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FAQs:
What is an LGBTQ Affirming Therapist?
LGBTQ-affirmative therapists can help clients who are questioning their sexuality or gender identity explore those questions, as well as help those who identify as LGBTQ+ navigate the bias and heteronormativity that arises in everyday life. Clients who have been shamed or abused for their identity, especially by their family of origin, may struggle with depression or substance abuse as a result; affirmative therapy can help them heal and come to see their identity as a source of pride, not shame.
What is LGBTQ?
The term “LGBT” technically stands for lesbian, gay, bisexual, and transgender. It includes both sexual orientation (LGB) and gender identity (T). But, it’s sometimes used as an umbrella term for anyone who does not identify as straight (heterosexual) or cisgender, so it’s important to know other sexual and gender identities the term covers.
Who Invented LGBTQ Flag?
The first rainbow flag was created by Gilbert Baker, a prominent figure among gay political activists in San Francisco in the 1970s. The first flag was hand-stitched and dyed with the help of volunteers and friends, including Lynn Segerblom (Faerie Argyle Rainbow), James McNamara, Glenne McElhinney, Joe Duran and Paul Langlotz, for its debut at the 1978 San Francisco Gay Freedom Day celebration.
Baker created the flag in 1978, at a time when there were few symbols available to represent LGBTQ communities. Milk asked Baker to create a symbol for LGBTQ people that had a positive meaning behind it. The most popular queer symbol at the time was the pink triangle — previously used to mark gay people during the Holocaust — and was used most frequently by gay cisgender men.
What Does a Rainbow Flag Represent?
The rainbow flag is a symbol of lesbian, gay, bisexual, transgender and queer pride commonly used at LGBTQIA+ rights events worldwide. The colors reflect the diversity of the community in addition to the spectrum of human sexuality and gender. Over the years, the flag has been updated and changed to be more inclusive of LGBTQIA+ individuals and their allies. In addition to the rainbow, there are many other flags and symbols used to communicate specific identities within the community.
When Did the LGBTQ Movement Start?
In 1924, Henry Gerber, a German immigrant, founded in Chicago the Society for Human Rights, the first documented gay rights organization in the United States. During his U.S. Army service in World War I, Gerber was inspired to create his organization by the Scientific-Humanitarian Committee, a “homosexual emancipation” group in Germany.
Gerber’s small group published a few issues of its newsletter “Friendship and Freedom,” the country’s first gay-interest newsletter. Police raids caused the group to disband in 1925—but 90 years later, the U.S. government designated Gerber’s Chicago house a National Historic Landmark.
How to Define Gender?
Gender refers to the characteristics of women, men, girls and boys that are socially constructed. This includes norms, behaviours and roles associated with being a woman, man, girl or boy, as well as relationships with each other. As a social construct, gender varies from society to society and can change over time.
What is the Affirmative Therapy Approach in Working with LGBTQ Persons?
Affirmative therapy is a type of psychotherapy used to validate and advocate for the needs of sexual and gender minority clients. Therapists use verbal and nonverbal means to demonstrate an affirming stance toward lesbian, gay, bisexual, and transgender (LGBT) clients. Although this therapeutic approach can be used with LGBT individuals across the lifespan, the case presented in this paper highlights the benefit of using this approach with older LGBT individuals. Discussion of the unique challenges faced by older LGBT people will be followed with an illustrative case that shows ways that affirmative therapy can help individuals achieve greater self-actualization. The case formulation and conclusion will highlight specific ways that therapists can convey an affirmative stance and help clients feel welcome and accepted in the therapeutic setting. Recommendations for environmental cues, intake questions, and treatment skills will be offered at the conclusion.
Why is Finding An LGBTQ Affirming Therapist so Important?
Your success in therapy is shaped, in large part, by the “therapeutic alliance” between you and your therapist. Research shows that when you and your therapist share a clear understanding of your treatment goals and how you will achieve them, you’re more likely to participate actively in therapy to achieve those goals.
When you feel empathy from your therapist, studies show, you are more likely to find therapy sessions rewarding, successful, and engaging. Researchers say you may feel your therapist is “sharing the emotional load” with you.
