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LGBTQ+ Affirmative Care Training in Counselor Education: A Community-Based Inquiry

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Title: LGBTQ+ Affirmative Care Training in Counselor Education: A Community-Based Inquiry
Language: English
Authors: Nancy E. Thacker Darrow (ORCID 0000-0002-6475-3656), Kamden K. Strunk (ORCID 0000-0002-5613-218X), Thea L. Racelis (ORCID 0009-0004-5884-4473)
Source: Counselor Education and Supervision. 2025 64(3):341-353.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 13
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: LGBTQ People, Health Services, Counselor Training, Counselor Educators, Educational Needs, Community Needs
DOI: 10.1002/ceas.12346
ISSN: 0011-0035
1556-6978
Abstract: Counselor educators, counselors-in-training, and LGBTQ+ community members engaged in a community-based qualitative inquiry exploring LGBTQ+ affirmative care education. Findings revealed counselor educators' components and delivery of content, developmental implications for applying LGBTQ+ affirmative care, and gaps between education and LGBTQ+ community needs. Implications for education and research are provided.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1483666
Database: ERIC
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  Value: <anid>AN0187978651;cev01sep.25;2025Sep17.06:45;v2.2.500</anid> <title id="AN0187978651-1">LGBTQ+ Affirmative Care Training in Counselor Education: A Community‐Based Inquiry </title> <p>Counselor educators, counselors‐in‐training, and LGBTQ+ community members engaged in a community‐based qualitative inquiry exploring LGBTQ+ affirmative care education. Findings revealed counselor educators' components and delivery of content, developmental implications for applying LGBTQ+ affirmative care, and gaps between education and LGBTQ+ community needs. Implications for education and research are provided.</p> <p>Keywords: counselor development; counselor education; curriculum; educational methods; LGBTQ+ affirmative care</p> <hd id="AN0187978651-2">Introduction</hd> <p>The counseling profession has increasingly worked to center multiculturalism and social justice in its educational standards (CACREP [<reflink idref="bib9" id="ref1">9</reflink>]). This focus comes in response to the call to action for counselors to support an increasingly diverse society (Kaplan and Gladding [<reflink idref="bib19" id="ref2">19</reflink>]). Over a decade from the initial call to action, preparation to work with diverse populations still varies. Of note, a specific training in LGBTQ+ issues is not a required component in counselor education (Moe et al. [<reflink idref="bib23" id="ref3">23</reflink>]), which leads individual programs and instructors to determine how to prepare students on the topic (Moe et al. [<reflink idref="bib24" id="ref4">24</reflink>]). Relatedly, counselors‐in‐training (CITs) have cited a lack of knowledge, skills, training, and/or experience in working with LGBTQ+ clients during their counselor education programs (Ginicola et al. [<reflink idref="bib16" id="ref5">16</reflink>]; Killian et al. [<reflink idref="bib20" id="ref6">20</reflink>]; Wanzer et al. [<reflink idref="bib38" id="ref7">38</reflink>]). Scholars and practitioners have aimed to address these discrepancies with an increased focus on LGBTQ+ affirmative care.</p> <p>LGBTQ+ affirmative care (also referred to as LGBTQ+ affirmative counseling or therapy) has been documented as an effective therapeutic modality for LGBTQ+ individuals (Gess and Horn [<reflink idref="bib15" id="ref8">15</reflink>]; Ginicola et al. [<reflink idref="bib16" id="ref9">16</reflink>]). Many helping professionals have contributed to best practices within the modality, including focused applications with gender‐expansive individuals (Chang et al. [<reflink idref="bib7" id="ref10">7</reflink>]) and adapting evidence‐based interventions to be affirming for sexually minoritized folks (Pachankis et al. [<reflink idref="bib25" id="ref11">25</reflink>]). However, LGBTQ+ individuals have reported difficulty seeking and securing affirming mental health providers (Ginicola et al. [<reflink idref="bib16" id="ref12">16</reflink>]), which suggests a gap exists between education and practice.</p> <p>Difficulty securing LGBTQ+ affirmative providers is particularly salient in the Southeastern United States, where LGBTQ+ individuals have reported higher rates of mental health distress than LGBTQ+ individuals in other US regions (Platt and Pepper [<reflink idref="bib26" id="ref13">26</reflink>]). Further, given recent proposed or enacted anti‐LGBTQ+ legislation across states in the Southeastern United States, counselors in this region face unique barriers as they seek to provide care (Rose et al. [<reflink idref="bib30" id="ref14">30</reflink>]). The tracked over 100 bills with anti‐LGBTQ+ legislation being introduced in every state in the region in 2024, including healthcare bans in seven states in the region (Trevor Project 2024). In the quest to support an increasingly diverse LGBTQ+ population, these recent reports elicited questions about the current state of LGBTQ+ affirmative care education in counselor education programs.</p> <p>The purpose of this community‐based qualitative inquiry was to understand the current landscape of LGBTQ+ affirmative care education and identify gaps between curriculum and practice. Given reports of heightened mental health distress among the population in the Southeastern United States, alongside the challenging legal landscape, the researchers narrowed the inquiry to counselor education programs in the SACES region (ACES 2021). We review current trends and barriers to LGBTQ+ affirmative care education before detailing findings and implications for education and research.</p> <hd id="AN0187978651-3">Current Trends in LGBTQ+ Affirmative Care Education</hd> <p>LGBTQ+ affirmative care is a strengths‐based framework for counseling that promotes authenticity and resilience while addressing the effects of discrimination and bias on LGBTQ+ individuals (Craig et al. [<reflink idref="bib10" id="ref15">10</reflink>]; Ginicola et al. [<reflink idref="bib16" id="ref16">16</reflink>]). LGBTQ+ individuals face discrimination and bias that contribute to increased rates of mental health disparities (e.g., depression, anxiety, and suicidality), compared to their cisgender and heterosexual counterparts (Medina and Mahowald [<reflink idref="bib21" id="ref17">21</reflink>]). As a result, LGBTQ+ people tend to seek counseling at higher rates than non‐LGBTQ+ people (Spengler et al. [<reflink idref="bib31" id="ref18">31</reflink>]). The need to prepare counselors to provide LGBTQ+ affirmative care is consequently essential. Yet, counselors have consistently reported they are underprepared to work with LGBTQ+ individuals (Carrington and Sims [<reflink idref="bib5" id="ref19">5</reflink>]; Ginicola et al. [<reflink idref="bib16" id="ref20">16</reflink>]; Killian et al. [<reflink idref="bib20" id="ref21">20</reflink>]; Moe et al. [<reflink idref="bib23" id="ref22">23</reflink>]).</p> <p>Some scholars have documented approaches to prepare counselors in LGBTQ+ affirmative counseling to address the gap of knowledge. For example, Killian et al. ([<reflink idref="bib20" id="ref23">20</reflink>]) utilized an experiential framework informed by key competences in counseling (i.e., MCSJCCs, Competencies for Counseling with LGBQQIA Individuals, Competencies for Counseling with Transgender Clients; Burnes et al. [<reflink idref="bib4" id="ref24">4</reflink>]; Harper et al. [<reflink idref="bib17" id="ref25">17</reflink>]; Ratts et al. [<reflink idref="bib27" id="ref26">27</reflink>]) to train students. Similarly, Craig et al. ([<reflink idref="bib10" id="ref27">10</reflink>]) integrated simulation‐based learning activities to demonstrate LGBTQ+ affirmative practice in groups. Some scholars, such as Dorn‐Medeiros and Christensen ([<reflink idref="bib14" id="ref28">14</reflink>]), have also developed evaluative tools to supervise students' work with LGBTQ+ clients, as effective supervision is a key contributor to developing LGBTQ+ competence (Carrington and Sims [<reflink idref="bib5" id="ref29">5</reflink>]). These approaches are examples of the ways educators can mobilize training standards to develop students' LGBTQ+ competence (Burnes et al. [<reflink idref="bib4" id="ref30">4</reflink>]; Harper et al. [<reflink idref="bib17" id="ref31">17</reflink>]).