Finding an LGBTQIA+ affirming therapist matters. No one should have to wonder whether their therapist accepts their sexual orientation, gender identity, relationships, or family. But being accepting and affirming is not necessarily the same thing as understanding the culture and experiences of the community you are working with.

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I know this from both sides of the therapy room. 

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As a lesbian, I have worked with straight therapists who were completely accepting of me. I never felt that they believed there was anything wrong with my sexual orientation or that my relationships with women were somehow less valid. They were good therapists, and I valued the work I did with them.

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But there were also times when therapy became unexpectedly tiring because I had to stop being the client for a moment and become the educator. Before we could explore what I was experiencing, I first had to explain some fairly basic aspect of LGBTQIA+ culture or relationships.

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That difference is worth talking about.

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Acceptance Is Important, But It Isn't the Same as Cultural Knowledge

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I have had conversations with therapists who want to market their practices to the LGBTQIA+ community. Sometimes I ask a simple question: What can you tell me about the community you want to work with?

Usually, the answer is surprisingly little.

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Being comfortable working with LGBTQIA+ people is an important starting point. But cultural competence involves more than being accepting. Communities develop their own histories, language, humor, relationship patterns, family structures, shared experiences, and social norms.

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You don't have to belong to a community to learn those things. But if you're going to work extensively with that community, it helps to know something about it.

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There is an old joke: What does a lesbian bring on a second date?

A U-Haul.

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Knowing the joke certainly doesn't qualify anyone to provide therapy to lesbians. But understanding why the joke exists tells you something about familiarity with the culture—and, as it happens, I once literally moved in with a partner on our second date. We remained together for ten years.

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A therapist can certainly be curious about a relationship progressing that quickly. There may be clinically meaningful things to explore. But beginning with the assumption that something must be wrong because the relationship didn't follow a more traditional relationship timeline is very different from being curious about what that decision meant in the context of that particular relationship.

Cultural knowledge provides context. It shouldn't replace curiosity.

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Relationships Don't Always Follow the Same Scripts

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There isn't one way LGBTQIA+ people form relationships, build families, date, have sex, divide responsibilities, or structure their lives. There isn't one heterosexual way to do those things either.

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But many of the social expectations surrounding relationships have historically been built around heterosexual couples and traditional gender roles. LGBTQIA+ relationships may follow some of those patterns, reject them, modify them, or develop entirely different ones.

A therapist working with LGBTQIA+ clients may encounter chosen family that carries as much or more importance than biological family. Former partners may remain significant friends or members of someone's support system. Dating pools and social communities may overlap. Couples may have different experiences around being out. Gender roles may be negotiated differently. Monogamy and nonmonogamy may be understood or approached in different ways.

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None of those things should automatically be viewed as healthy or unhealthy simply because they are common—or uncommon—in a particular community. They need to be understood in context.

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A therapist who already has some familiarity with that context may be able to spend less time trying to understand why this situation exists and more time helping the client explore what this situation means to them.

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Sometimes Being LGBTQIA+ Has Nothing to Do With Why You're in Therapy

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This may be just as important.

LGBTQIA+ people don't necessarily come to therapy because they are LGBTQIA+.

They come because they're depressed. Their relationship is falling apart. They're grieving. They're drinking more than they want to. Their childhood trauma is affecting them. They're overwhelmed caring for aging parents. They hate their job. They're anxious. They're lonely. They don't know what they want to do next.

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Sexual orientation or gender identity may be highly relevant to those concerns, somewhat relevant, or completely beside the point.

A culturally knowledgeable therapist doesn't need to turn every problem into an LGBTQIA+ issue. In fact, part of cultural competence is knowing enough about the community to recognize when something may be culturally relevant without assuming that everything is.

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When the World Outside the Therapy Room Matters

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There are also times when being LGBTQIA+ becomes relevant to therapy because of what is happening outside the therapy room.

For transgender and nonbinary people in particular, the current political and legal environment can create an additional source of stress. In recent years, proposed and enacted legislation and policy changes affecting gender-affirming healthcare, identification documents, schools, restroom access, and other areas of daily life have become an additional source of uncertainty for many transgender and nonbinary people. For someone directly affected by these changes or worried about what may happen next following the news can become much more personal than simply keeping up with politics. 

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That uncertainty can contribute to anxiety, fear, anger, exhaustion, or a sense of vulnerability, particularly for people who have also experienced discrimination or rejection. The psychological burden experienced by LGBTQIA+ people can come not from their identity itself, but from stigma, discrimination, rejection, and the need to navigate environments in which they may not always feel safe or accepted.

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In that environment, knowing that your therapist is genuinely supportive can become especially important. A client should not have to wonder whether it is safe to talk openly about fears related to gender identity, healthcare, relationships, family, or changes in the law—or whether their therapist views their identity itself as the problem.

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That doesn't require a therapist to share the client's identity or political views. It does require a therapeutic space in which the client knows their identity will be respected and that the real-world stressors affecting their life can be discussed without judgment or dismissal.

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Shared Identity Doesn't Guarantee a Good Therapist

None of this means that an LGBTQIA+ client should automatically choose an LGBTQIA+ therapist.

Being a member of the community does not make someone a better therapist, and it certainly doesn't mean they will be the right therapist for every LGBTQIA+ client. Our communities are enormously diverse. A lesbian therapist doesn't automatically understand the experience of every lesbian, much less every gay, bisexual, transgender, queer, nonbinary, or other LGBTQIA+ person.

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Likewise, straight and cisgender therapists can develop substantial cultural knowledge and provide excellent therapy to LGBTQIA+ clients.

Clinical skill matters. Experience matters. The therapeutic relationship matters. Personality and fit matter. The client's particular needs matter.

Shared identity is one consideration among many. But for some clients, it can be a meaningful consideration.

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Sometimes It's Nice Not to Have to Explain

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Being a member of the LGBTQIA+ community doesn't mean I automatically understand every LGBTQIA+ person's experience. Each person brings their own identities, history, culture, relationships, beliefs, and experiences into the therapy room.

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What it does mean is that LGBTQIA+ culture isn't something I first encountered in a continuing education course.

There are references I recognize, experiences I understand, and relationship dynamics that don't require an introductory explanation. And when I don't understand something about a client's particular experience, I can ask rather than assume.

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For some clients, that can make therapy feel different.

There can be relief in mentioning something about your relationship, your family, your community, or your history and discovering that your therapist already understands the context. You can simply continue with the story instead of stopping to explain the cultural context first.

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That doesn't make an LGBTQIA+ therapist the right choice for every LGBTQIA+ client.

But if you're choosing a therapist, cultural familiarity is a perfectly reasonable thing to consider alongside clinical experience, therapeutic approach, personality, availability, insurance, and all the other things that determine whether someone may be a good fit.

And sometimes, it's simply nice to spend your therapy hour being the client instead of the cultural translator.