Queer-Affirming Therapy: Green Flags & Red Flags

Published on April 14, 2025 by Zencare Team. Written by Christopher Stults, PhD.

Why LGBTQ+ Affirming Therapy Matters

LGBTQ+ people are at greater risk for a number of mental health problems, including depression, anxiety, PTSD, and substance use disorders. These mental health disparities are not due to people’s gender or sexual identities. Rather, they’re the result of the minority stress, stigma, and discrimination that all too many LGBTQ+ people face on a daily basis. Yet, LGBTQ+ people are resilient and resourceful. In fact, research shows that LGBTQ+ people are also more likely to seek out mental health services than their cisgender/heterosexual peers.

Unfortunately though, some therapists are not able to provide inclusive mental health care. This may be due to inadequate training, implicit biases, or the use of outdated, heteronormative frameworks. That’s why it is so important for LGBTQ+ people to find affirming and safe mental health support. In this article, we’ll discuss what LGBTQ+ affirming therapy is, some red and green flags to be on the lookout for, and how to find the right therapist for you.

What Does “Affirming” Really Mean?

Before you set out to find an LGBTQ+ affirming therapist, it’s helpful to understand what it means to be affirming of queer and trans people. LGBTQ+ affirming therapists don’t simply tolerate or accept their clients — they validate, support, and celebrate their clients’ identities. They’re knowledgeable about common experiences that queer and trans people face, including coming out, transitioning, navigating relationships, and coping with stigma and discrimination. They also understand how their clients’ sexual and gender identities may interact with other aspects of their identity, such as race/ethnicity, ability status, and religion/spirituality. Indeed, they approach their work with cultural humility. This stance acknowledges that we as therapists can never be fully expert in any one cultural group — rather, we commit ourselves to lifelong learning, openness, and self-reflection, both as it relates to cultural groups we identify with, as well as those we don’t.

Additionally, affirming therapists are aware of the social and political issues facing LGBTQ+ people (there’s no shortage of them these days) and can discuss them in session with their clients. Furthermore, they are knowledgeable about the latest advances in treatment for queer and trans clients. This may include therapies that were designed specifically for LGBTQ+ people (e.g., LGBTQ-affirmative Cognitive-Behavioral Therapy) or therapeutic approaches that are relevant for these groups (e.g., Trauma-Informed Therapy).

Lastly, LGBTQ+ affirming therapists practice proactive inclusion to create a safe and welcoming therapeutic space. This includes using inclusive and non-judgmental language at all stages of the therapeutic process — from filling out basic intake forms to using correct pronouns throughout treatment. This also includes avoiding cis- and heteronormative assumptions about people’s relationships and behaviors (e.g., assuming all partnered people are monogamous). In short, it isn’t enough for therapists to simply be neutral about their LGBTQ+ clients’ identities. For therapy to be most helpful, therapists must be affirming of their clients’ queer and trans identities, creating a supportive environment for the important work of therapy to take place.

Red Flags in Therapy: Boundaries, Biases, and Microaggressions

Now that you know what an LGBTQ+ affirming therapist is, let’s review some boundaries and red flags in therapy to be on the lookout for. These warning signs can show up at any time during the course of treatment, but it’s best to be on alert for them during the early sessions with a new therapist, or even when reviewing their profiles.

Red Flag #1: Pathologizing queer or trans identities

If a therapist explicitly states — or even implicitly suggests — that being LGBTQ+ is a mental illness, do not continue working with them. While homosexuality was once classified as a mental disorder by the American Psychiatric Association, it was declassified over 50 years ago. Similarly, being transgender has not been considered a disorder for more than 10 years. Thus, if you encounter a therapist that still adheres to these outdated and stigmatizing beliefs, lose their number!

Red Flag #2: Overemphasizing “objectivity” or saying “sexual/gender identity doesn’t matter”

While these kinds of statements are less obviously problematic than referring to LGBTQ+ identities as mental disorders, they can be similarly harmful and harder to spot because of their insidious nature. Anyone who identifies as queer or trans knows that their sexual and/or gender identities do matter. While they may not be your reason for going to therapy, they undoubtedly shape your experiences and should be viewed as relevant (and welcome!) in the therapeutic context.

