In LGBTQIA+ affirming therapy, your gender and sexuality are recognised and treated with respect. This goes beyond a counsellor simply being accepting of LGBTQIA+ people, to having the competencies required to help you to feel safe and supported (Fagan, n.d.). This allows you to bring all of yourself to therapy without fear of judgement or a need to hide parts of yourself and to feel understood when you share your experiences. This may feel helpful if you specifically want to speak about your identity or experiences of discrimination in therapy. Sometimes it just feels helpful to know that your therapist sees you for who you are, while you speak about topics that may not feel directly related.
‘Conversion Therapy’ (or ‘Gender Exploratory Therapy’; GLAAD, n.d.), is an acutely psychologically harmful practice in which a ‘therapist’ actively tries to change their client’s identity. This is prohibited by professional bodies of counsellors and psychotherapists in the UK (e.g. BACP; 2026). However, a therapist who is not involved in conversion therapy may still fail to hold an affirming and safe space for queer clients. In research studies, some queer clients have shared experiences of misgendering, stereotyping, their gender or sexuality being treated as or attributed to mental illness or an inappropriate level of focus being given to their identity (McNamara & Wilson, 2020; Mezzalira et al., 2025). LGBTQIA+ affirming therapy includes the smaller, everyday ways that a therapist listens, responds and understands your experience.
Due to social discrimination, LGBTQIA+ people often have an increased sense of vigilance about their level of safety within relationships. Previous experiences of feeling unsafe in relationships can create a sense of unease about forming new relationships and a feeling of having your guard up for self-protection (Thom, 2019). This makes it so important for therapy to feel like a safe enough space to be yourself and start to share your experiences openly. Research also suggests that having a therapist who does not affirm your identity is likely to limit the strength of relationship that you can develop with them and limit the effectiveness of the therapy (Foy et al., 2019). This is why it can be useful to be aware of the characteristics that help to make a therapist genuinely affirming and a safe person to support you.
What should I look for in an LGBTQIA+ therapist?
1. They listen without directing you.
An LGBTQIA+ affirming therapist should not tell you what your gender or sexuality means, or what decisions you should make about your life. How and when you decide to come out and who you decide to tell is completely up to you. The same is true for any gender-affirming steps you may decide to take. While a therapist may support you in considering different options, they should respect your ability to decide, rather than positioning themselves as the person who knows best.
2. They use your language.
Choosing language that feels like it fits you is much more important than any technical definitions. You might identify as lesbian, gay, bisexual, pansexual, queer, trans, non-binary or genderfluid. You might use several terms, none at all, or find that the language that feels right changes over time.
An LGBTQIA+ affirming therapist should follow the language you use, rather than imposing their own terminology. This also applies to your name and pronouns. If you tell your therapist how you would like to be addressed, they should honour this.
3. They have understanding and competence.
An LGBTQIA+ affirming therapist should be ‘culturally competent’ (McNamara & Wilson, 2020; Mezzalira et al., 2025), which means that they have some awareness of historical and current social issues affecting LGBTQIA+ people, including discrimination, stigma, minority stress and barriers to support. A culturally competent therapist should also be willing to educate themselves. You should not have to become your therapist's teacher about topics relevant to the LGBTQIA+ community.
There are some examples of cishet therapists working in an effective and affirming way with queer people, and this is possible if they are cultural competent, accepting and willingness to understand LGBTQIA+ experiences (Kelley, 2015; Puckett et al., 2023). If you prefer a therapist who shares aspects of your identity, this is also completely valid and a shared experience among some LGBTQIA+ people that access counselling (Leitch & McGeough, 2023). It may feel supportive to know that your therapist has understanding from lived experience, rather than learning second-hand.
4. They can acknowledge mistakes without making them about themselves.
Therapists are human and so will sometimes make mistakes. While this can feel disappointing or hurtful, the therapist’s suitability in working with queer clients can be seen in how they respond. An affirming therapist can acknowledge their error, correct themselves and move on with an intentional effort not to make that same mistake again. They should not over-apologise or mention how using the correct language is difficult for them. It is not your responsibility to comfort the therapist or pretend that the mistake was okay.
This same idea applies when talking about your experiences with family, friends, colleagues or other people. The focus should remain on your experience, rather than becoming centred around other people's discomfort with your identity.
5. They don't assume your identity needs explaining.
An affirming therapist will not assume that your gender or sexuality has been caused by trauma, mental illness, childhood experiences or neurodivergence. Rather than seeking a causal reason for your identity, they will accept that this is how you are. Pride and joy can very much be parts of the LGBTQIA+ experience!
6. They recognise that LGBTQIA+ people are not all the same.
There is no single LGBTQIA+ experience. Instead, your experience may be shaped by your age, culture, race, disability, religion, socioeconomic background, relationships, family and many other aspects of your life. An LGBTQIA+ therapist should therefore remain curious about your individual experience, rather than assuming that they already know what being LGBTQIA+ means for you.
