The disheartening statistics about mental health outcomes for the LGBTQIA+ community are widely cited and broadly known within much of the mental health and medical community. Just a few of those statistics include:

• Thoughts of suicide are higher among LGBTQIA+ youth, with 42% seriously considering attempting suicide.
• 75% of LGBTQIA+ youth stated they have experienced discrimination based on their sexual orientation or gender identity at least once in their lifetime (The Trevor Project, 2021).

   

Beyond simply being aware of the research that highlights health disparities that queer people experience, the individual truths behind these numbers are realities that we as therapists at Sentier hear about in detail from our queer clients all too often during therapy sessions.

In a society that tries again and again to devalue and deny LGBTQIA+ individuals and their identities and existence, LGBTQIA+ and gender-affirming care is more important than ever to support the overall well-being and safety of members of the LGBTQIA+ community. It is crucial for therapists and other professionals, both queer identifying and allies, to make sure that their queer clients feel that they can be authentically themselves and appreciated for that in therapy spaces.

What is an Affirmative Therapy Approach to Working with LGBTQIA+ Individuals?

When it comes to therapy settings, LGBTQIA+ and gender-affirming care provides a supportive and safe space for clients where their sexuality and gender identity is trusted and affirmed rather than being seen as something to fix, repair, solve, or solely tolerate. Gender-affirming care aims to provide interventions that help transgender youth and adults align the various domains in their lives – emotional, interpersonal, biological – with their gender expression and/or identity (American Psychiatric Association, 2017). This framework approaches gender on a continuum that includes male, female, a combination of both, neither, or fluid. If providers have any problem with the reality that people exist all over that continuum, providing an affirmative therapy space for queer clients is going to be difficult and they may have some work to do before providing care to those clients.

LGBTQIA+ folks must be celebrated and the things that they bring to therapy should be explored with openness, enthusiasm and joy. There is a difference between simply listening to someone talk about their identities and fully hearing, trusting, and affirming them. It is crucial that providers are not afraid to be curious and open with their clients, even if they may not fully understand or relate personally to what their clients are experiencing or expressing. 

Providers must themselves embrace the diversity and beauty of the LGBTQIA+ community, as so much of the deeper therapeutic work in a therapeutic relationship is felt and not spoken. A provider of LGBTQIA+ affirming care has embraced the concept and reality of queerness in themselves, even if they don’t identify with it.

Acknowledging that clients are the experts on themselves, not a therapist, no matter how much training or credentials they may have, is crucial to providing affirmative care. Building a safe container for a client to authentically express how they identify and to describe the unique and personal challenges they are facing is itself a healing process, even if explicitly talking about their gender or sexual identity isn’t a top priority.

Having a safe space is a building block to successful therapy of all kinds, and without genuine investment in the client as expert, they may not be able to reach the therapy goals that they have. Again, a therapist must be able to celebrate the queer community within themselves for this process of acceptance, processing, and healing in a therapy setting to take place organically.

Tips and Best Practices for LGBTQIA+ Affirming Therapists

Ongoing personal evaluation and pursuing continuing education opportunities is necessary for therapists to provide high quality care and services for their LGBTQIA+ clients. Therapists who are committed to understanding ongoing trends regarding language and best practices for LGBTQIA+ care, as well as societal and political issues that impact queer and trans people, will be best equipped to provide proper care.

Here are a few simple strategies for providing LGBTQIA+ affirmative therapy:

1. Talk about your LGBTQIA+ affirmative stance with individuals in your life including colleagues, friends, family, and potential clients.
2. When addressing new clients, avoid gendered terms until you have confirmation of a person’s identity and pronouns. Ask what pronouns a person prefers and use them.
3. If you make a mistake regarding a person’s name or pronouns, acknowledge that mistake, apologize briefly, and move on. 
4. Be aware of affirmative and supportive local resources in your community and ready to refer them to clients when needed.
5. Be aware of and challenge your own personal assumptions or biases regarding gender and sexuality.
6. Do not assume heterosexuality when asking about a client’s relationship or relationships important to them (i.e. their parents or other family members).
7. Use the same identifying terms used by the client (i.e. “gay”, “queer”, etc.) rather than making any assumptions about other words they may use to identify. 
8. Discuss confidentiality, especially working with minors. Some youth may want to discuss aspects of their sexuality or gender but may not have shared with their parents yet.
9. Understand barriers and know that LGBTQIA+ individuals may have had negative experiences with providers in the past.
10. Understand that there are subgroups within the LGBTQIA+ community. Do not make assumptions about the community that your clients are a part of.
11. Attend appropriate trainings that are relevant to the various LGBTQIA+ populations’ specific needs and concerns.

Why is Affirmative Therapy Important for LGBTQ Individuals?

In addition to providing a safe and accepting space for LGBTQIA+ individuals to receive the quality of care that best serves their needs, an affirmative provider also understands and validates the unique stressors and discrimination that the queer community faces from society at large as well as within health care systems. It is important to acknowledge the history of and the ongoing (often daily) negative bias that many people hold towards the LGBTQIA+ community and the barriers that keep individuals from receiving adequate care.

