Finding a good therapist can be especially tricky for those in the LGBTQ+ community. Even if you’re not particularly looking to discuss matters of gender or sexuality, you want to go in confident that all facets of yourself are understood and accepted.
Madison McCullough, a psychotherapist based in New York who is queer, knows firsthand how impossible it can be make headway with a mental health professional who doesn’t grasp the complexities of your identity.
“I often share with new queer clients during phone consultations that I have personally had the experience of being a queer person in therapy with a homophobic and heterocentrist therapist,” she told HuffPost.
“It was painful, compromised my sense of safety and made it incredibly challenging to do meaningful clinical work,” she said.
“If your therapist seems awkward when using contemporary terms like queer, pansexual, or non-binary, you’ll know that they haven’t taken the time become steeped in the subject.”
It’s so important to feel validated and affirmed in therapy because if you grew up queer, years of your life were likely spent concealing or repressing your true self, said Andrew Leaser, a therapy fellow at Kip Therapy in New York City.
“LGBTQ+ people are often given the message, either explicitly or indirectly through various microaggressions, that their identities are ‘wrong’ or ‘bad’ or both,” he said.
Even when you do finally feel safe to express yourself authentically, there’s often pressure to “prove” your queerness ― not only to cisgender people but also to other members of the LGBTQ+ community, Leaser said.
“So having a therapist that affirms our identities helps to alleviate these pressures so that we can just ‘be’ in sessions, which in turn allows us to explore our true thoughts and feelings without having to worry whether what we are sharing is ‘right’ or ‘wrong,’” he said. In short, “it can allow for a real examination of ourselves and whatever issues we are working through.”
There are a number of things to keep in mind when looking for the right LGBTQ+-affirming therapist. Below, mental health experts who fit that bill share tips for finding a therapist who aligns with your mental health goals.
Know the difference between LGBTQ-friendly vs. LGBTQ-affirming.
Before you begin your search, recognize that there’s difference between being LGBTQ-affirming and LGBTQ-friendly.
According to the American Psychiatric Association, “gender affirming therapy is a therapeutic stance that focuses on affirming a patient’s gender identity and does not try to ‘repair’ it.”
Someone who is “LGBTQ-friendly” is basically saying that they are willing to work with an LGBT client, said Mimi Hoang, a supervisor of the LGBTQIA+ Affirmative Therapy Center at the Airport Marina Counseling Center in Los Angeles.
“That doesn’t necessarily mean they are LGBTQ-affirming or well-versed in LGBTQ terminology and dynamics of power and privilege, or that they’ll be willing to help challenge the homophobia, biphobia or transphobia impacting their clients’ lives,” she said.
Utilize databases that cater to queer mental health when doing your initial therapist research.
These days, there are plenty of national directories of LGBTQ+ and affirming therapists at your disposable, most notably AGLP (The Association of LGBTQ+ Psychiatrists) and GLMA (formerly known as the Gay and Lesbian Medical Association). The National Queer and Trans Therapists of Color Network lists LGBTQ+ POC therapists across the country.
Psychology Today, probably the most thorough national listings of mental health professionals, lets you search by zip code and key terms (e.g., “gay,” “transgender”), though keep in mind that therapists can self-select these criteria.
You probably want to go a step further and review therapists’ websites to see if they mention LGBTQ-related training or a specialization in gender or sexuality, said Jesse Kahn, the director of the The Gender & Sexuality Therapy Center in New York City.
Kahn recommends considering the following questions while looking up a potential therapist’s web presence:
Is their website inclusive? (This could mean language and stock images.)
If they have blogs on their website, does the therapist write about content and express competence about topics that are important to you?
Are their forms inclusive? (For instance, do they offer more than two options for gender? Do they use gender-inclusive language throughout, like parents and guardians instead of mother and father?)
Do they seem comfortable talking about topics related to gender, sexuality and any topics or concerns you want to address?
Get a recommendation from a LGBTQ+ center in your community.
Another good place to start would be searching for LGBTQ+ centers in your city or nearby cities, Lesser said. If you’re in immediate need, some places can even connect you with you donation-based, walk-in peer counseling services for LGBTQ+ individuals.
“These centers often can provide properly vetted information about local therapists that specialize in LGBTQ+ specific issues, and may even have therapists on staff themselves,” Lesser said.
