What Queer and Trans Patients Wish Their Therapists Understood

It’s Wellness Vibes Week! We’re taking some time at the start of this brand new year to explore wellness culture/wElLnEsS cUlTuRe through a queer lens, specifically the kind of queer lens that you can only find at your local Autostraddle. No celery juice or vagina steaming, just some chill tips for making your spiritual, physical and mental health a little better in 2020.

It’s 2020 and we all know that ~*wE sHouLd aLl bE in tHerApY*~, and a lot of us are! Those of us who aren’t, a lot of us are very reasonably stymied by access, by our shitty health insurance, by not having health insurance at all, by not being able to find a therapist even within those systems that can actually help us. And for those of us who do have access to therapy, we can not infrequently find we’re navigating heterosexism, cissexism, white supremacy and more there too, which kind of undercuts the point. We sometimes wish our therapists had insight from actual queer people and not just theory about how to treat us more effectively – and we’re sure they do too, they want to help! That said, here’s our real-life insight and tips about how to help us get better better.

Bailey , Writer

When I tried to change therapists after moving back to the UK, I felt like an employer searching for the perfect, glittery unicorn who’s experiences mirrored mine. I’d either find “LGBTQ+ affirming” therapists who did not understand my blended family or “culturally affirming” therapists who did not understand my gender or sexuality. My success in therapy depends on me not having the explain all of my different intersections.I’ve learned one thing I need when I say I feel alone in POC spaces for being LGBTQ and I feel alone in LGBTQ spaces for being POC, is a nod that tells me they get it because they have felt similar dichotomies. That nod of understanding and relating has to be legit too, not a nod of pity or guilt but a nod of ugh fuck yes I see you in this feeling and the world can be shit lets talk about how everything is connected.

Himani Gupta, Contributor

I talk about race and gender a lot. I need to feel like I can say anything to my therapist when it comes to these two topics and not worry that I might offend them. I also need to know that I can speak candidly about how coming into my sexuality has been shaped by my family and South Asian culture, without having to worry that “Asians are homophobes” will be thrown back at me in some politely coded form. If I can’t trust my therapist in this way, then I know that I’m not going to be able to open up about my real issues.

So much of my experience of being a South Asian person who grew up and lives in America is feeling disempowered to make any claims about my own experience. I’ve often been left feeling like I’m not an expert on any kind of cultural or racial identity: I can’t speak to anything about being South Asian because I don’t live on the subcontinent, but I’m not an American because I’m brown. And when it comes to racism, so many of the situations have hinged on these subtleties so I really have no clue what’s going on – is it really racism? I need a therapist who can engage with all of this in a meaningful way without undermining me, whose questions aren’t caught up in the nitty gritty details but rather redirect my focus to how these experiences make me feel.

Ro White, Sex & Dating Editor

I’ve had a few therapists over the years. I wish my less helpful therapists had believed that my depression and anxiety have nothing to do with my gender identity or sexual orientation. Yes, I’ve experienced discrimination and rejection based on my queer identity, but that’s never been why I’ve sought mental health support. I’m a lucky gay duck — I’ve never felt any internal conflict or shame around my queerness. I deal with classic, run-of-mill worries and sadness without any rainbow flags attached. Yet some of my (straight, well-meaning) therapists have spent our sessions circling back to gender and sexuality when there have been more relevant, pressing issues to focus on. That’s frustrating. I need a therapist who lets me lead them to the root of my problems without making any assumptions.

So I’m not currently in therapy but am desperately seeking it. I’m somewhere between pissed and exhausted at how hard the search has been because I live in New York City and am astonished at how few therapists take my insurance, how many practitioners define sliding scale as “$200-$250” a session, and how often I have to prioritize either my race or sexuality in looking for a therapist. I have been lucky in the past to have a couple of really good queer therapists who were cis White men, but unfortunately I’ve had to break up with a fair share of therapists. I didn’t do the best job of ending it, so I would tell each of them the following:

