Good Enough, Safe Enough: Affirming LGBTQ+ Clients When You're Not a Specialist
Affirming LGBTQ+ clients when you are not a specialist: Curt Widhalm, LMFT, and Katie Vernoy, LMFT on being a good enough, safe enough therapist when you cannot refer out.
Curt and Katie take on a question therapists often avoid: what do you do when an LGBTQ+ client needs care, you are not a specialist, and referring out is not possible, not safe, or not honest? In this Pride Month episode, they make the case that you can be a good enough, safe enough therapist for LGBTQ+ clients even when affirming care is not your declared specialty.
Mental health deserts, narrow insurance panels, long specialist wait lists, and unsafe home environments mean referral is not always available, and sometimes referring out is closer to abandonment than care. Curt and Katie argue that scope of competence is too often used as polite cover for therapist discomfort, and that most clinical work with LGBTQ+ clients is the same work you already do well. Affirming care is the container, not a separate specialty.
They also get practical about being a safe enough stopgap therapist: building a just in time consultation kit, doing the cultural humility work, and reckoning with the invisible labor and consultation tax of allyship, including why you should never bill a client to research their own identity. And they name the specific moments when referring an LGBTQ+ client out is still the right and ethical call.
This is a useful conversation for generalist therapists, rural and solo clinicians, insurance-based practices, and anyone doing the ongoing work of affirming, culturally humble care.
In this episode, we discuss:
- Why "refer out" can be avoidance dressed as ethics, and when it is genuinely the right call
- How to tell a true scope of competence limit from your own discomfort
- What it means to be a good enough, safe enough therapist for LGBTQ+ clients
- How to build a just in time kit so an LGBTQ+ client never lands on you cold
- Why the invisible labor and consultation tax of allyship is yours to carry, not your client's to fund
- The specific signs that mean you should refer out anyway
Timestamps:
00:15 - Why a Pride Month episode on being good enough, not a specialist
02:56 - "Just refer out": sound advice or avoidance?
05:05 - Scope of competence versus therapist discomfort
13:08 - The good enough therapist, and when referral becomes abandonment
16:55 - Meeting clients where they are until specialist care opens up
19:03 - Building a just in time kit for your practice
24:44 - The invisible labor and consultation tax of allyship
32:10 - When you should refer out anyway
Full show notes and transcript: mtsgpodcast.com
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