What is LGBTQIA+ Counseling?

WARNING: this post contains in-depth language and information about suicide and self harm. If you are in acute crisis looking for help, please call the National Suicide Prevention Lifeline at 988 or dial 911.

LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, questioning, intersex, and asexual/aromantic/agender, “plus” all other identities along the gender and sexuality spectrum) counseling recognizes and validates the experiences of LGBTQIA+ individuals. Like traditional psychotherapy, LGBTQIA+ therapy provides a safe environment to discuss any mental health concerns you might have, build healthy coping skills, and reframe your perspective. LGBTQIA+ therapy also focuses on the intersection of your sexual orientation, gender identity, and mental well-being.

Above all else, LGBTQIA+ mental health services can create a safe space to explore your thoughts, feelings, and emotions with a compassionate mental health provider. Here's everything you need to know about LGBTQIA+ therapy so you can find the support you deserve.

How common are LGBTQIA+ mental health concerns?

Unfortunately, LGBTQIA+ mental health problems are common, especially among LGBTQIA+ teens and adolescents. According to a 2017 Centers for Disease Control study, 33 percent of transgender adolescents who are lesbian, gay, or bisexual had been bullied at school. Meanwhile, 27 percent had experienced cyberbullying on social media or other online platforms. One parent of a gender-nonconforming son described the environment that LGBTQIA+ students face as "walking through a hailstorm."

The psychological consequences of bullying, microaggressions, and discrimination can be devastating. Compared to non-LGBTQIA+ youth, adolescents who are lesbian, gay, bisexual, or transgender are four times as likely to experience suicidal ideation and attempt suicide, and three times as likely to experience depression and engage in self harm.

At the same time, LGBTQIA+ youth are more likely to seek therapy, experience a substance use disorder, and receive a mental health diagnosis. Studies consistently show that discrimination is a significant source of distress and anxiety for lesbian, gay, bisexual, and transgender/non-binary people.

What challenges do the LGBTQIA+ community face?

Although belonging to the LGBTQIA+ community is incredibly rewarding, it can also come with unique challenges. And while mental health issues vary from person to person, specific risk factors may contribute to disproportionate rate of psychological concerns among LGBTQIA+ teens and young:

• Identity issues: For adolescents and young adults, exploring gender identity and sexual orientation can be confusing. When you try to redefine identity based on an internal sense of what feels "right" and "wrong," you might experience major shifts in your self-perception. Sometimes, for example, transgender people may experience gender dysphoria, or psychological distress that stems from a mismatch between an individual's gender identity and biological sex, as defined by the American Psychiatric Association.
• Coming out/Inviting In: It's completely normal to fear rejection when coming out to (or, as we like to say at Charlie Health, “inviting in”) close friends, family members, and loved ones. Although this experience can be liberating, it's natural to wonder how other people might react—especially if you're not in a supportive environment. For some, the cost of expressing their identity fully to the people in their life can range from microaggressions to homelessness.
• Gender expression: Transgender people may take various steps toward gender expression, from changing pronouns to dressing differently. Some transgender people might seek surgical treatment or medical care (such as hormone therapy or puberty blockers) during the transition process. Unfortunately, it's not always easy to find gender-affirming care, and transgender people may face discrimination during their gender transition.
• Complex trauma: Homophobia, transphobia, stigma, and identity-specific bullying can be traumatic. In the United States, the LGBTQIA+ community faces multiple forms of discrimination, from stereotyping to higher instances of sexual assault than non-LGBTQIA+ people. Unfortunately, exposure to trauma can contribute to a heightened risk of post traumatic stress disorder (PTSD) among LGBTQIA+ individuals.
• Substance abuse: Substance use is common in the LGBTQIA+ community, and individuals may turn to substances to cope with mental health issues. LGBTQIA+ adults are nearly twice as likely as heterosexual adults to experience a substance use disorder, while transgender individuals are almost four times as likely as cisgender individuals.
• Homelessness: LGBTQIA+ youth face a significantly higher risk of homelessness—often due to family rejection or discrimination. According to research by UCLA, eight percent of transgender adults and three percent of sexual minorities faced homelessness in 2019 compared to one percent of non-LGBTQIA+ adults.

How can LGBTQIA+ counseling help?

LGBTQIA+ therapy provides LGBTQIA+-affirming care so you can explore your sexual orientation, express yourself fully to family members, and manage mental health issues. LGBTQIA+-focused mental health services create a safe place where you're free to express yourself without judgment.