  • If you don’t actually hold any competency in issues of racial, sexual, and gender diversity then please openly admit what you don’t know. I have experienced more than one therapist attempt to use me as a learning tool rather than simply admit to any gaps in their knowledge. The most glaring case was in a cis straight White woman asked me if I was thinking about race because of the day’s occasion. It was MLK day. I had to explain that, as a Black woman, I don’t have the luxury of only thinking about race on MLK day and during Black History Month.
  • It’s okay and actually necessary for me to be angry sometimes. It’s actually incredibly fucked up and triggering to be told I should “move past” my anger because it’s not productive. The angry Black woman trope already exists to shame Black women out of our feelings, specifically our righteous indignation. While I certainly recognize one can’t stay in anger, as my therapist you should especially be attuned to the need to express anger with the many systems working to oppress me.
  • Like others have said, my anxiety isn’t a result of my queerness or my Blackness. While my experiences of marginalization don’t help my condition, I have felt pushed to claim feelings of being ashamed or conflicted by my queerness when that either hasn’t been the case or isn’t the central issue I want to discuss.

Drew Burnett Gregory, Senior Editor

I didn’t switch therapists when I transitioned. I’d established a really nice relationship with my therapist and even though she was cis and straight what I really needed in that tumultous time was someone who knew me and knew how my anxiety and depression manifested. But when I moved to LA and had the opportunity to find a new therapist I knew I wanted to find someone who was queer. My current therapist is cis and bisexual and there is something so nice about having a therapist who understands queer culture. I feel like I can trust her judgement on certain things in a way I maybe couldn’t with my previous therapist. 

But she is still cis and there is a bit of a divide there. It’s not that she isn’t well-educated on transness. She just sometimes reacts to certain things with what feels like a sense of pity. I think a lot of cis people connote transness with tragedy, because of the larger cultural narrative and sometimes when I talk about something and she gets that sad cis look I want to be like I’m okay! It’s okay! I might be having a problem that’s specifically related to my transness, but it’s just like any of my other problems. It’s not heavier, because it’s about being trans. 

I should probably just say this to her! I always want my therapists to like me so badly, I sometimes don’t say things I should. This has inspired me. Next time she does this I’m going to explain why it bothers me.

Heather Hogan, Senior Writer + Editor

I have been in therapy, on and off, for over a decade, but each new phase of my journey has required a different therapist. At first I was only — well, “only” — in therapy to understand my mom’s personality disorder. I began with a Christian counselor who quickly became irrelevant because I left the church and realized she was just regurgitating Proverbs 31 nonsense to me anyway. Getting a secular therapist was a big deal! And then, when I came out, getting a gay-affirming therapist was a big deal! I spent most of my life in rural Georgia, the reddest county in the entire country — truly, these actually were big deals. 

When I moved to New York City, it felt like any therapist would do, because they were all, seemingly, well-versed in “LGBT issues.” I guess for a long time I didn’t really have a problem because I was seeking out therapists for specific things I was tackling — strategies for managing my anxiety, inner child work, career counseling — and none of it had anything to do with my sexuality. I’m cis and white and in a healthy and monogamous longterm relationship. Pretty mainstream narratives.

When I started to need to see a therapist regularly in 2016, to grapple with just so many things as they were happening in real time and with how my reactions were informed by my childhood trauma, it quickly became apparent that I was going to have to do more than select whatever therapist called me back first after I selected “five mile radius” on my insurance’s search portal. Just off the top of my head, here are some things I’ve perpetually had trouble making therapists understand: 

It doesn’t matter if it affects me directly; if it affects any oppressed person, it is deeply troubling and unacceptable to me and I want to figure out my role in combatting it. No, I cannot just “wait and see” what happens, because that is a luxury, and many people in my community will be hurt by my delayed action. Yes, I would probably be happier if I didn’t “seek out upsetting news” or if I remained silent sometimes, but freedom for everyone is my life’s purpose, not some kind of deliberately obtuse happiness. (Choosing ignorance is not self-care.) (Complacency is not contentment.) Terrible people can be part of accomplishing good things on a large scale in activist groups, but that does not diminish their abuses. The political is very personal to me, and I don’t know how to relate to anyone — including my own family — who do not feel the same way. It is my responsibility and my privilege to use my relative power to empower other people, to lift them above me, and that doesn’t mean I am giving up my own goals and dreams. Being sweet is a passive personality trait; being kind is a courageous and minute-by-minute choice. No, I don’t need to explore my general contempt for cis men. I can be full of so much rage and also full of so much tender, precious, gentle love. My wounds, as Adrienne Rich says, come from the same source as my power; I can’t close off one without closing off the other. 