</p> <p>Researchers have also indicated the importance of integrating critical theoretical frameworks such as minority stress theory (Meyer [<reflink idref="bib22" id="ref32">22</reflink>]), intersectionality theory (Crenshaw [<reflink idref="bib11" id="ref33">11</reflink>]), and/or queer theory (de Lauretis [<reflink idref="bib13" id="ref34">13</reflink>]) into the ways educators prepare students to conceptualize and practice with LGBTQ+ clients (Cor et al. [<reflink idref="bib8" id="ref35">8</reflink>]; Moe et al. [<reflink idref="bib23" id="ref36">23</reflink>]; Pachankis et al. [<reflink idref="bib25" id="ref37">25</reflink>]; Tilsen [<reflink idref="bib37" id="ref38">37</reflink>]). When critical theories are not utilized in curricula, counselor educators may rely on generally fostering students' cultural humility or developing their cultural competence, without providing clear guidelines for counseling LGBTQ+ folks specifically (Cor et al. [<reflink idref="bib8" id="ref39">8</reflink>]). Therefore, as educators aim to prepare multiculturally competent counselors, or culturally informed counselors, the ability to apply concepts from minority stress, intersectionality, and queer theories with LGBTQ+ clients is crucial (Chan et al. [<reflink idref="bib6" id="ref40">6</reflink>]; Cor et al. [<reflink idref="bib8" id="ref41">8</reflink>]; Moe et al. [<reflink idref="bib23" id="ref42">23</reflink>]).</p> <p>Despite existing training standards (Burnes et al. [<reflink idref="bib4" id="ref43">4</reflink>]; Harper et al. [<reflink idref="bib17" id="ref44">17</reflink>]) and documented approaches for the application of standards from a queer intersectionality lens (Cor et al. [<reflink idref="bib8" id="ref45">8</reflink>]), counselor educators still vary widely in their LGBTQ+ instruction. Moe et al. ([<reflink idref="bib23" id="ref46">23</reflink>]) found that counselor educators who reported higher levels of competence in their clinical skills were more likely to infuse LGBTQ+ affirmative care content into their teaching. Additionally, Moe et al. ([<reflink idref="bib24" id="ref47">24</reflink>]) found that valuing an affirming teaching philosophy was significantly related to coverage of LGBTQ+ issues in the classroom. These studies suggest that counselor educators should continually improve their LGBTQ+ clinical competence and apply an affirming teaching philosophy to be effective LGBTQ+ affirmative care educators.</p> <hd id="AN0187978651-4">Barriers in LGBTQ+ Affirmative Care Education</hd> <p>A notable barrier to including LGBTQ+ content in counselor education is anti‐LGBTQ+ legislation (Rose et al. [<reflink idref="bib30" id="ref48">30</reflink>]; Trevor Project 2024). For example, in US states where legislation restricts the inclusion of LGBTQ+ content in K‐12 schools, counselor educators are tasked to prepare their students to work within legal bounds while also maintaining ethical principles (ACA 2014). Educators in some Southeastern US states are additionally tasked to navigate state bans on "divisive concepts" in public higher education—legislation that challenges educators' abilities to prepare counselors in diversity and inclusion topics (Trevor Project 2024). The contradiction between law and ethics is a difficult task that may require counselor educators to adopt a flexible approach that considers student dispositions, values, and biases (Dorn‐Medeiros and Christensen [<reflink idref="bib14" id="ref49">14</reflink>]). To do so, counselor educators must also be self‐aware of their own positions and biases.</p> <p>Counselor educators' personal attributes and experiences impact how they deliver educational content. Of note, the institutional systems in which counselor education programs reside shape faculty expectations and practices. Some faculty who identify as LGBTQ+ may mindfully address LGBTQ+ educational content in a manner that preserves their safety and security (Thacker et al. [<reflink idref="bib35" id="ref50">35</reflink>]; Moe et al. [<reflink idref="bib23" id="ref51">23</reflink>]). Further, faculty hold personal values that influence their practices. When faculty hold biases against LGBTQ+ individuals, they can enact harm toward students. Minoritized counseling students have reported that some faculty engage discriminatory practices (e.g., microaggressions such as stereotyping, tokenism, and erasure) in the classroom, in supervision, or in mentoring relationships (Thacker and Barrio Minton [<reflink idref="bib34" id="ref52">34</reflink>]), which result in minoritized students feeling harmed, isolated, or discouraged. Such harm can result in complicated classroom dynamics that impact student engagement. With adversely affected levels of engagement, students may continue to report a lack of preparation to counsel LGBTQ+ people (Carrington and Sims [<reflink idref="bib5" id="ref53">5</reflink>]; Moe et al. [<reflink idref="bib23" id="ref54">23</reflink>]). This body of literature calls for counselor educators to not only improve teaching practices but also understand what students need to learn to best serve their LGBTQ+ clients.</p> <hd id="AN0187978651-5">The Current Study</hd> <p>In order to understand LGBTQ+ affirmative care education with depth, the iterative research process involved LGBTQ+ community members, CITs, and counselor educators (see Figure 1). The purpose of the study was to illuminate gaps in LGBTQ+ affirming care curriculum and practice. However, counselor education curriculum is informed in part by emerging research on a given population's specific needs. The authors consequently sought to understand not only what LGBTQ+ affirmative care education is being taught and learned and how that education aligns with the needs of the LGBTQ+ community. Still, the emphasis was on LGBTQ+ affirmative care educational preparation, and the research question was: What LGBTQ+ affirmative care educational curricula are CACREP‐accredited counselor education programs delivering?</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/CEV/01sep25/ceas12346-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ceas12346-fig-0001.jpg" title="1 Study design." /> </p> <p></p> <hd id="AN0187978651-7">Method</hd> <p>The researchers engaged qualitive community‐based methods (Jason and Glenwick [<reflink idref="bib18" id="ref55">18</reflink>]; Strunk et al. [<reflink idref="bib33" id="ref56">33</reflink>]). Community‐based methods have been used across disciplines to merge "the gap between scientific knowledge and practice" (Jason and Glenwick [<reflink idref="bib18" id="ref57">18</reflink>], 1). The collaborative nature of the method requires researchers and participants to be involved in each stage of research, particularly in making decisions on how the results are used (Strand et al. [<reflink idref="bib32" id="ref58">32</reflink>]). As a result, utilizing focus group interviews is relevant to create knowledge in the community and build upon information in a shared space. This approach can yield rich insights and is ideal for research aimed at creating change (Jason and Glenwick [<reflink idref="bib18" id="ref59">18</reflink>]). This approach has also been noted as particularly effective with LGBTQ+ groups (Strunk et al. [<reflink idref="bib33" id="ref60">33</reflink>]).</p> <p>The researchers grounded the use of community‐based methods in social constructionism and post‐modern thought. In other words, from an epistemological standpoint, generation of knowledge is through storied realities that people tell, and as a result, multiple truths exist (Browne and Nash 2016). This epistemological foreground is appropriate for community‐engaged research in social sciences because it provides a foundation for the variability inherent to iterative research designs like community‐based methods (Jason and Glenwick [<reflink idref="bib18" id="ref61">18</reflink>]). Thus, the research process could accommodate participant voices to drive the inquiry's direction and focus (Strand et al. [<reflink idref="bib32" id="ref62">32</reflink>]). At the same time, the researchers approached the inquiry with predetermined questions informed by literature to situate the collaboration with participants.</p> <hd id="AN0187978651-8">Participants</hd> <p>Participants included three groups: LGBTQ+ community members, CITs, and counselor educators. To be eligible for the study, LGBTQ+ community members must have been (a) 18 years or older, (b) identify as LGBTQ+, and (c) reside in the Southeastern United States, which was defined as one of 14 states in the SACES region (ACES 2021). CITs needed to have met the following criteria to be eligible to participate: (a) 18 years or older, (b) currently enrolled in a CACREP‐accredited counseling program in the SACES region, and (c) completed at least one quarter or semester of internship. Counselor educators were eligible if they met the following criteria: (a) held a doctoral degree, (b) were employed in a CACREP‐accredited counselor education program in the SACES region, and (c) worked as instructional faculty for at least 2 years. Aggregate participant demographics are included in Table 1 as participants named identities during the interview process.</p> <p>1 TABLE Participant demographic data.