What Is LGBTQIA+-Affirming Care? Plus, How To Practice It

If you’ve been hearing a lot about LGBTQIA+-affirming care, but are not quite sure what it means, read on to learn more.

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Seeking mental healthcare is vulnerable enough, but for many LGBTQIA+ people, it also comes with a fear of being misunderstood, judged, or invalidated. Despite major strides in social awareness and acceptance, the LGBTQIA+ community still faces significant discrimination, and the population continues to experience significant health and mental health inequities. Just look at the fact that there are still over 1,300 conversion therapy practitioners in this country. 

This is why LGBTQIA+-affirming care is crucial. It’s not just a “nice to have” perk that clinicians can offer; it’s potentially life-saving care that can make a hugedifference. Read on to learn more about LGBTQIA+-affirming care, why it’s important, how clinicians can learn it, and how we practice it at Charlie Health.

What is LGBTQIA+-affirming care?

Put most simply, LGBTQIA+-affirming care is care that validates and embraces queer identities with compassion, while also recognizing and deeply understanding the unique, very real challenges the community faces.

“[LGBTQIA+-affirming care] is beyond just a buzzword — it’s really an ethical obligation for mental health professionals,” says Abbey Greer, CTRS, CCLS, a Charlie Health Experiential Therapist. “We have to understand how LGBTQIA+ experiences amplify mental health conditions, and we have to offer specialized treatment to mitigate that, or our treatment is not going to be effective.”

Additionally, gender-affirming care is a key type of LGBTQIA+ affirming care. “It means we validate and support the gender identity of the client as they see themselves without trying to challenge, change, or question it,” says Kathleen Douglass, LCPC, MA, a Charlie Health Primary Therapist. “We give clients a non-judgemental place for the client to explore any issues related to identity and how they present themselves in the world.”

Why is LGBTQIA+-affirming care important?

The LGBTQIA+ population faces higher rates of mental health conditions as a result of the trauma they experience just for being themselves. “Queer-affirming care is an extension of trauma-informed therapy, and an example of cultural humility and competency. It is a baseline level of respect and awareness to provide safety for LGBTQIA+ folks who are displaying vulnerability by coming to mental health treatment,” says Sage Wile, LCSW, a Clinical Admissions Therapist at Charlie Health.

LGBTQIA+ individuals are 2.5 times more likely to experience substance misuse, depression, or anxiety compared to cisgender heterosexual individuals. Furthermore, 58% of transgender individuals struggle with their mental health, experiencing rates of mental health conditions four times higher than cisgender people. 

Additionally, Greer adds that LGBTQIA+ people experience substance abuse, homelessness, and violent crime at much higher rates than the cisgender heterosexual population, and they often lack affirming care. 

Without affirming care, LGBTQIA+ individuals may be further traumatized, invalidated, or pathologized by clinicians who lack training in LGBTQIA+ identities or rely on biased or outdated frameworks.

“As mental health providers, we are working to overturn a legacy of systemic bias in our own profession, specifically against LGBTQIA+ identities,” says Wile. For example, homosexuality was listed as a diagnosis in the DSM (Diagnostic and Statistical Manual of Mental Disorders) up until 1973.

“Because of this history, clinicians and other staff in mental health spaces must go above and beyond the usual ‘rapport-building’ to establish and maintain trust with LGBTQIA+ clients,” Wile adds. 

What LGBTQIA+-affirming care looks like in practice

Different clinicians may practice LGBTQIA+-affirming care in different ways, but here are some examples of how queer-affirming care can look in practice:

1. Challenging the concept of “normal”

“To be an LGBTQIA+-affirming provider is to challenge the narrative of conformity towards a white/cis/hetero/able/thin/male ‘normal,’ and affirm and embrace the diversity of queer identities,” Wile says. 

By rejecting narrow definitions of “normal,” clinicians can foster a space where clients feel safe enough to be themselves fully, however that may look.

2. Being curious about identity and not making assumptions

Clinicians need to avoid making assumptions about someone’s sexuality or gender based on their appearance. “In practice, what this means is that we are respectful of people’s pronouns without making assumptions about someone’s gender,” Douglass says. “We introduce ourselves with the pronouns that we use and ask clients what their pronouns are.”

3. Encouraging exploration 

For those who are questioning their identity, an affirming therapist will encourage this exploration and create a supportive, pressure-free environment where clients can safely try out language and define their identity on their own terms.

“Whenever I start a new therapy group, and I’m meeting people for the first time, I usually ask them to share their name and their pronouns as of this moment,” Greer says. “I acknowledge we’re all on our own journey of self-exploration, and if what’s on their screen today doesn’t feel affirming, we can try something else out.” 