This positive connection is especially important for LGBTQIA+ folks pursuing therapy. Discrimination, microaggressions, and health disparities are already part of the daily experience of most LGBTQIA+ people.
When you add the number of people who have been subjected to harmful procedures like conversion “therapy” — a disproven, discredited, and dangerous methodTrusted Source — the importance of finding a safe, knowledgeable, and culturally aware therapist becomes even clearer.
What is LGBTQIA+ Therapy?
LGBTQIA+ therapy is mental health therapy that is not only supportive of but created purposefully for the LGBTQIA+ community. It is also called LGBTQIA+ affirming therapy. Many different things inform the need for LGBTQIA+ therapy.
Mental Health Issues That LGBTQ Community Faces
People in the LGBTQ+ community are about twice as likely to have a mental health disorder in their lifetime compared to the general population. Of particular concern is mental health within the transgender community, as this group tends to have the highest levels of depression, anxiety and suicidal thoughts.
1. Anxiety Disorders in the LGBTQ+ Community
Anxiety is even more common in the LGBTQ+ community. The Rainbow Health survey found that two-thirds of Minnesotan adults who identify as LGBTQ+ feel anxious at least weekly. For BIPOC adults who identify as LGBTQ+, this number is even higher – 90% feel anxious on a weekly basis. Among youth who identify as LGBTQ+, 73% experience symptoms of anxiety, according to the Trevor Project survey.
2. Depression in the LGBTQ+ community
Depression is another common mental health concern in the United States – 1 in 20 people in the U.S. have regular feelings of depression. But as with anxiety, depression is far more common in the LGBTQ+ community. According to the Rainbow Health survey, about 75% of Minnesotan adults who identify as LGBTQ+ feel depressed one or more times per week, and about 20% feel depressed 5-7 days each week. Fifty-eight percent of LGBTQ+ youth report experiencing symptoms of depression, according to the Trevor Project survey.
3. Suicidal behaviors in the LGBTQ+ community
Identifying as LGBTQ+ makes it much more likely that someone will consider, plan or attempt suicide. LGBTQ+ youth are about four times more likely to try suicide than their heterosexual peers. The Trevor Project survey found that 45% of LGBTQ+ youth seriously considered suicide in the last year and 14% tried. Lesbian, gay and bisexual adults are also more likely to consider, plan or try suicide than the general population. According to a 2021 research article, suicidal behaviors among lesbian, gay and bisexual adults of all ages, races and ethnicities were 3-6 times greater than those among their heterosexual peers.
4. Substance use disorders in the LGBTQ+ community
The rate of SUD in the LGBTQ+ community is even higher. SAMHSA reports that 34% of adults who identify as lesbian, gay or bisexual have substance use disorders. Also, it’s estimated that between 20-30% of people who identify as transgender may have a SUD, but research is ongoing. Substance misuse is strongly connected to mental health concerns – among LGB adults with a substance use disorder, 70% also have a mental health concern, according to the SAMHSA reports.
5. Eating disorders in the LGBTQ+ community
About 9% of the U.S. population will have an eating disorder in their lifetime, according to ANAD (National Association of Anorexia Nervosa and Associated Disorders). But those in the LGBTQ+ community are much more likely to have eating disorders than the general population – this is especially true for boys, men and people who identify as transgender or gender nonconforming.
- Boys who identify as gay or bisexual are more likely to engage in food restrictive behaviors, self-induced vomiting, laxative abuse and diet pill use in order to control their weight, compared to their heterosexual peers.
- Gay adult men are seven times more likely to report binging and 12 times more likely to report purging than heterosexual adult men.
- Transgender college students are about four times more likely to have an eating disorder than their peers. People who are genderqueer and/or gender nonconforming are most likely to be affected.
Goals for LGBTQ Therapy
A good place to start your search is by asking yourself what you want to accomplish in therapy. Clarifying your goals up front can save time and money, and it can help you locate a therapist with the right training.
It’s also important to consider your list of must-haves and deal-breakers:
1. Do you want a therapist with expertise and training in a particular therapy approach, such as affirming cognitive behavioral therapyTrusted Source?
