What LGBTQ+ Clients Wish Their Therapists Knew: 25 Questions to Help Cisgender and Heterosexual Therapists Do Better
What if your LGBTQ+ clients didn't have to educate you before they could be your client?
For many LGBTQ+ people, finding a therapist who is genuinely affirming—not merely willing to say “everyone is welcome here”—can be surprisingly difficult. A therapist may be kind, compassionate, and well-intentioned while still making assumptions based on heterosexuality, cisgender identity, traditional gender roles, monogamy, marriage, family structures, or religious norms. Sometimes the problem isn't an overtly homophobic or transphobic statement.
Sometimes it's a question like:
“Does your boyfriend know?”
when the client has a girlfriend.
Or:
“Have you thought about having children?”
when the therapist has never asked whether parenthood is something the client wants—or whether the client is navigating fertility, dysphoria, family rejection, or complicated feelings about becoming a parent.
Or:
“Are you sure you're transgender, or could this be related to trauma?”
when the therapist would never ask a cisgender client to prove their gender identity.
These moments can seem small to the clinician. To a client who has spent years being misunderstood, judged, questioned, or required to explain themselves, they may not feel small at all.
The American Psychological Association's guidelines for working with sexual minority clients emphasize affirmative practice, including recognizing sexual minority identities as normal variations of human sexuality and considering the effects of stigma and oppression rather than pathologizing LGBTQ+ identities. Similarly, APA's guidelines for working with transgender and gender-nonconforming clients emphasize acceptance, support, understanding, and avoiding assumptions about gender identity or expression.
So, what does that actually look like in a therapy room? Sometimes, it starts with asking better questions.
A Note Before We Begin
There is no single LGBTQ+ experience. A gay cisgender man, bisexual woman, nonbinary person, transgender teenager, queer disabled person, lesbian parent, asexual person, and intersex person may have dramatically different experiences. LGBTQ+ people also differ in race, ethnicity, religion, socioeconomic status, disability, neurotype, age, relationship structure, immigration status, body size, and countless other dimensions of identity.
So, this isn't a list of things every LGBTQ+ client wants every therapist to know. Instead, these are questions worth asking yourself if you are a cisgender and/or heterosexual therapist who wants to provide more genuinely affirming care.
1. Do I automatically assume my client is heterosexual?
This may seem obvious, but heterosexuality is so deeply embedded in our culture that it can become the invisible default.
Consider how often therapists casually ask:
“What is your boyfriend’s name?” (instead of using the gender-neutral term ‘partner’)
“Do you want children?” (this is an assumed ‘naturally occurring’ next step in a cisgender, heteronormative relationship)
The questions are not inherently inappropriate. However, the problem is the assumption underneath them.
What LGBTQ+ clients may wish you knew
You don't have to know my orientation immediately. And you don't have to guess.
Instead of assuming, use neutral language until the client gives you information about their relationships and identity.
Try:
“How would you describe your relationship with them?”
or:
“Is there a partner (or partners) involved in this?”
or simply:
“Tell me about the important people in your life.”
This leaves room for the client to tell you who matters without having to correct you.
2. Do I assume someone's gender based on their appearance?
Gender presentation isn't a reliable shortcut to someone's identity.
A person with short hair isn't necessarily a man. A person wearing makeup isn't necessarily a woman. A person who appears masculine may be nonbinary. A person who appears feminine may be transgender. And someone's gender expression may change over time.
APA's transgender practice guidelines specifically encourage clinicians to avoid assumptions about gender identity and gender expression.
What can I do differently?
When appropriate, simply ask:
“What name and pronouns would you like me to use?”
And then use them. You don't need a lengthy explanation. You don't need to make the client reassure you that you're doing a good job (and you shouldn’t).
If you make a mistake:
“I'm sorry—I meant they.” (Or simply correct the pronoun in a sentence by following the incorrect pronoun with the correct pronoun such as the following: “it sounds like she—they—are having a hard time with this.”)
Then move on. Slip ups may happen at first; accept the responsibility when you make a mistake and let it go.
3. Do I make LGBTQ+ identity the explanation for everything?
This is the opposite problem from ignoring identity, but it can easily be a pitfall. A client may come to therapy because they're depressed, grieving, struggling with ADHD, experiencing burnout, navigating family conflict, dealing with trauma, or having difficulty setting boundaries. Their sexual orientation or gender identity may be relevant, but it also may not be the reason they're struggling.
