Finding an LGBTQIA+ Affirming Therapist: Questions and Answers to Help


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Looking for a therapist can sometimes feel like a needle-in-a-haystack situation: You need someone well-trained, experienced, and effective at treating your particular issues. You need someone who “gets” you and creates a space where you feel safe and supported. And then there’s the whole issue of affordability.

Given the long history of discrimination, health disparities, and “corrective” treatments that have made therapy downright dangerous for LGBTQIA+ folks, finding the right therapist is no small feat. Where do you even begin?

This Q&A may help.

What are my specific goals for 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:

  • Do you want a therapist with expertise and training in a particular therapy approach, such as affirming cognitive behavioral therapy?
  • Do you want to work with a therapist who has a certain gender identity?
  • Do you want a therapist who is experienced in treating certain conditions, such as PTSD or recovery from sexual assault or abuse?
  • 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?
  • Would you feel comfortable working with a therapist who isn’t LGBTQIA+ but is an educated and culturally aware ally?
  • 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.

Whose referral do I trust?

The short answer is that you should gather referrals from people you trust. Friends, colleagues, healthcare professionals, staff at community centers, and people in organizations that specialize in meeting the needs of LBGTQIA+ people are all good resources.

You may find referrals especially valuable if they come from people who know you, who understand the mental health issue you want to address, or who share aspects of your identity that you believe may be central to your therapy.

Beyond my inner circle, are there organizations I can trust to help me locate a therapist?

Nobody is just one identity. Every individual has a personal history, a community of origin, and a here-and-now community, as well as aspects of identity related to gender, sexuality, race, spiritual tradition, economics, education, talents, health issues — you name it. Identity is a complex, beautiful puzzle to piece together.

Here are some places to look for resources that may help you connect with a therapist who fits with your individual needs:

  • GLBT National Help Center’s LGBT Near Me guide allows you to type in your zip code to locate all kinds of services and support in your area.
  • Find an LGBTQIA+ community center near you. The 2020 LGBTQ Community Center Survey reported that nearly two-thirds of the centers provide direct mental health services to people in their community.
  • Check PFLAG’s network to find a chapter in your area. PFLAG offers support for families, too.
  • GLMA Health Professionals network maintains a searchable provider directory to help you find a therapist near you.
  • The American Association of Sexuality Educators, Counselors, and Therapists (AASECT) has a referral directory that may help you narrow your search.
  • The National Queer and Trans Therapists of Color Network offers a mental health practitioner directory to help queer and trans people of color find therapists who understand the unique needs of people living in multiple systems of oppression. You can find more resources for people of color here.
  • The World Professional Association for Transgender Health’s (WPATH) provider directory lists therapists in your search area, along with their certifications and specialties.
  • The Pink List provides a directory of queer-inclusive mental health practitioners in India.
  • Trikone’s DESI LGBTQIA+ organization offers a peer-support helpline for people of South Asian descent, available Thursdays through Sundays from 8 to 10 p.m. (ET)/5 to 7 p.m. (PT) at 908-367-3374.
  • HelpPRO has a search tool that allow you to choose a therapist who is LGBTQIA+ affirming. It can also help you locate a support group in your area.
  • The behavioral health treatment services locator or FindTreatment.org from the Substance Abuse and Mental Health Services Administration (SAMHSA) can help you find a treatment facility for substance use disorders.

If you’re working, you may want to check with your benefits department to see if there is an employee assistance program with mental health services.

If you’re a part of a faith community that supports the rights of LGBTQIA+ people, you might locate resources and referrals through that organization.

Most colleges and universities also offer mental health counseling to students on campus, or you can ask for a referral at a campus LGBTQIA+ center.

Once I pick a therapist, what kind of background research should I do? 

Once you’ve narrowed your search to several promising leads, it will probably be worth your time to read each therapist’s online profile and any research or writing they’ve published.

Doing this kind of homework up front can give you valuable insight into the therapist’s approach to treatment, guiding philosophies, and communication style.

As you explore your therapist’s individual profile and the website of the practice as a whole, notice whether they specify pronouns. If they do, it’s a good sign that the practice respects gender diversity. You can also look for statements expressing the practice’s commitment to inclusion.

It’s also important to verify the therapist’s credentials with your state’s licensing board. Many states also enable you to search for official complaints or censures on the therapist’s record.

What questions should I ask a therapist when we first meet?

Give yourself permission to ask any question that matters to you. In the week leading up to your appointment, you may want to jot them down so you don’t have to rely on your memory during the initial appointment.

If you’ve had a negative experience in therapy before, you may want to spend some time thinking about what you didn’t like, so you can ask questions to head off a similar experience with your new therapist.

A 2020 research review found that many LGBTQIA+ people have experienced poor quality mental healthcare in the past because their mental health professionals either didn’t understand their needs or held stigmatizing, heteronormative assumptions and beliefs.

The Human Rights Campaign and Mental Health America have created questions to help you be sure a prospective therapist will be LGBTQIA+ affirming. You can download and print this list of questions to take with you or consider emailing them to a prospective new therapist in advance.