2. Do you want to work with a therapist who has a certain gender identity?
3. Do you want a therapist who is experienced in treating certain conditions, such as PTSD or recovery from sexual assault or abuse?
4. Do you want a therapist who is a member of the LGBTQIA+ community and who may be able to understand some of your experiences firsthand?
5. Would you feel comfortable working with a therapist who isn’t LGBTQIA+ but is an educated and culturally aware ally?
6. Do you want to work with a therapist who shares other aspects of your identity and understands intersectionality?
If you’re not sure what basic knowledge an affirming therapist should have, take a look at the American Psychological Association’s practice guidelines or the list of competencies compiled by the Society for Sexual, Affectional, Intersex, and Gender Expansive Identities (SAIGE).
These lists explain the attitudes, beliefs, and skills a good therapist should have. Reading the lists could help you establish your baseline expectations for how you should be treated in therapy.
Once you’ve defined your goals and outlined the qualities you’d like in a therapist, you can start looking for recommendations.
Reasons for Seeking LGBTQIA+ Therapy
Here are some possible reasons a person may choose to seek LGBTQIA+ therapy or LGBTQIA+ affirming therapy:
1. Homophobia and transphobia from previous medical or mental health providers.
LGBTQIA+ therapy is vital because it is more likely to truly and genuinely be a safe space. The trauma from seeing uninformed providers can make it tough to reach out, contributing to an increase in or worsening mental health problems. Many LGBTQIA+ people have faced discrimination or missteps due to a lack of understanding, some of which are dangerous and even life-threatening, in the medical or mental health care system. LGBTQIA+ therapy is informed care and is a space specifically made for people in this population, making for better, more effective care.
2. Trust and acceptance.
Of course, medical and mental health settings aren’t the only place a person might experience homophobia or transphobia. As a result, it can be hard to trust people who may not deeply understand your community. You want to believe that people will accept you, but for many people, there’s a genuine risk that you’ll encounter someone who won’t. When you see an LGBTQIA+ therapist who makes it known that they welcome you as a whole person, you might find that your body and mind relax. It’s hard to be on guard all of the time, but unfortunately, this is a common experience among LGBTQIA+ people, hence why community and safe spaces are so crucial.
3. Understanding of LGBTQIA+ specific concerns.
Marginalized groups face unique concerns that people outside of those groups don’t always think about. Problems specific to LGBTQIA+ people, like coming out or gender dysphoria, will often be better understood by a provider in this setting. This can also be true for specific terminology that the community uses. Different therapists are suitable for different people. This can be true across the board because different therapists have varying areas of specialty or understanding. It makes sense to see someone who specializes in your population in any context, and many people have a preference for that. This is no different.
Benefits of Seeing an LGBTQ Therapist
An LGBTQ therapist, either someone in the community or with extensive experience counseling those within it, can help you feel validated, promote personal growth and encourage you to live your most authentic life. The following are a few examples of how an experienced LGBTQ therapist can help you.
1. Embrace Your Identity
Most people go through periods of their lives when they question or struggle with their identity — these struggles can be especially hard for members of the LGBTQ community. As a result, LGBTQ individuals often seek therapy at higher rates than their non-LGBTQ counterparts. Therapy provides a safe, non-judgmental environment for you to discuss any questions related to your gender and sexuality and embrace who you are.
For instance, gender dysphoria can make you feel uneasy about your assigned gender and identity, often leading to intense feelings like depression, anxiety and low self-esteem. Therapists can help you recognize the issues you’re experiencing and provide the knowledge to embrace your identity and cope with feelings more healthily. LGBTQ therapy offers a space to express yourself and receive the tools to live a happier, more fulfilling life.
2. Address Unique Struggles
LGBTQ therapy is more than just working with someone who accepts your identity — it’s a space that can provide you with the specific tools and knowledge that apply to your unique experiences. For instance, LGBTQ therapists can help you address how homophobia or transphobia might affect your life and mental health. They can also help with feelings that arise from experiences like bullying and discrimination or coming out to friends and family.
