Affirming Care: What LGBTQIA+ Clients Should Know About Therapy

June is Pride Month; a time to both celebrate identity as well as advocate for equality in all spaces, and the therapy space is no exception to that. All people deserve access to safe, supportive therapy services. However, there are several systems that have historically felt(and continue to feel) unsafe for members of the LGBTQIA+ community. The field of psychology as a whole has a long history of pathologizing individuals who fall outside of heteronormative and cisnormative standards, framing LGBTQIA+ identities as disorders rather than natural expressions of human diversity. For much of its history, the DSM labeled LGBTQIA+ identities as mental illnesses. Homosexuality was listed as a disorder until the early 1970s, and even after it was removed, other terms like “ego-dystonic homosexuality” kept the idea that queerness was something to be treated (Cabaj, 2023). Later editions of the DSM shifted some of the language around gender, eventually introducing “gender dysphoria” to describe the distress some people feel related to their assigned sex. However, there is still a lasting impact of pathologizing queer and trans experiences. 

It is important that LGBTQIA+ individuals who are seeking therapy know what to expect in the therapeutic process and what to look for in therapy services that are affirming and empowering, rather than pathologizing or othering. LGBTQIA+ clients deserve a therapist who respects their identity. This includes using the correct name and pronouns, avoiding assumptions about gender, sexuality, or relationships, and staying open to feedback and ongoing learning. Therapy should be a space where clients can explore who they are without pressure or judgment.

There are also some red flags to be aware of. These might include being misgendered or deadnamed, having your identity treated like a problem to be solved, or dealing with a therapist whose questions feel more intrusive than supportive. If the therapist seems more focused on their own comfort than on your safety, that’s a sign to reconsider the fit.

Affirming therapy includes many aspects, such as an awareness of an individual’s intersecting identities such as their race, gender, class, disability status, sexual orientation, a respect and understanding of the individual who is being served that goes far beyond “tolerance” or “acceptance” but instead strives to help individuals feel truly seen, validated, understood in therapy, and an understanding of how larger systemic issues and societal stigma towards members of the LGBTQIA+ community can contribute or cause anxiety, depression, suicidality, and trauma (Meyer, 2003). 

Finding a therapist who is the right fit can take time. Don’t be afraid to ask questions about a therapist’s experience, supervision, or how they continue learning about queer and trans issues. If you’ve had a harmful experience in therapy before, that pain is real and valid. You’re allowed to take breaks, start over, or seek a new therapist who is affirming of who you are. Healing is still possible, especially in spaces that truly see and support you. Affirming care isn’t about feeling safety, connection, and like you don’t have to explain the most basic parts of yourself. Everyone deserves that kind of support. 

References:

Cabaj, R. P. (2023). Working with LGBTQ patients. Psychiatry.org; American Psychiatric 

Association.https://www.psychiatry.org/Psychiatrists/Diversity/Education/Best-Practice-Highlights/Working-with-LGBTQ-Patients

Meyer I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual 

populations: conceptual issues and research evidence. Psychological bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674

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