For example, in New York City, there is The Lesbian, Gay, Bisexual & Transgender Community Center ― known simply as The Center ― which provides a list of mental health service providers in each borough under its “Resources” tab. If you’re not in New York, search “LGBTQ+ organizations near me” for groups in your area. (For instance, Southern California has The Los Angeles LGBT Center, Chicago has the Center on Halstead and North Central Texas has LGBTQ SAVES.)
Consider teletherapy, especially if you’re in a rural area and struggling to find an affirming therapist.
For those living in rural areas, access to these types of services can be challenging if the closest center or other organization is far away ― especially if someone lacks reliable transportation.
In that case, Leaser recommends finding an affirming therapist that provides telehealth services. Because of COVID-19, many therapists have gotten licensed in additional states to offer telehealth services outside of their hometown.
“If something good came from the COVID pandemic, it is the explosion of therapy providers offering their services online, which is not likely to go away any time soon given how many people have grown accustomed to the convenience of teletherapy,” he said.
McCullough agreed. She recommends people in rural areas make use of directories like Manhattan Alternative, a great directory of queer-affirming therapists in the greater New York City area.
“They might have a wider network of colleagues to connect you with in your area,” she said.
Interview therapists before selecting one.
Definitely do a little “therapist shopping” by calling and asking for a free 15-minute consult first so you can “feel out” a few therapists before making a decision, Hoang said. (Don’t feel beholden or obligated to pick someone just because you’ve spoken to them and used up their time; many therapists already offer trial calls like this.)
During these brief consults, give the therapist a synopsis of your presenting concerns ― that’s therapy-speak for what led you to seek out therapy ― and ask them about their general approach and professional experience with your particular concerns.
“I would mention that you’re looking for an LGBTQ-affirmative therapist, someone who has formal training in LGBTQ issues, and see what they say,” Hoang said. “If they don’t know what that even means, then I would pass. If they don’t have a lot of experience but are willing to learn, then you might still want to consider them.” (More on that in a moment.)
During the consultation, ask them these three questions.
To get specific, Kahn recommends asking them the following questions during your phone or video call:
Have you received (currently or in the past) specialized supervision, training or consultation related to working with trans and gender diverse people?
Do you currently have any trans, gender diverse and/or non-binary clients?
If it’s important to you, you can ask the therapist their identity and share why that’s important to you.
You can learn a lot from the content of the therapist’s response and the language they use, said Adam D. Blum, a psychotherapist and the founder of the Gay Therapy Center, a private therapy provider with offices in San Francisco, Los Angeles, New York and Washington, D.C.
“If your therapist seems awkward when using contemporary terms like queer, pansexual, or non-binary, you’ll know that they haven’t taken the time to become steeped in the subject,” he said. “If your therapist becomes defensive when questioned about topics related to sexuality or gender, that’s a red flag. Good therapists do not become defensive.”
And if your therapist refers to your sexuality or gender as a “lifestyle,” Blum said it’s a very good indicator that they have not done much work with LGBTQ people.
Don’t rule out queer-friendly therapists who want to learn.
In order for therapy to work, you need to feel safe with your therapist. That sense of safety can come through a variety of avenues ― not just them claiming they’re “LGBTQ-affirming” ― and is largely a gut check, McCullough said.
“If a therapist acknowledges that their experience working with queer clients is limited, I would ask if they’d be willing to read certain material that you think might help them learn more about queer experiences,” she said.
“If they’re eager to learn and grow, that’s a good sign, but you as the client need to assess your comfort with your therapist learning through you in that way,” she explained. “If they bristle at that suggestion, keep searching.”
It’s important to remember that even if a therapist discloses that they are a member of the LGBTQ+ community, it doesn’t mean that they’ll automatically be affirming and a good “fit,” Leaser said.
“Every person has their own unique background and internal biases that shape their perception of the world, he said. “An upper-middle class, cisgender, gay, Black man living in New York City may perceive the world very differently than his upper-middle class, cisgender, gay, Black male therapist who also lives in New York City, given how they each grew up and their unique individual experiences moving through life.”
If you’re unsure about your therapist, give it a session or two to see if it’s just initial nerves, and mention this hesitation you’re feeling to the therapist.
“Of course, if the potential therapist is not opening to hearing and addressing your initial concerns or is dismissive of them, that would be a big red flag that this therapist probably won’t be a good match for you,” Leaser said.
But oftentimes, he said bringing these concerns to light “allows you and the therapist to explore why you’re feeling this way and address any discomfort in a way that leaves you feeling confident in continuing therapy.”