Sarah Burgamy, a psychologist and member of the LGBTQ+ community, remembers well the foreboding feeling of coming out as a teen.
“I had struggled with the awareness that our culture was not welcoming and accepting of LGBTQ+ folks,” says Burgamy, who grew up in Colorado and now works in Denver. “I worried about how coming out as gay/lesbian would affect my most precious and important relationships.”
Her own experience and a growing feeling of protectiveness for her community led her to a focus on working with LGBTQ+ youth.
“Most young folks worry, at best, that sharing a diverse sexual orientation or gender identity will affect their relationships with those closest to them in unknown ways. At worst, they may be aware that the disclosure could jeopardize their basic needs and safety at home,” she says. “I have a deep empathy for the trepidation and, at times, fear, which can accompany this revelation.”
Being LGBTQ+ is not a mental disorder, but LGBTQ+ young people are at higher risk for anxiety, depression and suicide due to the stigma, shame and discrimination they often face.
Parents, likewise, are often concerned for their LGBTQ+ child but unsure of how to navigate a world that’s likely new to them.
Working with an LGBTQ+ affirming therapist can help young people explore their identities. It can also help parents who want to support their child but may not have the language or framework to do so yet.
Unfortunately, there is a shortage of mental health professionals trained to understand the issues facing LGBTQ+ young people. A 2023 JAMA Pediatrics study found just 28% of youth-serving mental health facilities offer LGBTQ-specific mental health services.
So, how can parents find an appropriate therapist for their child? We asked experts.
[Read: Low-Cost Therapy Options for Every Budget.]
LGBTQ+ Basics
Approximately 1 in 10 youth in the United States identifies as LGBTQ+.
LGBTQ+ stands for:
— Lesbian
— Gay
— Bisexual
— Trans
— Queer (or questioning)
The plus sign refers to additional ways a person may affirm their gender identity or sexual orientation.
You may also see the acronym “LGBTQIA+,” in which the “I” stands for intersex (a person born with male and female sex characteristics, such as genitals or chromosomes), and the “A” means asexual.
Second, “gender identity” and “sexual orientation” are not the same thing. Gender identity is what a person feels they are, regardless of their external sex characteristics, and can develop at a young age; whereas sexual orientation is who they are romantically or sexually attracted to.
For parents, it’s OK if this is confusing, and it’s not necessary to use all the “right” language. A simple willingness to be open to understanding is a great first step.
[Read: Helping Kids With Anxiety: What to Do and Not Do]
Why LGBTQ+ Youth Need Therapy
Unfortunately, LGBTQ+ youth are at increased risk for mental health difficulties and have more trouble accessing services.
The statistics are unsettling. According to the 2023 Centers for Disease Control and Prevention Youth Risk Behavior Survey of LGBTQ+ students:
— 41% have seriously considered suicide
— 65% have felt sad or hopeless
— 29% have been bullied at school
In addition, LGBTQ+ individuals are more than twice as likely to have a mental health disorder in their lifetime, the American Psychiatric Association reports.
However, young people aren’t more prone to anxiety or depression simply due to being LGBTQ+. Rather, the root causes are likely tied to identity-related life stressors and how these external factors impact them, Minor says.
These might include:
— Societal bias and discrimination
— Internalized stigma and shame
— Trauma and post-traumatic stress disorder (PTSD)
— Family rejection
— School stressors
[Read: How to Support a Child in Crisis]
Rebecca Minor, a therapist and gender specialist, has seen how these worries affect her clients — as well as their parents, who often are trying to understand what’s going on with their child.
“One of the families I worked with came to me after their teenager, Alex (not their real name), had been struggling with anxiety and depression for over a year. Their parents knew something was wrong, but every time they tried to talk to Alex, they shut down,” says Minor, who authored the upcoming book “Raising Trans Kids: What to Expect When You Weren’t Expecting This.” “Things escalated when Alex began missing school and isolating from friends. Eventually, they confided in a trusted teacher that they were questioning their gender identity but felt too scared to tell their family.”
Minor understands these challenges personally.
“I came out in early adulthood after years of internal questioning and navigating a world that promoted compulsory heterosexuality,” she says. “I know firsthand how isolating it can feel to not see yourself reflected in the world around you, and I also know how transformative it is to find community and affirmation.”
“One of my goals is to help families understand that their child’s identity isn’t something to be ‘fixed’ but something to be understood and celebrated,” Minor says.
