LGBTQIA+ counseling: The importance of inclusive counseling services

The LGBTQIA+ community is a diverse group of individuals — specifically, those who identify as lesbian, gay, bisexual, transgender, intersex, asexual, and a host of other identities. Despite outdated perceptions and unwarranted prejudice from others, cultural norms are shifting and society is becoming increasingly supportive of the community, thanks in part to the bravery of those who have chosen to speak their truth in spite of the hate they experience. However, LGBTQIA+ individuals still face unique challenges that threaten their mental health and emotional well-being, often on a daily basis. 

This is why it’s so important for LGBTQIA+ individuals to have mental health support that is aware of and caters to these issues. LGBTQIA+ clients can connect with providers who are fellow community members or who specialize in LGBTQIA-based issues. Not every LGBTQIA+ person might want a therapist in their community, but regardless of their provider’s identity, forming a strong therapeutic bond with a mental health professional (who understands their unique experience) is a crucial part of finding the support they need. 

Challenges Faced by the LGBTQ+ Community

Many LGBTQIA+ community members face constant stigma, not only in the form of hate, but also in society’s heteronormative (straight-centered) expectations and implicit judgment from others surrounding their very existence. 

Common challenges that those within the LGBTQIA+ community face include:

  • Having their identities ridiculed or unfairly questioned by those outside their community or social circle.
  • Homophobic comments, physical assault, and other hate-based attacks that threaten their bodily and emotional well-being, as well as the weight of worrying about their safety.
  • Gender roles that may feel (or be) forced onto them, creating internal and external conflict that feels unresolvable, especially if they aren’t ready or interested in coming out.
  • Dealing with constant confusion from others about their sexual orientation or gender identity. This can create unresolved feelings of anger and frustration that may affect their ability to trust others.
  • Family problems that may arise from relatives’ lack of understanding or acceptance of their identity, lifestyle, or self-image.
  • Little to no access to proper care and resources (i.e. medical, mental health, etc.), making it difficult or even impossible for them to have their basic needs met and cared for.
  • Lack of self-esteem or low self-worth, which may be caused and exacerbated by all of the above issues.

Each of these challenges affects LGBTQIA+-identifying people in unique ways, and each of them needs individualized emotional support to help them manage the impact they have on their mental health.  

How Can the Stigma and Hate Experienced by LGBTQIA+ Individuals Affect Their Mental Health?

The negative experiences LGBTQIA+ people have can affect their mental health in various ways, causing a number of different mental health conditions. Examples of common mental conditions seen in LGBTQIA+ individuals include: 

These conditions are highly prevalent in LGBTQIA+ communities, especially in youths. Many LGBTQIA+ people find it difficult to fit in and often get bullied for who they are and how they express themselves. 

Mental Health Disparities Within the LGBTQIA+ community

There are huge mental health disparities that disproportionately affect the LGBTQIA+ community. Consider a few statistics from Mental Health America:

  • LGBTQIA+ individuals are 3x more likely to develop a mental health condition.
  • LGBTQIA+ teens are six times more likely to experience depression.
  • LGBTQIA+ kids and teens are twice as likely to experience suicidal thoughts and four times as likely to attempt suicide. 
  • About 27% of trans individuals, and 8% of LGBTQIA+ individuals overall, say they have been outright denied necessary health care.

According to NAMI, LGBTQIA+ adults are more than 2x as likely as heterosexual adults to experience a mental health condition, and transgender individuals are 4x as likely. What’s even more troubling is that 39% of LGBTQIA+ adults reported being cut off from a family member after coming out, as Pew Research data indicates. 

Counseling can help the LGBTQIA+ community to address these challenges, from the mental health conditions they may struggle with to other life issues like building relationships with others and talking to loved ones about their sexual orientation and identity.

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How Can the Right Counselor Help LGBTQIA+ Individuals? The Importance of Specialized Counseling

The mental health disparity mentioned above begs the need for proper mental health care in the LGBTQIA+ community. Fortunately, more and more counselors understand the challenges these individuals face. 

Specialized counseling is the most equipped to deal with the above problems in a nonjudgmental and trauma-informed manner, meaning that clients will not have to deal with their own concerns while teaching their provider about their LGBTQIA+ experience and how it might differ from the heterosexual or cisgender experience. They can also provide clients with a sense of safety and security, something that doesn’t happen in many spaces.

Often, LGBTQIA+-affirming counselors will start by getting to know the individual, including their unique presentation of issues as well as their life goals. If you are a member of the LGBTQIA+ community and you decide to pursue counseling, your counselor might ask the following to get to know you better:

  • What are your interests?
  • Are you currently in a relationship—and if so, how does your relationship seem to impact your mental health? 
  • What is your living situation like?
  • Are you happy with your life right now?
  • What long-term or recent issues are you struggling with?
  • In what ways has your identity shaped your experience and interactions with others? 

Depending on whether one’s LGBTQIA+ identity is a central point of therapy, therapists may discuss the client’s openness about their sexual or gender identity, and perhaps help them come out to themselves through guided introspection and consistent positive regard. This is a very important part of the process of self-acceptance and love that therapy strives to foster.

It’s also important to note that it’s not always wise to lump people with gender identity experiences and sexual identity experiences together. Though they are technically part of the same community, transexual, non-binary, gender-fluid, and other individuals with gender identity experiences will often have very different struggles and concerns than gay, bisexual, asexual, and other people with sexual identity experiences. As such, their provider will specialize and individualize treatment depending on the client’s unique experiences.

