Gay Counseling | Guide to Why Homosexuality Is NOT a Mental Disorder

Therapy is a process meant to help the LGBT community understand themselves and live their lives. As the profession has seen for years, providing space for non-judgment of one’s identity is critical to proper counseling. Without it, there leaves no room for honest questions and exploration of personal topics, which can leave anybody confused, isolated, and alone. As a result, finding the right therapist can feel like a trial by fire.

For someone who may be questioning their identity or is secure, this hurdle can stop them from seeking help all together out of fear of judgment. Historically speaking, the psychology and psychiatry field has done enough to warrant that mistrust. Statistics show that gay men, when compared to heterosexual men, show a higher rate of having major depression, bipolar disorder, and generalized anxiety disorder.

When not directed to the right resources and unique counseling needs gay men to have, this can lead to worse issues like depression or even suicide. For whatever reason, you may be seeking counseling, and to what ends, it is vital to know that you are not alone and that there are proper, high-quality, affirming resources available to you out there.

What is LGBT Counseling?

LGBTQ counseling, sometimes called LGBTQ affirmative therapy, or gender affirming therapy, is targeted at improving the lives of LGBTQ individuals in all areas. It focuses on support of the questions and unfamiliarity with one’s gender and sexuality rather than seeing it as a problem to be solved or counseled.

two men at the counseling session

As a topic within an industry, it is evolving still, and competent therapists should be updating their vocabulary and demonstrating continuing education on the subject. Green flags are when therapists address with an affirmative approach seeking to recognize and help LGBTQ individuals navigate their difficulties effectively.

Another green flag is that they are aware of the multitude of changing terms and vocabulary around gender-affirming. It is not always the case, but it can be a green flag that a therapist also is specific and open about their identity as well (whether gender orientation, race, etc.) rather than specifying the types of relationships counseling they provide, as one may find in religious institutions – marriage counseling, family counseling, etc.

It is a counselor’s ethical responsibility to learn about cultural differences and have an understanding of diverse cultures apart from their own.

a man on his partner's shoulder

Health Issues & Stigma

Research suggests that LGBTQ individuals seek mental health services more frequently than their non-LGBTQ counterparts. There is ample evidence that societal prejudice causes significant medical, psychological, and other harm to LGBTQ people. To the general public, issues that concern the LGBTQ community can seem invisible.

Discrimination and stigma in its many shapes and severity can cause psychological distress or trauma. Living in a heteronormative society, prejudice, even through something small like microaggressions, can have an impact on mental health.

Over time, and without support, this can escalate for someone and lead to social isolation. This can be especially true for men. It is not often encouraged in the general public to talk about one’s mental health, and men can especially feel the stigma.

This leads to mental health issues among men not often being addressed and can leave men to go undiagnosed with their problems for too long. Depression and suicide are ranked as leading causes of death among men and even more so among gay men. 

Having the right professional in counseling can better help provide the coping skills and coping strategies needed to be at peace and move through society safely and perhaps even proudly and happily.

Come and be Who You Are

One of the most important things counselors do not identify as LGBT or gay in preparation for a patient of a different sexual orientation is to engage in the process of self-reflection on their own sexual orientation and gender identity. Not everyone in the queer community has the same relationship with their sexuality, and how it influences their life is very much part of unearthing in counseling and therapy in general.

two happy men in love hugging

Part of unique understanding a queer person’s unique position in society, if one’s counselor is straight, is self-awareness is identifying how that might affect the therapeutic relationship with a client who’s not.

We touch on this later, but a psychologist or counselor that focuses on relationships may miss on critical clues rather than a therapist that focuses on the idea of ‘come and be who you are.’

This is often used together with or in substitution of the term LGBT or gay counseling. A counselor that focuses and that advertises as ‘come as you are’ therapy often has done the private work of challenging their biases in their own lives and try to both create a place of acceptance for their client as best as possible. Ultimately, part of vetting out a proper counselor is assessing whether they would be a good advocate for you.

Addressing Stigma

Many that identify as LGBTQ still face discrimination, harassment, and other stigma as a community today. Stigma can be defined as negative social attitudes aimed towards a characteristic, leading to prejudice and discrimination against an individual. This can appear as hearing an anti-gay joke, or worse, enacting physical harm on the said queer individual.

It also suggests various contextual factors that influence the perception of gay people within our society. These factors include race and ethnicity (e.g., gender, place in a population, and religion). For gay men, the social pressure of men to be self-sufficient and emotionally neutral at all times may be a pressure preventing men from seeking therapy in the first place, even more so if it threatens their view of their perception of their sexual self.

a stigma ball dragging the person down into the water

These should all be considerations to take in when seeking professional help. It is ok and encouraged to find someone who will best understand you and your identity, and they may or may not also identify the same as you.

Who does one go-to for gay counseling, LGBT issues, or transgender issues? Trust is a huge concern for those seeing counseling within the gay community.

Traditional institutions for help like school counselors, family therapists, or church counselors, in the least severe case, may cause more harm but with the right intentions. At its extreme, homophobic and abusive and can endanger someone’s life. They were having someone who is aware of these stigmas affecting the gay community and is trained to address specific concerns for gay men to better assure the client of their safety.