Why It’s Important to Find LGBTQ+ Mental Health Care
Therapy can create an environment where LGBTQ+ youth feel safe to explore their identities without judgment or pressure, Minor says.
In doing so, young people can develop the tools to navigate a world that’s often not accepting of them, while also validating their experiences and emotions to foster self-acceptance and resilience.
“Identity exploration isn’t a (disease),” Minor says. “It’s a normal, healthy part of development.”
While therapy can help LGBTQ+ young people navigate their growing identity, seeing a therapist who doesn’t understand them or the issues they face can actually make things worse.
“This harm can take many forms, ranging from outright rejection or dismissal of a young person’s identity to more subtle invalidation, such as attributing their distress to ‘a phase,'” Minor says.
The first therapist Alex’s family saw dismissed their gender exploration as “just a phase,” Minor says. This left Alex even more withdrawn and their parents more confused about what to do next.
Which is why an LGBTQ-affirming therapist can be a safe place for a young person to land.
“When a young person is at their most vulnerable, most anxious and possibly most desperate, and worrying about whether they will be accepted or rejected by anyone in their lives, having a provider who they know will be supportive, accepting and knowledgeable is imperative,” Burgamy says.
LGBTQ-affirming therapists can provide guidance on:
— Helping parents and caregivers understand and support their child’s identity
— Navigating school environments, name and pronoun changes, and aspects of a social transition, such as clothing or hairstyle
— Addressing intersectional experiences, such as being LGBTQ+ and a person of color, neurodivergent or from a religious background with complicated views on gender and sexuality
— Connecting youth to affirming community spaces, peer support and resources
How will parents know if a therapist is LGBTQ+ affirming?
It’s not enough for a mental health professional to be LGBTQ+ “friendly” or to not turn a patient away because of their identity. They actually must be trained in treating LGBTQ+ people.
According to their ethics codes, all mental health providers should acquire competencies to treat people across broad spectrums of human diversity, specifically including sexual orientation and gender identity. Ideally, to be sufficiently skilled to treat LGBTQ+ youth, a therapist should have:
— Taken specialized coursework or continuing education classes
— Attended conferences, workshops or webinars on the topic
— Read foundational and current journal articles
— Talked to established providers with expertise in the area
— Become familiar with professional guidelines or standards of care for LGBTQ+ clients
— Treated other LGBTQ+ young people
However, that’s not always the case.
“Folks often note they have to ‘decode’ whether or not someone is LGBTQ+ competent,” Burgamy says. “Often, parents and guardians are left to internet searches of providers in their insurance network to see if there might be a professional webpage or listing that helps guide them in identifying an LGBTQ+ competent or affirming therapist.”
So, how can you know? If the therapist doesn’t specifically state in their online bio that they are LGBTQ+ affirming or competent, Burgamy says that’s a red flag.
“Not saying something says something,” she says. “I’d actually dissuade parents from a mental health provider who does not list LGBTQ+ specialty, competency, interest or affirmation, because a competent provider will know how important it is to be visible.”
Ultimately, Minor says finding the right psychiatrist or therapist for an LGBTQ+ youth isn’t just about the therapist’s credentials. It’s about whether they create a space where the young person feels safe, heard and empowered.
[READ: Therapy Red Flags: 8 Reasons to Leave Your Therapist]
Barriers to Accessing LGBTQ+ Mental Health Care
Unfortunately, there is a shortage of providers trained to treat LGBTQ+ youth, and those who specialize in this care often have long waitlists, Minor says.
Other obstacles to finding a therapist for your LGBTQ+ child may include:
— Financial and insurance issues. Many therapists, whether they specialize in LGBTQ+ care or not, do not take insurance or take a limited number of insurances. This leaves families with a lot of out-of-pocket expenses, making low-cost therapy options all the more important.
— Geographic limitations. Particularly in rural or conservative areas, LGBTQ+ competent therapists may be scarce or far away.
— Misinformation and bias. This continues to be a major impediment that causes confusion when looking for care.
“Parents may receive conflicting messages about gender-affirming care, making it difficult to determine which sources are trustworthy,” Minor says.
How to Find a LGBTQ-Competent Therapist for Your Child
To help you find available mental health services you can afford and decide whether someone is competent, Minor recommends taking advantage of curated directories and resources.
