Essential Questions to Ask When Choosing an LGBTQ+-Friendly Therapist

Finding the Right Mental Health Professional
By Linda Athanasiadou
Finding the right therapist is crucial for anyone seeking mental health support, but for LGBTQ+ individuals, it's especially important to work with a therapist who is knowledgeable and affirming of LGBTQ+ identities and experiences. Therapy should be a safe and supportive space where you can discuss your concerns without fear of judgment or misunderstanding. Unfortunately, not all mental health professionals are adequately trained or sensitive to the unique challenges faced by the LGBTQ+ community. To help you find the right fit, this guide outlines the key questions to ask when choosing an LGBTQ+-friendly therapist, along with qualifications to look for during your search.

Why LGBTQ+-Friendly Therapy Matters
LGBTQ+ individuals often face specific mental health challenges that may include dealing with societal stigma, family rejection, discrimination, or internalized homophobia or transphobia. According to the National Alliance on Mental Illness (NAMI), LGBTQ+ people are at a higher risk of experiencing depression, anxiety, and suicidal ideation compared to the general population. These risks make it all the more important to find a therapist who not only understands LGBTQ+ issues but is actively supportive and inclusive.
An LGBTQ+-friendly therapist should create a safe and affirming environment, be knowledgeable about issues like coming out, navigating relationships, or transitioning, and provide culturally competent care. So how do you know if a therapist is the right fit for you? Here are some essential questions to ask before making your decision.

1. What is your experience working with LGBTQ+ clients?
One of the most important things to ask when searching for a therapist is about their experience working with LGBTQ+ clients. You’ll want a therapist who has specific knowledge of the challenges faced by the LGBTQ+ community, not just a general understanding of mental health.
A good response would be something like, “I have extensive experience working with LGBTQ+ individuals and regularly participate in ongoing education to better understand the unique issues that impact this community.” This shows that the therapist is not only experienced but also committed to staying informed about LGBTQ+ issues.
If a therapist hasn’t worked with LGBTQ+ clients before, or they seem hesitant when answering this question, it might be a sign to keep looking. Having a therapist who understands the nuances of LGBTQ+ experiences is crucial for effective treatment.

2. How do you approach LGBTQ+ issues in therapy?
It’s essential to understand how a therapist integrates LGBTQ+ topics into their practice. Some therapists might take a “neutral” approach, avoiding conversations around gender identity or sexual orientation, while others might center these discussions depending on your needs. A therapist who is LGBTQ+-affirming will be open to talking about your identity and how it intersects with your mental health.
You could ask the therapist how they handle situations like helping a client navigate coming out or dealing with discrimination. The therapist’s approach should be informed, empathetic, and affirming, without making assumptions or projecting their own biases onto your experience.

3. What training have you had in LGBTQ+ cultural competency?
Not every therapist has received formal training in working with LGBTQ+ clients. It’s important to ask about specific training or certifications that a therapist has completed related to LGBTQ+ cultural competency. Some therapists may have taken continuing education courses focused on LGBTQ+ mental health, while others might be certified by organizations such as the American Psychological Association (APA), which offers guidelines and certifications in LGBTQ+ therapy.
You might ask, “Have you taken any courses or workshops specifically related to LGBTQ+ mental health, gender identity, or sexual orientation?” or “Are you familiar with the APA’s guidelines on working with LGBTQ+ clients?” A well-trained therapist should be able to demonstrate their commitment to understanding LGBTQ+ identities.

4. Are you familiar with intersectionality and how it might impact my mental health?
Intersectionality refers to how different aspects of a person’s identity—such as race, gender, sexual orientation, and socio-economic status—intersect and impact their experiences. For LGBTQ+ individuals, these intersections can significantly shape their mental health journey.
It’s essential to find a therapist who understands the importance of intersectionality, especially if you belong to multiple marginalized groups. A therapist who is aware of these dynamics will be better equipped to address your unique challenges.
For example, you could ask, “How do you consider intersectionality when working with LGBTQ+ clients?” or “Are you comfortable working with clients who face multiple forms of discrimination, such as racism and homophobia?”

5. How do you handle confidentiality and privacy, especially regarding LGBTQ+ clients?
Confidentiality is a fundamental part of therapy, but for LGBTQ+ individuals, there may be additional concerns. You may want to know how your therapist handles sensitive issues, such as coming out or discussing relationships that might not be accepted by your family or community.
Ask the therapist how they protect client confidentiality and if there are any circumstances under which they might be required to disclose information. This can provide you with peace of mind, knowing that your therapist will respect your privacy.
You might ask, “How do you handle situations where a client is not out to their family or workplace?” or “What is your policy on maintaining confidentiality in sensitive situations?”

6. Do you offer support for transgender or non-binary clients, including during transitions?
For transgender or non-binary individuals, it’s particularly important to find a therapist who is knowledgeable and supportive throughout the transition process. This might include addressing issues such as gender dysphoria, navigating healthcare systems, or providing support during hormone therapy or surgery.
If you’re seeking support around gender identity or transition, it’s important to ask whether the therapist has experience working with trans and non-binary clients. A knowledgeable therapist should be familiar with both the mental and physical aspects of transitioning and should be able to provide guidance or resources to help you through the process.
Ask, “Do you have experience supporting transgender clients during transition?” or “How do you handle issues related to gender dysphoria in therapy?”

7. Do you have a sliding scale or accept LGBTQ+-inclusive insurance?
Therapy can be expensive, and not all therapists accept every insurance plan. It's important to ask about payment options and whether the therapist works with LGBTQ+-inclusive insurance providers, such as those that cover transition-related healthcare for transgender clients.
In addition, many LGBTQ+ individuals face financial barriers to accessing mental health care, so it’s worth asking whether the therapist offers a sliding scale fee based on income.
You could ask, “Do you accept my insurance, and does it cover LGBTQ+-specific mental health services?” or “Do you offer a sliding scale for clients who may not be able to afford your standard rate?”

8. Are you connected to LGBTQ+ community resources or organizations?
An LGBTQ+-friendly therapist should be familiar with the broader LGBTQ+ community and resources that can provide additional support. This might include knowledge of LGBTQ+ support groups, social services, or healthcare providers that specialize in working with LGBTQ+ clients.
Ask the therapist whether they can connect you with local LGBTQ+ resources or recommend organizations like the Human Rights Campaign (HRC) or GLAAD, which offer support and advocacy for LGBTQ+ individuals.
You might ask, “Are you connected to LGBTQ+ community organizations or resources that could be helpful for me?” or “Can you recommend any support groups or services specifically for LGBTQ+ individuals?”

Finding an LGBTQ+-friendly therapist is an important step in ensuring that your mental health needs are met with understanding, care, and respect. By asking the right questions—about experience, training, inclusivity, and approach—you can ensure that you find a therapist who will support you in a way that aligns with your identity and needs. Remember, the right therapist will not only provide a safe space for you to express yourself but will also be your ally in navigating the challenges unique to the LGBTQ+ experience.