Having access to LGBTQIA+ competent therapy with a LGBTQIA+ specialist is important for queer teens, but what specifically is it about therapy that is so helpful for those populations?
Well to start, therapy is good for everyone! Whether you are actively experiencing mental health struggles or are looking for general support and skills building for challenges that may come around down the line, individual and/or group counseling is a great resource. LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual+) people deserve therapy for all the same reasons that everyone else does, whether it is related to their identity or not.
What can’t be overlooked, however, is that LGBTQIA+ folks experience unique stressors that can put a strain on their mental health and lead to worse mental health outcomes compared to their straight and/or cisgender peers. Because of the accumulation of those and other stressors, LGBTQIA+ individuals are 3 times more likely to develop a mental health condition and that unfortunate reality makes counseling a particularly important resource for queer people to cope, function, and thrive (Thriveworks, 2024).
Queer people certainly go to therapy for all sorts of reasons and don’t always seek it out for reasons related to their queer identity, but in this blog, I will dig deeper into some of the specific ways that therapy can help LGBTQIA+ teens related to their identities in ways that may not apply to straight and/or cisgender people.
Mental Health in Queer Youth
Teens in general have a lot to navigate, and that can impact their mental health. Being LGBTQIA+ can also introduce unique stressors that lead to significant mental health challenges for queer teens. This concept fits into the Minority Stress Model, which was designed to investigate the link between stressors that sexual minority populations experience and their impact on physical and mental health outcomes. Some of those outcomes include:
- Lesbian, gay and bisexual (LGB) youth have a greater risk for suicide attempts than non-LGB youths and higher prevalence of depression and anxiety diagnoses (SAMSHA, 2022).
- 41% of LGBTQ young people seriously considered attempting suicide in the past year. Those who are sexual minorities (transgender, nonbinary, genderqueer, etc.) and/or people of color reported higher rates than their peers (The Trevor Project, 2023).
Counseling, therapy, and other mental health interventions are a valuable resource and can help LGBTQIA+ teenagers in particular with some of the following:
Supporting Self-Discovery and Fostering Acceptance
The teenage years in particular are formative for identity development in ways that are exciting and also terrifying for teens to process. Personalities emerge, hobbies and interests become clearer, personal style and presentation may become increasingly important. And all of this at a time when it can feel so overwhelming to be perceived at all!
Affirmative therapy provides a space for individuals to safely express their thoughts and feelings about all of this change without judgment. Experimenting, playing, and trying out new things can be daunting, but that all helps teens find what makes them feel comfortable and happy, and in therapy, all of that is encouraged. All sexual identities and gender expressions are believed and valued in LGBTQIA+ affirming therapy, and that environment can help teens develop and trust their sense of self. Having a solid sense of self can help teens (and adults!) with general well-being and functioning.
Teenagers get messages all the time from the world around them, whether it be people or the media, that may lead to internalized stigma around their LGBTQIA+ identity, and that can take a big blow to their self esteem. Having a counselor to talk to about those things and affirm what they know and like about themselves is important.
Addressing Challenges in Social and Educational Environments
A study by the Trevor Project found that around half of transgender individuals and nonbinary young people found their school to be gender-affirming, and those who did not reported higher rates of attempting suicide (The Trevor Project, 2023). School might not be a safe space for all queer teens, but therapy can be, and having a trained mental health professional to provide support and help teens process what they see and feel every day in school can help them build tools to help support and advocate for themselves in school and other environments.
Building community isn’t always easy, and social stigma about queer people can bring with it outright bullying and teasing that leave teens feeling isolated and lonely. While often from peers, feelings of rejection can also come from adult figures in a teens life outside of their family. Outright rejection from friends, offhand comments from adults, a judging look or whisper from a teacher or peer, all of these things stick and can lead to low-self esteem at a time when there are messages targeting teens’ self-worth coming from all directions.
Low self-esteem and feelings of social exclusion can lead or contribute to mental health issues like depression, social anxiety, suicidal ideation, and gender dysphoria, all of which can be specifically addressed in therapy. In addition to individual therapy, group counseling is a way for teens who may be feeling isolated to build community and feel supported from folks who understand the challenges they are facing.