</p> <p> <ephtml> <table><thead><tr><th /><th>LGBTQ+ community members (<italic>N</italic> = 17)</th><th>Counselors‐in‐training (<italic>N</italic> = 12)</th><th>Counselor educators (<italic>N</italic> = 12)</th></tr></thead><tbody><tr><td>Race/ethnicity</td></tr><tr><td>White</td><td>10</td><td>10</td><td>10</td></tr><tr><td>Black</td><td>4</td><td /><td>2</td></tr><tr><td>White/Jewish</td><td>2</td><td /><td /></tr><tr><td>Asian</td><td>1</td><td>1</td><td /></tr><tr><td>Latina</td><td /><td>1</td><td /></tr><tr><td>Gender identity</td></tr><tr><td>Cisgender female</td><td>7</td><td>11</td><td>8</td></tr><tr><td>Cisgender male</td><td>5</td><td /><td>4</td></tr><tr><td>Transgender</td><td /><td>1</td><td /></tr><tr><td>Nonbinary</td><td>4</td><td /><td /></tr><tr><td>Agender</td><td>1</td><td /><td /></tr><tr><td>Sexual identity</td></tr><tr><td>Heterosexual</td><td /><td>7</td><td /></tr><tr><td>Lesbian</td><td>1</td><td>1</td><td /></tr><tr><td>Gay</td><td>5</td><td /><td>1</td></tr><tr><td>Bisexual</td><td>2</td><td /><td>1</td></tr><tr><td>Queer</td><td>4</td><td>4</td><td /></tr><tr><td>Sapphic</td><td>1</td><td /><td /></tr><tr><td>Asexual</td><td>4</td><td /><td /></tr><tr><td>Undisclosed</td><td /><td /><td>10</td></tr></tbody></table> </ephtml> </p> <hd id="AN0187978651-9">Researchers</hd> <p>The research team included two faculty members and one graduate student. Author one is a counselor educator who identifies as a White, queer, cisgender woman. Her professional experiences as a clinical mental health counselor and educator, as well as within‐group identity, informed her lens to the current inquiry. Author two is a professor focused on queer studies with a background in quantitative research methodologies and educational psychology. He is a White, queer, cisgender man with experiences in seeking and receiving mental health care in addition to a master's degree in clinical psychology. Author three is a doctoral student in education, with an emphasis in curriculum, culture, and change. She is a queer BIPOC woman with lived experience in seeking mental health services as a member of multiple minoritized groups and professional experience serving the LGBTQ+ community. Collectively, the research team had varied experiences seeking affirming mental health care across differences of race, gender, and sexual identity. We also varied in educational preparation to support LGBTQ+ people in clinical and higher education settings. However, we recognized the particular and often privileged positions from which we have interacted with mental health care and education as LGBTQ+ people. Our personal and professional experiences shaped our shared beliefs that LGBTQ+ people have distinct needs for mental health care, and helping professionals are often not consistently or adequately prepared. We were mindful of these beliefs as we enacted methodological integrity through our procedures.</p> <hd id="AN0187978651-10">Procedures</hd> <p>After receiving IRB approval, we utilized criterion‐specific, network, and snowball sampling methods to recruit participants. LGBTQ+ community members (<emph>N</emph> = 17) were recruited via social media and network sampling with community and academic organizations that serve LGBTQ+ communities across the Southeastern United States (e.g., PFLAG groups, collegiate LGBTQ+ resource centers, community LGBTQ+ centers). The researchers sent an IRB‐approved email to community organizations and requested they share the solicitation with LGBTQ+ folks and stakeholders. CITs (<emph>N</emph> = 12) and counselor educators (<emph>N</emph> = 12) were recruited via social media flyer distribution, email solicitations sent through counseling networks (e.g., CESNET), and direct emails sent from the researchers to eligible counseling program leads. As we connected with participants, the researchers utilized snowball sampling by asking participants to share the solicitation with other individuals who may qualify for the study. Each solicitation for participants included a link to a Qualtrics form whereby participants reviewed the research information letter and indicated eligibility to engage the study via Qualtrics. Once consent was gathered, participants were directed to sign up for a virtual interview time through an IRB‐approved scheduling software.</p> <hd id="AN0187978651-11">Data Collection</hd> <p>Data collection involved 60–90‐min focus group interviews with each participant group via Zoom. In total, we conducted nine focus groups with LGBTQ+ community members, seven focus groups with counselor educators, and five focus groups with CITs. Each group ranged from two to six participants. Considering our research question was focused on understanding LGBTQ+ affirmative care education, we developed interview questions for each group toward that focus. In short, LGBTQ+ community members were asked to illuminate on what they needed their counselors to learn, CITs were asked about what and how they were learning, and counselor educators were asked to describe what they were teaching. The iterative process of community‐based methods allowed us to build knowledge in the community, in focus groups, through the processes outlined next.</p> <p>We first engaged LGBTQ+ community members in focus group interviews. The semi‐structured interview guide included questions about what they looked for in a provider, what preferences, if any, they had for provider type or identities, and how they identified whether a provider was affirming. We also asked about specific experiences in seeking or receiving mental healthcare. Next, we turned to focus group interviews with counselor educators. The semi‐structured interview guide with counselor educators included questions about LGBTQ+ content within curriculum (e.g., what LGBTQ+ constructs, theories, models, practices, etc., do you teach students? What assignments do you require of students?), delivery of content (e.g., within what course(s) is this curriculum included?), and evaluation of learning (e.g., what are the learning outcomes connected to LGBTQ+ curriculum?). We also shared our initial insights from the LGBTQ+ community member participants with counselor educators; we were able to inquire about the degree to which counselor educators were addressing particular needs identified by LGBTQ+ community members in their teaching. Finally, we engaged in focus‐group interviews with CITs. The semi‐structured interview guide included questions about what LGBTQ+ content they were learning, in which courses and through which assignments did they learn, and how their learning was evaluated. We further inquired about the setting and populations CITs worked with to gather information about their application of learning with clients. We also provided initial findings from LGBTQ+ community members and counselor educators with the student group; we asked CITs to describe the degree to which they received the training counselor educators claimed to provide and if they believed they were being trained to meet the needs LGBTQ+ community members shared.</p> <p>After these initial interviews, we returned to the LGBTQ+ community group to share initial findings from counselor educator and CIT groups. We asked LGBTQ+ members to share their reactions to the initial findings and inquired about what they needed their counselors to learn to be affirmative providers. Finally, we engaged counselor educators for a final round of focus‐group interviews to share findings from all interviews. We asked that they share their reactions to the findings and assist the researchers in identifying gaps between curriculum and practice based on the findings.</p> <hd id="AN0187978651-12">Data Analysis</hd> <p>We used thematic analysis to analyze data (Braun and Clarke [<reflink idref="bib2" id="ref63">2</reflink>]), a common form of analysis when interviews are the primary source of data in community‐based research (Riger and Sigurvinsdotter [<reflink idref="bib28" id="ref64">28</reflink>]). The first step of analysis involved the researchers familiarizing themselves with the data by reviewing transcripts from the initial LGBTQ+ community member interviews. The researchers met to discuss the data and document initial impressions. The next step was to generate codes. All interviews were independently coded by at least two researchers. Codes were derived with focus on description of experience related to the research question. We repeated this step again after the counselor educator interviews and once again after the CIT interviews. The researchers met to debrief after each round of coding and compiled initial notes and memos to share with the next group of participants. The purpose of sharing initial analysis with each group was to honor our iterative, community‐based method by asking follow‐up questions that helped address the gaps between community needs, education, and practice that participants reported (Jason and Glenwick [<reflink idref="bib18" id="ref65">18</reflink>]). This analytic process resulted in adding questions as needed to the semi‐structured interview guides. For example, CIT reported typically learning about LGBTQ+ issues in only one course or through continuing education; we then added "how do you imagine infusing affirmative care education across the curriculum" as a question for counselor educators in the final round of interviews.