I recently sent therapist recommendations to a stranger. They were new in town and having a hard time finding a trans-competent provider, so I sent them a list of people recommended by other community members. Sharing resources with a stranger is common in the queer and trans circles I move in; what many of us seem to be searching for is an affordable, trauma-informed, LGBTQ2-affirming therapist who’s close enough that they “get” us, but maybe not so close that we’re always running into each other at parties and potlucks.
You may be wondering: Why are so many LGBTQ2 folks in need of therapy? It’s not because there’s anything inherently wrong or unhealthy about being queer or trans. It’s because, as gender and sexual minorities, we experience additional discrimination and oppression on top of the everyday stresses in our lives (what researchers call “minority stress”).
As a community, LGBTQ2 folks experience higher rates of trauma. Because of this, research shows that queer people have disproportionately high rates of mental health conditions, says Dr. Lori Ross, an associate professor of public health at the University of Toronto. Depression, anxiety, suicidality, self-harm and post-traumatic stress are often documented in these communities. Bisexual people and members of the trans community experience specific mental health challenges, as do Black, Indigenous and People of Colour (BIPOC) folks who are navigating the health effects of racism and colonization.
There are a lot of barriers to LGBTQ2-affirming mental health care—and to mental health care in general. One of those barriers is cost. “There’s a big difference between how the mental health system is set up and funded and what LGBTQ2+ people actually need,” Ross tells me. Publicly-available mental healthcare (the kind you might get for free through a hospital or clinic) tends to focus on assessment of symptoms and short-term care instead of the sustained, affirming mental health support many LGBTQ2 people need to heal and thrive. There are often long waits for services, with little to no choice of providers, and it’s a model of care that doesn’t fit well within the needs of people who’ve experienced trauma—something that affects the wellbeing of many LGBTQ2 people.
Most mental health care is delivered through the private system where people are either paying out-of-pocket or covered through insurance. Ross calls this system “extremely inaccessible” to LGBTQ2 community members who are disproportionately affected by poverty. However, even when they do find care, it can still be challenging to find an LGBTQ2-affirming therapist because many have little training in queer mental health.
The therapeutic profession also lacks diversity—for example, a recent American study found that 88 percent of psychologists were white—and this can create additional barriers for BIPOC community members who feel like a therapist of colour would help them feel safer and more understood.
With all these barriers in place, how can you start taking the steps to get the care you need to support your mental wellbeing as an LGBTQ2 person? These LGBTQ2 therapists have advice.
Be clear about what you’re looking for
It might be tempting to immediately start googling “affordable queer-competent, trauma-informed therapist near me who isn’t dating my ex” but all of the therapists I talked to suggested that you take a look at yourself first. J. Matsui De Roo, a registered clinical counsellor, clinical supervisor and a member of the BIPOC queer and trans community, encourages people looking for a therapist to get a sense of what their own needs are. For example, they suggest asking yourself questions like: “What kind of person am I?” “What are my goals for therapy?” and “What feels like a good fit for me?”
Dr. Alex Iantaffi, a non-binary family therapist, author and host of the Gender Stories podcast, says it’s helpful to ask yourself what you’re looking for before seeking potential therapists. “Do you want to see a therapist who shares some of your identities and experiences? If so, is [having a therapist who is also] in your community a concern? Are you looking for someone who specializes in certain issues, such as trauma, and who is also trans-competent? Are you looking for an individual therapist or someone who can work with relationships and/or families?”
Find the information you need to inform your choices
Now that you’ve become clearer on who you are and what you need from therapy, it’s time to gather the information that will help you figure out which therapists might be a great fit for you.
Iantaffi suggests strategies like finding therapists’ bios on their websites or in online directories, reading blog posts by those who write for the general public or going to talks by local therapists. If there’s an LGBTQ2 community centre in your area, you could contact them for referrals.
If research isn’t your strongest skill, consider asking a friend. LGBTQ2 social networks can come in handy, and can even get you a referral. “Personal referrals mean someone else has knowledge of a prospective therapist,” De Roo says. They suggest asking around in your community, or other folks in your life who might have appropriate connections.