I was recently thrown by a new trauma therapist I was getting along with quite well defending someone I was explaining was hurting a very vulnerable group of people in our community. I thought, at first, she didn’t understand what I was saying. I explained further, and still further. But no, she got it. She “just couldn’t” with the most basic expression of respecting the humanity of these folks. I took some books to her office a few days later, some resources for her to educate herself, and I told her I couldn’t see her anymore. 

She emailed me a few days later, to tell me she was having a hard time wrapping her mind around how she’d upset me so, and I told her that was for her to work out with someone else, and that I did not owe her any further explanation. So: therapy has also done very good things for me! 


Rachel Kincaid, Former Managing Editor

I’ve been very lucky to mostly have therapists who, while straight, did at least know the basics about LGBT cultural competency (with the exception of once trying to access a graduate student mental health service, where they told me they would try to get me a woman therapist but couldn’t guarantee it and I might “end up having to educate a bit” on LGBT issues. I did not continue services with them.). In my experience even with those therapists, though, I sometimes wish they would be a little more willing to know how much they don’t know, and can’t. Which is fine! No one can be an expert on a lived experience they don’t have, and they shouldn’t try to. I still find myself, though, often leaving out or glossing over specifically queer stuff in therapy because I don’t trust that it won’t be misinterpreted, or that the therapist’s ideas about what queerness is and how it functions won’t overshadow my own actual experiences.

As an example, I have a specific memory of relating to a therapist an anecdote from my youth about an early same-sex relationship I had, in which I offhandedly mentioned that neither of us had been out at the time. My therapist was fascinated by this, and couldn’t let go of it — I think in her received narrative about how coming out works, a queer person comes out formally to their entire family and social circle as soon as they “know” their identity barring any immediate concrete risks of violence or homelessness, and could not fathom why I hadn’t; this became the whole story to her, and my decision around out-ness clearly indicative of some larger theme or issue — when of course it isn’t, and also that wasn’t what I was actually trying to talk about at all, and the issue I actually needed to focus on got derailed. Lots of people come out (or don’t) in lots of ways; sometimes it’s for a specific reason, in this case it genuinely wasn’t, and wasn’t an important choice. Based on experiences like this, though, I find myself often shying away from getting in depth about the more “advanced topics” in queerness – how it impacts my relationships, how stigma or internalized stuff impacts my decisionmaking or how I experience myself, experiences around sexuality or my body, how my identity and developmental trauma interact with each other – because I worry that pretty common, unremarkable parts of a queer existence will be read as a pathology or aberration just because they’re not easily legible to a straight person.

I’d feel more confident about navigating this stuff with a straight therapist if I knew they had a sense of treating me as the expert on my own experience when it comes to queerness, committing to doing more listening than talking on things related to queerness specifically, and being willing to suspend some disbelief for things that don’t immediately make sense to them, (or maybe even research and learn more about them on their own time, without my having to do a quick 101 in session on my own dime!). In a lot of parts of the therapeutic process I think it’s important for me to understand I might be wrong, and my therapist might have insights or perspective that I don’t — but not on this topic, where coming up with new hot takes is more likely to do harm than good.

Abeni Jones, Contributor

My current therapist is a queer woman of color, which I’ve never had before and which has been literally life-changing. I had to fight for months with my insurance to get our sessions covered, though – and now my employer changed insurance providers and she’s not covered anymore. So to be honest, what I really wish is that insurance companies understood that seeing a therapist who shares one or more of our identities is crucially important and to quit fighting us on it?

But I’ve been in therapy for many years, and many of my therapists have been pretty bad (for me). My current therapist is amazing, but I would like my past, bad therapists to know:

  • Telling me that other people, like starving children in developing countries, have it worse than I do isn’t an effective way to help me address my depression. Suffering is contextual.
  • I’m not depressed because I’m trans. That being said, the persistent discrimination I experience because I’m trans surely does contribute to my depression.
  • Just because I can expect discrimination as a part of my life as a trans person doesn’t mean I have to be OK with it. It’s normal and natural for me to be bothered by it even if there’s nothing I can do about it. Not everything has to be accepted and tolerated in order for me to live a happy, healthy life.

