LGBTQ-Affirming vs. Friendly vs. Tolerant: Why the Difference Matters in Therapy
Finding a therapist is hard enough. Finding one who understands what it means to live as an LGBTQ+ person can feel even harder. Many therapists describe themselves as LGBTQ-friendly or affirming, but those words don’t mean the same thing. And while you’ll rarely see a therapist call themselves tolerant (at least not to the client), some operate from that quieter stance, even for non-malicious reasons, without realizing it affects the room.
Understanding these differences can determine whether therapy feels healing or draining.
When the Therapist Is “Tolerant”
A tolerant therapist may not say anything overtly negative, but you might still feel a distance. They may avoid talking about your identity altogether, or treat it as an aside instead of something that shapes you. Tolerant therapists aren’t necessarily “anti,” but may be uncomfortable or inexperienced in working with LGBTQ+ clients. You might hear them say things like, “I treat everyone the same,” which can sound fair but often erases the realities that come with being LGBTQ+.
These therapists might assume hetero- or cis-normativity and ask about a “husband” when you’ve already said you have a wife. They may shift the topic when gender or sexuality comes up, unsure of how to respond. Sessions might feel polite but flat. You may find yourself editing what you say to keep things comfortable or feeling responsible for teaching them what you need them to already know about LGBTQ+ persons. Over time, when uncertain about the therapist’s “stance” on LGBTQ+, that kind of effort can make you shut down or adjust how you present aspects of your identity.
You’re now not only doing therapy but managing the therapist’s comfort. That gets pretty laborious when you’re looking for relief.
When the Therapist Is “Friendly”
A friendly therapist often feels great at first. They have a rainbow sticker on the door, use inclusive language, and express support. You feel welcome, and that matters. But friendliness isn’t the same as competence.
Even well-meaning therapists can make assumptions that miss the mark. They may believe that your lived experience as an LGBTQ+ person is fraught with hardships. Or, conversely, they may assume it’s been unicorns and rainbows. They might link your concerns to minority stress, homophobia, or transphobia, when the issue may simply be the same as many face regardless of identity. They can also overlook how systemic bias and lived experience shape mental health in subtle ways. Friendly therapists are rarely harmful, but their approach may not go far enough.
Without awareness of how much effort you’re putting into explaining yourself, the space can start to feel generalized rather than customized to your lived experiences.
When the Therapist Is “Affirming”
An affirming therapist understands that being LGBTQ+ is not a sidebar to your story; it’s an integrated part of how you experience life, relationships, family, and safety. They’ve done the work and continue to do the work to build real clinical competence. That includes specialized training, supervision, and a willingness to keep learning.
They’re aware of how bias, privilege, and power show up in the room, and they’re not afraid to name those dynamics. They see the strength and resilience that come from surviving in systems that haven’t always supported you, while not making the marginalization the central theme of your work unless that is the work.
Affirming therapy often feels grounded. You can talk openly about identity without having to explain it from the ground up. You can explore how your identities intersect with anxiety, grief, trauma, or intimacy without worrying that it will be misunderstood or pathologized. You don’t have to shrink or overexplain.
An affirming therapist isn’t perfect—no therapist is. But their approach comes from an informed and LGBTQ+ positive lens with a deeper understanding of the barriers and stigma you may face that make it easier for you to be as you are.
Affirming care extends beyond the therapist. It includes the intake forms, the language used on paperwork, the reading material in the waiting room, and whether the bathrooms are inclusive and accessible. There’s much to affirming care that a brief blog post can realistically cover.
By the way, LGBTQ+-identifying therapists also fall across this spectrum. Having a shared identity does not automatically mean a therapist practices affirmatively. Some avoid conversations about sexuality or gender because they assume mutual understanding. Others may unintentionally universalize their own story, expecting clients to have similar experiences with coming out or internalized shame. Affirming practice requires awareness and reflection on the therapist’s part in understanding when their own lived experiences, unrecognized internalized trans- or homophobia, are clouding the work.
How to Tell If a Therapist Is Affirming
You deserve a therapist who is both informed and accountable. During a consultation, first session, or even with your current therapist, ask questions like:
1. How do you define LGBTQ-affirming therapy?
A good answer includes awareness of bias, minority stress, and advocacy.
2. What kind of training or supervision have you had?
Look for more than a workshop. Real training shows depth and humility.
3. How do you handle bias when it shows up, including your own?
The therapist should talk about reflection and self-awareness.
4. What experience do you have with trans, nonbinary, asexual, or bisexual clients?
Competence means understanding the nuances across identities.
5. What’s your stance on conversion or reparative therapy?
Most therapists, regardless of their experience working with the LGBTQ+ reject it outright and focus on healing and acceptance.
You Deserve More Than Acceptance
If you’ve ever left therapy feeling unseen or uncertain whether your identity really fit in the room, that wasn’t your fault. You deserve care that honors who you are, affirms your experience, and helps you move toward whatever healing or growth you’re ready for. I encourage you to talk to your therapist about what you experience with them, and see if they can make the changes to enable you to become more comfortable and genuine. If not, ask for a referral to an affirming therapist.
Want to Know More?
For readers who want to understand what affirming practice looks like from a professional standpoint, the American Psychological Association’s Guidelines for Psychological Practice with Sexual Minority Persons (2021) offers a clear, evidence-based framework. While the document focuses on sexual minority populations, its core principles apply across all identities. It outlines the attitudes, knowledge, and skills that define competent care for LGBTQ+ people and what ethical, informed practice entails.
If you’re on Instagram and want to see more reflections like this, you can find me at @relationalbodies.