Finding a therapist who you actually trust and whose services you can afford often feels like a daunting task. Navigating the healthcare system can be unnecessarily confusing in general, but doing so when you're in need of emotional support might make you want to abandon the whole process altogether. But working with a therapist or counselor who you click with, and who really hears you out can make a huge difference in your experience with therapy.
This is especially true for members of the LGBTQ+ community. Unfortunately, LGBTQ+ individuals face a number of health disparities due to discrimination, according to the American Psychiatric Association (APA). As a result, many people may delay or avoid seeking often necessary medical treatment, including mental healthcare treatment.
To be clear, identifying as LGBTQ+ is absolutely not a mental disorder. But it's true that LGBTQ+ individuals are more than twice as likely as heterosexual individuals to have a mental health disorder in their lifetime, and 2.5 times more likely to experience depression, anxiety, and substance abuse. "Sexual and gender minority people face a lot of stress and devaluation that can produce anxiety, depression, and other mental health troubles," explains Sheila Addison, PhD, LMFT, a psychotherapist in Oakland, CA. "But the source of the problem is how society treats you, not who you are."
On top of all this, studies suggest that more than 700,000 LGBTQ people have been subjected to conversion or "reparative" therapy, a medically unjust and destructive practice that's designed to change a person's sexual orientation or gender identity under the guise of "therapy." Having a therapist who is a LGBTQ+ ally, often called an "affirmative therapist," ensures that therapy will help rather than cause more harm, Dr. Addison says.
Having a mental healthcare provider who understands our identities and experiences, the systemic barriers we face, and how our existence is indeed resistance, well, as trans and queer people this can be literally lifesaving.
Alex Iantaffi, PhD, MS, SEP, CST, LMFT, chair elect for the Trans and Queer Advocacy Network for the American Association for Marriage and Family Therapy
As the name suggests, "affirmative therapists do not attempt to change someone’s gender identities, expression, or sexual identities, but rather they nurture and support authenticity and self-acceptance," explains Alex Iantaffi, PhD, MS, SEP, CST, LMFT, chair-elect for the Trans and Queer Advocacy Network for the American Association for Marriage and Family Therapy. Essentially, affirmative therapists create safe environments for LGBTQ+ clients through their words, actions, and therapeutic approaches.
"Being an affirming therapist means that, first and foremost, you assume that being a sexual or gender minority is perfectly normal and valid," Dr. Addison says. "It means you don't believe that being heterosexual or cisgender is 'normal' and everything else is a 'deviation' from normal." Sadly, this is not the norm among therapists and clinicians. Research has shown that the majority of therapists report never receiving training about working with LGBTQ+ individuals during school. "It's safe to assume that many therapists continue to practice for years without ever getting basic or updated information on sexual and gender minorities," Dr. Addison adds.
During a session with an affirming therapist, you can talk about whatever you want, from anxiety about work, to your relationship to your body, Dr. Addison says. "Some people go to therapy to help figure out who they are and what they want — who they want romantic and sexual relationships with, what gender modality will feel congruent and affirming to them, and so on," she says. Like any other therapeutic conversation, you might talk about your familial relationships, past traumas, or transitions in your life. Seeing an affirming therapist often means that you're more likely to reap the benefits of help with whatever brings you to therapy in the first place. "You deserve a therapist that affirms who you are and who can support you in achieving what you want to achieve and/or heal what you want to heal," Dr. Iantaffi says.
So, how do you seek out an affirming therapist? Sometimes getting matched with the right therapist means talking to a few different people, and asking what their approach is, Dr. Addison says. (Websites like TherapyDen, Gaylesta, and Psychology Today have therapist databases that let you search by specialty.) A good place to start is a local university in your area, which may have graduate training programs in psychology, marriage and family therapy, counseling, or social work. "Many university training programs have a clinic where students see clients for some of their training, and this is usually offered at a lower cost," she says. If that's out of your budget, consider group therapy sessions where you meet with a group for one to two hours to talk about your issues, she says. "I recommend LGBTQ+ people look for an affirming therapist leading a group, or a group specifically for sexual and gender minority people," she adds.
While therapist shopping might feel like one more hurdle, it's absolutely worth it in the long run. "In a world that continues to tell many trans, non-binary, and queer people that we should not exist... having a mental healthcare provider who understands our identities and experiences, the systemic barriers we face, and how our existence is indeed resistance, well, as trans and queer people this can be literally lifesaving," Dr. Iantaffi says.
If you are struggling with anxiety and are in need of information and support, please call the National Alliance on Mental Illness at 1-800-950-6264. For a 24-hour crisis line, text “NAMI” to 741741.
If you are an LGBTQ person thinking about suicide, please call the Trevor Lifeline at 1-866-488-7386.