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Key points
- LGBTQ+ allies are trained to be supportive.
- Affirmative therapists are trained to address internalized homophobia and transphobia.
- LGBTQ+ counselors draw insight from their lived experience.
- Gender specialists are trained in a variety of gender-related issues.
Psychology Today has a very useful LGBTQ+ search engine to help you find LGBTQ+ friendly mental health professionals near you. There's also a Transgender search engine if you're looking for therapists who specialize in gender diversity. If you're in a rural area with fewer providers, try searching the zip code of a major city in your state, as many counselors provide telehealth services to work with clients long distance.
With all these search results, though, how do you pick a practitioner who's right for you? How do you find someone who truly understands what you're going through? To figure this out, let’s break down some of the key terms to look for in their profiles.
LGBTQ+ Allies
Allied therapists have gone through Safe Space and Ally training to support sexual and gender minorities. These trainings provide helpful guidelines and a basic intro to LGBTQ+ issues like minority stress and the importance of social acceptance. Ally training does not, however, provide an in-depth education on LGBTQ+ mental health. This can sometimes make LGBTQ+ allies a bit of a mixed bag.
Sometimes you’ll find a therapist whose bio has no mention of anything LGBTQ+-related, except for including Transgender or LGBTQ+ in the list of issues they work with. This usually indicates that they’re open to working with LGBTQ+ clients but they may not be centering the demographic in their practice. By comparison, more active allies are typically involved with the community, and will usually mention their support for LGBTQ+ people in their bio to communicate their nuanced understanding.
Affirmative Therapists
Therapists who are more serious about LGBTQ+ mental health often go beyond allyship to continue their education through post-graduate courses, and many of them may become Affirmative Therapists. As a therapeutic modality, Affirmative Therapy normalizes the impact of minority stress; facilitates emotional awareness, regulation and acceptance; decreases avoidance strategies; restructures minority stress cognitions like internalized homophobia/transphobia; and seeks to empower a client by developing assertive communication.1 Affirmative Therapists specialize in working with sexual and gender minorities and have honed their skills to do so. Since their professional goal is to work with LGBTQ+ clients, you'll definitely know an Affirmative Therapist when you read their bio.
LGBTQ+ Counselors
LGBTQ+ Counselors, sometimes called Queer Counselors, are mental health therapists who are also members of the LGBTQ+ community. As you can imagine, this is a diverse pool of professionals. While many are trained in Affirmative Therapy, others are not, focusing on modalities like Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), or Person-Centered Therapy (PCT)—and some may integrate Affirmative Therapy with those modalities in hybrids like Affirmative ACT or Affirmative CBT.2,3
Not every gay or trans therapist will disclose their sexuality or gender identity in their profile, especially if it's incidental to their work. Just because a therapist is gay, doesn't mean they have to specialize in sexuality, right? But those who actively identify themselves as an LGBTQ+ Counselor typically do so because it's relevant to their practice. By integrating their personal lived experience into their practice, they seek to help LGBTQ+ clients in need of guidance. Additionally, those who identify as Queer Counselors are nodding to Queer Theory, a perspective advocating for sexual and gender minorities beyond the binary.
Gender Specialists
Gender specialists are licensed mental health professionals with advanced training in gender identity, dysphoria, and self-actualization. While Affirmative Therapists provide supportive care for LGBTQ+ individuals, Gender Specialists focus specifically on gender-related issues impacting men, women, transgender, and nonbinary people. This includes the social and psychological aspects of gender, as well as practical knowledge around transition, hormone therapy, and the letters needed for surgery.
What to Ask
The majority of therapists will offer a potential client a free, 15-minute telehealth consultation. During this time they'll ask you about yourself, and what you would like to work on in therapy. This is the perfect time for you to ask about their approach to LGBTQ+ mental health.
You can ask them professional questions like:
- How many LGBTQ+ clients have you worked with?
- Have you ever worked with a trans or nonbinary person?
- Have you ever worked with someone questioning their sexuality?
- Have you ever helped someone transition?
- Have you ever helped someone come out?
You can also ask them exploratory questions like:
- What are some of the socio-political issues facing gay people today?
- Why do you think questioning gender is so stressful?
- How do you help people work through internalized homophobia/transphobia?
- How do you include Chosen/Found families in your process?
- What is your approach to minority stress and issues like racism, sexism, and homophobia?
You can even ask directly if they fit what you’re looking for:
- I need a therapist who can also teach me about Queer culture. Is that you?
- Are you comfortable going deep on existential questions about life and death?
- I need a therapist who understands how intergenerational trauma is tied to gender. Is that something you can help me with?
- I struggle to know if I’m really understood, so I’m looking for a therapist who can relate to me. Do you have any personal experience with what I’m talking about?
- Are you political or apolitical with your clients? I need a therapist who can validate my anger and support me in my advocacy instead of just tell me to self-soothe.
It’s perfectly acceptable to ask a therapist about why they got into therapy, too. Just keep in mind that counselors must maintain personal and professional boundaries, so they may not give direct examples from their lives or regale you with detailed stories of their personal history. But when they give you an answer, pay attention to how well thought out or natural their response is. When a counselor speaks from a place of experience and common ground, it generally shows.
References
Proujansky RA, Pachankis JE. Toward Formulating Evidence-Based Principles of LGB-Affirmative Psychotherapy. Pragmat Case Stud Psychother. 2014;10(2):117-131. PMID: 26617475; PMCID: PMC4662552.
Stitt, A. L. (2022). Of Parades and Protestors: LGBTQ + Affirmative Acceptance and Commitment Therapy. Journal of LGBTQ Issues in Counseling, 16(4), 422–438. https://doi.org/10.1080/26924951.2022.2092931
Ashley Austin, Shelley L. Craig, Edward J. Alessi, (2017) Affirmative Cognitive Behavior Therapy with Transgender and Gender Nonconforming Adults. Psychiatric Clinics of North America, 40(1), 141-156,
https://doi.org/10.1016/j.psc.2016.10.003.
