This piece mentions instances of sexual assault and suicidal ideation.
I have been dragged into therapy kicking and screaming more times in my life than I can count. And while I believe that therapy (in its many modalities and definitions) can both change and save lives, I also firmly believe that a person has to choose it for themselves for it to make a difference.
In fact, it’s because of the forced nature of my first encounters with therapy that I took a 10-year break from the whole thing after turning 18, perhaps at a time when I needed it most. But my life has also been literally saved by talking to someone about my traumas, and I’m not so sure that the experience would have been nearly as transformative for me had I not sought out care from an LGBTQ+-affirming provider.
I first started going to therapy around 13 years old. Though my memories of the experience are a bit fuzzy, I can unequivocally say that I did not want to be there, as the only thing I said during those first few sessions was some variation of “I have nothing to say.”
Though I’d already blacked it out at the time and have only recovered the memories in recent years, I was suffering from severe trauma and PTSD from being sexually abused, and had been acting out as a result. My parents (who did not know about the assault) were concerned about my behavior and took me despite my persistent refusal. In time, though, both the therapist and my parents conceded to my stubborn Taurus nature, and we agreed to end therapy for the time being.
However, trauma’s gonna trauma, and for most, nothing as painful as sexual assault stays buried for long. While my adolescent brain had temporarily locked away the violence I’d suffered, the emotional roots of the experience had dug deep, and I had no real outlet to cope with what happened. My fraught relationship with my parents continued throughout my teenage years, and though they tried to send me to therapy several more times, it never stuck. After a few particularly shocking incidents — including one where I threatened to take my own life, was placed in an involuntary psychiatric hold, and misdiagnosed with bipolar disorder — my trust in the mental health establishment was threadbare at best.
Things only got worse when I was sent away to a residential behavioral program for “troubled teens” at 17, one meant to help repair our relationship as well as get me to stop doing drugs and other behaviors they deemed self-destructive. The program misrepresented itself and what it could do for me, and I was subjected to a year and a half of emotional abuse as unqualified staff members posed as counselors for weekly “therapy” sessions. During these sessions, I was told that any problems between me and my parents were my fault, no matter the context. I was told that I was “bad,” that I should ignore all my instincts and impulses and defer to authority figures even if their directives went against my core beliefs.
The experience cemented my hatred of therapy. Ironically, it was in that program where I first experienced queer love (while dealing with homophobia, as they separated me and the girl I was in love with with a punishment called “no talk,” which entailed severe punishments if we so much as glanced at each other). It took me 10 years after leaving before I’d seriously consider seeing another therapist again, and it is not a coincidence that it would be 10 years before I’d come out as queer.
Once I was able to find an affirming therapist, who told me that my identity was valid and asked me to be kind to myself as I would to a friend, I was able to come out of the closet and get a divorce. Prior to therapy, I thought I had to “be straight,” which was killing me inside. I firmly believe that if I didn’t have an affirming space to make these big decisions, my depression might have driven me to seriously harm myself.
My experiences are far from singular: LGBTQ+ people experience mental health disorders like major depression or generalized anxiety disorder three times as often as the rest of the population, issues that are magnified if a person experiences other marginalized identities. Additionally, being queer can sometimes feel like an obstacle toward finding healthcare in and of itself — not just for our bodies, but for our minds — as it’s often difficult to find providers who are not just affirming, but simply LGBTQ+-literate at all. (It can be even more difficult for trans folks, too.)
That’s why, when I finally realized that my depression, anxiety, and history of sexual assault would not go away, I decided to seek out an LGBTQ+-affirming therapist. I believe it was a crucial decision, one that helped me excavate some of the trauma that kept me closeted for 30 years and work toward living a life that’s more authentic to who I am. While I still live with depression and anxiety, those burdens feel a bit lighter now. I feel more ownership of my own life, and like I finally want to have a future. Though we all have different experiences and I can only speak for myself, finding a safe place to talk about things with other queer people is vital, especially for those dealing with mental health issue.
To that end, I spoke with a few clinicians about going to therapy as a queer person, why many find it important to find an LGBTQ+ or LGBTQ+-affirming provider, and how to find one of your own.
Why Some Queer People Seek an LGBTQ+ or LGBTQ+-Affirming Therapist
“In our current political climate, it’s perhaps more important than ever that we in the LGBTQ+ community bring mindful awareness to our mental health,” says John Carroll, a marriage and family therapist at the Institute for Human Identity in Manhattan, New York. “The road to equality is not a sprint, it’s a marathon, and taking care of ourselves physically and mentally is of utmost importance.”
He agrees that finding a therapist you share common ground with can alleviate some of the fear and anxiety that therapy can bring. Additionally, you might have to spend less time educating your therapist about your identity. Carroll says that while it’s not necessarily important for queer people to find a therapist who is LGBTQ+ themselves, it’s definitely crucial to find one who is LGBTQ+-affirming.
According to Madison McCullough, a licensed clinical social worker also based in New York City, talking to another queer-identified person in a therapeutic setting can be a great way to establish a sense of safety. She tells me that in the past, she’s felt the need to constantly justify her identity to a therapist who wasn’t LGBTQ+, making the experience more difficult. (She ultimately left that particular provider.)
