There are some unique struggles that queer and trans folks face when trying to access mental health care. From finding an LGBTQ-friendly therapist to clicking with a practitioner who can affirm their gender identity, it’s not always easy.
“Queer and trans folk might face having to come out to loved ones, friends, and colleagues and risk being rejected by them,” said Anthony Jauregui, a therapist and MyWellbeing community member. “As we zoom out and see how society is slow to accept queer folks and is even more slowly acknowledging trans folks’ existence and right to be treated as a human beings, we as therapists must be sensitive and compassionate towards these difficult and ongoing obstacles.”
Therapy-seekers often wonder if it’s important if their therapist shares their identity, whether their therapist will encourage them to come out if they’re not already, and what questions to even ask in the phone consultation or first appointment. So we asked our community of therapists to weigh in on how to find the best LGBTQ-friendly therapist for you.
And if they try to, that’s not a good sign! That’s not really what the therapeutic relationship is about.
“An LGBTQIA-competent therapist will never force someone to come out,” said Brie Scolaro, a therapist and MyWellbeing community member. “While some folx start therapy to specifically work on thoughts about their sexuality, gender identity, and/or gender expression, others are looking to work on something completely unrelated, like sleep or career performance. As the patient, you get to decide what to target in therapy and your therapist should non-judgmentally and collaboratively work with you toward that goal.”
In the media and even in the LGBTQIA community, there is sometimes a lot of weight put on coming out, and while it can be an incredibly significant process for some, each person’s experience is different and there’s no one right way to do it. If you’re struggling, though, it is something your therapist could help you navigate.
“‘Coming out’ can be a complicated process—one that may or may not be right for you at this point in your life,” said Teresa Thompson, a therapist and MyWellbeing community member. “Your therapist will not make you come out, but they can help guide you in exploring the complex emotions, values, and practicalities that may inform your decision. In my practice, I have clients who are out to everyone, clients who are out at home but don’t want to be out at work, and clients who aren’t ready to share their identity outside of therapy. Those are all totally okay places to be.”
While your therapist shouldn’t ever “make” you come out, they might want to explore the reasons behind why you might not want to, the relationships you might be concerned about, and the circumstances that have led to your decisions to come out or not as a way to get a fuller picture of your life—and better support you in your care. But only if that’s what you want to talk about in therapy!
“It is hard for me to imagine a therapist that would make someone come out,” said Birch Cooper, a therapist and MyWellbeing community member. “Personally, I believe most individuals share about their sexuality or gender identity when they are ready and feel safe to do so.”
“A therapist might encourage you to share what you are going through with a trustworthy person within your existing support network or meet others who have had similar experiences,” he said. “Support and community are two of the most important protective factors in mental health and wellbeing. Having said that, the encouragement to share or meet others should be gentle, without a timeline, and only once the therapist has an understanding of the fears, potential impact, and the complexity of sharing something so personal with others.”
This goes for most things in therapy: it’s your call! This is your experience, your time, your money, and your treatment. If finding a therapist who is queer and/or trans themselves is important to you, that’s totally valid.
“In my experience as an openly queer therapist, I find that many of my patients immediately feel more at ease knowing that I'm a member of the LGBTQIA+ community,” said Brie Scolaro. “However, I personally know many non-LGBTQIA therapists who are equally as able to connect with and effectively work with LGBTQIA+ folx.”
“While there are many shared social struggles across the community, each particular subgroup, such as trans or bi folx, face their own unique set of stressors and experiences,” they said. “It's important to understand that one's experience as a gay, white, cisgender man doesn't necessarily mean they understand and are competent in working with non-binary or BIPOC folx. Overall, it's more important to focus on how the therapist makes you feel than how they identify—Do they affirm, celebrate, and advocate your identity in its entirety, or do they see your LGBTQIA status as something to target or the root cause of your suffering?”
Especially when it comes to BIPOC therapy-seekers, finding culturally competent care is important. A culturally and linguistically competent mental health system incorporates skills, attitudes, and policies to ensure that it is effectively addressing the needs of patients and users with diverse values, beliefs, and sexual orientations, in addition to backgrounds that vary by race, ethnicity, religion, and language.
“Different therapists have different boundaries,” said Jennie Kogan, a therapist and MyWellbeing community member. “While I don't think a therapist needs to be queer or trans to be a great fit for a queer or trans client, I think a therapist needs to be working on unpacking homophobia and transphobia so they can show up for their clients with humility and compassion. No therapist or person knows any other person's triggers, but good therapists care to know and care to reflect on our biases.”
