Gender and Affectional Orientation, Sexual Orientation and 2SLGBTQIA+ Therapy

Mental health services including therapy can be affirming, life strengthening or even life saving for many people. Therapists are educated and trained to listen, to apply evidence-based techniques (modalities) when helping you through new or ongoing challenges including mental illness, and to help guide you through positive periods of personal growth.

However, the world of therapy does not have a history of being well designed for everyone—its foundations are straight, white and male. The therapy landscape looks different (better) today and it’s more inclusive for both practitioners and clients in research and representation. There is much more work to be done. Then, of course, out in the world there are layers of privilege and marginalization that inform each of our unique experiences in life and impact our mental wellbeing. 

Therapy is not a one-size fits all.

Therapy works best when you and your therapist are a good fit, when they’re able to see your challenges clearly, and they’re able to understand your world. That’s why, when you’re browsing for a therapist on First Session, you’ll notice a number of filters to help you drill down to therapists who specialize in aspects of who you are.

Here’s what to expect when working with a therapist who works with LGBTQ2IA+ clients and why this area of therapy is important as a specialization. 

We talk a lot about addressing pain and challenges, but remember: a big part of therapy is about living well, learning to deal and cope with stress more effectively, setting and reaching new goals, and connecting with yourself and others. You can go into therapy expecting joy and rejuvenating conversations with your therapist, as well as dealing with pain. 

Note: In Canada, you might start seeing this acronym presented as 2SLGBTQIA+. The 2S stands for two-spirited, and its historical roots are Indigenous. Putting the 2S at the beginning is one act of reconciliation taking place in Canada that recognizes the first complex spiritual, sexual and gender identities of North America. It will be presented as 2SLGBTQIA+ through the rest of this article.

What kinds of issues affect the 2SLGBTQIA+ community?

Anyone can be affected by mental health challenges like stress, self-doubt and imposter syndrome, anxiety and depression. Mental health challenges can certainly have nothing to do with queerness or gender. However, Statistics Canada data show that 2SLGBTQIA+ folks are at a higher risk of mental health issues than the general population. This can become more amplified by other marginalized traits of one’s identity like race, culture, socioeconomic status or ability. 

There is nothing about these parts of your identity that cause these mental health challenges, it’s external factors that are so often the sources of internal stress. First Session partner therapist Jupiter Vaughan groups these marginalizing experiences into a sense of social rejection. 

Social rejection can manifest in tangible ways like bullying and harassment, or by being told overtly or subtly that you need to change. It can be exhibited through misgendering by friends, family and the public (even if unintentional), or because of harms associated with “societal norms'' like the inability to change one’s gender or name on official documents, or using gendered washrooms and change rooms in clothing stores.

Legacies and systems of homophobia and discrimination against the 2SLGBTQIA+ community can permeate daily life and challenge self worth, even if you’re not targeted directly.

We can get very good at coping with such external challenges (which are often invisible to others) but over time they can have a very real impact on mental health and wellbeing. This could also lead to conditions as serious as post-traumatic stress disorder (PTSD).  

Vaughan says an important part of his practice is helping people recognize their own self-worth, to process trauma, and to help couples (who sometimes have conflicting traumas) build healthy connections.

At a high level, therapists who work with 2SLGBTQIA+ clients could address issues or topics like:

• Relationship with yourself and others
• Trauma, anxiety or depression
• Burdening (expectations of trans or nonbinary people to educate others)
• Navigating and coping with stress, or specific issues like microaggressions
• Intersectional contexts (cultural, racial or religious) 
• Gender affirming medical interventions
  

Therapy for trans and nonbinary people

Mental health professionals who work with trans and nonbinary clients will have additional skills and training to ensure they are providing affirmative therapy, ie validating and understanding the experiences of those who are not cisgender (identifying with the gender assigned to you at birth). 

You might hear the term gender dysphoria in your therapy journey. This refers to the distress that can arise when someone is navigating a mismatch between their gender identity and the gender they were assigned at birth. This can be a challenge only when you’re in public, or it can occur more in private (an internal feeling of disconnect). It does not, however, refer to gender identity as the problem

A therapist working with trans or nonbinary people will be more attune to recognize when mental health symptoms are tied to gender exploration and gender identity, and will work to help you understand you’re not broken or mismatched at all. They will also provide you coping skills to handle encounters when your identity is challenged in regular daily life. 

If you’re thinking about or are in the process of gender affirming medical interventions, this can be taxing on your mental health. It can be challenging to navigate the medical system and support resources can be limited. Even positive changes can be a weight on our mental wellbeing. 