Anyway, my current therapist doesn’t get into any of this bullshit, is nerdy and thoughtful and listens and challenges me and she has literally changed my life. If there’s a QTPOC therapist in your area, challenge your insurance company to see if you can get out-of-network coverage – it could happen!

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  1. fuck what a timely article. (there’s some potentially triggering stuff to follow if you’re struggling with eating or body image issues)

    I’ve been seeing the same therapist since I first started ED recovery, and I considered us as having “grown up” and learned about my gender and sexuality together. A couple of sessions ago I mentioned that it was the ten-year anniversary of getting my first binder, and how much of an affirming and lovely moment of my life that had been. Instead of believing in my joy, she told me quite offhandedly that she thinks it’s time for me to “transition” (no pun intended) away from binding, as she sees it as a form of indulging in my body issues and trying to “stay in a child’s body” instead of “moving gracefully into young womanhood” (which, WHAT the FUCK). Since then, despite repeatedly telling her otherwise, she seems to think this is our next big thing to tackle, rather than a very ordinary part of my life that I don’t see an issue with. I think her intentions are good, but needless to say I’m pretty hurt. I’ve been lucky to have someone I trusted (and could afford) for this long, but it’s probably time for me to find someone that meets me where I’m at. Smash tits and all.

    • That’s terrible, and must have been especially dismaying given the trust you would have built up over time. I hope you can find someone who’s a much better fit for you now.

    • Therapy in the eating disorder world can sometimes be incredibly glued to traditional gender roles, to the detriment of the clients in their care. You may need to find a therapist with a more general focus who has an understanding of eating disorders but isn’t focused on that area. It’s disappointing that someone who should understand and not judge would say this to you!

  2. I’ve just started reaching out to therapists to try and find someone for the first time so I really appreciate this! Thank you for sharing! What I am concerned about is finding someone who gets queer stuff, solo stuff, poly stuff, and kink stuff. I worry about someone trying to fix things that I am happy with instead of helping me navigate a world that thinks I’m messed up, you know?

  3. One time a therapist asked me if I felt more like a girl or a boy.

    Another time, a (different) therapist didn’t know that someone had shot up a synagogue in Pittsburgh the week after it happened, and insisted it wasn’t her job to follow the news because her job is depressing enough. (I told her I wasn’t coming back, on the spot.)

    Culturally incompetent shrinks are the worst.

  4. My heart breaks for every queer person that doesn’t have access to a (good) therapist that needs one.

    I’ve been extremely fortunate wrt my therapists-

    I was fully comfortable with my previous therapist, even though she was straight and cis, that I was able to explore and figure out my gender and my sexuality.

    And my current therapist (queer and cis) has been instrumental in me growing in and embracing my identities (and intersections) and communities.

    And both of them view(ed) me as a whole person- not JUST my queerness, but also not seperate from it either.

    I hope someday soon every queer person that needs/wants it, gets access to what I have.
    Until that day, I hope they’re able to hang on and live the best lives that they’re able to.

  5. timely fucking article! i’ve have a therapist for over 4 years who just told me she’s moving and i know that my next therapist i’m going to spend a Lot of time figuring out what perspective i want to support me. thanks for sharing!!

  6. Thank you for this, this article has made me start to rethink my need/desire to go to couples therapy with my wife. we definitely could use it, I just wish I knew where we could find a sitter for our kids (anyone in the North Bay up for watching our cute 3yr old twins???)

    On the same sort of note of being dismissed in the medical world, when I was pregnant my obgyn asked me how I was doing and I told her I was “tired, sore, etc,” you know the general feelings of a person who is pregnant with twins. In her next breath she responded that I should “feel lucky because many women have it much worse,” as if I were complaining, as if I wasn’t just responding honestly to the question SHE HAD JUST ASKED ME. It still makes me mad thinking about how she dismissed my feelings. Lucky for me she was not the dr that performed my c-section.

    • Um what do you mean by “North Bay” because I’m kind of not kidding that I would babysit? Like do you mean north of San Francisco? I dunno, it’s wild offer, but DM me if you want. I’m a grad student who would love some kid-time

      • @bicoastal Yes North of SF! We are in the Santa Rosa area. :) Would love to meet and great regardless, I’ve been hankering to meet with other Autostraddle peeps.

