LGBTQ Community Healing: Why Therapy Is A Need

Trigger warning: This article mentions suicide. If you or someone you know is experiencing suicidal thoughts or behaviors, seek help immediately. The National Suicide Prevention Lifeline can be reached 24/7 by dialing 988.

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

LGBTQ therapy provided by licensed mental health professionals is a valuable resource for members of 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. LGBTQ therapy offers a safe, supportive space to discuss lesbian, gay, bisexual, and gender nonconforming concerns, providing immediate help and affirming care.

The Community This Type Of Therapy 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” is often used as a blanket term to encompass all of the identities listed here.

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 nonbinary) under the umbrella of people who may benefit from affirmative therapy.

What Is LGBTQIA+ Affirmative Therapy And Why Is It Needed?

Therapists who specialize in providing affirmative care are educated on gender identities, expressions, and sexual orientations. They provide support 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 and/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 the conversion since conversion therapy statistics show that conversion therapy is harmful and ineffective.

Living as a member 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 family 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 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. 
• A study from 2013 found that 40% of adults who identify as LGBTQIA+ experienced rejection when they told a friend or family about their identity or orientation. 
• 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 identify 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”, and/or a sexual orientation besides “heterosexual” does not make someone more likely to experience a mental illness. 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.

Navigating LGBTQIA+ Stigma In Healthcare Settings

Almost 1 in 6 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. Pride Counseling, an online therapy service providing affirming care specifically for LGBTQIA+ people, was created by BetterHelp to address this need. 

If you identify as LGBTQIA+ and you’re searching for a therapist, you can use these suggestions to find a provider 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. 

Other Mental Health Tips For LGBTQIA+ Individuals

In addition to seeking affirmative therapy, 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 supportive environment, which may be in-person and/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). 

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 review of 106 meta studies found that cognitive behavioral therapy (CBT) can be effective for addressing the symptoms of these disorders. During CBT sessions, therapists help clients identify inaccurate beliefs about the world, themselves, and/or their future and reshape them to target maladaptive emotional and behavioral responses. 

If you prefer attending therapy sessions from the comfort of your own home, you might want to try online CBT. A 2017 study found that, when conducted online, CBT can be effective in addressing symptoms of anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar disorder, and depressive disorders. 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 Pride Counseling 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.