When looking for a therapist, it is important to find a mental health provider whose training, experience, and expertise match up with what you, the client, are looking for and what you hope to gain from therapy. For LGBTQIA+ clients, working with an LGBTQIA+ specialist is crucial to avoiding negative experiences and having the best quality care – even if you are not in therapy specifically to address anything specific to a queer identity!
Why is it important to work with an LGBTQIA+ specialist?
Despite the strides that have been made in the last decade or so regarding LGBTQIA+ acceptance and inclusivity, the prevalence of homophobia, transphobia, and heterosexism (prejudice based on the assumption that heterosexual and cisgender people are “normal” and others are not) are present in many settings and inherent to many systems that we can’t help but be a part of. For that reason, they continue to create unique stressors that can contribute to lower mental health outcomes for LGBTQIA+ folks.
Living life with an increased risk of violence, bullying, discrimination, and rejection can have significant negative impacts on mental health issues. This experience of dealing with persistent prejudice and discrimination is referred to as minority stress or the minority stress model.
LGBTQIA+ people are continually assessing for safety in situations that other folks may not worry about, and navigating the world with that lens of risk can greatly decrease mental well-being. According to one study, “Somewhere between 30 and 60 percent of lesbians, gay men, bisexuals, or transgender people deal with anxiety and depression at some point in their lives,” a rate which is up to 2.5 times higher that that of straight or gender conforming peers (Anxiety Disorders Association of America).
The impact of minority stress can cause queer people and gender minorities to feel a heightened sense of risk in their daily lives and contribute to things like anxiety, depression, PTSD, suicidal ideation, and other mental health concerns.
The systemic forces behind these mental health outcomes are complex and varied, but the message is clear: making sure that mental health care is inclusive and accessible for queer folks is crucial.
What makes someone a LGBTQIA+ specialist?
Mental health professionals that LGBTQIA+ affirming can practice all sorts of clinical practices and modalities – Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Narrative Therapy, Exposure Therapy, individual therapy, family therapy, group therapy…the list goes on and on!
What these providers bring to each of those modalities is an awareness of the ways that LGBTQIA+ individuals are perceived and treated in the world and how that may impact the sorts of presenting concerns that they bring into a therapeutic space. These therapists provide affirmative therapy for the queer population.
Specialists understand how factors outside of their client’s control, such as homophobia and transphobia, impact the lives of queer folks, both directly and indirectly, and how those things impact the disproportionate amount of mental health disorders in LGBTQIA+ people, particularly among children and teens. 
LGBTQIA+ specialists practice LGBTQIA+ Affirming Therapy, which operates on the understanding that the goal of the clinical practice is to affirm someone’s gender, sexuality, or any other aspect of their identity, rather than “repair” it. Perspectives that pathologize gender/sexuality will argue that it is a problem that needs to be solved or fixed. But the reality is that queerness is ever changing and evolving and doesn’t need to be solved.
Part of the responsibility of being a therapist is to continue to learn throughout one’s career through attending specialized trainings. There are tons of trainings, workshops, panels, discussion groups, and other learning opportunities available to therapists, including ones about LGBTQIA+ specific mental health concerns. It is okay to ask your therapist what makes them an affirmative therapist and what steps they have taken to ensure their cultural competence around LGBTQIA issues.
In addition to operating under a framework of affirmation, LGBTQIA+ specialists are making efforts to actively keep up with the latest research about a range of LGBTQIA+ identities (trans people, gay people, bisexual people, etc.) and how that impacts therapeutic work with queer clients. This can look like reading academic journals, articles, and studies, and it can also look like being in tune with the wider culture, particularly the flow of ever-changing language and vocabulary around identity and gender diversity.
LGBTQIA+ affirmative therapy means that mental health professionals recognize, trust, and validate their whole client, including identities that they may not relate to or share.
What an LGBTQIA+ specialist isn’t:
A misconception that people may have about LGBTQIA+ Affirmative Therapy or LGBTQIA+ Specialists is that the goal of the therapy is to make sure the client has an LGBTQIA+ identity. This is untrue!
The key to being an LGBTQIA+ specialist is meeting clients where they are in their journey and not prescribing any identities into them. The purpose of therapy is not to receive advice, and a provider should never try to tell a client who they are or who they should be. An LGBTQIA+ Specialist’s personal experience as queer or otherwise should not be a directive part of the therapy, though it may be disclosed at times.
A specialist might be a great resource for someone who is exploring their identity and wants to process how that feels, even if they don’t identify as queer, trans, bisexual, or anything else. LGBTQIA+ providers do not see clients who are questioning as queer or trans folks “to-be”, and they should never provide pressure for any sort of social or medical transition or coming out if that is not what their client wants or is ready for.
LGBTQIA+ specialists (and all ethical healthcare providers, for that matter) never tell clients who they should be, because the client is the expert and knows themselves better than a therapist or anyone else can.
What are the alternatives?
