Affirmative Therapy

Medically reviewed by April Justice, LICSW
Updated May 29, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention substance use-related topics that could be triggering to the reader. If you or someone you love is struggling with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357). Support is available 24/7. Please see our Get Help Now page for more immediate resources.

LGBTQIA+ affirmative therapy work is a counseling approach tailored to support those who identify as lesbian, gay, bisexual, transgender, intersex, queer, questioning, or asexual, as well as others in the community. In a safe and empowering environment, an individual can address unique challenges, like discrimination and stigmatization, and the ways they are impacted by those issues with an affirmative therapist. Given the mental health disparities faced by the LGBTQIA+ community, understanding affirmative therapy and its benefits may be helpful.

These challenges vary but often include difficulty finding a therapist, particularly one who understands their specific experiences and concerns. This difficulty is not limited to any particular age group but may disproportionately affect younger individuals due to pressure from parents and peers, with the Trevor Project reporting that 60% of LGBTQIA+ youth who wanted mental health care in 2022 did not receive it.
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Who does LGBTQIA counseling benefit?

Affirmative therapy may benefit a wide range of individuals, particularly those belonging to the LGBTQIA+ community. This type of therapy is designed to validate and advocate for the needs of sexual and gender minority clients. This therapy may be helpful for those grappling with their sexual orientation and gender identity, and it can offer a non-judgmental space to explore these terms.


LGBTQ affirmative therapy or affirmative counseling can be particularly beneficial for LGBTQ individuals who experience issues related to anxiety, depression, or self-esteem challenges stemming from societal stigmatization or family rejection. Therapists who provide an affirming stance can help LGBTQIA+ individuals develop self-acceptance and strengthen their sense of identity, which may help improve their overall mental health and well-being.


In addition, affirmative therapy can be beneficial for families with LGBTQIA+ members, especially when an individual comes out to their loved ones. Therapy sessions can help families struggling with pre-existing biases or misconceptions, which can help increase understanding and acceptance of a loved one’s identity.


LGBTQIA+ couples can benefit from affirmative therapy since it addresses the unique challenges they may face due to societal prejudice and discrimination. This type of therapy may also help partners understand each other better and strengthen their bond. Moreover, therapy can guide LGBTQIA+ couples through family planning discussions, including those that involve adoption or assisted reproduction. In many cases, therapists can offer support and resources for the specific needs of LGBTQIA+ couples.

In some cases, therapy can be integrated with other forms of therapy (such as substance use therapy) to address any coexisting challenges faced by LGBTQIA+ individuals. This form of counseling can create an inclusive environment to discuss the obstacles and challenges specific to the LGBTQIA+ population.

History of treatment

Historically, mental health professionals often lacked the training and understanding to address the specific concerns of LGBTQIA+ individuals. In some cases, traditional therapeutic approaches even pathologized LGBTQIA+ identities and gender expression, promoting harm rather than providing an affirmative stance.

Prior to the development of affirmative therapy, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) was not inclusive of LGBTQIA+ experiences. In fact, the DSM previously classified homosexuality and a man loving other men or a woman loving other women as a mental disorder, which further stigmatized LGBTQIA+ individuals and contributed to harmful therapeutic practices.

It wasn't until 1973 that homosexuality was removed from the DSM, marking a turning point in mental health care. However, it took more time and advocacy for the field to evolve and create therapeutic approaches that meet the unique needs of the LGBTQIA+ community.
A tailored approach to sexual orientation and gender identity

In the late 20th century, the awareness of LGBTQIA+ challenges grew. Mental health professionals began to recognize the need to practice affirmative therapy and for a therapeutic approach that acknowledged and respected the experiences of LGBTQIA+ clients. Affirmative therapy emerged to fill this gap in beliefs. Today, it offers a more inclusive and supportive framework that validates and advocates for gender and sexual minorities.

What is the role of counselors in affirmative care?

Affirmative therapists often focus the majority of their efforts on the mental health needs of LGBTQIA+ individuals. A compatible affirmative therapist can provide a supportive and validating environment in which clients can explore their sexual orientation and gender identity. Other types of therapists may lack the experience or knowledge to address the diverse experiences and identities within this community. 

Affirmative cognitive behavioral therapists undergo specialized training to help them address various clinical challenges that LGBTQIA+ individuals face in their life. Specific training courses for affirmative therapists may involve identifying minority stress, understanding LGBTQIA+ mental health, and developing affirmative psychotherapy skills.

In addition to validating and affirming clients' experiences, affirmative therapists may use different therapeutic techniques to help LGBTQIA+ individuals overcome challenges. Some of these techniques may include encouraging self-acceptance, teaching healthy coping skills, and facilitating communication in family therapy sessions. 

CBT and other techniques

Affirmative therapists may also integrate cognitive behavioral therapy or other therapeutic techniques or treatments to approach challenges related to gender identity and sexual orientation. They can also help their clients address conditions like depression, anxiety, or substance use.