</p> <p>Once the initial round of interviews and coding for each group was complete (i.e., we made a full circle in Figure 1), we returned to LGBTQ+ community members for a second round of interviews. We then coded the transcripts from this round per the process outlined above. Then, we repeated this step with a second round of interviews with counselor educators and coded the corresponding transcripts.</p> <p>Once all coding of first and second‐round interviews was complete, the researchers met to combine codes within each group of transcripts (i.e., counselor educators, CIT, and LGBTQ+ community members) into themes. Similarities across codes were noted, and the researchers were able to engage in the subsequent step of determining the significance of themes. Finally, the researchers met to reach a consensus on themes for each group, which allowed for the development of the findings below.</p> <hd id="AN0187978651-13">Methodological Integrity</hd> <p>Multiple methods were employed to ensure methodological integrity and rigor. Given the nature of community‐based methods (Jason and Glenwick [<reflink idref="bib18" id="ref66">18</reflink>]), member‐checking was integrated throughout multiple phases of the research process. Participants contributed to interview protocols and provided feedback on the themes identified from their interviews. The researchers engaged memoing during data collection and analysis to document any iterative thematizing that occurred. Memoing was also crucial to note how the researchers' positionalities influenced the interpretation of data (Brown and Nash [<reflink idref="bib3" id="ref67">3</reflink>]). The researchers engaged in debriefing meetings regularly throughout the research, where memos and positionalities were discussed.</p> <hd id="AN0187978651-14">Findings</hd> <p>Community‐based methods allowed us as researchers to partner with participants to uncover current educational trends in LGBTQ+ affirmative care in counselor education. Thematic analysis of focus group interviews with three groups of participants yielded three themes: (<reflink idref="bib1" id="ref68">1</reflink>) Community needs for accessing and securing affirming providers, (<reflink idref="bib2" id="ref69">2</reflink>) educational methods applied in silo, and (<reflink idref="bib3" id="ref70">3</reflink>) developmental implications for providing affirmative care. We expand on each theme next with supporting quotes from participants.</p> <hd id="AN0187978651-15">Community Needs for Accessing and Securing Affirming Providers</hd> <p>LGBTQ+ community members described both affirming and disaffirming experiences seeking mental health counseling. Their contributions were organized into two subthemes: (a) how to look for and access an affirming provider, and (b) how affirmative care is provided. Given the purpose of the study, we focused our questions to LGBTQ+ community members on how they needed their providers to be trained in order to signal and provide affirmative care.</p> <hd id="AN0187978651-16">How Affirmative Care Is Located</hd> <p>LGBTQ+ individuals began by sharing key words and symbols they look for to signal an affirming provider. Some examples included counselors indicating competency in LGBTQ+ issues on their websites or Psychology Today profiles, non‐religiously affiliated language, and symbols like pride flags or stickers.</p> <p>I would say that if I'm looking through a list of providers and some of them have pronouns by their name and some of them don't, I'm immediately going to go to the ones that have the pronouns first, especially if it says something in their blurb about LGBT+ affirming, or especially if it says something about intersectionality, it's even better. So the little tags that people can put on their [Psychology Today] profile matter.</p> <p>LGBTQ+ community members also noted the need for inclusive intake forms that offered open response options to document sexual and gender identities. "All of their forms had open option pronouns on the actual forms. And that was immediately a green flag." Although not necessary, participants indicated preference for counselors who were LGBTQ+ themselves or at least had clear insider knowledge. One participant shared: "I wanted to pick someone who shared some sort of identity with me." But another participant stated: "I don't have to be in all the same demographics as my provider, but I need to know that they are sensitive to my needs. [My counselor] is not LGBT herself but is knowledgeable about the LGBT experience." Some LGBTQ+ participants noted that they "generally do look for younger counselors." One participant noted this was because "when you're bonding with someone of a similar age group, or one who's just a few years ahead, they're able to understand." Another participant noted: "I just think that they'll be more accepting of that kind of thing," indicating younger counselors were more likely to be LGBTQ+ affirming.</p> <p>Finally, LGBTQ+ folks stressed the importance of accessibility as a significant part to affirmative care. One participant noted: "My therapist has to be within my insurance because I could probably find someone who'd be a great fit, but I can't or won't pay out of pocket for it." Another shared: "At the moment too, [finding a counselor is] just a matter of what can I afford and what's easy to schedule." Ability to access care physically and financially, at times, superseded the aforementioned signals in identifying an affirming provider.</p> <hd id="AN0187978651-17">How Affirmative Care Is Provided</hd> <p>Once LGBTQ+ folks matched with a counselor, participants noted there was still risk in the counselor being disaffirming. LGBTQ+ individuals shared that how the counselor presents themselves is a strong indicator of whether or not they will be affirming. One participant shared: "I think it's important for counselors to do a self‐inventory to see how they could potentially be perceived by people of other demographics. The way that people present can immediately arm or disarm someone." An example of affirming presentation included the ways that counselors would nonverbally respond when clients discussed their LGBTQ+ identities: "Whether it's in facial expressions, body language, anything like that, I need someone who's going to visibly demonstrate to me that they're affirming." Presentation also involved visible symbols of allyship and involvement with LGBTQ+ people in the counselor's office (e.g., pride flags, symbols that show engagement with diversity and inclusion). "When I walk in my therapist's office, there's pride flags and pictures of her at pride events and things like that. I appreciate that."</p> <p>LGBTQ+ folks also described what they wanted their counselor to know and how the counselor should communicate their knowledge in order to be affirming. Specifically, participants indicated they needed their counselor to understand intersections of identities and within‐group differences. "There are a lot of intersections that I would want a counselor to be mindful and cognizant of, so my queer identity, my religious identity, socioeconomic class." Further, the counselor should have insight into relevant history and cultural phenomena that may affect LGBTQ+ people. "A counselor having educated themselves on gay history, I think would be something that would be helpful." This included being updated on LGBTQ+ terminology with an ability to use it appropriately in context, knowledge about polyamorous relationships, and sensitivity to family dynamics.</p> <p>Participants shared they needed their counselor to not assume that all mental health struggles are related to LGBTQ+ identity but still recognize that the issues at hand will be uniquely experienced as a LGBTQ+ person. One participant noted they needed a "counselor to be cognizant of the fact that not all emotional trauma is based on being gay. I was undiagnosed bipolar for a really long time, and I think it was because the focus was always on me being gay." Another participant similarly stated: "I've had my asexuality medicalized." Attending to the unique challenges LGBTQ+ people can encounter while not medicalizing their experiences was important.</p> <hd id="AN0187978651-18">Educational Methods Applied in Silo</hd> <p>Counselor educators described a myriad of content delivered and techniques utilized to prepare their students to provide LGBTQ+ affirmative care. Educators' contributions were organized into two subthemes: (a) LGBTQ+ content covered and (b) LGBTQ+ educational delivery methods. The overarching takeaway from counselor educators was that some LGBTQ+ content was included but often in siloed courses, and depth of delivery was instructor‐dependent.