The Benefits Of LGBTQIA+ Focused Therapy

LGBTQIA-specific therapy provides affirming care for individuals whose gender identity and/or sexuality generally differ from those who identify as cisgendered (gender and/or expression aligns with sex assigned at birth) and heterosexual (attracted to the opposite sex). 

Affirming therapy provided by licensed mental health professionals is a valuable resource for the LGBTQIA community. Finding the right therapist who understands the challenges of gender transition, gender nonconforming identity, and discrimination can be critical to resolving mental health issues, relationship issues, and anger management. The LGBTQ+ therapy space can offer a safe, supportive space to discuss lesbian, gay, bisexual, and gender nonconforming concerns, providing immediate help and affirming care.

About the community that LGBTQ counseling supports

LGBTQ stands for lesbian, gay, bisexual, transgender, and queer. This term has evolved over time, and more inclusive terms now include LGBTQIA (which adds an “I” for intersex and an “A” for asexual), LGBTQ+ (the ‘+’ refers to other identities not specifically referenced in the acronym), or QUILTBAG (queer and questioning, unsure, intersex, lesbian, transgender and two-spirit, bisexual, asexual and aromantic, and gay and genderqueer). The word “queer” may sometimes be used as a blanket term to encompass all the identities within the LGBTQ community. However, not all people within the LGBTQ community are comfortable with this terminology, so ask a person before using a word to refer to them, and choose whichever term is most comfortable for you.

In addition to LGBTQIA individuals, the American Psychological Association also includes a diverse array of sexual minorities (including pansexual, queer, fluid, and asexual), expressions (such as gender non-conforming and androgynous), and gender identities (including transgender, third gender, genderfluid, transitioning, and gender non-binary) under the umbrella of people who may benefit from affirmative therapy.

What is LGBTQIA+ affirmative counseling and why is it needed?

Licensed therapists who specialize in providing affirmative care to clients are educated on gender identities, expressions, and sexual orientations. They provide support and therapy services for LGBTQIA+ clients who are navigating negative experiences, trauma, and mental health concerns related to stigma and minority stress. In addition, these therapists can be a helpful resource for people who are currently exploring or questioning their sexuality or gender, or who are experiencing gender dysphoria. Counselors who practice affirmative therapy are held to a high standard for providing conscientious and empathetic gender-affirming care. Affirmative therapy is much more appreciated than therapy focusing on conversion since conversion therapy statistics show that conversion therapy is harmful and ineffective.

Helpful statistics

Living as part of the LGBTQ community can come with unique challenges due to pervasive homophobia, transphobia, and heterosexism. These factors can lead to social stigma, minority stress, and an increased risk of violence. Bullying, discrimination, and a lack of family acceptance or outright rejection are common LGBTQ youth-related problems. Seeking the services of a licensed therapist who specializes in working with the LGBTQ+ community can be a valuable source of support and guidance for individuals who identify as queer—particularly those who are younger. Many studies and surveys have indicated the prevalence of discrimination and its mental health effects on queer people, including the following:

• A survey from The Trevor Project found that 45% of youth who identify as LGBTQIA+ considered suicide or experienced suicidal ideation in 2022.
• A 2019 survey found that 86% of LGBTQIA+ youth reported harassment or assault at school. 
• 30–60% of people who identify as queer are estimated to experience anxiety or depression at some point, which is 1.5 to 2.4 times higher than the rates at which cisgendered heterosexual individuals may. 
• One long-term study found that transgender individuals were six times more likely to have an anxiety or mood disorder, and six times more likely to attempt suicide than individuals without gender incongruence. 
• In 2022, 60% of youth who identified as LGBTQIA+ and wanted to get mental health services were not able to do so.

Identifying with a gender identity besides “cisgender,” a gender expression besides “gender-confirming,” or a sexual orientation besides “heterosexual” does not make someone more likely to experience a mental illness in their life. However, the lived experience of mistreatment does. While many spaces are still not inclusive, affirmative therapy can provide a safe space for individuals to process and understand their lived experiences, get connected with other support services or peers, and receive gender-affirming care. To find a therapist that offers counseling in this area, consider both in-person and online therapy services for LGBTQ adults.