By maintaining up-to-date knowledge of best practices, affirmative therapists can ensure that their clients receive effective care in a supportive environment, regardless of their sexual orientation, gender identity, or other circumstances. Affirmative therapists often strive to remain sensitive to multiple points of view, as this allows them to reach a wide audience and provide empathetic care and greater acceptance for LGBTQIA+ individuals.

If you’re facing challenges with self-acceptance around your sexuality it may be helpful to seek out affirmative therapy from a therapist who respects and understands your identity. Through affirmative therapy, LGBTQIA+ individuals can often receive the support they need to overcome obstacles and maintain a healthy sense of mental well-being.

While there are various forms of therapy available, online therapy can be a convenient option. This form of remote therapy can help bridge the gap for people in need of specialized care.


What to expect from LGBTQIA+ therapy

LGBTQIA+ affirmative therapy has been shown to be effective for various individuals, including sexual and gender minority youth. This community-based and evidence-based approach effectively addresses depression and helps young people cope with both common and minority-specific situations. Findings highlight the importance of affirmative therapy in promoting mental well-being for LGBTQIA+ youth.

You can expect to discuss different struggles like internalized homophobia, transphobia, and coming out. Sessions may also address minority stress, substance use difficulties, and strategies to improve mental health.

Empathetic support

These sessions may prioritize empathetic support, creating a safe and accepting space where clients can express their feelings and experiences without fear of judgment. Through validation and active listening, affirmative therapists can promote a sense of belonging and understanding for their LGBTQIA+ clients.

Internalized stigma

Therapists may help clients recognize and challenge any feelings of shame or self-hatred that stem from societal stigma and oppression. By exploring and dismantling internalized homophobia or transphobia, individuals can develop greater self-acceptance and self-esteem.
Coming out
Therapists can offer support, guidance, and resources for coming out to friends, family, and society. As a gay man or any LGBTQIA+ person, individuals may gain confidence and improve their mental health by addressing fears, concerns, and challenges related to the coming out process.
Coping with minority stress
Minority stress can stem from discrimination, harassment, and prejudice experienced by LGBTQIA+ individuals. Therapists can help people identify and address these unique stressors, developing coping strategies that promote resilience and mental well-being.
Addressing substance use difficulties
Scientific research indicates that LGBTQIA+ individuals may experience substance use disorder at a higher rate when compared with heterosexual cis-gendered individuals. Therapists can help you explore any underlying challenges that contribute to substance use. In sessions, these challenges may be trauma, anxiety, or depression that directly relate to the experiences of those in the LGBTQIA+ community.
If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.
Mental health improvement

Overall mental health improvement may involve developing mindfulness techniques, setting healthy boundaries, and building a support network. Compared to other forms of therapy, LGBTQIA+ affirmative psychotherapy may reflect a deeper understanding of the challenges facing members of the LGBTQIA+ community. This customized approach can lead to improved mental health outcomes such as decreased depression, anxiety, and stress.

Seeking support and where to find it

When seeking support, it may be important to find a therapist who understands and respects your identity, actively listens to your concerns, and adapts the therapeutic process to suit your needs. 
Finding the right therapist may involve researching their background, experience, and qualifications. Consider looking for professionals who have completed LGBTQIA+-specific training in psychology or have a history of working with LGBTQIA+ clients. You can also seek recommendations from friends, community centers, or support groups within the LGBTQIA+ community. 
During initial sessions, you may want to discuss your expectations and goals openly. An effective therapist will often create an open, non-judgmental atmosphere for patients where you feel comfortable expressing your thoughts and feelings. Remember that it’s normal to try different therapists until you find one who makes you feel understood and supported.

Online support

There are a number of online options for affirmative therapy, including AFFIRM Online, which is designed for  LGBTQIA+ youth, children,and young adults. The eight-session affirmative therapy method provided by AFFIRM resulted in reduced symptoms of depression, improvements in coping skills, and better stress management.

Online therapy can be a valuable resource for lesbians, gay men, individuals who self-identify as nonbinary, and other members of the LGBTQIA+ community who face barriers to in-person therapy. Some of these individuals may be hesitant to discuss challenges related to their sexual or gender orientation for fear of judgemental behaviors or attitudes. Online settings may help put people at ease discussing sensitive topics like these. This form of remote support may also be more convenient since it can be sought from home.
Online platforms like BetterHelp encourage diversity and may offer a convenient way to seek cognitive behavioral therapy for LGBTQIA+ individuals who face specific challenges.
Getty/Vadym Pastukh


LGBTQIA+ affirmative therapy is a personalized approach that supports individuals in the LGBTQIA+ community by validating and advocating for their needs. This form of therapy can offer a safe and empowering environment to address unique challenges that community members face, including discrimination and stigma. Online therapy platforms like BetterHelp may provide easier opportunity to find support via specialized therapists who understand the unique challenges of the LGBTQIA+ community.
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