</p> <hd id="AN0187978651-19">LGBTQ+ Content Covered</hd> <p>Counselor educators indicated some LGBTQ+ affirmative care content that complemented LGBTQ+ community members' statements. Specifically, they noted the importance of teaching students to indicate their pronouns and ask for clients' pronouns early in the therapeutic relationship or in intake paperwork. "I tell students on your intake paperwork, have questions that allow for open response for the spectrum of sexual and gender identities." Some educators also encouraged students to advocate and attend LGBTQ+ events in the community to learn about the population: "Be active in LGBTQ <emph>[sic]</emph> communities. Go to PFLAG meetings, go to pride events and set up a booth and have a table or do things where you're actively involved in these communities." Finally, educators prompted students to familiarize themselves with LGBTQ+ terminology and display visible LGBTQ+ cues in their offices: "I have students think about the environment, what their office looks like, making sure they have demonstrations of diversity and inclusivity, like pride flags or representation of LGBT youth in posters, in their office."</p> <p>Counselor educators also described soft skills they aimed to teach their students, which they posited to align with tenets of LGBTQ+ affirmative care. First, they emphasized validation and empathy as significant skills to implement. "One of the first skills is to be very, very present and authentic with their clients. Honoring who that client is." Second, some counselor educators described teaching students about broaching (Day‐Vines et al. [<reflink idref="bib12" id="ref71">12</reflink>]):</p> <p>Using broaching in the first session or two. You can start to talk about those differences between the two of you [counselor and client], and that might give inroads to discuss further any concerns more directly connected to their queer or trans identities or other identities that they're presenting with.</p> <p>They also noted discussing the importance of receiving feedback and correction from clients without defensiveness. "Accepting feedback without becoming defensive would be another behavior I'd be looking for." Showing curiosity in these moments was important. Some educators used self‐disclosure about their own clinical experiences to drive this point home:</p> <p>I use examples of here's a time I didn't engage in affirming behavior. I misgendered someone or I misused terminology, I did something that was a microaggression. And then what do you do in that situation? And I'll try to use examples of myself again trying to normalize, we aren't going to get this right all the time. We can't and that's okay.</p> <p>Another educator similarly shared: "I like to bring in anecdotes of my experiences working with LGBTQ+ clients, especially times when I learn something new or have to repair with a client."</p> <p>Some counselor educators discussed teaching students about promoting LGBTQ+ affirmative practices and managing LGBTQ+ restrictive policies. For example, one school counseling educator noted:</p> <p>We have lots of conversations about the dynamics of what you can do in your office, and what you can't do in the school, perhaps. So if you're in a school that's not supportive, we discuss how you manage to honor a student's pronouns when the school is not honoring a student's pronouns.</p> <p>Other counselor educators reflected on the impact of legislation in their teaching as well: "With some of the laws that are being passed, especially in some southeastern states, laws that impact higher education and what we are 'allowed' to teach, there is concern about how we include diversity education anywhere in the curriculum."</p> <p>Some counselor educators noted teaching students about intersectionality and the minority stress model. "I do think teaching about minority stress or marginalization stress is important. Because even if queer or trans identity isn't a central piece of why [clients are] coming, how are their experiences of stress possibly heightened because of systemic factors?" Another participant agreed: "We do talk about the fact that the intersection of multiple marginalized identities creates a compounded set of challenges for children and students." One counselor educator noted utilizing applied research to teach students about LGBTQ+ affirmative care and even developing a LGBTQ+ affirmative training:</p> <p>Some of my colleagues and I developed a training in LGBTQ Affirmative Counseling that we're running this semester in our program ... When I'm talking about affirming counseling, I apply the [Pachankis et al. [<reflink idref="bib25" id="ref72">25</reflink>]] article. They reference the minority stress model for adaptive strategies and interventions to be affirming.</p> <p>This counselor educator further shared the ways they see affirmative care education moving more into a liberatory space by focusing on resiliency:</p> <p>I know I've taught more that harm reduction model where it's minority stress, marginalization stress. And I'm seeing more shifts now, we're trying to be more intentional about incorporating more about resiliency. Instead of gender dysphoria, move to gender euphoria. It's not just minority stress over here and here's all these negative mental health outcomes, but there's also a lot of resiliency and positive mental health outcomes that can come from holding LGBTQ+ identities and being true to who you are.</p> <p>Other counselor educators agreed on the utilization of a liberatory model of affirmative care education but questioned how to consistently implement this approach in counseling curriculum: "When you look at the ways this has been done, there's so much variation."</p> <p>Many educators discussed covering general concepts to support diverse people rather than content aimed at understanding specific LGBTQ+ constructs: "When I was mentioning the infusion of [LGBTQ+ content] in other courses, rather than it being like a 'Here's a model of identity development,' for example. I think more so it's in practice, 'How can we support diverse individuals?'" Another counselor educator shared: "I think a lot of our instructors are using diverse case studies and talking about LGBTQ+ identities in class, but there's not particular competencies or content tied like career counseling with LGBTQ folks." When probed why specific LGBTQ+ content was not included, counselor educators noted time and CACREP standards as challenges to integrating more LGBTQ+ content:</p> <p>We still don't have time to teach everything we need to teach... With CACREP, the conversation around multicultural issues and cross‐cultural counseling is required, but that could be intersectionality, or it could be anything. They could spend a whole semester, for instance, on social economic status, and not ever touch LGBT issues.</p> <p>Overall, all counselor educators indicated the importance of infusing multicultural concepts into curriculum and having diverse case studies, but only a few discussed providing students with instruction on specific LGBTQ+ constructs or critical models (e.g., minority stress).</p> <hd id="AN0187978651-20">LGBTQ+ Educational Delivery Methods</hd> <p>Counselor educators began discussing delivery methods by indicating the course(s) in which they believed LGBTQ+ content resides in their programs. All counselor educators noted their programs include LGBTQ+ content in the multicultural class. Some described other courses where LGBTQ+ affirmative care content could be integrated, such as human development, internship, or practice of mental health counseling.</p> <p>Most counselor educators indicated a program‐wide adoption of LGBTQ+ affirmative care instruction was lacking. For those programs where there was some LGBTQ+ focus, it was often led by one or few counselor educators within a program: "At the program level, we have nothing at all [about LGBTQ+ affirmative practice]. And that focus didn't come in until I came [to the program]." Another participant agreed: "What a great question, and such an easy answer, because I don't think we actually have one [LGBTQ+ affirmative care curriculum], to be really bluntly honest." One counselor educator offered a salient example to the point of diversity instruction without LGBTQ+ specificity: "Diversity is infused in all of our classes, but I can't tell you to what extent. And I suppose it would depend on the individual instructor, as to what amount of focus is placed on a certain population."</p> <p>Counselor educators also discussed instructional tools they utilized to teach students. In order to effectively engage LGBTQ+ clients, all counselor educators indicated the importance of fostering students' critical self‐reflection of their experiences and biases. One participant shared the importance of going beyond awareness and critically reflecting through discussions:</p> <p>I also try to help the students to really unpack the ways in which they experience socialization and critically questioning those things. And not just like, "Oh yeah, I'm aware of it." It's this clarification of values in that process and helping them to trace through how they've experienced socialization related to their affectional identity or gender identity. So I think that goes a step beyond being aware but really sitting back and critically questioning.</p> <p>Critical self‐reflection was also facilitated through assignments.