In therapy, you can learn how to identify any uncomfortable or uneasy emotions you might associate with your identity, like internalized homophobia or anxiety. It can be challenging to face these feelings alone, but experienced therapists can help you manage and challenge these unwanted emotions.
3. Feel Validated and Advocated For
Often, people in the LGBTQ community have experiences that are different from others, for better and for worse. Knowing how to handle these situations can be challenging, which is where an experienced LGBTQ therapist comes in. Therapists can help you address societal stigmas and navigate murky waters, as counseling programs are designed specifically for the unique needs of the LGBTQ community.
In therapy, you enter a safe space for discussing issues like minority stress, discrimination and mental health concerns related to mistreatment. Therapists who are part of the LGBTQ community might be even more helpful since they can have insight and provide validation for these shared experiences.
Affirmative LGBTQ counseling empowers LGBTQ individuals in all aspects of their lives while celebrating their unique experiences. Therapists also focus on helping you find efficient ways to overcome daily obstacles. There are many challenges unique to the LGBTQ community, so it often takes a member of the community or someone who best understands their experiences to provide effective therapy.
4. Receive Relationship Support
Whether you’re in a long-standing partnership, starting a relationship or hoping for family counseling, LGBTQ therapy can provide many benefits. For instance, gay marriage counseling can help you with the following:
- Increase affection or intimacy in your relationship
- Establish healthy and rewarding roles within your marriage or relationship
- Achieve a healthy level of independence
- Feel self-love, regardless of gender expression or identity
- Learn how to celebrate your partner while fully embracing who you are in the relationship
- Handle societal expectations or stress associated with being in an LGBTQ relationships
- Learn how to incorporate more success and happiness into your relationship
LGBTQ therapy allows you and your partner or family to explore and discuss all aspects of your relationship and individual lives. In couples counseling, you can work toward meeting your relationship and personal needs, whether mental, sexual, emotional or spiritual.
5. Gain Self-Acceptance and Self-Love
Sometimes those who discover their LGBTQ identity struggle to come to terms with it — they may struggle to accept their identity and love themselves because of it. Trying to live an everyday life while harboring negative feelings about yourself can be tough, and it can impact your relationships, work and sense of self.
Many people in LGBTQ therapy choose these services to work through trauma and feelings of shame surrounding their sexuality or gender experience. In therapy, you can address feelings of shame in a safe, supportive environment. Over time, you can apply this optimism to your life and accept yourself fully. Self-love is vital for living a happier life. Gaining these tools can set you up for success in all aspects of your life, including academic, professional or relationship-wise.
While everyone can benefit from talking to a therapist who understands their unique situation, those with gender and sexuality concerns benefit best from seeing an experienced LGBTQ therapist equipped to offer the support and guidance necessary to navigate challenges safely and confidently.
What Happens in LGBTQIA+ Therapy
You can go to LGBTQIA+ therapy for anything that impacts your mental health or life overall. You don’t have to talk about LGBTQIA+ specific topics in treatment; you may pursue it simply because it makes for a more comfortable space to talk about anything that’s going on in your life.
Examples of what you might talk about in therapy include but are not limited to:
Relationships
Relationships aren’t just limited to those and the category of romantic relationships. They also include friendships and other bonds you might have in life. You can see an LGBTIA+ affirming therapist for individual therapy, couples therapy, family therapy, or even group therapy. Some of the benefits of group therapy for LGBTQIA+ is the platform to meet others who also experience the same struggles as they do.
Mental And Physical Health Conditions
About one in five adults within the general population in the United States live with a mental health condition. That number increases for those in the LGBTQIA+ community. Additionally, physical health problems, such as chronic illnesses, can negatively impact mental health, which no one is immune to.
Life Stress
We all face life stress. Life stress may refer to stress in the workplace, at school, or in other settings and environments. Exposure to things like homophobia can compound other sources of stress and is known to lead to higher stress levels, and this is a fact backed by research. So, in addition to the other stressors a person might face in their life, such as a large workload, navigating life as a new parent, or an otherwise busy schedule, stress levels can be higher among people within the community, leading us to understand once again there’s a prevalent need for affirming care.