While seeking recommendations from people is a good step, De Roo also encourages you to honour your intuition about which therapist might be the best fit for you; the most important part is doing it in a way that feels right to you.
Connect with potential therapists in a way that works for you
Okay, so you’ve done your research and hopefully now have a few names of potential therapists who seem like they might be what you’re looking for. The therapists I talked to recommended connecting with the folks on your list to learn more about who they are and how they work. You can do this by phone or email—many therapists are open to connecting with potential clients for a free initial conversation to explore your wants and needs as a prospective client.
“You are hiring them to do a job, and that job is to support you. Therapy can be super costly, so it makes a lot of sense to choose your investment wisely,” says Carly Boyce, a queer and genderqueer femme who is a therapist and facilitator.
Iantaffi says it’s also a way to get a sense of the client-therapist dynamic. “We would not commit to other intimate relationships without getting to know the other people involved first, yet when it comes to therapy, we often commit to the first person we find. It’s ok to take your time!”
Ask questions (and pay attention to the answers)
In advance of making a phone call or emailing a potential therapist, decide on the questions you want to ask them, keeping in mind the needs and goals you’ve established for therapy. “There are no bad questions or wrong questions for prospective therapists,” De Roo says. “It’s okay to ask what you want to know in terms of whether you’re going to be comfortable sharing space with this person and sharing vulnerable details with them.”
“You might want to ask a prospective therapist what LGBTQ2 competency means to them,” they note. “Most therapists won’t say they’re not affirming, but that doesn’t necessarily mean they’re affirming.” Iantaffi suggests asking whether prospective therapists have worked with trans and queer clients, BIPOC and/or disabled clients. “You might also ask whether they have experience with the specific issues you want to address, whether they have additional specialized training in specific areas or how long they’ve been working in the field.” (BIPOC folks may want to check out the questions listed in these articles by Jeff Baker and CarmenLeah Ascencio on how to find a queer- and trans-affirming therapist as a BIPOC person.)
And remember, it’s not just your questions that matter—it’s the answers you get! In reflecting on their own experiences as a therapy client, Boyce says, “I ask therapists about their politics and their approach, but the actual answers are of only medium importance to me. Mostly what I’m paying attention to is how I feel while we are interacting.
Things that would turn me off would be if I felt like the therapist was making their own judgements about what things are ‘problems,’ if I felt judged or disbelieved, if I felt condescended to or if I felt pressured in any way.”
Remember that therapy is a relationship, and trust your gut
When choosing a therapist, remember that you’re entering into an intimate relationship with another person and it needs to feel right for you. “Research tells us that, regardless of approach, the therapeutic relationship is key to the healing process,” Iantaffi says. They encourage you to trust your gut; if you feel like a prospective therapist isn’t a good fit for you, it’s okay to keep looking.
“The most important thing is that you feel supported and believed,” Boyce notes. “I don’t care much what training someone has, I care about how safe I feel with them.” Boyce acknowledges that,”to many folks who have experienced multiple traumas that oppression can wreak, safety might be a state beyond reach. I hope to feel safe-r or safe-ish with a therapist early in the relationship.”
You have the right to give your therapist feedback if something goes wrong in one of your sessions. “If there’s something that came up for you in session, name it, make space for it. If you feel so uncomfortable that you can’t bring it up with your therapist, that might be a red flag about the therapeutic relationship,” De Roo says. Boyce agrees, “The therapy room can be an incredible place to practice asking for what we truly need and letting someone important to us know when they’ve made a mistake.”
If you don’t feel safe or supported by your therapist (and finding a different therapist feels feasible to you), it’s okay to end the relationship. Boyce frames it as “an opportunity to practice ending or shifting a relationship that isn’t working for you (or isn’t working anymore).”
Following these steps won’t remove all of the barriers that stand between you and your ability to easily access LGBTQ2-affirming mental health care—we need radical system transformation for that—but they might help empower you in your search for a therapist who can support your healing and mental wellbeing. Every LGBTQ2 person deserves that kind of care, including you.