Affirmative therapy—a subset of LGBTQIA+ mental health counseling—aims to validate and advocate the needs of sexual and gender minority clients. This type of psychotherapy can be beneficial, even if you're not dealing with issues specifically related to gender or sexuality. Affirmative therapists distinguish who a person is from what they do in their daily life, so your therapist can help you determine whether your behaviors and who you are as a person align with who you want to be.

When you have a licensed therapist in your corner who can relate to the experiences you're going through, it can make all the difference in your mental wellness. In addition, affirming mental health counseling can help you cope with stressful and stigmatizing situations, helping you identify the intersection of your identity and mental health.

Most importantly, an affirming therapist will consistently remind you that your identity is valid. Whether you're navigating your gender identity, considering affirmative gender surgery, or dealing with self-esteem issues, the right therapist will create a supportive space to make these big decisions, learn healthy coping skills, and work toward your mental health goals

What's the difference between LGBTQIA+ therapy and conversion therapy?

LGBTQIA+ therapy recognizes and validates the experiences of LGBTQIA+ individuals. Meanwhile, conversion therapy attempts to "change a person's sexual orientation, gender identity, or gender expression," according to the Gay & Lesbian Alliance Against Defamation. This is both mentally and often physically harmful to LGBTQIA+ young people, especially when certain programs utilize electroshock therapy as a means to (impossibly) “convert” someone.  

With attempts to combat sexual orientation change efforts in recent years, some mental health professionals have changed their terminology to avoid detection. To protect your mental wellness, absolutely avoid choosing therapists who compare the altering of sexual orientation, gender identity, or gender expression with the treatment of a diagnosable mental illness. Some practitioners may claim that they're helping clients "cure" or "repair" issues like "gender confusion" or "unwanted same-sex attractions." This is not evidence-based in any way and is not an effective way to address mental health issues, let alone any LGBTQIA+-related support that you may need.

If you ever feel ashamed, uncomfortable, or judged during therapy sessions, trust your gut and end contact with that therapist. LGBTQIA+ therapy should never look like conversion therapy. A sexuality- and gender-affirming therapist will never attempt to change your sexual orientation, gender expression, or gender identity—and counseling should never feel like coercion.

How can you find the right counselor?

Finding the right therapist can feel like a daunting task. You need someone with years of experience treating queer and transgender clients, along with the training to treat your specific mental health issues. Most importantly, you need someone who "gets" you and creates a safe space to navigate the therapeutic process, according to the American Psychological Association.

If you've tried therapy before, you're probably already well aware that being LGBTQIA+ can feel like a major roadblock to finding quality mental health care. It's not always easy to find LGBTQIA+-friendly therapists. And for some people, it might feel impossible to find clinicians who are LGBTQIA+-literate at all.

Whether you're dealing with gender dysphoria, exploring gender expression, or experiencing general mental health concerns, your therapist should have cultural competence training. Your therapist should understand and acknowledge the difference between a person's sex, gender, and sexual attraction. They should celebrate gender diversity and recognize that a wide range of gender identities exist along a fluid spectrum.

When you're ready to reach out for professional help, online therapy can make your life so much brighter. Whether you're living in a rural area, dealing with specific mental health issues, or juggling a chaotic schedule, online therapy provides access to quality mental health care—all from the comfort of home. With evening and weekend appointments, online therapy can be especially helpful for adolescents and young adults, since you won't have to put your life on hold for therapy sessions.

At Charlie Health, our intensive outpatient programs (IOPs) provide additional support beyond traditional once-per-week therapy sessions. We're committed to working with clients and families throughout treatment to meet their unique goals. Our professional counselors will meet you where you are with compassionate, LGBTQIA+-affirming mental health care so you can recognize your strengths, celebrate your identity, and build resilience.

Contact Us

Pride doesn't (and shouldn't!) end with Pride Month. And for mental health professionals who work with LGBTQIA+ clients, it's essential to honor and celebrate these identities year-round. Your therapist should always provide a safe space to explore your sexuality, navigate your gender identity, and dive into your mental health concerns.

At Charlie Health, we offer comprehensive mental health treatment for adolescents, young adults, and their families. Our virtual intensive outpatient program (IOP) combines individual therapy, group therapy, family therapy, and psychiatric support (if needed) to create a personalized treatment plan based on your unique background, preferences, and mental health needs.

No matter how you're feeling, we'll meet you where you are with compassionate, down-to-earth mental health counseling so you can heal on your own terms. Contact us today to start your journey toward mental wellness.