Ask yourself:
Am I exploring LGBTQ+ identity because it is clinically relevant—or because I'm uncomfortable not knowing more about it?
An LGBTQ+ client deserves to have a whole life outside of their identity. Their identity can be central to therapy without becoming the entirety of their therapy.
4. Do I assume LGBTQ+ people are traumatized because they're LGBTQ+?
LGBTQ+ people can experience minority stress, discrimination, rejection, violence, and other forms of stigma. Those experiences can have significant mental-health consequences. Research summarized by the National Academies identifies stigma, discrimination, and structural factors as important contributors to disparities affecting sexual and gender diverse populations while also emphasizing resilience and protective factors. But LGBTQ+ identity itself isn't a pathology.
Instead of:
“Being gay must have been really difficult for you.”
Try:
“What has your experience of being gay been like for you?”
The first assumes the answer. The second lets the client tell you.
5. Do I understand that coming out isn't a one-time event?
A client may have come out years ago. That, unfortunately, doesn't mean they never have to come out again. They may have to decide whether to disclose their identity:
at work
at a new job
to a doctor
to a new friend
to a landlord
at church
to extended family
at school
while traveling
when meeting a new partner's family
And disclosure (or lack thereof) isn't always about shame. Sometimes, it's about safety.
Consider asking:
“Are there places or people in your life where you feel comfortable being fully yourself—and places where you don't?”
That question can reveal far more than simply asking whether someone is “out.”
6. Do I understand that being “out” isn't always the safest or healthiest choice?
Therapists sometimes unintentionally treat coming out as an inevitable milestone toward authenticity, but disclosure is a personal decision. A client may remain closeted around a family member because they rely on that person financially. They may conceal their identity at work because they fear discrimination. A transgender person may not disclose their gender history because it isn't relevant to someone they're meeting. A bisexual person may not disclose their bisexuality because they are currently in a heterosexual relationship and don't want to answer invasive questions. Affirmation means respecting their autonomy.
The goal isn't:
“How do we get you to come out?”
It may be:
“How do we help you make decisions about disclosure that are consistent with your values, safety, and goals?”
7. Do I understand bisexuality beyond the stereotype?
Bisexual clients frequently encounter assumptions that they are:
confused
indecisive
secretly gay
secretly straight
more likely to cheat
incapable of monogamy
“just experimenting”
These assumptions can appear even in otherwise LGBTQ+-friendly environments.
APA's sexual minority guidelines specifically identify binegativity and the tendency to invalidate bi+ identities as issues relevant to affirmative practice.
A better approach:
Believe clients when they tell you who they are. Someone's current partner does not determine their sexual orientation. Their sexual history does not determine their sexual orientation. Their attraction to one gender doesn't invalidate attraction to another.
8. Do I automatically assume monogamy?
This is an especially important question for therapists.
A client may be:
ethically non-monogamous
polyamorous
relationship anarchist
open
in a nontraditional relationship structure
casually dating multiple people
intentionally single
None of those automatically indicate a need for concern. A therapist should still assess for coercion, abuse, consent violations, or distress—but those assessments should be based on the actual relationship dynamics rather than the number of partners.
Instead of:
“Is there a reason you are left unsatisfied with one partner?”
Try:
“How does your relationship structure work, and what parts of it are feeling supportive or difficult right now?”
Curiosity is different from judgment.
9. Do I treat queer relationships as less serious?
Sometimes this appears subtly.
A therapist may ask:
“Is this a serious relationship?”
when they wouldn't ask a heterosexual married couple the same question. Or they may treat same-sex relationships as temporary, experimental, or primarily sexual.
Ask yourself:
Would I respond differently if this client were describing a heterosexual relationship? That question alone can reveal unconscious heteronormativity.
10. Do I assume everyone wants marriage, children, or a traditional family?
The traditional life script often looks something like: date, marry, buy a house, have children, grow old together. Sound familiar? However, LGBTQ+ people may intentionally construct lives outside that script. Some want marriage. Some don't. Some want children. Some don't. Some want biological children. Some want adoption. Some want chosen family. Some want several partners. Some want no partners at all. None of these automatically represents a failure to mature.
