How to find an LGBTQ+-affirming therapist

What does it mean to be LGBTQ+-affirming, anyway?

While there’s no single definition of affirmative care, an affirmative therapist is generally one who has extra expertise, specialization, or experience working with the queer and trans population and the unique challenges they face, Yates explains.

LGBTQ+-affirming doesn’t refer to a specific type of therapy (like cognitive behavioral therapy) or therapist (like marriage and family therapist). Instead, it refers to a matter of adapting evidence-based practices to the unique needs and experiences of clients who identify as lesbian, gay, bisexual, trans, queer, questioning, intersex, asexual, or otherwise non-heterosexual or non-cisgender.

All that said, people often use LGBTQ+-affirming more broadly in their search for a therapist who, for lack of a better term, “gets it”. You may not be looking for someone who specializes in addressing queer or trans issues—you could just want a therapist with working knowledge of how your queer or trans identity might color other areas of your life.

Dulcinea Pitagora, Ph.D., psychotherapist and founder of community-vetted therapist directory Manhattan Alternative, defines an LGBTQ+-affirming therapist as one who “not only accepts and/or shares the identity in question, but seeks to normalize the lived experience of LGBTQ people.” That involves recognizing and understanding the unique challenges people with marginalized sexualities and genders face without making assumptions about who they are or reducing them to their identity.

While part of this foundation can come from a therapist’s own lived experience as a queer or trans person, Dr. Pitagora warns against conflating a therapist’s identity with their ability to provide effective therapy. Not only can an ally make for a supportive provider, but a therapist is not automatically LGBTQ+-affirming simply because they’re queer and/or trans themselves.

How to actually find an affirming provider

Word of mouth and referrals

This is where Dr. Pitagora and Yates tend to start: firsthand recommendations within the community. After all, few things are more reassuring than hearing from someone who’s already vetted a provider for the qualities you’re looking for.

You could ask your other providers, especially if you’ve had a positive experience with them (like your PCP, dentist, or gynecologist). You can also tap into knowledgeable members of your local LGBTQ+ community—your nonbinary hairdresser or the owner of the lesbian bar might know a great, affirmative therapist in town.

But while it’s tempting to ask your best friend or partner for a recommendation, Yates says it’s not usually a great idea to see the same provider as someone you’re very close to. Simply put, we talk about the people we care about in therapy, Yates explains, and things can get complicated when your therapist gets outside information about one client from another.

Search online directories with LGBTQ+ filters

Browsing providers can get overwhelming fast if you’re not filtering by the characteristics that are important to you. When searching for a provider at Thriveworks, you can filter your results by the LGBTQIA+ specialty tag to see which providers have experience or expertise working with the community.

Psychology Today’s therapist finder gives you similar filter options. You can search by the umbrella LGBTQ+ term or by individual identity labels such as “lesbian,” “transgender,” and “bisexual.” Once on their profiles, providers can further list community allyship (such as “gay allied,” “intersex allied,” or “HIV/AIDS allied”).

Search LGBTQ+-specific resources

Plenty of nationwide directories start with the premise that you’re looking for a LBGTQ+-affirming therapist. Here are a few that might help:

• The LGBTQ+ Healthcare Directory: You can search for many types of providers in this directory, from mental health professionals to primary care.
• Inclusive Therapists: Designed with social justice in mind, this directory features providers committed to LGBTQIA+, racial, disability, and neurodiversity affirming care.
• QTBIPOC Mental Health Directory: This directory from the National Queer & Trans Therapists of Color Network has more than 350 providers across the US.
• LGBT Near Me: This search engine is a program of the LGBT National Help Center, and it connects you with local community resource centers.
• Manhattan Alternative: Founded by Dr. Pitagora, this nationwide listings website features affirmative providers with expertise serving trans, gender non-conforming, and LGBQ individuals, as well as people in kink, polyamorous, and sex work communities.

It’s also worth tapping into your local resources, whether that’s a local LGBTQ+ community center, online message boards, or social media pages.

What to look for when searching for an affirming provider

As you browse through provider profiles and therapist websites, here are a few things to consider:

How they discuss LGBTQ+ people and issues

Yates and Dr. Pitagora both suggest paying attention to how therapists talk about things that matter to you, either on their profile or in conversation. Do they mention specific communities and concerns or offer vague platitudes about inclusivity? Do you connect with their vocab and point of view? Are they explicit about their approach, or do they rely on buzzwords that don’t tell you much about how they support clients like you?

Yates adds that a lack of explicit detail isn’t automatically a red flag, particularly in states where supporting LGBTQ+ clients can carry professional or personal risks. For example, a therapist might not list gender-affirming care on their website if it’s banned in their state, but that doesn’t mean they won’t offer it. “Sometimes you have to ask, because unfortunately, because of the state of queer and trans rights, a lot of therapists are hiding their services,” Yates says.

The vibes you get

Whether you’re reading their profile, sussing them out on a consult call, or going through your first session, pay attention to the general vibe you get. When it comes to positive outcomes, little matters more than the relationship between you and your therapist. Simply put, if the vibes are good—they make you feel seen, heard, and understood—that’s a great sign, says Yates.

In that way, your definition of LGBTQ+-affirming care might just be what makes you feel affirmed, even if you can’t describe exactly how. “What clients have most often told me they appreciate about having an affirming therapist is that they can be more relaxed and engage more in the therapeutic process, knowing that they will not be judged, so they can bring all aspects of themself to the work,” Dr. Pitagora says.