In addition to these important questions, here are some nuts-and-bolts practicalities you may want to address:

  • Is the therapist a provider in your insurance network?
  • How long will it take to get to your therapist’s office from home or work?
  • Does the therapist offer a sliding scale or income-based fee schedule?
  • What’s the appointment cancellation policy?
  • Are the office hours compatible with your work schedule?
  • Does the therapist offer virtual visits?
  • How does the office staff treat you when you call to schedule or reschedule an appointment?

Is online therapy a good option for me?

If you live in an area where the in-person options are slim, or if your schedule doesn’t make it easy to connect with a therapist during regular office hours, telehealth or online therapy might be a good choice.

The COVID-19 pandemic broadened the online options for many kinds of healthcare — and it made lots of people more open to the possibility of working with a healthcare professional on a screen.

The biggest benefit of online counseling is that it expands your choices, allowing you to connect with therapists whose expertise might not be available nearby.

In a 2018 survey conducted in Austria, therapists reported that the number one reason to use online therapy is that it “bridges distances.” The other top benefits: Online therapy is discreet, and it increases your time flexibility.

Recent research has shown that having access to online therapy can be especially important to LGBTQIA+ people in rural areas with fewer resources. The study also revealed that online therapy still needs development when it comes to meeting the needs of LGBTQIA+ clients.

You might want to explore Pride Counseling, a subsidiary of the online therapy platform BetterHelp. Talkspace is another popular option. Many practices, such as The Gay Therapy Center, offer both in-person and virtual sessions.

Online therapy might not be a good option for you if:

  • your health insurance plan doesn’t cover online therapy
  • you have a serious mental health condition
  • you are in an emergency situation and you need immediate help
  • you need a psychiatrist who can help you with hormone therapies
  • you want an in-person therapy experience

If you decide to try online therapy, it’s a good idea to read online reviews of the providers you’re considering. While everybody’s experience is unique, reading reviews can save you time and frustration by pointing out drawbacks you might otherwise have to discover on your own.

What if I’ve made a big mistake?

It happens. Your first impression of your new therapist turns out to be wrong, the hoped-for connection doesn’t materialize, or your needs just change. It’s OK to switch therapists if the first one doesn’t work out. You don’t need a reason, ever, to change therapists.

Finding a new therapist after you’ve invested in the relationship certainly isn’t ideal. To reduce disruption and stress, it might be worthwhile to meet with several therapists before you choose one. Many therapists are happy to have a brief phone or online “interview” so you can determine if their experience and style are what you need.

What if I need help right now?

If you’re in immediate danger — if, for example, you’re thinking about harming yourself or someone else, please reach out to a helpline or crisis center like the National Suicide Prevention Lifeline at 800-273-8255.

Contact a trusted friend, family member, or healthcare professional, or consider calling 911 or your local emergency number if you can’t get in touch with them.

There are so many more resources than there used to be, and you are not alone. There are hundreds of trained people all over ready to help.

You can find someone to listen and support you at any of the centers below.

If you need help now

  • Call The Trevor Lifeline at 866-488-7386, text START to 678-678, or use TrevorChat.
  • LGBT National Help Center’s Hotline offers text and email support at 888-843-4564.
  • Reach the LGBT National Help Center’s National Youth Talk Line at 800-246-7743 or the Senior Hotline at 800-234-7243.
  • Call or text the oSTEM’s THRIVE’s Lifeline at 313-662-8209.
  • If you’re a young person of color, text STEVE to 741741.
  • Call the Trans Lifeline Hotline at 877-565-8860 (US) or 877-330-6366 (Canada).
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) Helpline can help at 800-662-4357.
Healthline

Why is finding an 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 method — the importance of finding a safe, knowledgeable, and culturally aware therapist becomes even clearer.

What if I need a low-cost or no-cost therapist?

Most health insurance plans cover mental health services. You’ll probably need to contact your benefits administrator or consult your provider network to be sure your therapist is covered.

Medicare and Medicaid both pay for mental health services, too.

If you don’t have health insurance or your deductibles are high, you may also be able to access low-cost or no-cost services through:

  • a community health center
  • an LGBTQIA+ organization in your area
  • a therapy “scholarship” fund, such as the National Queer and Trans Therapists of Color Network mental health fund

Some online therapy providers may be able to connect you to a therapist who offers income-based pricing.

If you are an LGBTQIA+ person trying to leave an abusive relationship, you may be able to free get counseling services and support through a local domestic violence organization. Many offer therapy for children as well.

The takeaway

Finding an affirming, empathetic therapist can be life changing. Taking these steps could make the process easier for you:

  • Clarify your goals.
  • Identify your deal breakers and must-haves.
  • Gather referrals from people you trust.
  • Leverage LGBTQIA+ organizations in your search.
  • Consider online therapy and support groups.
  • Ask all the questions.
  • Reach out to a helpline if you’re in immediate need.

And last — but definitely not least — keep searching until you find a therapist who meets your needs. Your well-being is worth the effort, intuition, and time you’ll invest.


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