Red Flag #3: Overemphasizing your sexual or gender identity

Okay, so I may sound like I’m contradicting myself here, but bear with me. A therapist that makes everything about your sexual or gender identity, especially your sexual behaviors, is likely not an LGBTQ+ affirming therapist. This red flag is harder to spot, because there are many times where your sexual or gender identity are relevant topics for discussion with your therapist. As such, you may need to rely on your gut to make the call. But perhaps it is best to keep the “Goldilocks principle” in mind when deciding if your therapist is focusing on your LGBTQ+ identity too much or too little. A competent LGBTQ+ affirming therapist will collaborate with you to find the balance that’s just right.

Red Flag #4: Defensiveness when corrected

On the topic of working with your therapist to find the right balance between over- or underemphasizing your identities, LGBTQ+ affirmative therapists are open to your feedback and motivated to create a validating therapeutic environment. They will not become defensive if you provide them with your thoughts or feelings about how they interact with you. Rather, they strive to treat you in a manner that feels supportive and affirming.

Red Flag #5: Dismissal of pronouns, chosen names, or relationship agreements

These likely go without saying but, if your therapist dismisses or refuses to use your correct pronouns or chosen name, it’s time to send them packing! Similarly, if you are in a non-monogamous relationship and they refuse to acknowledge the importance of your sexual or romantic partners, it’s time to find a new therapist.

Red Flag #6: You feel drained, judged, or invisibilized after sessions

It’s normal to sometimes feel tired or spent after a therapy session, especially if you discussed a particularly difficult subject or explored some uncomfortable emotions. But if you’re feeling emotionally drained or judged after your therapy sessions, you’re probably not working with an LGBTQ+ affirming therapist. Indeed, you should feel uplifted, supported, and validated after most therapy sessions.

Green Flags in Therapy: What to Look For in a Queer-Affirming Therapist

Now that we’ve covered the boundaries and red flags in therapy or warning signs, let’s talk about green flags in therapy — signals that you have found a competent, LGBTQ+ affirming therapist.

Green Flag #1: Explicit mention of LGBTQ+ competence or training

LGBTQ+ affirming therapists will have evidence of their competence. This may include classes or workshops that they completed, supervised experience during their professional training, and/or a documented track record of working with queer and trans people. If finding a therapist that identifies as LGBTQ+ is important to you, just make sure they have the relevant expertise, as well.

Green Flag #2: Open discussion of gender, sexual, and other identities important to you

These likely go without saying, but an LGBTQ+ affirming therapist should be able to facilitate a comfortable and open conversation about your gender and sexual identity, but they should also be open to discuss other aspects of your identity that are central to who you are, including race/ethnicity, socioeconomic status, relationship status, and so on. These conversations should feel supportive and validating, and you should walk away feeling like all of the parts that make you unique were acknowledged and valued.

Being LGBTQ+ is not a disorder; but growing up and living in a world that is often hostile to LGBTQ+ people can lead to mental health problems. That’s why having a therapist that acknowledges the impact of homophobia, transphobia, and other forms of bias and discrimination on mental health is so important. Said otherwise, the problem isn’t just “in your head.” Indeed, there is a larger social and political context that must be taken into account when addressing your mental health concerns.

Green Flag #4: Consistent curiosity and willingness to learn

These are good traits in any therapist — but they’re especially important in LGBTQ+ affirmative therapists. Our understanding of sexual and gender identity has evolved rapidly in recent years and it seems likely they will continue to do so. As such, it’s important for therapists to maintain a stance of curiosity and openness to new knowledge. While you may be able to detect this by talking to them, you can also ask them what they do to stay up-to-date on the literature related to working with LGBTQ+ clients.