Try asking:
“What does the life you actually want look like?”
rather than:
“Why do you think you haven’t settled down yet?”
11. Do I understand chosen family?
For some LGBTQ+ people, biological family isn't their primary support system. A client's closest relationships may include:
friends
ex-partners
current partners
metamours
community members
mentors
former roommates
queer elders
coworkers
online communities
These relationships can be deeply meaningful.
Ask:
“Who are your people?”
It's a simple question, but it can open an enormous door.
12. Do I automatically assume family reconciliation is the goal?
Family relationships can be complicated. Sometimes reconciliation is meaningful. Sometimes it is impossible. Sometimes it is unsafe. Sometimes a client doesn't want reconciliation. A therapist should not assume that the healthiest outcome is restoring contact with a rejecting parent.
Instead ask:
“What kind of relationship, if any, would you like to have with them?”
The client's desired relationship—not the therapist's preferred family narrative—should guide treatment.
13. Do I understand that religious trauma and LGBTQ+ identity can intersect?
For some LGBTQ+ clients, religion may be a source of tremendous comfort. For others, it may be connected to rejection, shame, conversion efforts, family estrangement, sexual shame, gender policing, or internalized homophobia or transphobia. And sometimes it is both. A client can simultaneously love their faith tradition and be deeply hurt by what happened within it.
Avoid assuming:
“Religion is the problem. You just need to disconnect from your faith.”
or:
“Religion is the answer. You just need to reconnect with your faith.”
Instead ask:
“What role does spirituality or religion play in your life now?”
Let the client decide whether faith belongs in the room.
14. Do I know what conversion therapy actually means?
Some clients have experienced formal sexual-orientation or gender-identity change efforts. Others have experienced subtler versions:
prayer intended to eliminate same-sex attraction
counseling focused on becoming heterosexual
being told their gender identity is caused by trauma
being encouraged to suppress LGBTQ+ relationships
being told they need to become more masculine or feminine
religious counseling intended to eliminate queer identity
APA has concluded that sexual-orientation change efforts are unlikely to be successful and may involve risks of harm. Affirmative care instead emphasizes acceptance, support, coping, social support, and identity exploration without imposing a predetermined identity outcome. A therapist doesn't need to interrogate a client about their history, but knowing that these experiences exist matters.
15. Do I know that “affirming” means more than putting a rainbow flag on my website?
A rainbow flag on a website can communicate welcome as can a booth at your local Pride events. It cannot substitute for competence. Affirmative therapy includes:
using appropriate language
understanding minority stress
recognizing internalized stigma
knowing LGBTQ+ terminology
understanding intersectionality
examining heteronormative assumptions
understanding gender diversity
knowing when you need consultation
knowing relevant community resources
respecting chosen names and pronouns
understanding LGBTQ+ relationship structures
addressing discrimination and systemic stressors
APA describes affirmative practice as recognizing sexual minority identities as normative aspects of human sexuality while considering stigma and oppression within clinical practice.
In other words:
Affirmation is a clinical practice—not a marketing adjective.
16. Do I expect my LGBTQ+ clients to educate me?
This one deserves special attention.
There is a difference between saying:
“I want to make sure I understand your experience. Could you tell me more about what that means for you?”
and repeatedly asking a client to explain basic LGBTQ+ concepts that the therapist could reasonably learn independently. Your client should not have to become your continuing-education instructor.
A good rule:
Be curious, but do your homework.
If you don't know what a term means, it is sometimes appropriate to ask. But you can also research, read professional guidelines, seek consultation, and pursue continuing education outside the therapy hour.
17. Do I know enough about transgender healthcare to avoid becoming an accidental gatekeeper?
Transgender clients may seek therapy for many reasons unrelated to transition. But when gender-affirming healthcare enters the conversation, therapists may find themselves navigating letters, documentation, referrals, or collaboration with medical providers. Therapists should understand their professional role and the current standards relevant to the care they provide rather than treating themselves as the person who gets to decide whether someone is “trans enough.”
APA's transgender guidelines specifically address assessment, therapy, intervention, stigma, barriers to care, and collaboration with other healthcare professionals.
