A look at “The Development of LGBTQ+ Cultural Competence and Cultural Humility Among LGBTQ+ Counselors: A Constructivist Grounded Theory” by Rattanakorn Ratanashevorn, Phillip Waalkes, Susan Kashubeck-West and Rafe McCullough (2026)
You might assume that a queer therapist would automatically be brilliant with queer clients. Shared experience helps, of course. But this American study suggests that genuinely skilled LGBTQIA+-affirming practice is something that’s grown, tended and sometimes rescued from drought. And the authors use a delightfully horticultural metaphor to describe it.
What they found
The researchers interviewed 12 LGBTQIA+ counsellors, nominated by their peers as working particularly well with LGBTQIA+ clients. They asked how these counsellors had developed two things. Cultural competence is the knowledge and skills to work well with LGBTQIA+ clients. Cultural humility is the ongoing openness to learn, to admit what you don’t know and to be led by the client. From the interviews, they built a five-stage model.
- Planting the seed. Motivation to “do right by” queer clients came from noticing gaps in training, seeing harmful practices in the field, awareness of injustice, and a strong sense of responsibility.
- Cultivating the nutrient soil. Counsellors reflected on their own cultural position, including their privileges, blind spots and identities, and actively built their knowledge and skills.
- Growth and expansion. They brought what they’d learned into sessions while openly acknowledging its limits. They didn’t assume that knowing about LGBTQIA+ issues in general meant knowing this client.
- Fruition. The results showed up as strong relationships with clients, keeping LGBTQIA+ issues central where relevant, and advocacy beyond the therapy room.
- Nourishment and remedies for dryness. The work can be draining, especially for queer therapists carrying their own experiences of minority stress. Counsellors described self-care, support networks and keeping a positive outlook as essential for staying the course.
The authors highlight three hallmarks of cultural humility in practice: a lack of arrogance, embracing mistakes, and focusing on the other person.
A grain of glitter ✨
This is a thoughtful study with a memorable and practical model, and recruiting through peer nomination is a clever way to find skilled practitioners. But it has the usual limits of a small qualitative study.
Twelve participants is a modest number, and peer nominations reflect reputation, which isn’t always the same as actual skill. The model is built entirely from therapists’ perspectives, so we don’t know whether their clients would describe them the same way. That’s a gap the authors acknowledge. All participants were LGBTQIA+ themselves, so the model may not apply directly to non-queer therapists, and it’s set in a US context.
Why this matters
If you’re looking for an LGBTQIA+-affirming therapist, this study offers a useful lens. Look for someone who knows their stuff but doesn’t think they know everything about you, who’s comfortable admitting mistakes, and who keeps the focus on your experience. Shared identity can be a wonderful bonus, but humility and curiosity matter just as much.
A great therapist is less like a finished topiary unicorn and more like a well-tended garden: always growing, occasionally weeded, never quite done.