Issues and next steps for LGBTQ+ inclusion in clinical psychological science

Recently, much-needed attention has been brought to the issue of diversity in clinical psychological science, recognizing the systemic barriers that historically underrepresented groups, especially racial and ethnic minority individuals, face to inclusion and equal opportunity in the field. However, such conversations often neglect diversity of sexual orientation and gender identity.

LGBTQ+ individuals are underrepresented in the sciences (Freeman, 2020). Studies have documented higher attrition on pathways to STEM careers for LGBTQ+ individuals (Hughes, 2018), as well as frequent experiences of discomfort, pressure, and invisibility for LGBTQ+ academics (Bilimoria & Stewart, 2009; Patridge et al., 2014). Exclusionary work environments in STEM have been linked to negative effects on productivity, career success, and job satisfaction (Mattheis & Yoder, 2019). The social sciences have a reputation for greater openness and inclusivity, but a 2015 study of 1,427 LGBTQ+ professionals in various academic fields showed that psychology faculty report levels of identity openness lower than faculty in the other social sciences, closer to the rates seen in fields such as engineering and math (Yoder & Mattheis, 2016). While research on exclusionary attitudes in clinical psychology in particular is not available, a 2020 survey found that LGBTQ+ clinical psychology PhD applicants typically reported being advised not to discuss personal information such as sexual orientation in interviews (Hsueh et al.).

It is unclear why psychology seems to prove an exception in LGBTQ+ inclusivity among the social sciences, but the field certainly has a thorny history with sexual and gender minority identities. While attitudes have shifted greatly in recent decades, the DSM pathologized homosexuality as a “sociopathic personality disturbance” or “sexual deviation” until 1973. Even currently, most individuals who seek gender-affirming care must be diagnosed with “gender dysphoria,” placing mental health care providers in a gatekeeper role that requires individuals with non-cisgender identities be formally designated as disordered. Moreover, while LGBTQ+ literacy is growing among mental health care providers, many LGBTQ+ people currently interested in pursuing psychology may have had negative or traumatic experiences related to mental health care in their personal histories, including being subjected to the harmful and discredited practice of conversion therapy or involuntarily hospitalization in single-sex wards incongruent with their gender identity. In short, clinical psychology has considerable baggage that may discourage or even dissuade individuals who are otherwise motivated to enter the field.

Psychological science is held back by these challenges to diversity. Systemic barriers and a non-inclusive climate deter talented LGBTQ+ individuals from entering the field and hamper the career success, longevity, and productivity of those who do. Furthermore, research shows that teams composed of people with more diverse perspectives are better equipped to solve complex problems. In fact, a large study recently showed that researchers with underrepresented identities are more likely to produce “scientific novelty,” though such contributions also tend to be systematically undervalued (Hofstra et al., 2020).

This is also a matter of justice. Sexual orientation and gender identity should not determine the success of an individual’s research career or their comfort at work. Research is clear that work environment is a major determinant of wellbeing, and stressors such as identity concealment, expectations of rejection, and experiencing exclusionary behaviors have a well-documented impact on emotional and physical health. While progress has been made, further change is needed to create an environment where LGBTQ+ researchers can thrive in clinical psychological science and the field can receive the full benefit of the inclusion and nurturance of LGBTQ+ talent.

What can be done? Here are some proposed steps:

• Recognize sexual orientation and gender minority status as a valuable form of diversity. LGBTQ+ clinical psychology PhD applicants weigh programs’ commitment to diversity more heavily than cisgender heterosexual applicants in their decision-making processes (Hsueh et al., 2020). Research environments, including training programs, should actively recruit LGBTQ+ candidates and take steps to foster a climate that is inclusive and supportive for them once they arrive. Both training programs and other research settings can provide education and implement policies to create a more aware and inclusive climate for LGBTQ+ people.
• Conduct research on the experiences of LGBTQ+ people in the field. Recently, small amounts of research have directly explored the experiences of LGBTQ+ trainees or faculty in engineering (Cech & Rothwell, 2018), biology (Cooper et al., 2019), social work (Prock et al., 2019), and school psychology (Chen et al., 2021). However, no such comparable research has been done for clinical psychology, limiting our understanding of the issue.
• Facilitate access to quality mentorship and other networking opportunities. Lack of adequate mentorship is a recognized issue for underrepresented minorities, and without it, students and early career researchers may struggle to navigate the complex “hidden curriculum” of academia. Intentionally or unintentionally, mentors often support those similar to them. It may be challenging for LGBTQ+ trainees or early career researchers to find support, especially given that the presence of a significant “out” LGBTQ+ community in research is relatively new — openly gay and lesbian individuals were barred from federal employment until 1975, and LGBTQ workplace discrimination protections have made inconsistent progress.
• Use inclusive language. Written and spoken language is an important indicator of climate. Avoiding assumptions and reducing cisheteronormative language can go a long way towards creating greater comfort and connectedness in academic settings for LGBTQ+ individuals. This includes sharing and respecting personal pronouns and acknowledging that these may change over time.