Consider asking:
“What would feel most helpful from me in navigating this process?”
rather than:
“What can you say or do to convince me that you are really transgender?”
18. Do I understand that gender identity and gender expression aren't the same thing?
A client doesn't have to dress, speak, or behave in stereotypically masculine or feminine ways to have a particular gender identity. A nonbinary person doesn't have to look androgynous. A trans woman doesn't have to be traditionally feminine. A trans man doesn't have to be traditionally masculine. And a gender-fluid person's presentation may change.
Your job isn't to determine whether someone “looks” like their gender.
Your job is to understand the person sitting in front of you.
19. Do I recognize that LGBTQ+ clients can have internalized stigma without assuming they are “in denial”?
Clients may carry beliefs they've learned from family, religion, culture, media, peers, or society. They may experience:
internalized homophobia
internalized biphobia
internalized transphobia
shame
fear of rejection
body shame
gender dysphoria
sexual shame
These experiences deserve compassionate exploration, but labeling someone “in denial” can recreate the very power dynamic therapy should help dismantle.
Try:
“What messages did you receive about people like you growing up?”
20. Do I understand that LGBTQ+ people can be extraordinarily resilient?
It is easy to focus exclusively on risk, but the LGBTQ+ communities also contain enormous amounts of:
creativity
humor
resilience
activism
chosen family
community care
identity development
cultural connection
self-determination
joy
The APA's updated sexual-minority guidelines explicitly emphasize resilience alongside stigma, stress, and disparities.
Ask:
“What has helped you survive—and what has helped you thrive?”
Not every LGBTQ+ story needs to be framed as trauma. Sometimes, therapy should make room for queer joy.
21. Do I understand that “LGBTQ+” is not one culture?
The experiences of a bisexual Black woman, a gay Latino man, an autistic nonbinary person, a transgender Christian, an asexual disabled person, and a lesbian immigrant may overlap—but they are not interchangeable.
A therapist's LGBTQ+ competence should not come at the expense of cultural humility regarding race, disability, religion, socioeconomic status, age, nationality, or other identities.
The National Academies similarly emphasizes that health disparities among sexual and gender diverse populations are shaped by intersecting factors including stigma, discrimination, race, age, gender, and other life-course factors.
22. Do I create a therapy environment where clients don't have to brace themselves?
This may be one of the most important questions. Many LGBTQ+ clients have learned to scan for danger.
Will this therapist judge me?
Will they think my relationship is weird?
Will they misunderstand my gender?
Will they tell me my problems are because I'm queer?
Will I have to defend myself?
Will they accidentally out me?
Will they treat my partner differently?
The therapy room should not require constant vigilance. That means paying attention to the little things:
intake forms
pronoun fields
relationship-status options
waiting-room materials
website language
referral lists
paperwork
documentation
telehealth privacy
how partners are described
how families are discussed
Affirmation is often communicated through systems before a therapist ever says a word.
23. Do I know how to respond when I make a mistake?
You will make mistakes. Even experienced LGBTQ+-affirming therapists sometimes use the wrong pronoun, misunderstand a term, make an assumption, or miss something.
A good response might be:
“I realize I made an assumption there. Thank you for correcting me.”
Or:
“I want to acknowledge that I used the wrong pronoun. I'm sorry.”
Then continue.
Avoid turning the client's correction into emotional labor.
You don't need:
“Oh my gosh, I'm so sorry! I'm terrible at this. I feel awful. Please don't think I'm a bad therapist.”
Now the client has to comfort you. A brief acknowledgment and correction is usually enough.
24. Do I believe my LGBTQ+ clients when they tell me about discrimination?
An LGBTQ+ client may describe being:
misgendered
excluded
harassed
rejected by family
denied services
discriminated against at work
bullied
threatened
fetishized
stereotyped
treated differently by healthcare providers
The therapist doesn't need to automatically assume every interpretation is correct, but neither should the therapist automatically search for alternative explanations that make the discrimination easier to dismiss.
Try:
“That sounds like it had a significant impact on you. What did you need in that moment that you didn't receive?”
Validation doesn't require conducting a courtroom trial.