Sounds like a tall order to find the right therapist fit. So, how does that work?

Choosing an 2SLGBTQIA+ therapist

Finding a therapist fit ultimately comes down to your relationship with them. You’ll want to be sure you find someone who is licensed or certified in your area, that you can schedule your visits with them easily, and to find someone that you can afford or who is covered by workplace benefits. 

You might find it best to seek out a queer-identified therapist who also matches other parts of your identity. It’s not a must to do this, but it can help. Look under our partner therapist’s “specialties & common subjects” on their profile pages to see if there are specializations that match other aspects you’re looking for. First Session posts intro videos with all of our therapists, which can be a great way to get a sense of them before reaching out. 

Something as simple as a therapist proactively using affirming language (trans, nonbinary, acronyms like AFAB/AMAB or assigned female/male at birth) are cues you can look for, especially in your first few sessions, to determine your therapist’s familiarity with the community and if they’re up-to-date with recent gender diversity and 2SLGBTQIA+ practices. If you’re unsure, or have a question, simply reach out to the therapist and ask before you book—you can send a message to therapists directly from their profile pages on First Session.

These are some other concepts or practices you can expect from a therapist who specializes in working with any marginalized demographic, including 2SLGBTQIA+ therapy:

• Culturally Sensitive Therapy: The therapist’s understanding of their client’s background and values systems are more emphasized. This can be applicable to any form of therapy, and is helpful if there is a need for someone to be sensitive to characteristics like age, race, religion, as well as gender, sex or sexuality. 
  

• Anti-Oppressive Practice (AOP): This is a technique usually used in the practice of social work. AOP means therapists will be better poised to consider and know the impacts of systems of power and how groups might have power or influence over less powerful groups.
  
  
• Trauma-Informed: identifying, coping with and processing trauma is the aim of this therapy. It gets to the underlying reasons for distress and usually follows principles like realizing the trauma, recognizing its impact, building safety and empowerment together with the therapist.
  

Some questions you can ask a therapist to assess fit include:

• What experience do you have working with the 2SLGBTQIA+ community? 
• What specialized training or certifications do you have that relate to working with the 2SLGBTQIA+ community or [insert your 2SLGBTQIA+ identity]?
• What experience do you have working with people who match my [identity as] or [sexual, gender, affectional orientation]?
• What is your/your practice’s position on anti-2SLGBTQIA+ discrimination and how have you contributed to this in the broader community?
• How would you describe your knowledge of challenges such as stereotypes, misconceptions, biases, traumas or microaggressions facing my [insert your 2SLGBTQIA+ identity]?

Techniques used in 2SLGBTQIA+ therapy 

Once you’re working with someone, therapy will look different for everyone. Typically, therapists will work with a few core evidence-based techniques or approaches to help you work through emotional or mental challenges and to guide your work together. 

Common therapeutic modalities (techniques) you might see listed on the profiles of therapists who specialize in 2SLGBTQIA+ therapy on First Session include:

• Cognitive Behavioural Therapy (CBT): this therapy would help with reframing negative thought patterns about yourself to change unproductive behaviours and emotions that could be related to a sense of non-acceptance.
  
  
• Acceptance and Commitment Therapy (ACT): Similar to CBT, ACT is about accepting emotions, including negative ones. It brings clarity to our personal values and enables commitment to positive change.
  
  
• Boundary setting: Because of the impact external situations and interpersonal relationships can have on mental health, boundary setting can be an incredibly effective coping tactic to learn. When you’re misunderstood or uncomfortable, it’s about how you can mentally or physically distance yourself from that safely.
  
  + Safety and belonging: While not a modality, part of the approach and technique will be to communicate safety and privacy to you in their practice. It can be non-verbal, such as using inclusive imagery on their website or in their office, or they might proactively communicate to you how they keep your information confidential and private. For some, therapy confidentiality can be a very real factor of physical and psychological safety. 
  

Even if you have one or a few sessions with a new therapist, there is no commitment to keep working with them if something isn’t feeling right. You can always keep looking for someone who is better suited to your needs.

Many therapists offer free 15-minute consultations, which are great opportunities to ask some of these questions and assess your fit with them before starting.

Find therapists that specialize in 2SLGBTQIA+ therapy on First Session.

This content has been professionally reviewed by Asta Au, Expressive Arts Therapist and Pre-Licensed Professional, and Charlotte Pidgeon, Registered Psychotherapist (December 2021). Corrections or comments? You can get in touch with us here.