These answers draw in part from “Minimizing Implicit Bias in Practice: We Can Do Better for LGBT+ Folx” by Cassi Breaux, M.A., M.S., BCBA (BehaviorLive), and extend it with peer-reviewed research from our library of 27,900+ ABA research articles. Clinical framing, BACB ethics code references, and cross-links below are synthesized by Behaviorist Book Club.
View the original presentation →Gender identity is a person's internal sense of their own gender, which may be male, female, non-binary, or another identity. Gender expression is how a person outwardly presents their gender through clothing, behavior, hairstyle, and other visible characteristics. Sexual orientation refers to the pattern of emotional, romantic, or sexual attraction to others. These three dimensions are independent: knowing one does not determine the others. A transgender person can have any sexual orientation. A person whose gender expression does not conform to stereotypical expectations may identify as cisgender. Understanding these distinctions is essential for accurate clinical communication.
Implicit bias operates outside conscious awareness and can influence clinical decisions, therapeutic rapport, and the treatment environment. Specific effects may include inconsistent use of correct pronouns, differential attention or engagement during sessions, avoidance of identity-related clinical topics, misattribution of identity-related distress as behavioral problems, selection of goals that implicitly enforce gender conformity, and differential application of clinical standards based on perceived gender or sexual orientation. Because these effects are subtle, they may not be recognized by the practitioner but are often perceived by the client, affecting their sense of safety and engagement in treatment.
No. Targeting a client's gender identity or expression for modification is a form of conversion therapy, which is widely recognized as harmful and is explicitly contrary to ethical practice standards. A client's preferred name, pronouns, clothing, play preferences, mannerisms, and other forms of gender expression are not appropriate targets for behavior change. If a referral source or caregiver requests goals that target gender expression, the behavior analyst has an ethical obligation to decline that request and educate the stakeholder about why such goals are harmful. Supporting a client in developing skills for navigating their social environment is appropriate; attempting to make the client conform to gender norms is not.
This is a complex clinical situation requiring careful navigation. The behavior analyst should not take sides but should advocate for the client's well-being and rights. Provide the family with accurate information about gender diversity. Connect the family with appropriate support resources such as family counseling. Maintain the client's trust by using their chosen name and pronouns during sessions even if the family has not adopted them, as clinically appropriate. Be aware of confidentiality considerations, particularly for adolescents who may have disclosed their identity to you but not to family members. Consult with colleagues experienced in gender-affirming care and be prepared to involve additional professionals when needed.
When you use the wrong pronoun, correct yourself briefly in the moment, use the correct pronoun, and continue the interaction. Avoid lengthy apologies that center your discomfort rather than the client's experience. If a colleague uses incorrect pronouns, provide a brief, matter-of-fact correction. Establish organizational norms that treat pronoun use as a professional competency rather than a personal preference. For clients whose pronouns are unfamiliar to you, practice using them outside of sessions until they become fluent. Consistent errors communicate that the client's identity is not important to you, so investing in fluency is a clinical priority.
Concrete changes include updating intake forms to include gender identity options beyond male/female and space for chosen name and pronouns, displaying inclusive materials in waiting areas, ensuring restroom access is not restricted by gender, reviewing clinical documentation templates for inclusive language, training all staff on affirming communication practices, adding affirming practice to your organization's policies and procedures, and making visible indicators of inclusion part of your physical and digital presence. Each of these changes serves as a discriminative stimulus for LGBT+ clients, signaling that your practice is a safe environment.
Several Ethics Code standards apply directly. Code 1.06 prohibits discrimination based on sexual orientation and gender identity. Code 1.07 requires cultural responsiveness, which includes knowledge about gender diversity and sexual orientation. Code 1.10 requires awareness of personal biases that may affect professional work. Code 2.01 requires effective treatment, and affirming care is the recognized standard for effective care with LGBT+ individuals. Code 2.15 requires minimizing risk, which includes avoiding practices that attempt to change gender identity or sexual orientation. These standards collectively establish that affirming practice is not optional but is an ethical requirement.
Historically, behavioral techniques were used in attempts to change sexual orientation and gender identity, practices now recognized as harmful and ineffective. Modern ABA should have no connection to conversion therapy. However, behavior analysts must be vigilant against inadvertently engaging in conversion-adjacent practices, such as targeting gender-atypical play for reduction, reinforcing gender-conforming behavior, or selecting goals that serve to suppress authentic gender expression. The distinction between appropriate skill-building and identity suppression requires ongoing ethical awareness. When in doubt, ask whether a goal would exist if the client were cisgender and heterosexual. If not, it likely reflects bias rather than clinical need.
Assessment should account for identity-related variables as potential antecedent conditions. Consider whether the client's environment is affirming or hostile and how that affects their behavior. Evaluate whether behaviors identified as problems may be stress responses to identity invalidation. Use the client's chosen name and pronouns throughout all assessment activities and documentation. When assessing social skills, recognize that gender-diverse individuals may interact differently in safe versus unsafe environments and that social withdrawal in hostile settings may be adaptive rather than deficient. Include the client's own perspective on their needs and goals wherever possible.
Several avenues are available. Professional organizations focused on behavior analysis and LGBT+ issues publish guidelines and continuing education content. Peer-reviewed journals in psychology and healthcare publish affirming care standards that behavior analysts can translate to their practice. Consultation with colleagues who specialize in gender-affirming care provides case-specific guidance. Organizations focused on transgender health publish standards of care that provide comprehensive clinical guidance. Engaging with the lived experiences of LGBT+ individuals through community resources and advocacy literature provides essential context that clinical training alone cannot offer.
The ABA Clubhouse has 60+ on-demand CEUs including ethics, supervision, and clinical topics like this one. Plus a new live CEU every Wednesday.
Ready to go deeper? This course covers this topic with structured learning objectives and CEU credit.
Minimizing Implicit Bias in Practice: We Can Do Better for LGBT+ Folx — Cassi Breaux · 1 BACB Ethics CEUs · $10
Take This Course →We extended these answers with research from our library — dig into the peer-reviewed studies behind the topic, in plain-English summaries written for BCBAs.
280 research articles with practitioner takeaways
258 research articles with practitioner takeaways
233 research articles with practitioner takeaways
1 BACB Ethics CEUs · $10 · BehaviorLive
Research-backed educational guide with practice recommendations
Side-by-side comparison with clinical decision framework
You earn CEUs from a dozen different places. Upload any certificate — from here, your employer, conferences, wherever — and always know exactly where you stand. Learning, Ethics, Supervision, all handled.
No credit card required. Cancel anytime.
All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.