Common Approaches to LGBTQIA+ Therapy

Depending on your story and journey, you may find a counselor who uses a specific counseling approach, such as cognitive behavioral therapy (CBT), solution-focused therapy (SFT), dialectal behavior therapy (DBT), or more. More specifically, a counselor who identifies as LGBTQIA+ or specializes in working with the community can help you address the damage and impact of: 

  • Trauma: Whether you’ve experienced turmoil or adverse experiences in the past or present, an LGBTQIA+-affirming counselor can help you resolve and start to heal the damage and impact of trauma on your daily life. 
  • Family conflict: If coming out, your lifestyle choices, or arguments over your identity have caused rifts in your relationships with relatives, your counselor can help you to learn how to better navigate these connections, minimizing the negative effects that may rebound on you. 
  • Relationship difficulties: Whatever the nature of your romantic relationship, an LGBTQIA+ counselor can help you and your partner stay connected, grounded, and aware of each other’s needs and goals. 
  • Anxiety: Whether you’ve come out or aren’t interested or ready, talking with a counselor can help you manage the anxiety that may arise from concerns over how others will respond to your truth. 

The bottom line with LGBTQIA+ counseling—and any kind of therapy or counseling—is that clients will lead with their own goals. The provider is there for support and guidance, not to give specific direction or set goals for the client.

This is especially related to LGBTQIA+ counseling when considering therapy goals and identity. Though one’s identity in the LGBTQIA+ community can have a great impact on their life and goals, not every LGBTQIA+ person will center their therapy goals around their LGBTQIA+ identity—this is only one facet of their life, and therefore it can’t be assumed that their identity is the cause of their concerns.

If a provider feels that even more specialization is needed to give a client the care they need, they can also offer references to specialists in specific LGBTQIA+ issues (body dysmorphia, gender dysphoria, gender-affirming care, trauma, etc.).

The right provider can help ensure their LGBTQIA+ client’s resilience and freedom of expression remain intact, even while navigating potential discrimination and unjustified hatred.

Thriveworks Approach to LGBTQ Counseling: Work with an LGBTQIA+ Counselor to Navigate Your Journey

Again, it’s important to know that counseling often focuses on more than just the problem at hand. A counselor’s ultimate mission is to help their client live an overall happier, healthier, and/or more successful life and, perhaps most importantly, to be a safe, nonjudgmental person for LGBTQIA+ individuals to talk to and lean on for support.

This often means that one’s counseling sessions will involve discussing and working toward their goals, in addition to making positive changes to best benefit one’s mental health and well-being. That said, no one counseling journey is the same: Your counselor will design treatment based on all of the information they gather in your initial sessions. The end goal, though, is always the same: to help you live better.

Table of contents

Challenges Faced by the LGBTQ+ Community

Mental Health Disparities Within the LGBTQIA+ community

How Can the Right Counselor Help LGBTQIA+ Individuals? The Importance of Specialized Counseling

Common Approaches to LGBTQIA+ Therapy

Thriveworks Approach to LGBTQ Counseling: Work with an LGBTQIA+ Counselor to Navigate Your Journey

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Kate Hanselman, PMHNP in New Haven, CT

Kate Hanselman, PMHNP-BC

Kate Hanselman is a board-certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC). She specializes in family conflict, transgender issues, grief, sexual orientation issues, trauma, PTSD, anxiety, behavioral issues, and women’s issues.

Emily Simonian

Emily Simonian, M.A., LMFT

Emily Simonian is a Licensed Marriage and Family Therapist (LMFT) who has direct training and experience working with family and relationship issues, as well as working with individuals. She also specializes in treating stress/anxiety, depression, and substance abuse, as well as self-esteem issues and general self-improvement goals.

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Evan Csir, LPC

Evan Csir is a Licensed Professional Counselor with over 9 years of experience. He is passionate about working with people, especially autistic individuals and is experienced in helping clients with depression, anxiety, and ADHD issues.

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Hannah DeWitt

Hannah is a Junior Copywriter at Thriveworks. She received her bachelor’s degree in English: Creative Writing with a minor in Spanish from Seattle Pacific University. Previously, Hannah has worked in copywriting positions in the car insurance and trucking sectors doing blog-style and journalistic writing and editing.

We only use authoritative, trusted, and current sources in our articles. Read our editorial policy to learn more about our efforts to deliver factual, trustworthy information.

  • LGBTQ+ communities and mental health. (n.d.). Mental Health America. https://mhanational.org/issues/lgbtq-communities-and-mental-health

  • LGBTQI | NAMI: National Alliance on Mental Illness. (n.d.). https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/LGBTQ

  • A survey of LGBT Americans | Pew Research Center. (2020, May 30). Pew Research Center’s Social & Demographic Trends Project. https://www.pewresearch.org/social-trends/2013/06/13/a-survey-of-lgbt-americans/

We update our content on a regular basis to ensure it reflects the most up-to-date, relevant, and valuable information. When we make a significant change, we summarize the updates and list the date on which they occurred. Read our editorial policy to learn more.

  • Originally published on May 27, 2020

    Author: Jason Crosby

    Reviewer: Emily Simonian, M.A., LMFT

  • Updated on March 15, 2024

    Authors: Hannah DeWitt; Kate Hanselman, PMHNP

    Reviewer: Evan Csir, LPC

    Changes: Updated by a Thriveworks clinician in collaboration with our editorial team, adding information about the importance of specialized counseling, the impact of stigma and homophobia on mental health; updated statistics on mental health disparities in the LGBTQIA+ community; article was clinically reviewed to double confirm accuracy and enhance value.

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