</p> <p>I have had students do assignments matching terminology, doing experiential activities like the coming out stars in classes, giving them the gender unicorn or gender galaxy and saying, "Hey, fill this out and reflect on it." It's to enhance their own awareness of themselves and then how are they relating to others around gender and sexuality.</p> <p>Educators also discussed the utility of case studies and role plays in class that included LGBTQ+ individuals and issues relevant to the community: "I do case studies, and not just with LGBTQ people, but just in general of trying to present diverse clients, diverse families, diverse religious backgrounds." Another counselor educator shared: "One activity we're using is a video of a gender expansive person who is sharing example of being misgendered over the phone and asking students would they respond if a client was sharing experience like this as counselors." Some educators also noted bringing in guest speakers who identified as LGBTQ+ into their classrooms. Others included assignments where students were required to engage LGBTQ+ folks in the community or research LGBTQ+ topics. However, these assignments were often situated as group projects where only one group of a few students in a class would cover LGBTQ+ topics: "I do group paper projects as a culminating activity in that class. And usually, I'll often have one of my groups do their child counseling project on working with LGBT youth."</p> <p>In sum, the content and delivery of LGBTQ+ topics was generally housed within multicultural courses. Some counselor educators reflected on specific LGBTQ+ curriculum and instruction on critical models. However, most educators discussed general multicultural concepts and skills (e.g., critical self‐reflection, soft skills, inclusive intake paperwork, encouraging students to interact with diverse populations) rather than specific strategies to support LGBTQ+ individuals.</p> <hd id="AN0187978651-21">Developmental Implications for Providing Affirmative Care</hd> <p>CITs highlighted unique considerations for applying LGBTQ+ affirmative care with clients. Students' contributions were organized into two subthemes: (a) how affirmative care was learned, and (b) how affirmative care is provided.</p> <hd id="AN0187978651-22">How Affirmative Care Was Learned</hd> <p>In agreement with counselor educators, CITs discussed the role and impact of critical self‐reflection as they learned to become affirming counselors. They emphasized needing to understand their own lived experiences and biases in order to be effective counselors. "A big thing for me is just constantly checking my values and my biases and my assumptions." Another participant agreed: "There's a big push to understand how our own identities are interacting with the identities of clients." One CIT shared how they explored biases in their program: "We do activities to push you to think about your own privileges and I guess lack of privileges that you hold and how you would interact with somebody else. So it is a lot of journal and reflection activities." Students noted needing to learn LGBTQ+ terms and practice sharing pronouns and engaging in inclusive language with clients.</p> <p>Some CITs shared they received LGBTQ+ affirmative care training from their programs, largely through their multicultural class: "We talk about [LGBTQ+ content] in multicultural class, which is where we talk about general topics regarding other cultures and communities and all like that." Most participants noted learning terminology through the course: "In multicultural counseling, we went over terminology, for sure. It looked at the difference between sexual orientation, sexual identity, gender identity, intersex and all of that." One CIT described an assignment in their multicultural course focused on biases that could involve LGBTQ+ content:</p> <p>In my multicultural class, we have a bias resistance project and it's a multi‐step project throughout the entire semester that we have. And we identify a population that we might have bias or discomfort or a gap of knowledge in. And I've actually had people be very vocal in the class to say that "no, I picked a LGBTQ population." Or they specifically said, "I picked a trans population." And our professor, you propose your concept, you propose how you plan to educate yourself and that's tier one. Tier two is: receive an education, educating yourself on your own time. And phase three is the final phase where we actually engage one‐on‐one with someone and get firsthand experience.</p> <p>Some also noted learning in their ethics course: "We did discuss affirming counseling in ethics, as like, don't impose your own values onto clients." Some CITs indicated their instructors utilized continuing education opportunities outside of the program: "I'm doing the SAIGE [Society for Sexual, Affectional, Intersex, and Gender Expansive Identities] training, it's an assignment in my multicultural counseling class."</p> <p>Most CITs, however, indicated they did not learn particular theories or models to work with LGBTQ+ people: "I didn't learn specific theories to use for the LGBTQ+ population. It was more general counseling theories and how to adapt for diverse clients." Another agreed: "I really don't feel like I could say confidently that I've had any kind of training that has prepared me to work with LGBTQ+ clients." As a result, some CITs sought LGBTQ+ content through continuing education outside of their program requirements: "I definitely utilize conferences to learn more." Another participant shared: "I'm going to two presentations [on LGBTQ+ affirmative counseling] in April hosted by PESI [a web‐based continued education resource]."</p> <p>Some CITs indicated that despite learning about various affirmative care techniques, their ability to implement affirmative care was challenged at their clinical sites. One participant shared: "I asked my internship site supervisor what the preferred <emph>[sic]</emph> pronouns for specific students are that I was working with, and she was like, oh no we're not going to worry about that." A CIT shared a similar non‐affirming example from their practicum: "We had an LGBTQ‐training, and we were learning different pronouns and just ways of using inclusive language. And my supervisor just straight up was like, 'Morally, I can't do this.' And it turned into this whole legal thing."</p> <p>Some participants indicated that supervision with counseling faculty was helpful, particularly when clinical sites presented challenges to LGBTQ+ affirmative care: "I've gotten a lot of feedback on ways to use effective broaching." Another participant agreed: "We were taught broaching my first semester and every class has a broaching assignment in it." One participant shared receiving feedback from a LGBTQ+ identifying faculty was especially helpful:</p> <p>I have a trans‐masculine faculty who just happens to be my advisor as well and he makes a point to disclose identity and kind of does modeling with how he would approach a client case differently because of his lived experience as a counselor, but also how a LGBTQ+ client might view that.</p> <p>Another CIT talked about feedback through internship evaluations from faculty as well: "There's multiple different sections about multicultural competence in a counseling relationship, how I demonstrate respect for culture, like race, ethnicity, gender, sexual orientation, gender expression and awareness and responsiveness."</p> <p>Most CITs believed they needed more instruction on LGBTQ+ affirmative care in their programs. "More education overall, maybe more trainings, more personal experiences as well could be really helpful in hearing how other people have either a) counseled people of that population, or b) LGBTQ+ people that feel comfortable sharing their experiences." Another participant agreed: "I think I would definitely add more curriculum about [LGBTQ+ affirmative care] because again, I don't feel like it is talked about enough." Finally, some participants acknowledged wanting their programs to implement a consistent LGBTQ+ affirmative curriculum:</p> <p>I feel like a lot of times it is students who hold marginalized identities that are doing a lot of the speaking up about LGBTQ+ issues, and that's obviously great if they feel empowered to do so. But in terms of faculty just being on the same page about things, I feel like that's something that could definitely be improved with my program.</p> <p>Another participant agreed, sharing an example of how LGBTQ+ content is integrated inconsistently: "It's kind of professor dependent. One of my instructors that really brings up the multicultural and LGBTQ+ aspects and is very aware of those, he is a professor who holds multiple minority identities." CITs overall agreed that their LGBTQ+ affirmative care training varied based on the instructor.