25. Am I willing to examine my own assumptions?
This may be the question underneath all the others. You may genuinely care about LGBTQ+ clients. You may consider yourself accepting. You may have LGBTQ+ friends or family. You may even have completed LGBTQ+ cultural-competency training. And you may still carry assumptions you haven't noticed. That's not a moral failure. It's part of living in a culture where heterosexuality and cisgender identity are frequently treated as defaults.
The important question isn't:
“Am I completely free of bias?”
It's:
“Am I willing to notice it, learn, repair it, and change?”
What LGBTQ+ Clients May Actually Be Asking For
When you put all of these questions together, the request is surprisingly simple. Many LGBTQ+ clients aren't asking therapists to become experts on every aspect of queer culture. They're asking therapists to:
Believe them.
Don't assume.
Don't pathologize their identity.
Respect their autonomy.
Use their name and pronouns.
Don't make them defend their relationships.
Understand minority stress without reducing them to it.
Don't treat heterosexuality, cisgender identity, monogamy, marriage, or parenthood as universal goals.
Learn enough that they don't have to teach you everything.
Be willing to repair mistakes.
Make room for both pain and joy.
And perhaps most importantly:
See them as whole people.
The Difference Between LGBTQ+-Friendly and LGBTQ+-Affirming
There is an important distinction between being LGBTQ+-friendly and practicing LGBTQ+-affirming therapy.
A friendly therapist might say:
“I work with everyone.”
An affirming therapist asks:
“What assumptions might I be making about this person's identity, relationships, family, or goals—and how can I make space for the client to define those things for themselves?”
A friendly therapist may avoid saying anything overtly negative. An affirming therapist actively creates conditions in which the client doesn't have to wonder whether they are being judged. A friendly therapist may have LGBTQ+ clients. An affirming therapist recognizes LGBTQ+ cultural experiences, minority stress, stigma, resilience, and intersectionality as legitimate clinical considerations. And an affirming therapist understands that acceptance is not the same thing as competence.
A Final Question for Therapists
Before your next LGBTQ+ client walks through your virtual or physical door, consider asking yourself:
“What would I do differently if I knew this client had spent much of their life expecting people like me to misunderstand them?”
Maybe you would slow down. Maybe you would ask instead of assume. Maybe you would change an intake form. Maybe you would learn about identities you don't understand. Maybe you would seek consultation. Maybe you would reconsider the language you use around relationships and family.
Maybe you would become more comfortable saying:
“I don't know enough about that yet, but I'm willing to learn.”
That humility can be more affirming than pretending to know everything. Because LGBTQ+-affirming therapy isn't about becoming a perfect therapist. It's about creating a therapeutic relationship in which an LGBTQ+ client doesn't have to spend their precious therapy hour proving that their identity, relationships, family, or life are legitimate. They deserve to spend that hour working on the things they actually came to therapy to address.
For LGBTQ+ Clients: What Do You Wish Your Therapist Knew?
If you're LGBTQ+ and have had therapy before, you may have your own list. Maybe your therapist said something that made you feel deeply understood. Maybe they said something that made you want to disappear. Maybe they were affirming in some ways but still made assumptions that left you doing emotional labor. Your experience matters.
And if you're looking for an LGBTQ+-affirming therapist, consider asking potential therapists:
“How do you define LGBTQ+-affirming therapy?”
“What experience and training do you have working with LGBTQ+ clients?”
“Are you competent in working with transgender and nonbinary clients?”
“Are you competent in working with bisexual and pansexual clients?”
“Are you competent in working with ethical non-monogamy?”
“How do you approach religious trauma and LGBTQ+ identity?”
“How do you work with internalized homophobia or transphobia?”
“How do you approach gender-affirming care?”
“What happens if you don't know something about my identity or community?”
You don't need to find a therapist who knows everything. However, you do deserve a therapist who is curious without being invasive, knowledgeable without being arrogant, affirming without being performative, and willing to learn without making you responsible for teaching them.
References & Further Reading
American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people.
American Psychological Association. (2021). Guidelines for psychological practice with sexual minority persons.
American Psychological Association. (2009). Report of the APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation.
American Psychological Association. (2022). Updated guidelines for sexual minority people focus on resilience.
National Academies of Sciences, Engineering, and Medicine. (2020). Understanding the well-being of LGBTQI+ populations. National Academies Press.