Affirming Therapy Options for the LGBTQIA+ Community

LGBTQIA+ people who have anxiety, depression, or other mental health concerns may benefit from therapy options specialized to the LGBTQIA+ experience.

Studies consistently show members of the LGBTQIA+ population report higher rates of mental health struggles than the general population. That includes higher rates of:

  • Anxiety.
  • Depression.
  • Post-traumatic stress disorder.
  • Substance abuse disorders.

Discrimination is a known factor in higher rates of mental health concerns among the LGBTQIA+ community. Like other marginalized groups, LGBTQIA+ people face higher rates of discrimination, harassment, and violence.

In recent years, providers and researchers have adapted common therapy models to better serve LGBTQIA+ people.

“Certain kinds of therapy protocols are more effective,” says Joy Gero, PsyD, director, Population Health and Improvement, and program manager, LGBTQIA+ Health, UPMC. “It’s thinking about people whose experience of depression, anxiety, or substance abuse is a result of marginalization and discrimination.”

Learn more about therapy options specialized to the LGBTQIA+ community to see if it’s right for you.

LGBTQIA+ Therapy Options

There are many options for seeking therapy if you need it. Many existing treatments center on cognitive behavioral therapy (CBT).

CBT helps people process the relationship between thoughts, feelings, and actions. It provides strategies to help people change their thoughts, feelings, and actions to better cope.

Existing mental health treatments can help both LGBTQIA+ and non-LGBTQIA+ people, says Kristen Eckstrand, MD, medical director, LGBTQIA+ Health, UPMC.

“There is no evidence to say that existing treatments for depression, anxiety, PTSD, work less for LGBTQ people or don’t work for LGBTQ people,” Dr. Eckstrand says. “So, if you’re feeling bad, the treatment options that exist in the area are good treatment options.”

However, some LGBTQIA+ people may feel more comfortable with a treatment that reflects their experience.

LGBTQIA+ affirmative therapy

CBT is the foundation of affirmative treatment models, which have become more specialized to meet the needs of the LGBTQIA+ community.

“They don’t change the treatment,” Dr. Eckstrand says. “But what these treatments really get at is that there are unique experiences or unique circumstances that can come up for members of the LGBTQ community that might lead to unique feelings and unique thoughts.”

The therapy takes components of CBT and adapts them for LGBTQIA+ people. It recognizes that their anxiety, depression, or other mental health burden may stem from causes like discrimination. It aims to help people change some of their negative thoughts and feelings.

“As an example, ‘Let’s talk about the benefits of being an LGBTQ person and how that has helped your life,'” Dr. Eckstrand says. “‘What are the things that you like about it? And then, if you’re feeling constrained in some environments, are there ways to change that?'”

Dr. Eckstrand says affirmative models can prove effective at reducing depression and anxiety. She says some evidence shows it may also help curb substance abuse.

Dialectical behavioral therapy (DBT) for LGBTQIA+ people

Dialectical behavioral therapy (DBT) is similar to CBT but adapted to people with intense emotions.

DBT focuses on mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. It aims to help people better manage their specific situations and improve their lives. It has shown benefits for people with severe mental health struggles like suicidal thoughts.

“DBT is a well-researched treatment protocol for people who are in crisis or distress,” Dr. Gero says. “It teaches a number of skills to help people manage their experience of crisis or distress and can provide the tools to allow someone to do deeper work.”

Like CBT, DBT can adapt for the LGBTQIA+ community to focus on their specific experiences. People can learn not only the causes of their symptoms — such as discrimination — but also strategies to overcome them.

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LGBTQIA+ Mental Health Care at UPMC

UPMC Western Psychiatric Hospital provides specialized therapy services for LGBTQIA+ individuals who wish to receive it. Options include the LGBTQIA+ Intensive Outpatient Program (IOP) and a group therapy program for teens.

LGBTQIA+ Intensive Outpatient Program (IOP)

At the LGBTQIA+ Intensive Outpatient Program (IOP) at UPMC Western Psychiatric Hospital, dialectical behavioral therapy is the foundation. The IOP aims to help LGBTQIA+ adults who are experiencing sudden or severe changes in their mental health. It offers trauma-informed care and support for LGBTQIA+ people who need it.

The program acknowledges the causes of people’s mental health concerns, like discrimination or harassment. It also helps provide strategies for how people can better manage those causes and their reactions to them.

“It’s about sort of riding that line between being really validating about how their feelings and experiences go hand in hand, and saying, ‘How can we change this direction so that when this comes up, it doesn’t lead to not being able to work or not being able to function as well?'” Dr. Eckstrand says.