Sometimes, providers may not even know that a person is struggling because they may not feel safe or ready to disclose information about their gender, sexuality, or the social pain they experience for being who they are. This is an even stronger reason why access to gender-affirming therapists, social workers, and other professionals is important, and that they must be practicing affirmative care so as to not further harm their LGBTQIA+ clients or patients.

What Are the Benefits of Affirmative Therapy?

Therapy is beneficial to so many people. Members of the LGBTQIA+ community may come to therapy to address more broad issues such as depression, anxiety, post traumatic stress disorder, and substance use disorders, as well as to focus on gender identity and other related things. Sometimes LGBTQIA+ individuals are seeking therapeutic services to support them in their journey to understand their own identity and sense of self or to come out to friends and family when ready.

It is important for providers to understand the intersectionality and often added complexity or layers related to a person’s sexual orientation or gender expression or gender identity based on their own level of acceptance and integration as well as how they have been responded to by others in their life. Having a therapist and a community that understands, affirms and celebrates, and has knowledge in these areas can increase the likelihood of positive experiences and greater understanding of self.

LGBTQIA+ and gender-affirming care in therapy settings can reduce depression, anxiety, and shame by helping the individual practice acceptance and compassion towards the self. Having a safe space to explore topics that are difficult to discuss with someone who understands why that is and shows compassion and care can make all of the difference.

Other Benefits of Affirmative LGBTQIA+ Therapy

• Prevents further and ongoing distress from other providers.

• Unfortunately, many LGBTQIA+ individuals have experienced outward discrimination or bias from healthcare providers or professionals who simply lack knowledge and understanding to fully support LGBTQIA+ clients in their clinical practice in effective ways.

• Gives a voice to the individual’s experience.

• Validation of one ‘s individual and unique experience is key to a healthy therapeutic relationship. Sometimes, an LGBTQIA+ person may have no other outside relationships that validate their identity or experiences.

• Reduces stigma.

• According to the Substance Abuse and Mental Health Services Administration (2013), properly trained LGBTQIA+ affirmative therapists directly decrease harmful practices and the spread of incorrect and discriminatory treatment in the behavioral healthcare system.

• Provides a sense of connectedness.

• Affirming therapy reminds people that they are not alone in their struggles. This leads to overall improved mental and physical health outcomes.

• Improves mental health.
• Rates of depression and anxiety decrease when LGBTQIA+ persons have supportive professionals and individuals in their lives.

What Does an LGBTQIA+ Affirming Framework Look Like Outside of the Therapy Session?

A therapy provider should always be considering the accessibility and availability of their services to the LGBTQIA+ community. For example, does their website and promotional materials reflect an inviting and inclusive environment for queer individuals? If an LGBTQIA+ person walks into the clinic, is there signage and materials that affirm inclusivity and acceptance? Additionally, a clinic or provider should also update the language and options used on their clinic forms or website to ensure they are LGBTQIA+ affirming. Examples of this include having appropriate options for clients to express their gender and sexuality or to use their preferred names and pronouns and not having only “he/she” on forms.

In conclusion, affirmative providers are committed to treating LGBTQIA+ individuals with the dignity, respect, and affirmation that they deserve. They seek to center the person as the expert on themselves and approach their needs with compassion, emotional holding, and understanding, and without treating their identities as a problem to be fixed. Affirmative care is crucial in order to give queer people not only a space to share their needs authentically, but also to be met with the care they need and deserve. Affirmative care takes into account their specific situation and the social factors that impact it.

If you are looking for additional LGBTQIA resources and support, please visit our Resource Page.

Blog written by Sentier therapist, Tana Welter, MSW, LICSW.

Sources:

Centers for Disease Control and Prevention (CDC). Gay and Bisexual Men’s Health. https://www.cdc.gov/msmhealth/substance-abuse.htm#print

Hadland, Scott E., Yehia, Baligh R., Makadon, Harvey J. (2016, December). Caring for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth in Inclusive and Affirmative Environments. https://doi.org/10.1016/j.pcl.2016.07.001

McNamara MC, Ng H. Best practices in LGBT care: A guide for primary care physicians. Cleve Clin J Med. 2016 Jul;83(7):531-41. doi: 10.3949/ccjm.83a.15148. PMID: 27399866.

National LGBT Health Education Center. (2016, February 17). Providing Inclusive Services and Care for LGBT People: A Guide for Health Care Staff. https://www.lgbtqiahealtheducation.org/wp-content/uploads/Providing-Inclusive-Services-and-Care-for-LGBT-People.pdf.

North Dakota State University. (2020, October 8). LGBT Affirmative Therapy. https://www.ndsu.edu/fileadmin/hdfs/documents/misc/Affirmative_therapy_handout.pdf

Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). Moving Beyond Change Efforts: Evidence and Action to Support and Affirms LGBTQI+ Youth. https://store.samhsa.gov/sites/default/files/pep22-03-12-001.pdf

The Trevor Project. (2021). National Survey on LGBTQ Youth Mental Health 2021. https://www.thetrevorproject.org/survey-2021/

World Health Organization. Health Topics – Gender. https://www.who.int/europe/health-topics/gender#tab=tab_1