Pride in Practice: Creating Affirming SLP Services for LGBTQ+ Clients
At The Big Picture SLP, we believe that adequate speech-language pathology (SLP) services must be rooted in equity, identity, and intentional care. That means going beyond “treating communication disorders” and into creating therapeutic spaces where every client feels seen, heard, and respected.
For LGBTQ+ clients—especially those who are transgender, nonbinary, or gender nonconforming—speech-language services can be deeply personal, transformative, and sometimes harmful if not approached with affirming practices.
In honor of Pride and year-round advocacy, let’s talk about what affirming care looks like in SLP—and why it’s time to reimagine what inclusive practice means.
🌈 What Is Affirming SLP Care?
Affirming care means more than using correct pronouns or rainbow-themed visuals. As Lunaris et al. (2023) emphasize, affirming SLP practice involves:
Cultural humility and reflection on clinician biases
Systemic understanding of how LGBTQ+ individuals experience healthcare
Client-led goal setting that centers identity, safety, and self-expression
In other words, affirming care isn’t a checkbox. It’s a commitment to equity-driven clinical practice.
💼 Inclusive Intake and First Impressions Matter
The client experience begins long before the first session. Intake paperwork, waiting room visuals, and how you introduce yourself all send messages.
Affirming practices include:
Intake forms that include open-ended fields for name, pronouns, and gender identity
Offering opt-in privacy for legal vs. preferred names
Using gender-inclusive language throughout documentation and conversations
Creating physical and digital spaces that reflect diverse identities, not just heteronormative ones
As Vastine & Butcher (2024) note, environments that reflect LGBTQ+ lives signal psychological safety—a key ingredient in therapeutic progress.
🎯 Goal Setting That Reflects the Whole Person
Too often, goals are written from a “norm-referencing” perspective: What does the client lack? What’s “appropriate” or “typical”?
Instead, affirming goal setting asks:
What does this client want their voice or communication to do?
How does their gender, culture, or identity shape that?
What situations matter most to them?
For example, a trans client seeking voice therapy may want to explore pitch, intonation, and resonance—but also voice confidence in public speaking, work meetings, or with family.
Hosbach-Cannon et al. (2022) urge clinicians to avoid over-reliance on binary gender models and instead co-create voice goals that reflect nonbinary and gender-expansive experiences. That might include playing with fluidity, adaptability, and expressive range.
🗣 Voice Therapy Without the Binary Box
Voice therapy is one of the most direct ways SLPs engage with gender and identity. But it’s also where harmful assumptions can sneak in.
Common microaggressions include:
Assuming a binary “masculine” or “feminine” target
Using cisnormative voice samples as the only model
Centering anatomical or diagnostic frameworks instead of lived experience
Instead, affirming voice care means:
Asking clients how they want to sound, feel, and be perceived
Using the Hancock et al. (2024) voice questionnaire to guide discovery, not judgment
Exploring a wide range of vocal possibilities and emotional nuance
Respecting fluidity, change, and ambiguity in voice expression
❌ Common Microaggressions—and How to Avoid Them
Micro-aggressions may seem “small,” but they erode trust and reinforce harm. Some to watch for in SLP:
Misgendering clients, even “accidentally”
Asking about medical transition when it’s irrelevant
Referring to gender identity as a “preference” or “lifestyle”
Treating voice change as “optional” or “non-essential”
To avoid these:
Practice correct pronoun usage daily—even when clients aren’t present
Check your documentation for outdated or binary language
Apologize sincerely and move forward when mistakes happen
Prioritize ongoing education—don’t rely on clients to teach you
📣 A Call to Reflect and Grow
Affirming care is a lifelong practice. It requires curiosity, humility, and the willingness to get it wrong—and try again.
Here are some questions to reflect on this week:
How affirming is my intake process—for trans, queer, and gender-diverse clients?
Do my therapy materials reflect LGBTQ+ lives and voices?
Am I creating space for clients to lead their own goals?
What have I done lately to expand my knowledge of gender-inclusive care?
If you're ready to grow, learn, and reimagine what inclusive therapy looks like, we’re here to support you.
💬 Let’s Build Better Together
At The Big Picture SLP, we offer affirming voice therapy, identity-centered care planning, and clinician mentorship grounded in equity and reflection.
🗓 Book a consult or download our LGBTQ+ inclusive practice guide at
👉 bigpicturespeechlanguageservices.com
Pride isn’t just a month. It’s a practice.
References
Lunaris, A. et al. (2023). Upholding LGBTQ+ Inclusive Practices in CSD
Hosbach-Cannon, J. et al. (2022). Voice Models Beyond the Binary
Vastine, M. & Butcher, L. (2024). Culturally Responsive Gender-Affirming Voice Care
Hancock, A. et al. (2024). Exploring Client Voice Preferences Questionnaire