coming out scenarios with your clients, consider the following strategies and decision points. 

Coming Out With Family 

To help your trans and gender diverse clients come out to their families, these are a few points to consider and talk through with your clients. Think and talk through their family of origin culture, and what the overal narrative within their family is around politics, religion, transgender rights, and LGBTQ+ rights. Also consider what kind of language is used within the family, and if there’s a history of strict control or violence. 

If your client is a dependent, discuss any potential threats to their physical safety, and what access they have to housing, food, and financial support. It’s also important to consider the emotional impacts of your client going low or no contact with their family, or being prevented from having contact. 

Coming Out With Friends 

To help your clients come out with their friends, there are slightly different factors to consider. It’s a good idea to test the waters before the reveal. Advise your client to ask their friends how they feel about trans issues and politics, or their knowledge and feelings about transgender celebrities or community events like PRIDE. 

There are also some physical safety recommendations you can make for these discussions. Some of these, particularly for when coming out, include being in a public environment, and being able to physically get away if needed. It’s also a good idea to be fully clothed as appropriate for the location and weather, and to avoid being in spaces where movement is limited (like in a car with a seatbelt on) or where physical obstacles may impeded movement (like in a crowded café.) 

You can also advise your client to have a safety contact on deck for when they are having a coming out conversation, and make sure that contact is someone your client fully trusts. This contact should know who your client is with, where they plan to be, when they plan to return, when your client will contact them, and what to do if that planned contact doesn’t happen. 

Coming Out at School

If your client wants to come out at school, they should learn their state’s policies on gender diversity in schools, as well as their specific school and school district’s policies. These are a few excellent resources to find this information: 

• HRC State Equality Index 
• Legislation tracker 
• Child Trends blog 

They should also explore LGBTQ+ student groups or organizations at the school. I recommend using the Gender Spectrum’s Schools in Transition Guide with a guidance counselor or school administrator to develop a plan. If your client’s parents are supportive, they should attend that meeting as well. For student athletes, I’ve compiled some specific resources you can use to navigate those conversations. 

Coming Out at Work

Coming out in the workplace can be tricky. If your client comes out during the application process, they may be able to avoid a negative work environment, but it also may severely limit their employment opportunities. Some employers publish their diversity policies. Not having a published or accessible policy may hint at an unaccepting environment, so that’s something to watch out for. Online and local communities may be able to provide some inside knowledge about the company and culture, so those are resources your client may be able to use to scope out what companies are really like to work for. 

If your client comes out after they receive an offer, that gives them some legal options if their offer is revoked after disclosure. Encourage your client to weigh the job benefits, especially if it’s financially urgent, against the emotional and physical impact of working in a potentially hostile environment. Also encourage them to consider any background check requirements, and if that’s something they’re comfortable with. Lastly, talk through whether or not any legal documents are consistent with your clients chosen name(s), and if that may complicate their decision. 

All these factors apply to your client coming out with a new job. If they’re considering coming out at their current job, it’s vital to do a review of the company’s internal workplace policies, and then consult with HR and/or their supervisor to get an understanding of what that conversation might look like, and the impact it might have. 

Here are a few additional resources about coming out at work that you can share with your clients: 

• Transitioning in the Workplace HRC Guide 
• Coming Out as Trans at Work HBR article 
• Employment discrimination Transequality resources 

Coming Out While Dating

Identity disclosures on a dating profile can help your clients avoid some difficult conversations down the road, but may also attract “chasers.” Encourage your clients to consider using apps that include options such as “only show my profile to” and “I only want to see” filters, and to think through other safety factors like the ability to change the name others see, and what email they opened the account with. 

Of the dating apps, OkCupid has a robust structure for self-identification and profile management in place. Bumble has good options as well, and Butterfly is a new and small transgender-focused dating site your clients can explore as well. Lex is another option that’s all text-based rather than photos. 

Similar to when coming out to friends, early conversations with potential romantic partners can test the waters to determine if it’s safe to share more details. The safety precautions for dates are also similar. Your client should make sure to be in a public place, have a safety contact person, and be aware of immediate surroundings and exit points. Personnel at the location of the date, like servers or bar staff, may be allies and able to help in an emergency as well. 

Coming Out Online

A lot of the strategies for coming out online are similar to those for coming out to friends or while dating. Your clients can consider being out in their profile if they chose to, and they should have similar test the waters conversations early on. Here, they should also be aware of ways to shut down unwanted conversations through methods like blocking and reporting.

You and your client should also have resiliency and after-care plans in place for both celebrating after good outcomes, and healing after bad ones.

Building Your Resource List 

All of the links included above are excellent additions to your resource list, and there are many ways to build it out even more. Your local LGBTQ+ community center or organization should have regional resources, and you can check online to find your local center.

At QueerDoc, we have built both state-specific lists for the states we serve and a specific list of virtual communities and support groups. I make sure to vet organizations and providers we list. We have a brief listing form that folx complete prior to becoming a referral or resource. I also frequently do a brief video session with potential referrals or resources. It is important that you vet your own resources to avoid additional trauma for trans and gender diverse clients. 

Want to Learn More? 

There are multiple opportunities for gaining more experience and knowledge around serving your transgender and gender diverse clients. Here are a few that I highly recommend: 

• The Transgender Training Institute, which offers pay-what-you-can trainings by mental health experts with lived experience. 
• QueerCME, which has both free and paid content from a medical expert with lived experience. It’s a great resource for providers to watch to learn more about how trans people have to move through the world and for their clients to get actionable tips and tricks.
• National LGBTQIA+ Health Education Center, where you can enroll in a free account and access free CE andCMEon trans health and mental health topics. 

There are also a few conferences I recommend to learn more, including:

• Philadelphia Trans Wellness Conference, which is a community-lead, community-focused space to both educate and empower the trans community alongside providers and allies alike on all things health and wellness.
• Gender Spectrum, which is an online gathering of professionals from a range of disciplines committed to the affirming care and support of transgender youth and their families. 
• The World Professional Association for Transgender Health (WPATH) is also a great resource. 

Putting it All Together

Coming out is both a series of repeated one-time events and a long-term process. Each instance of coming out has a unique set of risks and benefits, and safety calculations around coming out may be complex. The mental health benefits of coming out must be weighed against the potential risks in housing, financial stability, physical safety, and health care. These risks can compound and are often higher for individuals who experience multiple marginalizations. 

Culturally, LGBTQ+ people are often expected to disclose their genders and sexualities on demand. However, we don’t owe that information to anyone, especially when doing so can be dangerous or even deadly. Mental health providers have a unique opportunity to help your clients build their skills for navigating coming out interactions. If you can’t do so, refer them to another provider who can. 

Coming out can be joyful and celebratory. Engaging in skill-building, knowledge-gathering, and practical planning can help you ensure that your clients can come out on their terms and in safety.