Support in Coming Out
The coming out process looks different for everyone, and teens should be allowed to come out, if they want, how they want. Therapy can help teens navigating the coming out process and the friend or family dynamics that may come into play while or after they come out. Thirty nine percent of LGBTQIA+ adults reported being cut off from a family member after coming out, and being cut off from family support as a teen is highly damaging and traumatic event with unique challenges as teens rely on adult support in their daily lives (Thriveworks, 2024).
“Coming out” usually isn’t a one time thing, and having to constantly assess the risk of disclosing one’s sexual and/or gender identity to different situations and groups of people is mentally exhausting for anyone, including teenagers. Having a trusted adult who can help develop a plan and practice ways to take care of themselves is crucial for queer teens.
Family Dynamics and Relationships
Family support is one of the biggest things that helps queer teens maintain their well being and safety, yet fewer than 40% of LGBTQ young people found their home to be LGBTQ-affirming (The Trevor Project, 2023).
When familial support isn’t there, teens’ psychological and physical safety is threatened in a way that can have lasting impacts on their mental and physical health. Teens may not always want to go to their parents with concerns, but having another trusted adult might help them open up about what they are feeling and may be struggling with.
Family therapy is another option to help improve family understating and communication. Again, family therapy is a great resource for anyone! And for families navigating their child’s queer identity, it can be helpful too. Navigating acceptance issues with a therapist can help foster supportive family relationships int he long run in a way that would be hard for a teen to do themselves.
Support for Gender Transition
Gender-affirming care in a counseling or therapeutic setting is an important supplement to other forms of care that teens receive when they are going through a gender transition. This could be a social transition, which might include a legal or social name change, changes in physical presentation, or using different pronouns than they were assigned at birth, or a medical transition, such as top surgery or hormone replacement treatment.
Transgender people face a lot of obstacles to having a safe and affirming transition, and having a space to be heard and supported through the ups and downs of those changes can help teens feel more comfortable in their gender identity and able to cope with the challenges that come along with transitioning.
Mental health support along with medical transition guidance if that is the route that a teen and their family want to take is the best option. Therapists and other providers, such as medical doctors, can work together during this important time for teens and having a care team that collaborates with one another can ensure the best outcomes for transgender teens. 
Cultural Competency in Youth Counseling
Crucial to impactful therapy for the queer community is ensuring that counselors are equipped to support queer youth effectively. This means training in LGBTQIA+ issues, sensitivity, and inclusive counseling practices. Thankfully, this kind of knowledge is becoming more and more common among providers and professionals, but given psychology’s history of pathologizing LGBT individuals and their experiences, some providers may overlook their LGBTQIA+ clients’ strengths or struggle to understand the presentation of their symptoms (Psychol Sex Orientat Gend Divers, 2014).
Conclusion
Counseling plays a critical role of supporting the mental health and well-being of queer teenagers at a time when significant mental health concerns may become activated or worsen. Social stigma about mental health care has made huge strides in the past decade, and normalizing therapy as a way to improve one’s well-being can start with having a teenager meet with a therapist to help them navigate struggles specific to their queer, sexual, and/or gender identity.
Blog written by Sentier Client Care Coordinator, Ellie Struewing, BS.
To inquire about LGBTQIA+ affirming therapy for teens at Sentier, email Ellie at [email protected]
Sources:
2023 U.S. National Survey on the mental health of LGBTQ Young People. The Trevor Project. https://www.thetrevorproject.org/survey-2023/
DeWitt, H. (2020, May 27). LGBTQIA+ counseling: The importance of Inclusive Counseling Services. Thriveworks. https://thriveworks.com/therapy/lgbtq-counseling/
Lesbian, gay, and bisexual behavioral health: Results from the 2021 and 2022 National Surveys on Drug Use and Health. SAMHSA. (2022). https://www.samhsa.gov/data/sites/default/files/reports/rpt41899/2022_LGB_Brief_Final_06_07_23.pdf
Lytle, M. C., Vaughan, M. D., Rodriguez, E. M., & Shmerler, D. L. (2014). Working with LGBT Individuals: Incorporating Positive Psychology into Training and Practice. Psychology of sexual orientation and gender diversity, 1(4), 335–347. https://doi.org/10.1037/sgd0000064