Search national directories of LGBTQ+ affirming therapists
— GLMA (previously known as the Gay and Lesbian Medical Association)
— AGLP (The Association of LGBTQ+ Psychiatrists)
— The National Queer and Trans Therapists of Color Network
Get other parents’ recommendations
“Many parents who call my office will note having been referred by another parent or family. Word of mouth from other trusted parents can be indispensable,” Burgamy says.
Minor suggests joining support groups for parents of LGBTQ+ kids to connect with other families on a similar journey and find therapist recommendations.
Use community services
LGBTQ+ community centers can often help you find, or even provide, mental health services for your child. Find an LGBTQ+ community center near you at Centerlink‘s directory.
Go online
If you can’t find in-person resources in your area, check out online groups. The LGBTQ+ support network PFLAG has virtual meetings and a private Facebook support group in addition to local chapters, so you can network with other families and share information.
Broaden your search area
If there aren’t sufficient options for local therapists, telehealth services can provide access to specialists regardless of location. Check out:
Consider your child’s personality and needs
Even among gender-affirming therapists, not every one is going to mesh well with your child.
“Most parents are faced with day in and day out challenges of trying to guess what will appeal to their children, whether it is dinner, an activity or a therapist,” Burgamy says.
Talk with the therapist before committing to see if they might be a good fit.
Realize trans youth require a therapist with additional skills
For families with transgender or gender-nonconforming youth, the provider should be specifically knowledgeable about this type of gender identity development.
“Working with trans youth requires an understanding of social, medical and legal aspects of transition,” Minor says.
The therapist should also be able to write gender-affirming letters for name and gender marker changes and for medical treatments, such as hormone therapy.
A therapist unfamiliar with these aspects may unintentionally delay or complicate access to care, reinforcing barriers rather than removing them, Minor says.
Ask questions
If you want to be sure a therapist has the right experience, talk with them. Many therapists offer a free or low-cost consultation.
Minor says to consider the following questions when selecting a therapist:
— Does the therapist have specific experience with LGBTQ+ youth? Ask if they have treated any young people who are LGBTQ+ or have specific training or certification. They should also treat children and adolescents regularly.
— How do they talk about gender and sexuality? An affirming provider should not be dismissive of identity exploration and should use inclusive language.
— Do they involve parents appropriately? A good therapist will help parents support their child while respecting the young person’s autonomy.
Should the therapist be LGBTQ+ themselves?
Not necessarily, but it may help. A shared identity can go a long way toward building a trusting relationship with a therapist, Burgamy says.
“The youth may feel more comfortable with someone who shares their lived experience, but what matters most is that the therapist is knowledgeable, affirming and genuinely supportive,” Minor says.
What to Do If Your Child Is Hesitant to Talk to a Therapist
LGBTQ+ adolescents may be concerned the therapist is going to repeat private information to their parents, which can hinder building a trusting therapeutic relationship.
“Many young people worry that their therapist is simply a proxy for their parent or guardian,” Burgamy says.
Best practices include being clear with both the young person and the parents about when the therapist must share information — usually for safety concerns, especially suicidal intent — and when they would ask a parent to allow their child privacy in order to build a working relationship that can serve their best interests.
“In my experience, this approach often contributes to a more positive working relationship, as the teen client and therapist can discuss what to share with parents and when in a collaborative fashion,” Burgamy says.
This isn’t to keep secrets from parents, but rather to help the young person learn how and when communication and sharing with a parent can be to their advantage.
“We, as mental health providers, can be pivotal in helping a family system navigate a difficult or confusing time while building stronger trust and rapport,” Burgamy says.
Research confirms that parental acceptance and support has a very significant impact in reducing suicidal risk.
Bottom Line
Being able to explore gender identity in an affirming and pressure-free way, while allowing parents to work through their own emotions, is a key component to helping LGBTQ+ children gain confidence in expressing their identity.
For Alex, they are thriving because the family was able to get access to competent gender-affirming care.
This type of care can be life-changing for young people who have spent their lives feeling unseen or misunderstood, Minor says.
“It’s not just about mental health treatment, It’s about giving LGBTQ+ youth the validation, resources and support they need to thrive,” she says.
More from U.S. News
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Low-Cost Therapy Options for Every Budget
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How to Find a Therapist or Mental Health Professional for Your LGBTQ+ Child originally appeared on usnews.com
Update 06/30/25: This story was published at an earlier date and has been updated with new information.
