M.C. Barrett, Ph.D. • June 1, 2026
LGBTQ people deserve affirming, skillful mental healthcare. This guide can help you find the right therapist.
In the early morning hours of June 28, 1969, police raided the Stonewall Inn in New York City. The resulting resistance from the LGBTQ community is now known as the Stonewall Riots and is considered the spark that ignited the LGBTQ rights movement.Today, in honor of the Stonewall Riots, June 28 is honored as International LGBTQ Pride Day. In the United States and many other countries, June is also recognized as LGBTQ Pride Month. Over the years, Pride has become a celebration of LGBTQ identity, love, culture, political resistance, and courage.
Despite the progress made since the Stonewall Riots, LGBTQ continue to face discrimination that impacts their daily lives and their mental health, resulting in higher rates of many mental health conditions, lower access to resources, and unique, complex needs in therapy.
Starting therapy and finding the right therapist are huge undertakings for anyone. For LGBTQ people, the process can be especially complicated. Therefore, to recognize LGBTQ Pride Month and to support LGBTQ people who are seeking therapy, Aviva Psychology Services provides this guide as a resource to the LGBTQ community.
A Painful Past but a Brighter Future
To understand the unique mental health needs and challenges of the LGBTQ community, we must first acknowledge the role of history. Previously, medical and psychological science considered being anything other than heterosexual and cisgender to be a mental health disorder. Historically, the fields of medicine and psychology have engaged in harmful, discriminatory, and highly pathologizing practices toward LGBTQ people.
While change is still ongoing and much more growth is necessary, much progress has been made. Many historic perspectives are now recognized as scientifically inaccurate, unethical, and deeply harmful. Influential and respected psychological organizations like the American Psychological Association (APA) now have explicitly pro-LBGTQ stances and ethical standards. The APA has issued official resolutions affirming the validity of
LGBTQ identities and
gender-diverse and transgender identities and
opposing all discriminatory laws, policies, and practices.
However, the history of discriminatory beliefs within medical and psychological fields has a lasting impact on the LGBTQ community, resulting in significant and understandable mistrust related to medical and mental health treatment.
If you’re feeling uncertain about the process, know this: you are not alone in your hesitation, and there are many mental health providers who respect you, support your rights, and would love to help you meet your mental health goals. Some clinicians are not just supportive: they are specialists who seek advanced training to better understand LGBTQ experiences and meet the needs of LGBTQ clients. Some are members of the LGBTQ community themselves, allowing them to bring both clinical expertise and lived experience to the therapy process.
LGBTQ-Friendly vs. LGBTQ-Affirmative Therapy
Fortunately, the more accepting political and scientific landscape led to updates to the ethical codes and education of mental health clinicians, beginning in the 1990s. This means that most mental health providers are at least LGBTQ-friendly.
LGBTQ-friendly therapy means that the provider is not opposed to LGBTQ rights, does not engage in harmful practices like conversation therapy, and approaches therapy in an open-minded, non-discriminatory, and respectful way. If you’re in therapy with an LGBTQ-friendly therapist, sessions often feel polite and nonjudgemental. However, LGBTQ-friendly therapy can also feel oblivious to realities experienced by the LGBTQ community, even if the clinician is welcoming and well-intentioned. For some LGBTQ people, this sense of neutrality feels safe, appealing, and adequate. For many, however, it can feel invalidating, frustrating, and limiting to the therapeutic process.
In contrast, LGBTQ-affirmative therapy goes beyond being merely non-discriminatory. LGBTQ-affirmative therapy approaches LGBTQ identity in a much more active way, even when the focus of treatment is on other primary concerns, such as depression or trauma. Rather than just being open and nonjudgmental, an LGBT-affirmative therapist is broadly informed about LGBTQ experiences, actively supportive rather than merely open and nonjudgemental, and values staying aware of important topics so they can understand the experiences of their LGBTQ clients.
In LGBTQ-affirmative therapy, your therapist will pay attention to your LGBTQ identity, be curious about its role in your mental health and other experiences, and seek to empower you as an LGBTQ person. In LGBTQ-affirmative therapy, you can have greater confidence that your therapist will already understand concepts like gender-affirming care, the impact of recent sociopolitical events on the LGBTQ community, and be comfortable with conversations about LGBTQ-specific topics. LGBTQ-affirmative therapy feels intentional and sensitive to culture and context, not merely polite and open-minded.