Standards & Complications

The American Psychiatric Association (APA) opposes psychiatric treatment “based upon the assumption that homosexuality is a mental disorder or based upon the assumption that a patient should change his/her sexual homosexual orientation” and describes attempts to change a person’s sexual orientation by practitioners as unethical. They also state that its advancement may cause social harm by sharing these unscientific views about sexual orientation.

In addition, to date, multiple states (California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, Utah, Virginia, Vermont, Washington, the District of Columbia and Puerto Rico) all have laws or regulations protecting youth from this harmful practice. 

Those seeking gay, queer, or LGBTQ affirming therapists (see post) and counseling should be looking for therapists that specify that they are queer affirming in counseling practice.

In addition to intentionally carving out non-judgmental spaces (in advertising, it should be explicit), it is especially important that counselors respect confidentiality. It can be especially damaging for an individual exploring gender identity in addition to seeking mental health services to have their trust breached, or worse, have their lives put in danger.

The doctor is responsible for this transparency. For example, when a session’s discussion starts developing towards a patient’s sexual orientation, your doctor will usually clarify that what is talked about is strictly between doctor and client.

graphic illustration of gay couple at the counseling
A Note on Minors and Coming Out

This can be a very touchy subject if said individual is not willingly seeking therapy or counseling, and their orientation unfolds itself. In these situations, the responsible clinician has available resources that can be given to the teenager.

Depending on the situation, while there may be a need to balance communication with the teenager’s parents, the clinician’s primary responsibility is to the patient.

It is growing up in traditional counseling, where a person’s identity can add to the general mistrust of therapists in general. Even when more severe information is disclosed in sessions, it is important patient confidentiality not be broken.

In some situations, breaking that confidentiality can severely impact that individual’s well-being. Families can mean well for their child, but ultimately, counseling is meant to help the person and their life goals.

Conflict with Religion & Sexuality

There also is therapy and counseling towards examining a client’s motivation about changing perceptions of their sexual orientation. The APA’s policy (1998), “Appropriate Therapeutic Responses to Sexual Orientation,” offers a framework for psychologists that work with clients who are concerned about the implications of their sexuality.

As mentioned above, religious institutions and one’s gender expression or sexuality can be a complex relationship. Sometimes, for an individual seeking to reconcile both their religion and sexuality, the ultimate goal may be to be at peace with both, rather than choosing one or the other.

One of the major differences with counseling centered around the queer experience or ‘come as you are’ is that it does not seek to solve the problem of their sexuality, as counseling through a religious institution might (a marriage counselor through a church, for example). This highlights the importance of individuals having many different goals with counseling and not falling into black and white thinking when coming out or exploring one’s sexuality.

For gay men facing these questions, these pressures to decide one way or the other can be especially difficult. In a heteronormative society, the burden of responsibility for relationships of a partner or family member can feel like it rests on the male individual (physical needs, financial needs met, etc.) But the one part of therapy is not that a decision has to be made. It is so one comes to terms with their sexuality and their relationship with self.


One of the biggest benefits of helping improve one’s quality of life is using therapy to honestly voice their problems and questions for themselves in a place of non-judgment. This can prove especially helpful if individuals find themselves in social isolation for who they are but may not know why.

two men celebrating love with red balloons

Friends and family can, and in the best-case scenarios, be there for support and understanding. But in the cases where they are not or are the cause of seeking therapy, counselors can prove helpful to address loneliness.

Statistically, most LGBT people find themselves more lonely than those that identify as heterosexual. The confusion, stress, lack of intimacy, fear, and possible abuse could all be stressors leading to loneliness, if not treated, can lead to depression. The general social isolation with feeling misunderstood can be a heavy burden for someone to bear.

One thing finding a therapist that is gender-affirming can help with is the coming out process. The term “coming out,” depending on the counselor, is often more a spectrum than a status. It is not always the end goal of counseling.

An appropriate therapist should be aware of cultural differences and consider the well-being of the individual first and foremost, and sometimes, depending on the situation, coming out can be the least safe option.

With this in mind, a good therapist ultimately should be supportive, acting as an advocate and cheerleader for their client. A therapist, a life coach, or a counselor should ultimately guide their client towards acceptance, providing emotional support, or being informative, so an individual exploring their identity is not afraid to explore and process their feelings, thoughts, and emotions.


Ideally, a client can feel free in counseling to explore and go on a journey of self-exploration. However, a gay or LGBT client has unique counseling needs. Awareness of microaggressions, how a heterosexist society affects an individual are all part of psychotherapy. That being said, culturally, many counseling services are operated out of institutions that are traditionally not affirming of fluid sexual identity or of the LGBTQ community.

a person holding a heart colored as LGBTQ flag in front of his face

For men seeking to better understand themselves, social stigma can seem to be more overbearing as some cultures may not see therapy as an acceptable outlet. Religious institutions may offer queer affirming therapy but may focus on other aspects of mental health issues or stressors, such as family members, schools, or self-esteem, rather than a client’s relationship with themselves.

While not endorsed by the larger clinical institution, it is necessary to remain open to the many solutions to addressing an individual’s mental health. Client confidentiality and confidence are critical to assess when one is choosing the right therapist. this can be true of any individual seeking help from a counselor.

Most professionals advertising on the Internet resources are fairly transparent, but it is up to the individual to assess whether they are an appropriate match for each other.

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