Gender Dysphoria
Feeling comfortable in your body is something that most struggle with at some point in their lives. However, gender dysphoria (defined by the American Psychiatric Association as a “conflict between a person’s physical or assigned gender and the gender with which he/she/they identify”) is a unique condition experienced by transgender people. This is only one of many different issues that transgender people might face in their day-to-day life that can affect mental health. Gender dysphoria can affect both binary and nonbinary transgender people.
How to Find an LGBTQ Therapist
1. Ask a trusted provider
If you’re already seeing someone, but want to work with an LGBTQ-affirming mental health provider, ask your existing provider for recommendations. Most therapists want what is best for their clients and will be happy to help with a referral. FOLX providers and care teams can help members find LGBTQ-affirming mental health resources and therapists near them.
2. Try an internet search for LGBTQ-specialized therapists
The internet is a great place to search for an affirming therapist. Curate your search online for therapists who specify they work with queer people or identify as queer or LGBTQIA themselves. For example, you could google "LGBTQ therapists near me" or "gender-affirming therapists."
3. Start with your state
Make sure your location setting is on for your Google search for an LGBTQ therapist. Often, states will have specific mental health resources tailored to queer people. Additionally, it's important to search within your state because therapists can only work with people in states they hold a license in. If there aren't any listings in your area, it might be helpful to expand your search by considering online therapy, where you'd meet with your therapist virtually.
4. LGBTQ mental health search engines
Another option for finding a competent therapist is to use an LGBTQ health search engine. GLMA, the Gay and Lesbian Medical Association, has an LGBTQ+ Health Directory. You can search for therapists, psychiatrists, and sex therapists within a specific zip code. Providers list the therapies they specialize in, including gender-affirming and LGBTQ-affirming care.
For queer people of color, having a queer therapist of color might feel important. Studies show BIPOC LGBTQ folks experience more significant psychosocial stress. White therapists may not understand the full impact of racial microaggressions people of color experience. One directory of queer-competent and queer-identified therapists includes the National Queer and Trans Therapists of Color Network (NQTTCN).
5. Ask your community
Sometimes, your best resource is your community. If you know other LGBTQIA people who are in therapy, ask for their recommendations. You can post in local queer Facebook groups or "queer exchanges'' to check for queer-competent providers in your area.
If you contact a recommended provider that isn't accepting new patients, don't be afraid to ask if they have a waitlist or if they have referrals. They may know of other mental health resources like hotlines, support groups, group therapy, and family therapy. Just because someone cannot see you doesn't mean they can't help guide you in the right direction.
How to Tell If a Therapist is LGBTQ Friendly
Some signs indicate an LGBTQ-friendly therapist, even before the first meeting. Are their pronouns listed on their website or professional page? Do they mention anything about working with LGBTQ individuals?
The best way to know if a therapist is LGBTQ-friendly is by asking a few direct questions during your first visit. It might seem awkward or intimidating at first. However, you can be empowered to take this opportunity to see if your therapist is a true LGBTQ advocate and has the experience you are looking for.
Therapists often offer free, no-charge consultation calls with prospective clients. During the visit, have a list of questions handy to see if it's a match made in queer heaven.
Questions could include:
1. What is your experience providing counseling services to the queer community?
2. What training(s) have you completed to better understand working with queer people?
3. Are you willing to disclose if you are a member of the LGBTQ community? (Some therapists may not want to disclose this, but many will!)
4. Do you currently have other queer clients?
5. What would you do if I shared something you weren't familiar with or educated on regarding LGBTQ issues?
6. Are you in supervision? Does your supervisor understand queer and trans identity?
If they aren't able to answer these questions, it may not be wise to move forward with this therapist. They may not have the skill and competency you want. If your mental health provider doesn't check all your boxes, weigh the pros and cons of sticking it out with them. Don’t be afraid to therapist shop! It is common for it to take several conversations to find the right fit.
Sources:
The content herein is provided for general informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Medical information changes constantly, and therefore the content on this website should not be assumed to be current, complete or exhaustive. Always seek the advice of your doctor before starting or changing treatment. If you think you may have a medical emergency, please call your doctor or 9-1-1 (in the United States) immediately.