</p> <hd id="AN0187978651-23">How Affirmative Care Is Provided</hd> <p>CITs emphasized applying similar types of affirmation that educators noted: ask clients about pronouns, inclusive intake forms, and use neutral language when discussing romantic or sexual partners. "During that intake, I specifically ask, what are your pronouns? How do you identify? So just that clear communication and understanding." Another participant shared:</p> <p>During the first session, just broaching with them and asking what aspects of their identity they feel are the most salient and asking them to describe how those identities present themselves in their lives could be really valuable. I've also been practicing at my site is asking, "Are you in a relationship? Do you have a partner?" to be more inclusive regarding romantic relationships as well.</p> <p>One slight variation between CITs and counselor educator groups was in the application of advocacy as an affirmative technique. CITs described the importance of making LGBTQ+ advocacy or allyship visible to their clients. While counselor educators did reflect on teaching LGBTQ+ advocacy strategies and encouraging students to engage with the LGBTQ+ community, they did not emphasize making one's advocacy concretely visible to clients. Some examples of visible allyship included: having photos of participation in LGBTQ+ events visible in the counselor's office, having a public professional social media page to display LGBTQ+‐related content, and discussing the counselor's LGBTQ+ legislative advocacy with clients. For example: "It's important that LGBTQ+ clients know I'm actually an ally and not just saying that I am. So I make sure to have pictures of me attending Pride or other LGBTQ+ events in my office space." Counselor educators generally noted not having previously considered this strategy in their teaching methods.</p> <p>That's neat. I haven't really thought of that connection. It's not just performative, because I think sometimes the signaling could potentially be just performative, "Oh, let me put up a rainbow." But if I'm actually going and doing these things, then it's more of a reality of, "No, I'm actually committed to being affirming and being an advocate." That's useful.</p> <p>Some counselor educators noted variability in visible allyship could be related to age, in that they perceived millennial or GenZ CITs to be socialized within a more open and affirming environment compared to older generations.</p> <p>Another component of CITs methods that differed from counselor educators was around language use. Students indicated the importance of signaling affirmation by using "non‐judgmental" as a phrase in their marketing materials. "As far as what I give to clients, obviously I'm always non‐judgmental." Another participant shared: "In any intake that I receive a new client, I always state that I'm non‐judgmental and that this is a place where they can feel safe."</p> <p>Interestingly, the LGBTQ+ community group members indicated the phrase "non‐judgmental" would be disaffirming, in that if a provider were truly affirming, they would not need to signal themselves as non‐judgmental. From our LGBTQ+ community participant perspectives, "non‐judgmental" indicates someone is trying to appear inclusive without being so. One LGBTQ+ community member shared: "I'm not so sure about putting non‐judgmental care. I think it's become a political issue, and just to me, that actually indicates someone more conservative than someone who's more liberal." Other LGBTQ+ community participants agreed: "I feel like that should be a given that counselors are not going to be judgmental. If you have to say, I'm not judgmental, to me that's a sign that they probably actually are and they're fighting it." Another example: "I tend to prefer things in the affirmative care versus non‐judgmental." Counselor educator participants described this finding as developmentally appropriate given CITs novice status and alignment with core principles of the therapeutic relationship (i.e., genuineness, empathy, unconditional positive regard; Rogers [<reflink idref="bib29" id="ref73">29</reflink>]. In sum, CITs reflected learning some LGBTQ+ affirmative care content but with varied degrees of depth and consistency, which led them to seek additional education or supervision.</p> <hd id="AN0187978651-24">Discussion</hd> <p>Through community‐based methods, LGBTQ+ community members, CITs, and counselor educators informed our understanding of what and how LGBTQ+ affirmative care curriculum is currently being taught in counselor education. By interviewing multiple groups, we created a feedback loop to identify key gaps between education and practice. Findings yielded implications for educational practices that should continue and those that may be improved upon.</p> <p>Counselor educators are preparing CITs in this sample to meet some of the identified needs among LGBTQ+ community members. Of note, current LGBTQ+ terminology, inclusive intake paperwork, affirming signaling in marketing materials, using neutral and affirming language for sexual and gender identities, broaching, and counselors' critical self‐reflection abilities were identified as being taught, learned, and needed from each group. This finding complements existing LGBTQ+ affirmative practice recommendations (Burnes et al. [<reflink idref="bib4" id="ref74">4</reflink>]; Ginicola et al. [<reflink idref="bib16" id="ref75">16</reflink>]; Harper et al. [<reflink idref="bib17" id="ref76">17</reflink>]; Pachankis et al. [<reflink idref="bib25" id="ref77">25</reflink>]) and indicates a positive trend in LGBTQ+ affirmative care education. However, there were notable gaps in the delivery of this LGBTQ+ content: depth of critical self‐reflection and consistency in delivery.</p> <p>First, findings related to critical self‐reflection showed that LGBTQ+ community members generally assumed younger counselors were more likely to be knowledgeable about LGBTQ+ issues, accepting, and/or more liberal in political ideology. Client preferences for counselors with particular characteristics have previously been shown as an important factor in help‐seeking behaviors among LGBTQ+ people (Spengler et al. [<reflink idref="bib31" id="ref78">31</reflink>]), which indicates CITs must critically examine how LGBTQ+ clients may perceive them. Second, CITs largely received LGBTQ+ affirmative care training in a singular course from one or two counselor educators who may identify as LGBTQ+ themselves or from an external resource outside of their counseling programs. This finding is not surprising, given existing research that documents a lack of robust LGBTQ+ curricula in counselor education (Moe et al. [<reflink idref="bib23" id="ref79">23</reflink>]) and consistent reports of under‐preparedness to work with LGBTQ+ people from counselors (Carrington and Sims [<reflink idref="bib5" id="ref80">5</reflink>]; Ginicola et al. [<reflink idref="bib16" id="ref81">16</reflink>]; Killian et al. [<reflink idref="bib20" id="ref82">20</reflink>]; Moe et al. [<reflink idref="bib23" id="ref83">23</reflink>]).</p> <p>Expanding on existing research that documents a dearth of LGBTQ+ curricula in counselor education, our findings indicated a notable gap between education and practice via a lack of utilization of critical theories (e.g., minority stress theory, intersectionality, queer theory) in instruction. Counselor educators relied more generally on developing students' general multicultural competence to serve diverse populations. Similar to implications from previous research, this approach neglects the importance of training students to be culturally informed for LGBTQ+ and other minoritized groups specifically (Chan et al. [<reflink idref="bib6" id="ref84">6</reflink>]; Cor et al. [<reflink idref="bib8" id="ref85">8</reflink>]). This gap in instruction may be due to the legal challenges that participants reflected on, which other researchers also indicated as a barrier (Rose et al. [<reflink idref="bib30" id="ref86">30</reflink>]). Yet, the importance of counselors being knowledgeable about the impact of discrimination on mental health (i.e., minority stress) and the role of power and privilege (i.e., intersectionality), alongside conceptualization skills that deconstruct heteronormative ideas of identity and healthy relationships (i.e., queer theory), cannot be overstated.</p> <hd id="AN0187978651-25">Limitations</hd> <p>There are several limitations to consider in the current study. First, community‐based methods require that participants interact with each other, which may introduce subjectivity or unintended influence between participant groups and the researchers. The authors acknowledge this potential limitation, but the purpose was to embrace the subjectivity rather than eliminate it. The sample was predominantly White and cisgender, and the study was situated in the Southern US region. By focusing on one US region, we acknowledge the transferability of our findings to other regions may require attending to variable cultural norms. Another limitation is that the authors did not examine the relationship between counselor educators' identities or experiences and their inclusion of LGBTQ+ affirmative care instruction. Additionally, snowball sampling could have resulted in connections between participants that were unknown to the researchers. Maximum variation sampling may be used in future research designs to address this limit. Next, the scope of the research was limited by the narrow scope of existing research on LGBTQ+ affirmative care in counseling. This limitation indicates that continued research and expansion of affirming care for LGBTQ+ folks is needed.