7. They understand the difference between identity and distress.
An important part of LGBTQIA+ affirming therapy is recognising that distress can arise from the way a person is treated because of their identity, rather than being due to the identity itself. For example, anxiety, depression or low self-esteem may be connected to rejection, discrimination, bullying, isolation, family conflict or pressure to conform to expectations about gender and sexuality. This is sometimes described as minority stress.
How can I tell if a therapist is LGBTQIA+ affirming?
It can be difficult to know what a therapist will actually be like from a profile alone. In my experience, some therapists who describe themselves as ‘LGBTQIA+ affirming’ may have knowledge and experience with some identities, but not so much with others. You can absolutely ask a therapist what experience they have in working with people who share your identity characteristics, or what they mean when they describe themselves as ‘LGBTQIA+ affirming’.
What matters most when choosing a therapist?
There is no checklist that can tell you whether a particular therapist will feel right for you. The way in which you value different aspects of a therapist’s competencies in working with LGBTQIA+ is likely to be specific to you and your experiences. For example, shared lived experience may feel really important to you. You may prefer that you therapist is more knowledgable about gender diversity or sexuality or minority stress.
A useful question to ask yourself might be: ‘Do I feel safe, respected and able to be myself with this therapist?’
If the answer is yes, you may have found a therapist who you can begin to talk openly about whatever has brought you to therapy, including your identity, relationships, mental health, life experiences or other areas that matter to you.
LGBTQIA+ Affirming Therapy - At One Practice Therapy
I am a therapist with lived experience of gender and sexuality diversity and offer LGBTQIA+ affirming counselling for adults. I welcome people who are lesbian, gay, bisexual, queer, trans, non-binary, genderfluid, questioning, or who do not use a particular label. Whether you want to talk about your identity, coming out, discrimination, minority stress, or a different part of your life altogether, I aim to offer a space where you can feel safe, understood and able to bring your whole self to therapy.
Written by Izzi Norrington (MBACP), Counsellor.
View references for this article here.
FAQs
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Yes, absolutely! Whether you identity as queer or not, people come to therapy for all kinds of reasons. For example, grief, anxiety, depression and life transitions like the end of a job or changes in health. An affirming therapist will respect your identity without assuming it is the cause of your difficulties or focusing on it in sessions more than you want to.
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Yes. You do not need to have a clear understanding of your sexual orientation or gender identity before starting therapy. An LGBT affirming therapist will respect your uncertainty, without pressuring you to adopt a label, come out or reach a particular conclusion about your identity.
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You can raise your concerns with the therapist if you feel safe doing so, or speak to the governing body they are registered with (e.g. BACP or UKCP) if you are concerned. When looking for a new therapist, you may find it helpful to ask about their experience supporting LGBT clients. Remember that you deserve to be treated with respect and dignity.
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Minority stress is the additional stress that can result from stigma, prejudice, discrimination and fear of rejection associated with belonging to a marginalised group. For queer people, this can include concealing their identity, having their chosen name or pronouns disrespected or being judged for the kinds of relationships they are in. Affirming therapy can help you understand and process the impact of these experiences on your thoughts and feelings.
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Support Groups
There are multiple organisations that run support groups in London, such as London Friend, Spectra and MindOut. Some of these groups are for everyone in the LGBT community and others are specific, such as for trans and non-binary people, gay people, lesbians or older queer people.
Community Events
There are many types of queer events that happen in London, including crafts, yoga classes and drop-in sessions. Some spaces that offer queer community events this are London LGBTQ+ Centre and Queer Britain. Some helpful websites that show queer events across London are OutSavvy and PlaceCal.
Helplines
Whilst most LGBT helplines are national, they can also be accessed from London. Some examples are:
0800 0119 100
Daily, 10am - 10pm
For Trans, Agender, Gender Fluid and Non-binary people
0300 330 5468
Fridays, 8pm-11pm
LGBT+ Anti-Abuse
0800 999 5428
Hours vary
Healthcare
56 Dean Street is based in Soho and offers sexual health support and services for trans and gender diverse people.
Counselling
If you are unable to access private counselling, it may be possible to access means-tested LGBT counselling via London-based charities, such as ELOP and Arcus.
Here at One Practice Therapy, I offer LGBT-affirming counselling online and in London Bridge, Greenwich and Blackheath. Please feel free to book a free 15-minute intro call here to find out more.
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You can find LGBT affirming therapists through professional directories, such as Counselling Directory and Psychology Today. I would suggest looking for therapists who describe their approach as LGBT affirming and have experience with counselling for LGBT clients.
I am a BACP-registered therapist, who offers LGBTQIA+ affirming online counselling. I also offer in-person sessions in London Bridge, Greenwich and Blackheath. You can book a free 15-minute introductory call with me just here.