Green Flag #5: They repair when they mess up — without getting defensive

Like the green flag above, this is an important quality for any therapist. LGBTQ+ affirming therapists acknowledge when they’ve made a mistake. Therapists are like every other human being — they’re flawed and bound to mess up from time to time. However, a good therapist acknowledges their mistakes and works to repair any harm that was done to the relationship with their client. For example, if a therapist accidentally misgenders a new client, they will apologize and acknowledge their intention to use the correct pronouns going forward. Not only does that help to address any hurt that was caused, it also serves as a model for how the client can effectively resolve conflict in their other relationships.

Navigating Boundaries: What’s Normal vs. What’s Not

The therapeutic relationship is unlike any other relationship we have. As such, it can be difficult to know what the appropriate and most helpful boundaries are. While it can be an incredibly intimate, confidential, and challenging relationship, it’s also a professional one. To help orient you to the boundaries of therapy, let’s talk about what’s normal and not.

In a healthy therapeutic relationship, the therapist is warm and human, but they also maintain a professional stance throughout the course of therapy. Therapy should not feel like talking to a friend or family member, but rather it should feel like talking to a highly engaged, attentive, empathetic, and knowledgeable helping professional. You should feel safe to talk about whatever concerns you have, including some of your most private and personal matters. You should also feel comfortable disagreeing with your therapist, if they misunderstood you or you don’t see things the same way. And lastly, you should feel like it’s okay to set your own boundaries of what you do and don’t want to talk about during any therapy session.

In an unhealthy therapeutic relationship, your therapist may overshare or disclose too much information that isn’t relevant to the therapy. While it’s okay (and often helpful) for your therapist to selectively share information about themselves, those moments should feel like they are enhancing your therapy experience, not detracting from it. Also, you shouldn’t feel pressured to educate your therapist on queer or trans issues — especially if they claim to be an LGBTQ+ affirmative therapist. A lapse in knowledge from time to time is understandable, but it’s not your job to make sure your therapist is competent to work with LGBTQ+ clients. Lastly, they should not frame any aspect of your queer or trans identity as “confusion.” While confusion about other aspects of life is normal, your existence as an LGBTQ+ person should never be questioned.

How to Find an LGBTQ+ Affirming Therapist

Now that you know what a queer affirming therapist is, let’s talk about how to find one. Many people rely on therapist directories to find a therapist. Most directories, including Zencare, will allow you to filter the results to find:

A therapist who specializes in working with LGBTQ+ people.
A therapist who identifies as LGBTQ+.
Or both.

Use these in combination with other filters that may be important to you, such as the problem you want to address in therapy or the modality (i.e., in-person or virtual). When reviewing the profiles of therapists that interest you, make sure that they address their expertise in working with LGBTQ+ clients. Be on the lookout for other indications of cultural humility, such as references to intersectionality or acknowledgment of systemic factors that impact mental health. You may also consider asking your queer and trans friends or social networks for recommendations. These word-of-mouth referrals can be a great way to find an LGBTQ+ affirming therapist.

Once you’ve identified a few potential therapists (I always recommend “shopping around” and talking to a few), it’s typical to schedule a brief consultation call. During that preliminary call, you can ask questions to determine if they are the right fit for you and if they provide inclusive mental health care.

Consider asking questions like:

“What experience do you have working with LGBTQ+ clients?”
“What training do you have related to working with LGBTQ+ people?”
“How do you approach your work with clients who have multiple marginalized identities?”

These questions can help you to find out whether you are talking with an LGBTQ+ affirmative therapist. Also, trust your intuition. Research shows that the match between the client and therapist is one of the best predictors of positive outcomes in therapy. So it’s important that you find someone that you feel safe and comfortable with. It’s perfectly okay to schedule several consultation calls or initial sessions prior to settling on someone to work with long term.

Final Thought: You Deserve a Therapist Who Affirms You

The therapeutic relationship is meant to create a safe space for self-reflection, exploration, and healing. It is not a place for repression or self-erasure. While it can be tiring or frustrating to do so, it is important to advocate for yourself and insist that you receive the very best care possible. Trust your instincts — you know what it feels like when you encounter someone who is hostile toward or ignorant about LGBTQ+ people. Give yourself permission to walk away from therapists who don’t affirm your identity as an LGBTQ+ person. And give yourself the great gift of therapy.