People enrolled in the IOP go through three three-hour group therapy sessions per week. They also get weekly individual therapy sessions and help with medication management.

For more information, call 412-246-5600.

UPMC group therapy for LGBTQIA+ youths

UPMC Western Psychiatric developed a 10-week group therapy program for LGBTQIA+ youths ages 13 to 18. The program will teach CBT skills to help LGBTQIA+ teens navigate their feelings and emotions.

“It’s meant to supplement therapy,” Dr. Eckstrand says. “And it is also built on an affirmative treatment model and is much more based in CBT.”

LGBTQIA+ youths are at especially high risk for mental health difficulties. According to the Trevor Project’s 2022 National Survey on LGBTQIA+ Youth Mental Health:

  • 73% of LGBTQIA+ youth reported experiencing symptoms of anxiety.
  • 58% reported experiencing symptoms of depression.
  • 45% reported seriously considering suicide during the previous year.
  • 14% reported attempting suicide during the previous year.

Seeking Therapy if You’re LGBTQIA+

If you’re LGBTQIA+ and you’re dealing with mental health concerns, getting help is important. Everybody’s therapy needs are different. Whether you seek existing therapy treatments or an affirmative care model, getting help can make a major difference in your mental well-being.

“Whether it’s affirmative treatment models or standard models, both can help people feel better,” Dr. Eckstrand says.

Dr. Eckstrand notes that no matter what therapy model you choose, it takes time.

“The biggest driver for what makes a treatment effective is sticking with the treatment,” Dr. Eckstrand says. “So, if you do the treatment, these treatments are quite effective for reducing symptoms. They don’t always make us as happy as we want to be (right away). But those are things that come over time.”

When should I seek therapy?

There is no wrong time to seek therapy. If you’re not feeling as good as you used to mentally or emotionally, seeking help is important for your well-being.

If you find that your emotional status is interfering with your job, school, or everyday life, evaluation or treatment can help. And it’s especially crucial for people dealing with suicidal thoughts.

“If you notice that the way that you’re feeling is causing these impairments in your life, that’s a really important time to go get treatment,” Dr. Eckstrand says. “If you get to a space where you are thinking about potentially ending your life, you’re having thoughts of self-harm, you’re engaging in self-harm, or making plans to end your life, that’s also a very important time to come in.”

Finding the right therapist if you’re LGBTQIA+

What you’ll find most helpful in a therapist depends on your situation. Maybe you feel most comfortable with a therapist who understands the specific needs of the LGBTQIA+ community. Or, maybe you feel like that’s less necessary.

“Your fit with a therapist or a kind of treatment protocol is very individualized,” Dr. Gero says. “If you don’t like your therapist or you don’t feel connected to your therapist, that’s a problem because you’re going to see them regularly and the hope is that you can open up to them. Finding a good fit is generally important in therapy.”

Dr. Gero says many LGBTQIA+ people look for one or more of the following in a therapist:

  • A therapist who is affirming to the LGBTQIA+ community.
  • A therapist who is knowledgeable about LGBTQIA+ issues and/or experienced in working with LGBTQIA+ people.
  • A therapist who is a member of the LGBTQIA+ community.

See tips on how you can find an affirming therapist.

It’s important to know that you may not find the right fit with your first therapist. If you aren’t connecting with your therapist, don’t hesitate to speak up. You should find a therapist who makes you feel connected to them.

At UPMC Western Behavioral Health, we strive to provide compassionate, patient-centered care for LGBTQIA+ people. The Human Rights Campaign designates UPMC Western Psychiatric Hospital as a leader in the Healthcare Equality Index for LGBTQIA+ individuals. For more about LGBTQIA+ care at UPMC, visit our website.

Editor's Note: This article was originally published on , and was last reviewed on .

Cindy J. Chang and Jeffrey M. Cohen, DBT Bulletin, Doing Affirmative Dialectical Behavior Therapy with LGBTQ+ People: Clinical Recommendations. Link

Nadav Antebi-Gruszka, PhD, Ariel A. Friedman, and Kimberly F. Balsam, PhD, Journal of Gay & Lesbian Mental Health, Multiple Forms of Discrimination, Mental Distress, and Well-Being Among Lesbian, Gay, Bisexual, and Queer Individuals: The Role of Brooding. Link

The Trevor Project, 2022 National Survey on LGBTQ Youth Mental Health. Link

About UPMC Western Behavioral Health

UPMC Western Psychiatric Hospital is the hub of UPMC Behavioral Health, a network of community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors. Our mission is to provide comprehensive, compassionate care to people of all ages with mental health conditions. UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. We are here to help at every stage of your care and recovery.