Finding LGBTQ-Friendly vs. LGBTQ-Affirmative Therapy
You may already feel you have a strong preference between LGBTQ-friendly or LGBTQ-affirmative therapy. If you’re wondering how to figure out if a therapist is more one or the other, we have two suggestions.
First, explore their website to gather information. Look for language that describes their approach to diversity, inclusion, and working with LGBTQ people and other oppressed groups. An LGBTQ-friendly therapist might use broadly welcoming language like “open to working with people from all walks of life.” You might also see a brief mention of allyship or an LGBTQ pride icon without any further details. These are often indications that a provider or practice is LGBTQ-friendly but not particularly LBGTQ-affirming.
LGBTQ-affirming providers and practices generally speak about identity, justice, and inclusion more directly. For example, the
About Page at Aviva Psychology Services talks specifically about providing equitable and affirming services to all people and about promoting growth, tolerance, and freedom. It also includes a formal Statement on Inclusion that acknowledges the impact of oppression and discrimination and states that Aviva Psychology Services seeks to create a safe, inclusive, affirming environment for the full spectrum of human diversity, including LGBTQ+ people. This website content reflects a specifically LGBTQ-affirming stance.
Second, and likely even more useful than reviewing websites, ask questions. Assessment is generally the first stage of therapy, and the process should go in both directions. You can learn a lot about whether a therapist is LGBTQ-friendly or LGBTQ-affirming by asking questions such as:
- Do you consider yourself to be an LGBTQ-friendly or LGBTQ-affirmative therapist? What do those terms mean to you as a therapist?
- What kind of training have you had in working with LGBTQ people (or trans women, gay men, etc)?
- How much experience do you have providing therapy to LGBTQ people?
- How do you approach therapy with LGBTQ people vs. cishet people?
- How do you document sensitive information such as sexuality and gender identity?
- How do you stay informed about LGBTQ issues?
Take note of the therapist’s answers and also how the therapist responds. Ideally, your therapist will be happy to respond to questions and will provide specific, non-defensive answers. If the therapist is not able to answer, seems bothered by the questions, or doesn’t understand their relevance to your mental health treatment, they likely aren’t LGBTQ-affirming.
Beyond Affirmation: Specialization and Expertise
For many LGBTQ people, LGBTQ-friendly therapy simply isn't enough and LGBTQ-affirmative therapy is the desired minimum. However, sometimes even more is needed: LGBTQ-specific expertise that comes from advanced academic and clinical training.
For example, an LGBTQ-affirming therapist would approach work with a trans client with attention to identity, be open to discussing the impact of transphobia in the client’s life, and have a desire to support and empower the client. However, they may lack adequate training to engage in discussion about or evaluation for gender-affirming care. This lack of skill can be disruptive to therapy or even harmful to the client, as inadequate or inaccurate documentation by the therapist could impair the client’s ability to pursue life-saving, gender-affirming services such as surgeries and hormone replacement therapy.
A therapist with expertise in trans mental healthcare would have training, experience, and confidence with important documentation such as World Professional Association for Transgender Health (WPATH) letters. They would talk early and often with clients about diagnoses, documentation, and any goals the client has related to medical forms of gender-affirming care. They would be knowledgeable about barriers to gender-affirming care and aware of the potential impacts of HRT on mood, cognition, and physical health. They would be prepared to help their client identify and navigate transphobia in multiple settings, including healthcare. They wouldn’t just be supportive, they would be skillful.
As another example, many clinicians have specialty areas. However, this doesn’t automatically mean they have specific training or experience in addressing their specialty area with every kind of client. A grief specialist may also be LGBTQ-affirming, but this does not necessarily mean they have the experience or education to address the many nuanced, specific forms of
disenfranchised grief that LGBTQ people experience, such as relationships and opportunities lost due to anti-LGBTQ bigotry, divorce due to gender transition, being unable to participate in family or cultural mourning rituals due to anti-LGBTQ bigotry, or experiences of collective loss and traumatic grief due to trans homicide. The most effective therapy for these experiences requires expertise in grief
and
expertise in LGBTQ experiences, culture, mental health, and resources.