Questions to ask upfront

It never hurts to ask for an initial consult call to get a sense of potential fit, Dr. Pitagora says, and it’s often something therapists offer for free before you commit to booking your first session. During this brief call, you should feel free to ask whatever is important to you—this is someone you want to be comfortable around.

“I’ve had clients ask me all kinds of great questions over the years, from my views on gender and sexuality to who I voted for,” Yates says. Some therapists might decline to answer certain inquiries while others will be thrilled to share—either way, it’s useful feedback about whether they’re a good fit for you personally.

Here are some questions you might consider asking:

• What’s your experience working with LGBTQ+ people, particularly those who identify as [your identity]?
• Have you worked with clients navigating [specific issue you’re dealing with]?
• What’s your approach to addressing [specific issue you’re dealing with]?
• What’s your connection to the LGBTQ+ community?
• How does your own identity inform your practice?
• Have you received any LGBTQ+-specific training or education?
• What would you do if you realized you’d made an incorrect assumption about a client’s identity or experience?
• What does LGBTQ+-affirming therapy mean to you?

Outside of your personal preferences and a few red flags, there aren’t necessarily right and wrong answers here—it all comes back to what you’re looking for and, yes, vibes. “Listen to your internal intuitive and somatic reaction to the language and tone that they use,” Dr. Pitagora suggests. In other words, pay attention to how their answers make you feel. Understood and validated, or guarded, defensive, or unimpressed? Do you connect with them or not?

Of course, you’re allowed to reassess whether or not a provider is right for you at any time. “Sometimes it will feel like a good match and we only realize after a few sessions that someone is not a good fit,” Dr. Pitagora says. “It’s always OK to stop and find a new therapist at any time for any reason.”

Is it better to have a provider who shares your identity?

There are certainly instances where having a therapist who shares your sexuality or gender can be helpful, Yates says. If you’re working through very specific issues (maybe medically transitioning or coming out later in life), someone with lived experience might have a deeper understanding of the nuances involved or be more likely to stay current on relevant research and resources. You may also just feel more comfortable relating to someone who shares certain aspects of your identity.

That said, queer and trans people aren’t a monolith, so sharing a sexuality or gender doesn’t always equal the same experiences. And even if you do share some common ground, a responsible provider still has to treat those commonalities with care.

“It’s problematic to assume that because I have something in common with a client, that I will automatically understand where they’re coming from or have had the same experience,” Dr. Pitagora explains.

Finding the right fit with someone who “gets it” can still establish a strong therapeutic alliance, even if they don’t share your gender or sexual orientation.

Frequently asked questions (FAQs)

What’s the difference between a therapist who is “accepting” and one who is “affirming”?

While there’s no single definition of affirmative care, an affirmative therapist is generally one who has extra expertise, specialization, or experience working with the queer and trans population and the unique challenges they face. On the other hand, “acceptance” speaks more to a therapist’s belief system—such as seeing LGBTQ+ people as valid, deserving of rights and respect, and free to define their own identities.

Do I have to see an LGBTQ+ therapist, or can any therapist be affirming?

Any therapist can be affirming. While some people prefer working with a therapist who shares their sexuality or gender, it’s not a requirement for knowledgeable, respectful, evidence-based care. Not to mention, a common identity with your therapist hardly guarantees they’ll “get it” on a deeper level or provide better care—a good therapist will prioritize understanding you regardless of their own experience and POV.

How do I bring up my identity when searching for or contacting a therapist?

However you’d like. You can explicitly ask something such as, “I’m looking for a therapist who has experience working with people like me—do you have a lot of trans clients?” Or you can casually drop it into your initial conversation and observe how they respond. It depends on why you’re asking and what response you’re hoping to get. If you feel it’s relevant to your care, feel free to bring it up.

What is conversion therapy, and how do I know a therapist won’t practice it?

Conversion therapy is the practice of trying to change, suppress, or eliminate a person’s sexual orientation or gender identity. To avoid therapists who engage in these approaches, be on the lookout for coded language that suggests conversation therapy like reparative therapy, reorientation therapy, sexual orientation change efforts (SOCE), and gender identity change efforts (GICE). You can always broach the topic during a consultation call, whether you frame your question as, “What are your views on conversion therapy?” or “Do you provide LGBTQ+-affirming care, and what does that mean to you?”

Can I find an LGBTQ+-affirming therapist who takes my insurance?

Yes, many LGBTQ+-affirming therapists provide in-network care with major private insurance plans, as well as Medicaid and other public insurance programs. Thriveworks lets you filter your search by both insurance and LGBTQ+ specialty, making it easier to narrow your search. If you can’t find a provider that accepts your insurance, try looking for one who offers sliding scale fees, low-cost community clinics, or pro bono services. A local LGBTQ+ organization might be able to connect you with options.

What if I’m in a rural area that feels less LGBTQ+-affirming—are there still options?

Telehealth can often help you widen your search to providers elsewhere in your state, potentially in cities with more LGBTQ+-affirming providers. That said, don’t assume a therapist isn’t affirming just because their profile or website doesn’t say so explicitly. In areas where queer and trans rights are restricted, some providers may avoid advertising certain services or specialties due to legal or safety concerns. If someone seems promising, it may be worth reaching out directly and asking about their experience working with LGBTQ+ clients or their approach to affirming care.