Navigating LGBTQIA+ stigma in healthcare settings

Almost one in six LGBTQIA+ adults have experienced stigma and discrimination in a healthcare setting, leading 1 in 5 individuals in this community to avoid seeking out healthcare services due to fear. Those who experience discrimination also tend to experience a higher risk of heart disease and high blood pressure, making it even more important for them to receive routine healthcare. Reachable, affirming care is lacking in both physical and mental health services. Non-binary clients, for instance, often have trouble relating to therapists or experience outright prejudice and discrimination. They may struggle to find a therapist with experience treating gender dysphoria or offering mental health resources to gender-diverse individuals.

Finding a provider

If you identify as LGBTQIA+ and you’re searching for a therapist, you can use these suggestions to find a provider with expertise who may be a good fit:

• Seek a therapist who states that they provide LGBTQIA-affirming care. 
• Read up on the therapist, their client focus, and their specialties to learn more about their experience in this area. 
• Ensure they are licensed and check their educational background and years of experience. 
• Look for someone you think you could feel comfortable talking to. For example, you may be more at ease or understood when working with a therapist who has the same identity as you. 
• Make a list of questions to ask during a phone interview or first session, one of which might be about their past experience working with people with your identity or in your situation. If you are transgender and you need your therapist to write a letter supporting gender-affirming medical care or changes to legal documents, ensure they know how to navigate this process. 
• If you’re uncomfortable calling a therapist out of fear of misgendering, you may want to consider having a friend or family call for you. 
• If you decide your therapist is not a good fit, it’s okay to look for someone else.
• Consider whether you’d like to try individual treatment, couples therapy, or family therapy and whether you want to receive in-person or online therapy.

Other mental health tips for LGBTQIA+ individuals

In addition to seeking affirmative therapy with licensed therapists, there are other actions you can take and resources you can help maintain or improve your mental health as an individual of the queer community:

• Find a safe space or other accepting and supportive environment, which may be in-person or online.
• Find the nearest LGBTQIA+ community health center, which gender-diverse people often consider to be valuable resources. 
• For students, join a student-run Gender & Sexualities Alliance Network to build resilience in the community and organize with other youth who identify as LGBTQIA+. 
• Read about LGBTQIA+ journeys on the It Gets Better Project website. 
• Read books and listen to podcasts created by people whose gender and/or sexuality do not conform with societal expectations, which can provide a sense of connection, joy, improved self-worth, and acceptance. 
• Consider incorporating preventative practices, even if you’re satisfied with your current state of mental health. These may include talking about your feelings with friends and/or family, getting enough sleep, practicing positive self-talk, eating a balanced diet, staying physically active, socializing, volunteering, and practicing mindfulness or meditation.
• Consider calling a hotline if you don’t know where to get resources or you’re looking for someone to talk to. If you’re worried that you or someone you know is in danger, call emergency services immediately (911 in the United States). 

Support hotlines

Hotlines that are available to support LGBTQIA+ people 24/7 include the following:

• LGBT National ​Hotline: 1-888-843-4564
• Trans Lifeline: 1-877-565-8860
• The Trevor Project: 1-866-488-7386
• National Domestic Violence Hotline: 1-800-799-SAFE (7233)
• National Suicide Prevention Lifeline: 988
• Crisis Text Line: Text HOME to 741741

Affirming therapy can help

Some of the most common mental health challenges among people who identify as LGBTQIA+ are anxiety disorders, major depressive disorders, and substance use disorders. A six-week therapist-guided online intervention for anxiety and depression was effective in reducing symptoms for the 46 participants. A greater reduction in symptoms was observed in the online-delivered treatment recipient group as compared to the control group. During CBT sessions, therapists help clients identify inaccurate beliefs about the world, themselves, their work life, and their future and reshape them to target maladaptive emotional and behavioral responses. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Online support options

If are struggling to schedule an appointment with an in-person therapist, or if you prefer attending therapy sessions from the comfort of your own home, you might want to try online CBT. Affirmative therapy providers can incorporate CBT techniques into sessions, which is shown to be efficacious. If you’re interested in virtual affirming therapy, an online therapy platform like BetterHelp can match you with a licensed, affirming provider based on your needs and preferences, and you can meet with them via phone, video call, and/or online chat to address the challenges you may be facing.