Additionally, LGBTQ people have unique experiences that may bring them to therapy. While many therapists say they support clients in navigating "difficult life transitions,” they may not have completed training to competently support LGBTQ people who are questioning their sexuality or gender, going through the process of coming out, experiencing overt, covert, or institutional forms homophobia or transphobia, or who are encountering the medical and social complexity of gender-affirming care. In these instances, an LGBTQ-affirming stance is necessary but often not sufficient for optimal therapeutic support. Commonly, working with a therapist without adequate expertise results in LGBTQ clients feeling like they must educate their therapist about the very issues they’re paying the therapist to help them navigate. For many LGBTQ people, this dynamic is invalidating and counterproductive to healing.
As described above, the best way to find a therapist who has the expertise you need is to closely evaluate their training and approach by reviewing written materials, such as their website, and speaking with them directly.
It is healthy and appropriate to ask about your therapist's training and experience. You should feel empowered to ask them specific questions about their ability to meet your specific needs, goals, and preferences. An LGBTQ-affirmative, well-trained expert will not be bothered by questions, will take your concerns and needs seriously, will provide specific rather than vague answers, and engage with you in a collaborative way. If your questions are not well-received, you can consider your question clearly answered: that's not the right therapist for you!
Considering Therapeutic Approaches
In addition to considering LGBTQ-specific concerns, an important part of the process of finding the right therapist for you is considering if you have specific preferences about the types and styles of therapy you receive.
For example, you may prefer the structured, evidence-based style of
Cognitive Behavioral Therapy or the reflective process of
Narrative Therapy. You may benefit from the values-based approach of Acceptance and Commitment Therapy, which helps clients explore what kind of life they want to be living. Or you may have a specific condition you want treatment for, such as OCD, and want a treatment like
Exposure and Response Prevention that exclusively focuses on that diagnosis.
Not all therapists offer all forms of therapy, so if you know what you’re looking for, it is helpful to ask directly and early in the process of establishing care. If you don’t know what you’re looking for, that’s ok, too! Ask your therapist to teach you about their approach to therapy and about the specific interventions they offer. Don’t be shy: ask about pros and cons (and they should share both!), ask about how they think their expertise could help you with your specific concern, and ask how they problem-solve if it becomes apparent the treatment approach isn’t a good fit.
In addition to more academic questions related to theory and interventions, it’s important to think about variables related to therapeutic style and therapist identity. You may prefer a therapist whose approach is direct, pragmatic, and steadily nudges you toward growth. It might feel important to work with a therapist who is open and comfortable discussing sociopolitical events. Maybe it feels helpful to work with a therapist who is also a member of the LGBTQ community or who has a specific gender identity. Perhaps you want to prioritize a therapeutic relationship that feels warm and gentle.
No preferences are right or wrong, but not knowing them can make it hard to find the right therapist. Taking time to reflect on your preferences can go a long way in helping you decide which therapist is the right fit for you.
Starting Therapy with a Skillful, LGBTQ+ Affirmative Therapist
Even after considering your specific needs related to therapy, actually getting started with a therapist can feel daunting. Don't worry: with the right therapist, that feeling won’t last long!
There are many LGBTQ-affirming therapists in the state of Massachusetts, including the entire team here at Aviva Psychology Services. Additionally, some psychologists at Aviva have completed specific, advanced training working with LGBTQ people and therefore can offer more specialized care for LGBTQ clients. You can read more about individual psychologists, their training, and their style in the individual bios provided on the
Team Page. If you’re interested in becoming a client, you can begin by filling out the
Request an Appointment form.
Selected References and Additional Reading:
- American Psychological Association (2023, December). APA LGBTQ Resources and Publications [Review of APA LGBTQ Resources and Publications]. American Psychological Association.
https://www.apa.org/pi/lgbt/resources
- Affirmative Therapy by Psychology Today. (n.d.). Www.psychologytoday.com.
https://www.psychologytoday.com/us/therapy-types/affirmative-therap
- Burger, J., & Pachankis, J. E. (2024). State of the science: LGBTQ-affirmative psychotherapy. Behavior Therapy, 55(6), 1318-1334.
- American Psychological Association (2008). APA Policy Statements on LGBT Concerns [Review of APA Policy Statements on LGBT Concerns]. American Psychological Association. https://www.apa.org/pi/lgbt/resources/policy
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