  7. Huh, I just saw a new therapist last night. She was very nice, and I hope things work out, but the first question she had after I told her that I’d had bottom surgery was “who are you going to have sex with now” which I mean let’s work our way up to that, shall we.
    What she wanted to know was my sexuality. So: Therapists, don’t assume trans people suddenly change their attraction when they change their genders.

  8. This is so timely! I’m finally looking for a therapist and I’m not really sure what to be looking out for. I’m trying to find a queer woman of colour hopefully, but I know how hard that can be. This article has definitely given me ideas on questions to ask potential therapists.

  9. Ugh I wasn’t out even to myself and when I described not being attracted to men and finding dating them to be a miserable chore, she was very into me just continuing to give it the old college try. That I might not be straight didn’t even enter the conversation. Thankfully, I managed to admit that to myself a few months after ending therapy. I’m not saying it was her job to have that revelation for me, but I do think she should have been able to at least bring up the possibility.
    It’s been a few years and I’ve considered going to another therapist, but I have a long commute and finding one who is gay friendly and in my insurance with reasonable hours sounds like a friggin nightmare.

  10. Wait help — I’ve had several of these negative experiences but hardly any of the good ones. Like, you know, the time I told a therapist my anxiety was fixating on climate change lately and she told me she was also scared in the 60’s but she’s still alive so that proves we’re definitely going to be okay??? To say nothing of discussing my relationship stuff. Rather than continuing to search for a therapist that I feel can “handle me” (the words I say to myself) I’ve just stopped searching and lie to my family and friends that ask if I’m making progress finding someone. It’s too exhausting! And bad therapy feels kinda worse than no therapy for me. What do I do? How do I…find someone (Berkeley)? It’s a rhetorical question but it feels nice to scream into the void.

  11. this is so amazing!

    thank you especially for articulating the tendency to ‘shrink’ queer parts of our lives around shrinks that don’t feel amazing — I definitely do that and hadn’t totally identified it as such, so I really appreciated it.

  12. Thanks for this article. I feel like there’s a ton of emphasis on everyone having to be in therapy and it being great and appropriate all the time, to the point where it’s almost taboo to talk about negative experiences.

    I don’t go to therapy now, and I’m happier for it – I’m pretty okay at doing that kind of introspective work on my own, and at this point in my life I know more about my mental illnesses than a general therapist would (and I don’t have any interest in seeking out a specialist because the specific therapies people use for people with my problems do more harm than good for me personally.) I don’t want to take part in any emotionally intimate relationship with the power dynamic involved in therapy, and I think that’s a reasonable way to feel.

    I don’t think people who still want to be in therapy should give up on it, but I do think that a lot of people who spend a lot of time in social spaces with an emphasis on healthy living are pressured into continuing to pursue talk therapy beyond what they want or need to do. If there’s anyone reading this who doesn’t get a lot out of the basic premise of talk therapy (or who only gets negative things out of it) and wishes they had permission to disengage – congrats, now you do! There are plenty of ways to be a relatively happy and relatively stable person, no matter what the people who talk the most about healthiness and recovery have to say about it.

    • Agreed about talk therapy – I’ve had some decent experiences, but I’m a fairly introspective person too and usually get pretty quickly to a point where I feel like I’m doing all the work myself. I have on the other hand had some really effective sessions in more somatic-based therapy, but again I know that’s not readily available to, or appropriate for, everyone.

      I think when people do find something effective they want to try to solve everyone else’s problems with it, but it is important to remember that each person has their own process to go through and not everyone will respond to various kinds of treatment in the same way.

    • “I don’t want to take part in any emotionally intimate relationship with the power dynamic involved in therapy, and I think that’s a reasonable way to feel.” Whew!! Good point.

  13. As a therapist for 13 years – some of these therapists are terrible at their jobs. If I was supervising them – we would be having some conversations about appropriate behavior and basic therapy skills.

    • Yes. “There are starving kids in other countries” is a comment I’d expect from a lazy parent, not a trained therapist.

  14. Abeni, I know you don’t need telling, but the therapist who brought up starving kids in other countries is an appalling therapist. Like shouldnt-be-in-that-job appalling.

  15. “Being sweet is a passive personality trait; being kind is a courageous and minute-by-minute choice.”

    Heather! I want this on both sides of a t-shirt.

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