Because of the way I’ve been treated by mental health professionals in the past, it took me a while to get comfortable talking about my sexuality in therapy, even with a therapist I knew was affirming and LGBTQ+-identified themselves. But knowing that they wouldn’t judge me created a safe space to explore complex feelings, and it eventually helped me come out to others in my day-to-day life.
Finding a Queer or LGBTQ+-Affirming Therapist
First, it’s worth noting that therapy can be expensive, especially if you don’t have health insurance. Not everyone can or wants to see a therapist, and that’s okay. If you have the resources and ability to see one, though, it can be a great tool to help improve your mental health.
That said, finding the right therapist can be a daunting task, especially when you really need one. It’s a horrible paradox that mental anguish can make asking for help that much harder. Fortunately, there are many resources to help folks find exactly the kind of therapy or therapist that they’re looking for. The following list is not exhaustive, but may be a good first step or give you an idea of where to start looking for your own.
If you feel like you may harm yourself or someone else or otherwise feel like you’re in immediate danger, don’t wait to find an LGBTQ+ or -affirming therapist — see a doctor, go to the emergency room, or call an LGBTQ+ crisis hotline, like the National Suicide Prevention Lifeline (800-273-8255), The Trevor Project (866-488-7386, for LGBTQ+ youth ages 13-24), The Gay, Lesbian, Bisexual and Transgender National Hotline (888-843-4564), or the Trans Lifeline (877-565-8860).
There are some national directories of LGBTQ+ and -affirming therapists you may want to begin your search with. Psychology Today is one of the most thorough national listings of mental health professionals, and has filters to narrow your search by the therapist’s identity, modality, and other classifications. The National Queer and Trans Therapists of Color Network lists LGBTQ+ POC therapists across the country. Organizations like GLMA (previously known as the Gay and Lesbian Medical Association), AGLP (The Association of LGBTQ+ Psychiatrists), and others have national listings of queer and queer-affirming mental health professionals, though they may not be fully up to date.
Some local LGBTQ+ mental health organizations exist, and may provide a more thorough listing if you live in a city served by one — New York City has Lighthouse and Manhattan Alternative; San Francisco has Gaylesta; Utah/Salt Lake City have The LGBTQ-Affirmative Psychotherapist Guild of Utah; and Kansas City has The LGBT-Affirmative Therapists Guild. You may wish to search to see if you live in an area with a similar group.
Often, local LGBTQ+ centers have staff therapists trained to work with the LGBTQ+ community, or can refer you to local therapists who can. The Los Angeles LGBT Center, Chicago’s Center on Halstead, Denver’s The Center on Colfax, Nevada’s The Center, and others can help connect you with local mental health resources. Your state likely has an LGBTQ+ center that can help connect you with mental health professionals near you. Many cities also have LGBTQ+ group therapy practices that specifically serve the queer community; these are for- or not-for-profit organizations of professionals specifically dedicated to helping queer clients, like the Seattle Counseling Service, InstaSpectrum Counseling in Chicago, Atlanta’s Pride Mind, and others.
It can sometimes be harder — but not impossible — to find queer-affirming therapists outside urban areas. Larger directories like Psychology Today can help, and your state’s LGBTQ+ center can help refer you to queer mental health professionals in your area. There’s also the option of using an e-counseling platform like BetterHelp or Talkspace, which have counselors who specialize in LGBTQ+ issues, or Pride Counseling, which specifically serves LGBTQ+ folks.
Accounting For Other Identity Factors
While sexual and gender identity are hugely important factors in our lives, each of us relates to others in incredibly complex ways, and some folks may prioritize other aspects of our identities when choosing a therapist. You may feel it more necessary to see a therapist of the same race, for example, or a provider who practices the same religion. Perhaps seeing a therapist who specializes in treating eating disorders or a specific modality of therapy is more important to you than someone who is LGBTQ+ — and that’s totally okay. “I would encourage anyone looking to get therapy to really take some time to reflect on what is important to them, the type of concern they want to work on, and the personality of the therapist they want to work with before they start researching therapists,” says Carlos Cavasos, a licensed psychotherapist and certified sex coach based in Texas.
Many clients know fairly quickly whether their therapist will be a good fit or if they need to keep looking. “I think there are signs and queues right from the beginning that can be indications that this is gonna be a supportive environment,” McCullough says. For example, providers may use inclusive language on intake forms, ask clients their pronouns, or ask about relationship structures to show from the beginning that they’re affirming of certain things.
One Last Thing
“Therapy doesn't work unless there's a real connection, right?” McCullough adds. “So much of the therapeutic work that happens — beyond any evidence-based practice, beyond any kind of formal training — is really about the relationship that exists between the therapist and the client. Often, so much of that is just a gut feeling. It’s about how you feel when you're in the room with this person.”
Regardless of how you choose your therapist, it’s important to remember to be as open with them as you can, and remember that if your relationship does not feel supportive or like they can help you with what you’re hoping to accomplish, there’s always another therapist out there. Finding the right one isn’t easy, but it could change your life if you do.
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