Mental healthcare is changing all the time. After all, early editions of the Diagnostic and Statistical Manual (DSM) categorized homosexuality as a mental disorder. Sometimes academia lags behind public understanding and it can take longer than the general public to catch up with what is socially and culturally understood. Homosexuality is no longer a diagnosis in the DSM.
Thankfully, Conversion Therapy, which aims to “make” people cisgender and straight, is becoming more rare. While it may be less sinister as overt Conversion Therapy, providers who may be perfectly trained in a modality and be good at that work but who don’t have the cultural competency of LGBTQIA identities or an understanding of the intersections of identity and mental health may still unintentionally cause harm by not taking into account a client’s truth or creating an environment that opens the door to holistic healing. Every person’s life experiences are going to be different, and an ethical provider is not invested in client’s identifying in specific ways. 
Having an understanding of the history of LGBTQIA+ healthcare in the United States and around the world helps providers understand how LGBTQIA+ people have been mistreated and misunderstood by medical professionals and highlights the importance of providing stable and affirmative therapeutic relationships so that clients have positive experiences in their therapeutic journey.
Taking the step to begin therapy is a brave and important one, and the last thing someone needs in that space is to not be affirmed and accepted as their whole self. Therapists who aren’t training in LGBTQIA+ specific things can actively cause harm to queer clients, even if unintentionally.
What can LGBTQIA+ therapy help with?
Having a LGBTQIA+ affirming therapist is important for clients who identify as queer even if they may not be in therapy to specifically address those identities. There are also specific ways that LGBTQIA+ specialists can provide support, including the following:
- Support around social or medical transition
- Making the decision to transition, either medically, socially, or both, can bring with it many joys and challenges, and having an experienced therapist to help process the impacts of those changes is a great resource.
- Identity exploration
- LGBTQIA+ specialists are comfortable sitting in the unknown with their clients! Perhaps you feel confused or curious about your sexual or gender identity and want to talk to someone about it. Being in therapy is a great way to think through things that may be hard to put words to with someone who trusts your lived experience and won’t make assumptions or pretend to know you better than you do.
- Trauma
- Many queer people have experienced emotional and/or physical harm because of their LGBTQIA+ identities. Transgender and gender non-conforming people are often the victims of hate crimes and at least 25% have reported being attacked in their lifetime (APA). Processing the trauma of being targeted and mistreated is important to do with someone who understands the source and implications of that trauma.
- Gender dysphoria
- Gender dysphoria can result in deeply uncomfortable and distressing feelings, behaviors, and sensations. Therapy can provide a safe space to work on strategies for easing those experiences while in a world that may be telling someone that what they are doing or feeling is wrong.
- Family Therapy or Relational strugglesMany LGBTQIA+ people are part of romantic relationships or dynamics that may fall outside of the “norm” of what partnerships or families are perceived as. Having a provider who affirms the validity of all sorts of relationships is important. There are providers with even more specific specialities, such as working with queer couples, polyamorous people, parents who have transitioned, and families with queer parents or children.
Even in their work through more general mental health conditions, like anxiety and depression, LGBTQIA+ specializes have an understanding of how different factors related to their LGBTQIA+ identities may impact how their clients symptoms present.
How can I find an LGBTQ specialist?
The prospect of finding a new therapist may feel intimidating, but there are some easy steps you can take to get the ball rolling.
Sites like TherapyDen and Mental Health Match have directories of providers in your area as well as filters for things like price, location, and specialties, including LGBTQIA+ Issues.
If you see a therapist you are interested, try to notice their vibe. Do they have pronouns listed on their page? Is the language on their website inclusive? Do they list LGBTQ as a specialty?
Word of mouth is another great way to find a therapist. If you know people who are in therapy, ask them how they found their provider and if they would recommend them.
Many providers offer free consultations which are a great way to see if it feels like a good fit before starting therapy with them. Trust your gut! If after a consultation or a few sessions, you aren’t feeling like the therapist is seeing or respecting your authentic self or approaching your therapy with openness and curiosity, perhaps it’s time to look for a new provider.
Remember – you deserve to have a therapist who makes you feel safe, understood, heard, and trusted, and you shouldn’t settle for anything less!
All of Sentier’s therapists are LGBTQIA+ specialists and practice with an LGBTQIA+ affirming lens. To inquire about availability, please email our Client Care Coordinator, Ellie, at [email protected]
Blog written by Ellie Struewing.
Sources
Gender-affirming therapy. American Psychological Association, APA – Gender-Affirming Therapy. https://www.psychiatry.org/psychiatrists/diversity/education/transgender-and-gender-nonconforming-patients/gender-affirming-therapy
What is gender dysphoria? American Psychological Association, APA – What is Gender Dysphoria? https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria
Understanding anxiety and depression for LGBTQ people. Anxiety and Depression Association of America, ADAA. (2016, May 18). https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/understanding-anxiety-and-depression-lgbtq