</p> <hd id="AN0187978651-26">Implications</hd> <p>The study findings offer multifaceted implications for improved practice in LGBTQ+ affirming care training in counselor education. To begin, LGBTQ+ community members indicated a desire for counselors who appear younger. This is a challenging finding because neither counselors nor counselor educators can control client assumptions or profiling. However, counselor educators should expand beyond reflective activities related to student biases and be intentional in having their students reflect on how they may be perceived by future LGBTQ+ clients. Being mindful of how one may be profiled can also generally support increasing accessibility of affirmative care for LGBTQ+ and other minoritized groups. To mitigate potential profiling as disaffirming due to age, CITs should ensure visible signs of affirming practice, such as those described within the findings—visibility throughout marketing materials, intake paperwork, and interpersonal interactions with potential clients is needed.</p> <p>Given the findings indicated a lack of consistency in coursework delivery, holistic integration of LGBTQ+ affirmative care instruction is needed in counselor education programs. Reliance on one or few counselor educators to bear the burden of instruction can not only lead to underprepared counselors, but it also can result in counselor educators' experiencing tokenism, isolation, and burnout (Thacker and Barrio Minton [<reflink idref="bib34" id="ref87">34</reflink>]). Affirmative care should be infused throughout the curriculum rather than placed in a single course or on a single educator.</p> <p>Integration of LGBTQ+ affirmative care instruction throughout coursework may include immersion and experiential activities that provide opportunities for students to learn LGBTQ+ history, practice affirming counseling skills (i.e., curiosity and acceptance in nonverbal cues, open questions, accurate reflections that utilize LGBTQ+ constructs), practice effective uses of LGBTQ+ language, practice conceptualization skills that are non‐medicalizing of LGBTQ+ people or issues, or practice advocating for the population. At the program level, counseling faculty can examine when and how to integrate one or more of these learning opportunities into each core area of learning. At an individual level, counselor educators can use self‐disclosure as an instructional tool to discuss how they have navigated clinical work with LGBTQ+ clients. Counselor educators may also integrate relevant research (e.g., Pachankis et al. [<reflink idref="bib25" id="ref88">25</reflink>]) into their instruction to enhance students' LGBTQ+ affirmative care knowledge.</p> <p>Integration of relevant LGBTQ+ affirming care research in the classroom should also involve critical theories. LGBTQ+ community members indicated that they could sense when counselors were trying to be neutral but still came through as uncomfortable or unknowledgeable. Critical theories can help merge the gap between a counselor being simply non‐judgmental from a neutral stance and truly understanding the LGBTQ+ people's experiences and needs. Importantly, critical theoretical frameworks would also help reduce the likelihood of medicalizing LGBTQ+ issues (Tilsen [<reflink idref="bib37" id="ref89">37</reflink>]). Counselor educators should be mindful to educate themselves on critical theories and apply them in the classroom. Critical theories may first be a component of the counseling theories course, but they should also be integrated into other core areas (e.g., assessment and diagnosis, human development) and clinical courses so that students have opportunities to apply them in practice with clients.</p> <p>Finally, CITs encountered challenges in applying LGBTQ+ affirmative care at their practicum and internship sites. Counselor educators can be mindful to build relationships with clinical sites that more readily integrate affirming practices. In times where that is not possible or legally challenging, counselor educators should engage advocacy with site supervisors. For example, educators may offer LGBTQ+ affirmative care trainings to site supervisors and confirm supervisors understand and can evaluate a supervisee's practice of LGBTQ+ affirmative care. Consistency between training and practice is key, and counselor educators hold the necessary power and influence to ensure students are trained effectively and LGBTQ+ clients are ultimately well served.</p> <p>The study findings and limitations offer considerations for future research. To begin, the participant sample was limited such that future research can expand on findings by pursuing a national, racial, and gender‐diverse sample. Given the significance of a counselor educator's philosophy and experiences on their teaching (Moe et al. [<reflink idref="bib24" id="ref90">24</reflink>]), researchers may explore connections between participant identities and professional practices. The curriculum‐practice gaps identified in this study may be related to the privileged identities among many of the counselor educator and CIT participants. These participants also may have entered the study from a committed stance to LGBTQ+ affirmative care, which may not be the case for all counselor educators or CITs. Future research may address the needs for preparing counselor educators with dominant, privileged identities to improve their attention to issues of intersectionality throughout curriculum. Finally, future research may employ a similar community‐based method to explore LGBTQ+ affirmative care training in counselor education but also include counselors in the field. Inquiring about the gaps between continuing education post‐degree and practice could be fruitful.</p> <hd id="AN0187978651-27">Conclusion</hd> <p>A community‐based exploration with LGBTQ+ community members, CITs, and counselor educators indicated significant gaps in LGBTQ+ affirmative care training in counselor education. Namely, counselor educators can improve integration of LGBTQ+ content across the counseling curriculum, integrate critical theories into instruction, and support students through clinical experiences. There have been impactful advancements in counselor education, and there is always room to grow.</p> <hd id="AN0187978651-28">Acknowledgments</hd> <p>The project was funded by the Spencer Foundation.</p> <ref id="AN0187978651-29"> <title> References </title> <blist> <bibl id="bib1" idref="ref68" type="bt">1</bibl> <bibtext> Association for Counselor Education and Supervision. 2021. Regions. accessed, 2025, https://acesonline.net/regions/.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref63" type="bt">2</bibl> <bibtext> Braun, V. and V. Clarke eds. 2021. Thematic Analysis: A Practical Guide. Sage.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref67" type="bt">3</bibl> <bibtext> Brown, K. and C. J. Nash, eds. 2016. 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  Data: LGBTQ+ Affirmative Care Training in Counselor Education: A Community-Based Inquiry
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  Data: <searchLink fieldCode="AR" term="%22Nancy+E%2E+Thacker+Darrow%22">Nancy E. Thacker Darrow</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-6475-3656">0000-0002-6475-3656</externalLink>)<br /><searchLink fieldCode="AR" term="%22Kamden+K%2E+Strunk%22">Kamden K. Strunk</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5613-218X">0000-0002-5613-218X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Thea+L%2E+Racelis%22">Thea L. Racelis</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0004-5884-4473">0009-0004-5884-4473</externalLink>)
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  Data: <searchLink fieldCode="DE" term="%22LGBTQ+People%22">LGBTQ People</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Services%22">Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22Counselor+Training%22">Counselor Training</searchLink><br /><searchLink fieldCode="DE" term="%22Counselor+Educators%22">Counselor Educators</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Needs%22">Educational Needs</searchLink><br /><searchLink fieldCode="DE" term="%22Community+Needs%22">Community Needs</searchLink>
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  Data: Counselor educators, counselors-in-training, and LGBTQ+ community members engaged in a community-based qualitative inquiry exploring LGBTQ+ affirmative care education. Findings revealed counselor educators' components and delivery of content, developmental implications for applying LGBTQ+ affirmative care, and gaps between education and LGBTQ+ community needs. Implications for education and research are provided.
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