In efforts such as these, institutions must balance ensuring minority communities can offer their valuable contributions to diversity initiatives with avoiding tokenism or making excessive demands of an already marginalized community. That means taking care to not rely solely on members of these groups to mentor students with similar identities, educate those around them, or advocate insistently in order for changes to be made. This outlines a clear and active role for allies — perhaps better conceived as “accomplices” — in disrupting the status quo and creating opportunities to improve the experiences of LGBTQ+ individuals in clinical psychology.

References

Bilimoria, D., & Stewart, A. J. (2009). “Don’t ask, don’t tell”: The academic climate for lesbian, gay, bisexual, and transgender faculty in science and engineering. NWSA Journal, 21(2), 85–103.

Cech, E. A., & Rothwell, W. R. (2018). LGBTQ inequality in engineering education. Journal of Engineering Education, 107(4), 583–610. https://doi.org/10.1002/jee.20239

Chen, C. Y.-C., Panebianco, A., & Verkuilen, J. (2021). Exploration of the experiences of sexual and gender minority students in school psychology programs. Psychology of Sexual Orientation and Gender Diversity. Advance online publication. https://doi.org/10.1037/sgd0000485

Cooper, K. M., Brownell, S. E., & Gormally, C. (2019). Coming out to the class: Identifying factors that influence college biology instructor decisions about revealing their lgbq identities in class. Journal of Women and Minorities in Science and Engineering, 25(3). https://doi.org/10.1615/JWomenMinorScienEng.2019026085

Freeman, J. B. (2020). Measuring and resolving LGBTQ disparities in STEM. Policy Insights from the Behavioral and Brain Sciences, 7(2), 141–148. https://doi.org/10.1177/2372732220943232

Hofstra, B., Kulkarni, V. V., Galvez, S. M. N., He, B., Jurafsky, D., & McFarland, D. A. (2020). The diversity–innovation paradox in science. Proceedings of the National Academy of Sciences, 117(17), 9284–9291. https://doi.org/10.1073/pnas.1915378117

Hsueh, L., Werntz, A., Hobaica, S., Owens, S. A., Lumley, M. A., & Washburn, J. J. (2021). Clinical psychology PhD students’ admission experiences: Implications for recruiting racial/ethnic minority and LGBTQ students. Journal of Clinical Psychology, 77(1), 105–120. https://doi.org/10.1002/jclp.23074

Hughes, B. E. (2018). Coming out in STEM: Factors affecting retention of sexual minority STEM students. Science Advances, 4(3), eaao6373. https://doi.org/10.1126/sciadv.aao6373

Mattheis, A., De Arellano, D. C. R., & Yoder, J. B. (2019). A model of queer STEM identity in the workplace. Journal of Homosexuality, 67(13), 1839–1863. https://doi.org/10.1080/00918369.2019.1610632

Patridge, E. V., Barthelemy, R., & Rankin, S. R. (2014). Factors impacting the academic climate for LGBQ STEM faculty. Journal of Women and Minorities in Science and Engineering, 20(1), 75–98. https://doi.org/10.1615/JWomenMinorScienEng.2014007429

Prock, K. A., Berlin, S., Harold, R. D., & Groden, S. R. (2019). Stories from LGBTQ social work faculty: What is the impact of being “out” in academia? Journal of Gay & Lesbian Social Services, 31(2), 182–201. https://doi.org/10.1080/10538720.2019.1584074

Yoder, J. B., & Mattheis, A. (2016). Queer in STEM: Workplace experiences reported in a national survey of LGBTQA individuals in science, technology, engineering, and mathematics careers. Journal of Homosexuality, 63(1), 1–27. https://doi.org/10.1080/00918369.2015.1078632