How do you find an LGBTQ-affirming therapist who is actually affirming?

by Urielle Samis, LCSW (she/her), Founder and Therapist, Healing Umbrella Psychotherapy

If you’re queer, you know how hard it is to find a safe and affirming therapist. If you’re wanting therapy because you’re exploring your gender identity or sexual orientation, you probably have run across a lot of therapists who identify as “LGBTQ-affirming,” but then you may have gone to see them and not felt seen or understood. Or worse, you may have been hurt by them.

And if you’re a therapist like me, you have filled out countless profiles like Psychology Today that have a box you can check saying you are “LGBTQ-affirming” or something similar. I have often wondered what this means, because sadly many clients who come to me talk about how they have been traumatized by therapists, some of whom had checked this box.

So what makes a therapist truly LGBTQ-affirming? I will try to answer this question by looking inside myself as both a therapist and a transgender person, and also speaking with trusted colleagues.  

Is it knowing stuff?

Yes, but that’s not nearly enough. While a basic understanding of LGBTQ+ identities is essential, we can’t just take a 101 training, put up a pride flag, and check that box. I have attended trainings charging plenty of money that promise to equip mental health clinicians for working with the trans community. While some are very helpful, I have also been personally traumatized by more than one such training.

Is it my own queer identity?

Is it the fact that I myself am transgender? I would argue both yes and no.

The ‘yes’ first. Being in the community makes it easier to understand. My clients and I can exchange a healing glance that says “I see you” or “I know what you’re going through” without saying those words. Similarly, there are tools, strategies, and many ongoing “aha” moments I have in my own queer journey that may help a client going through something similar. I believe my queer identity brings an unspoken sense of hope to clients struggling with their LGBTQ+ identities.

At the same time, however, I would argue that therapists who are in the community are not LGBTQ-affirming for that reason alone. It’s often easy for us well-intentioned queer helpers to make the mistake of assuming another’s journey is like our own, and therefore want to “advise” or “guide.”

While that may be partially true and helpful in some cases, it is frequently not true. Affirming means being with, seeing, and understanding the person as their journey is unfolding in real time. Every human’s experience of gender, sexuality, and relationships are unique and dynamic.

This is especially true when it comes to intersecting identities within the LGBTQ+ community. For example, being a Black trans woman in the United States is most often a more marginalized experience than being a white trans woman, even though both are marginalized and so frequently discriminated against. A neurotypical white cis gay man from New York would likely not experience the same hardships felt by an autistic nonbinary person from the South. I remind myself every day of how much I don’t know about the unique person sitting with me.

So what is it?

Attunement

I often hear that it’s important for an LGBTQ-affirming therapist to be “non-judgmental,” or to create a “safe space.” But these qualities in the absence of attunement just can look like being ‘othered’ even though you’re not being judged in a negative way. It’s kind of like when you’re telling someone you are gay and they respond with something like “I don’t judge that” or “I have lots of friends who are” or just look at you blankly and don’t say anything bad.

So what is attunement? I think of it as a dynamic relational connection providing safety, love, consistency, and genuine curiosity.

Dan Siegel teaches us that attunement is a relational state in which we allow our inner state to noticeably shift in a way that’s felt by the other person. It’s a key experience a caregiver can consistently provide their child to create secure attachment, or the sense of feeling safe in an intimate relationship with another.

You know when someone is attuning to you because you feel seen, heard, felt, and understood. You feel both a sense that the person is present and will stay with you, while also having room to explore your inner being and outer world.

This can sadly be a missing experience for queer and questioning individuals, who can walk through parts of life feeling “not real” – a false and traumatic sense of invisibility put into place by oppressive cis-heteronormative systems.  This is particularly true now when discriminatory anti-LGBTQ+ laws are being passed in various states, including my own.

Through attunement, an LGBTQ-affirming therapist provides this missing experience. That’s needed whether or not the person is working directly on LGBTQ+ issues, since queer identity is at the same time inextricable from our day-to-day life and also only an aspect of who we are.

Genuine curiosity is the component of attunement that truly brings me closer to the other person. I am reminded daily that as a queer therapist working with queer and questioning clients, I have to embrace what I don’t know as much as what I do know. My attunement is necessary for my client’s nervous system to feel safe.

Vulnerability and Motivation for Self-Discovery

Anyone in the queer community understands the importance of vulnerability. It is the only way to work with the shame-holding parts of us that try to protect our emotional and physical safety by preventing the discovery and unfolding of who we truly are.

Being a helpful therapist in general is very often most achieved by doing our own work. This greatly affected my personal queer journey, but more on that in later posts. To be LGBTQ-affirming, we must maintain ongoing openness, curiosity, and introspection around our own sexuality, relationships, and gender, regardless of whether we are queer ourselves.

Noticing and working to shift all of our own internalized biases and judgments will flow naturally from this vulnerability. Addressing our own internalized racism, transphobia, homophobia, ableism, ageism, misogyny, etc. is part of the gift that emerges from self-discovery as a therapist.

Understanding of Minority Stress

When I started hormone replacement therapy (HRT), a first line approach for addressing gender dysphoria that many trans folks (but by no means all) decide to use, I remember the 1-hour phone call with my health insurance company trying to get them to cover my appointments. They have an exclusion that specifically discriminates against transgender people that allows them to not cover transgender care. When I bring up the memory of that call, I can still feel my nervous system responding to the minority stress – the feeling of invisibility, otherness, and of being pathologized.

Being LGBTQ-affirming means understanding minority stress. Minority stress is the mental and physiological distress one experiences from being “othered” or different from the majority of people in some way. It results from a lack of safety, lack of opportunity, and lack of visibility that are all privileges of being a member of the dominant culture.

Willingness and Ability to work with the Legacy of Trauma

I have not yet worked with a queer individual, including myself, where working on trauma is not part of the healing. Every queer person alive is a survivor. The definition of trauma is not limited to horrific events such as rape or abuse, though those numbers are significantly higher in the LGBTQ+ community.

Trauma also includes rejection, bullying, being made to feel invisible or wrong, religious trauma, shame about sex and sexuality, shame about one’s body, and feeling “unnatural.” Being LGBTQ-affirming is also being trauma-informed, trained, and emotionally ready to work on healing from trauma.  

Chronic and excessive loneliness is also a traumatic experience common to LGBTQ+ individuals, so often being LGBTQ-affirming means helping the person build safe and supportive connections in their community including support groups, affirming healthcare, and social opportunities.

My hopes

The above list feels incomplete, but it’s a start!

If you are a therapist, I hope you find working with queer and questioning individuals to be a meaningful gift that deepens your relationship with yourself and helps you show up authentically with all of your clients!

If you are an ally or family member trying to support an LGBTQ+ loved one, I hope you can see how these qualities are for you also. They will provide so much for your person and could save their life.

If you are a client searching for an LGBTQ-affirming therapist, I hope that you will look beyond the checkbox that populates those words in a therapist’s profile. Know that you deserve and have the right to affirming, competent, sex-positive, and trauma-informed mental health care. Interview and search for these qualities from the initial phone consultation and through each session. Please reach out if Healing Umbrella can help!

Urielle Samis founded Healing Umbrella in 2021 to create a queer therapy practice offering LGBTQ-affirming, trauma-informed, and sex-positive therapy to adults and young people in Tennessee.