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What is LGBTQIA+ Affirming Therapy? | A Guide for LGBTQIA+ Clients

What does “LGBTQIA+ affirming” actually mean?

For members of the 2SLGBTQIA+ (Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, Asexual, and other associated identities) community, finding a therapist who feels safe and accepting can be difficult. LGBTQIA+ clients are looking for more than a therapist who simply states “I accept LGBTQ people.”

At its core, LGBTQIA+ Affirming Therapy:

  • Recognizes and respects 2SLGBTQIA+ identities

  • Does not treat someone's sexual orientation, gender identity, or gender expression as a problem to be fixed

  • Understands how stigma, discrimination, family rejection, and minority stress can impact mental health

  • Is intersectional--meaning that affirming therapists understand and acknowledge how clients’ (and their own!) social and political identities create different experiences of privilege and discrimination.

I would like to emphasize that clients do not need to be struggling specifically because they are LGBTQIA+ to benefit from affirming therapies. Being 2SLGBTQIA+ is NOT the problem. The stress of navigating a world that isn’t always accepting can be.

What does an LGBTQIA+ affirming therapist do?

An affirming therapist will:

  • Use your chosen name and pronouns.

  • Avoid making assumptions about your gender, sexuality, relationships, or family.

  • Ask open-ended questions rather than assuming heterosexuality or cisgender identity.

  • Respect different ways of expressing gender and sexuality.

  • Understand that identities can be fluid or change over time.

  • Support you in exploring your identity without pushing you toward a particular label.

  • Recognize the impact of discrimination, microaggressions, conversion practices, family rejection, and other forms of stigma.

  • Help you navigate coming out, relationships, family dynamics, or gender transition if those are things you want to explore.

Why does LGBTQIA+ affirming therapy matter?

Minority stress--the stress that impacts people of marginalized identities--affects many members of the LGBTQIA+ community. According to The Trevor Project’s 2025 US Survey, 90% of LGBTQ+ youth respondents reported stress or anxiety in response to “recent anti-LGBTQ+ laws, policies, and debates” (2025).

LGBTQIA+ identities are NOT mental illnesses. However, LGBTQIA+ are more likely to experience:

  • Discrimination and harassment

  • Anticipated discrimination

  • Family rejection

  • Religious or cultural stigma

  • Internalized stigma

Again, these stressors are not a result of being LGBTQIA+. Instead, societal prejudices contribute to the above experiences, which increases mental health disparities.  

How can you tell whether a therapist is actually LGBTQIA+ affirming?

What you can look for on their website or in their paperwork:

  • Specific language on the therapist's website rather than just a rainbow symbol.

  • Do they mention particular LGBTQIA+ populations (trans, nonbinary, bisexual, etc.)

  • Does their intake paperwork uses inclusive language?

  • Do they have relevant training or experience?

Questions you can ask during a consultation:

  • “What does LGBTQIA+ affirming therapy mean to you?”

  • “What experience do you have working with LGBTQIA+ clients?”

  • “How do you work with clients who are questioning their gender or sexuality?”

  • “How do you approach pronouns and chosen names?”

  • “How do you incorporate intersectionality into your work?”

You deserve a therapist who sees your identity as a part of you--not a problem to solve. Therapy is a place where you can explore what it looks like to be your authentic self.

If you're looking for LGBTQIA+ affirming telehealth therapy in Washington state, you can learn more about my approach and get in touch here.

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