LGBTQ+ counselling can look like a million different things. Like anyone else, a member of the LGBTQ+ community could be coming to counselling for any reason.
When a gay, bisexual, or transgender person does come to therapy, it’s important that they feel that their whole being is accepted and not pathologised or othered. That’s why many therapists today describe themselves as offering LGBTQ-affirmative therapy: therapy that affirms LGBTQ+ identities.
As we enter Pride Month 2025, it’s the perfect time to explore questions like: What is LGBTQ-affirmative therapy, and how can it help the mental health and wellbeing of LGBTQ+ clients? In this blog, we’ll dive into these questions in more depth. But first – a quick look at what LGBTQ+ means.
What does LGBTQ+ stand for?
LGBTQ stands for:
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- Lesbian: most often defined as a term for a woman who is solely or primarily attracted to other women.
- Gay: a broader term for a person who is solely or primarily attracted to the same gender as themself. This could be used to describe anyone of any gender, but is often used to describe men who are attracted to other men in particular.
- Bisexual: to be bisexual is to be attracted to multiple genders. Though it uses the etymological root “bi” meaning “two”, being bisexual does not necessarily mean you are only attracted to two genders. Many bisexual people would define their sexuality as including attraction to “multiple” or “more than one” gender identity. This is similar but distinct from the label of “pansexual”, which describes people who are attracted to other people regardless of gender identity.
- Transgender: a term describing people whose gender identity is different to the gender identity (i.e., “female” or “male”) they were assigned at birth.
- Queer or Questioning: The Q in LGBTQ can be understood to mean different things. Some believe it stands for queer, an umbrella term for those who are not cisgender and/or heterosexual. This is a political term, as it has been reclaimed – it has a history as a homophobic slur, and to some it still is a hurtful and controversial word. To others, it is a more fluid and liberating term than other identity labels. Meanwhile, others see the Q in LGBTQ as standing for questioning, to include those who are not yet sure about their gender or sexuality, but are exploring it.
Sometimes, “I” is also included in this acronym to signify intersex people. These are people who are born with sex characteristics (such as chromosomes or genitals) that do not neatly fit into the category of “female” or “male” only.
The “+” in LGBTQ+ symbolises that there are many other labels that people may use to describe their gender or sexuality, and an infinite number of ways to identify.
While it encompasses many people, with many differences between them, the acronym LGBTQ+ exists to represent the community and common struggle for rights and representation that exists between marginalised people who exist outside of society’s sexuality and gender norms.
LGBT Mental Health and Wellbeing
Identifying as gay, bisexual, transgender or anything else doesn’t cause mental health problems. There are many joyful and supportive aspects to being part of the LGBTQ+ community.
But living in a society that stigmatises and discriminates against LGBTQ+ people can take a toll on mental health and wellbeing. This is sometimes referred to as “minority stress”: the concept that individuals belonging to marginalised or minority groups often experience additional stressors, which can negatively impact their mental health.
LGBTQ+ people are more likely to have mental health issues like anxiety, depression, or PTSD. They are also more likely to struggle with chronic diseases and physical health issues, which in turn can impact mental health further.
LGBT Mental Health Statistics in the UK
A 2018 study by the LGBTQ+ charity Stonewall showed that in the preceding year:
- Over half of LGBTQ+ people had experienced depression.
- One in eight LGBTQ+ people aged 18-24 had attempted to take their own life.
- Almost half of transgender people had thought about trying to take their own life.
- 41% of non-binary people had harmed themselves.
What is LGTBQ-Affirmative Therapy?
LGBTQ-affirmative therapy is all about positively affirming LGBTQ+ identities.
Therapists who are LGBTQ-affirmative work to create a safe, judgment-free space for clients with LGBTQ+ identities. In a world that can be so hostile to these identities, the healing space of the therapeutic relationship needs to provide a reprieve from shame.
In practice, this means that LGBTQ-affirmative counsellors may implement the following:
- Validate LGBTQ+ identities by accepting how people identify and treating it as a morally neutral fact about them.
- Learn more about LGBTQ+ identities and ways of supporting people of different sexualities and genders.
- Join the struggle for LGBTQ+ rights as an advocate.
- Self-reflect and work to challenge internalised biases and stereotypical beliefs about LGBTQ+ people.
- Address “minority stress” and homophobia or transphobia in the counselling room.
- Use affirming and inclusive language in paperwork and resources – for example, asking for preferred pronouns on an intake form.
Counselling LGBT Clients: How LGBTQ-Affirmative Therapy can Help
In many ways, counselling for an LGBTQ+ person is no different to counselling for heterosexual people. Everyone is individual, and so counselling is always a unique journey.
But there are some common problems that LGBTQ+ people might bring to therapy, and times when having an LGBTQ+ friendly therapist can be particularly vital.
Dealing with “Minority Stress”
Members of the LGBTQ+ community, like any other marginalised group, are subject to “minority stress”.
This means the extra stresses that come about due to homophobia, transphobia, systemic discrimination, and generally being a minority in society.
LGBTQ-affirmative counselling can help face by minority stress by providing an environment in which those experiences can be heard and felt.
Tackling Shame and Coming Out of the Closet
“Coming out” is an experience that’s common to many members of the LGBTQ+ community – and it never just happens once.
Coming out is about openly and proudly expressing your true identity. This can be a difficult process for some, particularly those with a familial, social, or cultural background that has caused them to feel shame around their identity.
A good LGBTQ-affirmative therapist may be able to support you to work through your shame and embrace who you really are.
LGBTQ+ Family-Making
Building a family and having children can look different for LGBTQ+ people than their straight counterparts.
It might involve donors, surrogates, and rounds of fertility treatment. It could also mean fostering or adopting, or finding family and community in non-traditional ways.
Having a therapist who understands these processes can be very helpful for LGBTQ+ people navigating the sometimes-confusing road to becoming a family.
Intersecting Identities
LGBTQ+ identities can overlap with other marginalised identities. People can also identify with multiple identities under the LGBTQ+ umbrella – for example, you could be transgender and also gay.
A supportive, experienced therapist can work with you to understand how your multiple identities intersect to form your unique experience and what they mean to you.
Get LGBT Affirmative Counselling in London or Online
If you’d like to work with an experienced LGBTQ-affirmative therapist, Leone Centre can support you. You can book an appointment with our individual, couples, or family therapists in London or online.
- About the Author
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Co-founder and director of Leone Centre, 20+ years of experience supporting people, and offering valuable knowledge through Couples Counselling and Individual Counselling. Before becoming a therapist, I worked in the financial sector.