4. Not identifying queerness as a problem

Throughout every step of client care, treatment should be identity-affirming without an overemphasis on queerness as a problem, Wile says. “We know that identifying as queer does not itself cause mental health symptoms; it is the societal reaction and discrimination that impacts the mental health of queer folks,” they say.

Additionally, Douglass says that it’s important to remember that not everyone who’s living as a different gender from their assigned sex at birth views their gender identity as the main reason for seeking treatment. “Affirmative care treats standard psychological concerns — like mood disorders, post-traumatic stress disorder (PTSD), or substance abuse — while recognizing how gender-related stress may intersect with those issues.”

5. Protective documentation

One thing to consider, especially when working with adolescents, is protective documentation, especially if the home is not a safe space, since parents can have access to medical charts, Greer says. 

This could look like charting “client discussed their identity, personal expression, and pushback from their peers” instead of something explicitly sexuality related, Greer says. In general, protective documentation prioritizes client safety and confidentiality by using thoughtful, non-specific language when necessary, while maintaining clinical accuracy, ethical standards, and insurance coding obligations.

How LGBTQIA+-affirming care is taught to clinicians

Regardless of a clinician’s gender or sexual identity, training is necessary to most effectively practice LGBTQIA+-affirming care. Here are a few ways for clinicians to learn.

1. Specialized trainings

Trainings are a great place to start for baseline information and guidelines on affirming care, why it’s important, and examples of how to put it into practice, especially when a therapist is just beginning their career.

However, trainings and educational materials on their own aren’t enough. Anyone can click through a slide deck, Greer says, but going beyond this and truly learning how to put it into practice is another thing.

2. Mock sessions

Clinicians can have mock therapy sessions with each other, or multiple clinicians can have a mock group session that involves role-playing and feedback.

“We oftentimes don’t really even realize how gendered or heteronormative, or even monogamy-focused, our examples and lenses are until someone calls us out,” Greer says. “Mock sessions allow critiques of ‘Okay, here, you may have used gendered language, or defaulted to this type of belief or lens.’”

This type of practice, getting an outsider’s perspective on a clinician’s approach, can be invaluable. 

3. Self-exploration

No matter your gender identity or sexual orientation, self-exploration is valuable. You want to make sure that you identify and address any personal biases you may have, Douglass says.

“Clinicians should explore what their own identities and relationships are regarding gender and sexuality,” Wile adds. “Building insight into your own self-concept, identity, expression, and desires is helpful and furthers an extension of empathy to others. Clinicians can benefit from asking questions about themselves and their self-concept in their personal therapy space, in supervision, or from queer therapists or consultants, such as myself.”

4. Practicing cultural humility

No matter the population a clinician serves, practicing cultural humility is key. Cultural humility refers to being willing to admit that you don’t know something and being willing to learn from clients who have different cultural backgrounds from you.

“Cultural humility allows us to appreciate and acknowledge our differences and the areas of growth we have as providers to better understand the populations we encounter in our work,” says Wile.

This is especially important when you’re working with queer people who are also members of other marginalized groups, such as queer people of color, who experience even higher levels of minority stress and discrimination, Wile adds.

How we implement LGBTQIA+-affirming care at Charlie Health

The majority of Charlie Health clients — 68% — identify as LGBTQIA+, so it’s paramount that we offer the best LGBTQIA+-affirming care that we can.

“Charlie Health champions gender-affirming care and requires a mandatory training course for all new employees and an endorsement for employees so that we only provide qualified and interested group facilitators in our LGBTQIA+ groups,” Douglass says.

Laying the framework like this allows Charlie Health to create a queer-affirming experience for clients right from the start, including at intake. For example, the Clinical Admissions Team identifies clients’ preferred names and pronouns and clearly documents them in initial assessments, Wile explains.

Additionally, Charlie Health works to match queer clients with therapists who list LGBTQIA+ as a specialization in their individual work, Wile says. There are also LGBTQIA+ cohorts — groups of LGBTQIA+ individuals with similar mental health challenges. This allows people to discuss their mental health experiences through a queer lens among peers who get it, Wile says.

Our clinicians also ensure that anti-LGBTQIA+ rhetoric is never tolerated, Greer says. This way, therapy is a safe space that promotes healing and doesn’t include constant exposure to hateful comments or beliefs, they say. 

Join Charlie Health’s Clinical Team 

If you want to join an affirming, expert team of providers working to connect kids, teens, and adults to life-saving behavioral healthcare, apply to join the Charlie Health Clinical Team today. We have nationwide openings for clinicians across the spectrum of licensure and offer flexible scheduling, fully remote work, and other competitive benefits.