Think about what you want in a therapist and a therapeutic relationship because, like any relationship, you won’t be a perfect fit with everyone, and that’s okay. Your goals, or what you want the therapist to help you achieve; your tasks, or what the therapist will do and what you will need to do as an active and engaged client; and the bond between you are all part of your therapeutic relationship.
“The most important factor in finding a therapist is fit,” said Matt Milburn, a therapist and MyWellbeing community member. “Are you going to be comfortable being vulnerable with someone and trusting them to show care in your most raw moments? For queer and trans folks, it can be useful to find a therapist with a similar background so that the relationship is built on shared understanding of identity, community, and a safe place to explore the intricacies of being a gender or sexual minority.”
"One benefit of having a queer or trans clinician is that they will have experiential knowledge of queer culture,” said Menemsha Milnor, a therapist and MyWellbeing community member. “As most queer people can attest, explaining queer life to straight people is tiring at best.”
“One downside of having a queer therapist, if the clinician is your contemporary, is that your social circles may overlap at some point, even in a city as big as New York,” she said, “Think about how you might feel seeing your therapist on a dating app, for example!"
“It’s helpful to reflect on specifically how you hope having a therapist with a similar identity will improve your treatment,” said Teresa Thompson. “Will having a trans therapist provide a deeper level of affirmation and validation while you are exploring your new trans identity? Are you hesitant to talk about your sex life, but expect you’ll be a little less nervous if your therapist is queer too? Being part of the LGBTQ community is not a guarantee that your therapist will have exactly your same life experience or know everything about what queerness means to you, but getting clear on why certain commonalities are important to you can help guide the therapeutic work.”
And just because your therapist shares your identity, doesn’t mean they specialize in queer-focused therapy!
“It all depends on what you want from your therapy sessions,” said Joanne Davies, a hypnotherapist and MyWellbeing community member. “For example, I identify as queer and provide a queer-normative space, but I am not a queer therapist. I rarely read theory and do not regularly train in emerging queer-specific approaches to therapy. It’s possible that an ally with extensive experience supporting LGBTQIA+ clients may be better placed to help in some instances, whereas a queer-identified therapist may have a natural affinity that works better in others.”
We’re big fans of the phone consultation. Although it can be scary to jump on the phone and talk to a complete stranger, the phone consultation (which should always be complimentary) will give you insight as to whether you and a potential therapist would be a good fit.
“I suggest being as direct as possible during the consultation by stating whatever questions or concerns are on your heart,” said Jessica Holt, a therapist and MyWellbeing community member. “Notice how you feel about the therapist’s response for clues about how you might feel working with them during a session. Did you feel safe? Understood? Dismissed? Something else? If you aren’t sure where to begin here are a few questions you can ask:
Wait, I can ask a total stranger all of that? Yes!
“I don’t hold back on these types of questions!” said Birch Cooper. “I would ask them for their point of view on a topic that is important and relevant to you in order to ensure the two of you are aligned. At times, these questions can help identify any preconceived notions the therapist might have about your sexuality or gender identity. We are talking about your mental health, so in addition to alignment, you deserve to work with an advocate or ally. Share your pronouns at the beginning of the call and give them an opportunity to use them. This will help ensure they are seeing and hearing you as you are.”
In the phone consultation, you can ask about their experience working with other clients. While they’re not going to give you details about the clients themselves, you’ll be able to understand the types of clients they usually work with and what potential commonalities you share with their typical clients.
“As a queer person, when I am looking for my own therapist, I make sure to take ask any potential therapist what history they have working with queer individuals, if they are comfortable helping me explore my gender and sexual identity, and how they might provide treatment to someone who is a gender or sexual minority,” said Matt Milburn. “It can also be helpful to take note of how they brand themselves (e.g., do they provide their pronouns, do they explicitly advertise as LGBTQ-affirming).”
Connecting with an LGBTQ-affirming therapist can be an additional hurdle for queer and trans folks who are seeking mental health support, but giving yourself time to find a list of potential therapists, thinking about what’s important to you when it comes to treatment, deciding how therapy is going to fit into your budget, and getting ready for the phone consultation and first appointment can make the process much easier. You deserve to find the mental health support you need—and remember that you always get to decide what works best for you!
Caitlin is an organizational change strategist, advisor, writer, and the founder of Commcoterie, a change management communication consultancy. She helps leaders and the consultants who work with them communicate change for long-lasting impact. Caitlin is a frequent speaker, workshop facilitator, panelist, and podcast guest on topics such as organizational change, internal communication strategy, DEIBA, leadership and learning, management and coaching, women in the workplace, mental health and wellness at work, and company culture. Find out more, including how to work with her, at www.commcoterie.com.