Who’s Trained in LGBTQ+ Mental Health? Affirmative Counselors, Gender Therapists & More

Allied Counselors

An allied counselor is a licensed mental health professional dedicated to uplifting and empowering sex, sexual, and gender minorities. Since allies are usually members of the majority, the working assumption is that they’re always heterosexual cisgender people. This is not wholly accurate because of sub majorities and intergroup alliances within the LGBTQ+ community. For example, a gay cisgender man may be an ally for the transgender and nonbinary community by educating himself about gender diversity, and by opposing the oppression and exclusion of gender-diverse people.

In turn, a white transgender person can be an ally to trans people of color by learning how race and ethnicity factor into sex and gender inequality, and by taking a stance against racism and intersectional forms of oppression.

Safe Zone and Ally Training workshops raise awareness, provide basic skills, and are primarily educational. They do not teach therapeutic interventions. Allied counselors, therefore, practice inclusion, offer a safe space, and gather community resources for their clients, but are not necessarily trained in LGBTQ+ mental health issues. Those who are will specify this in their online bio.

Much of the ally training model stems from the four key steps presented in Washington and Evans’ chapter “Becoming an Ally,” published in the 1991 manual Beyond Tolerance: Gays Lesbians and Bisexuals on Campus.

• During the Awareness stage, allies examine their own bias, privilege, and personal experience, while debunking the myths and stereotypes about sex, sexuality, and gender. For counselors, this may include the myth that internalized homophobia and gender dysphoria are the root of all LGBTQ+ mental health issues.
• At the Knowledge/Education stage, allies learn about the diversity of LGBTQ+ people and how they’re affected by oppression.
• Accruing Skills, allies expand their vocabulary, role-play how to correct themselves, and how to intervene when they encounter intolerance.
• Finally, the Action stage encourages allies to speak up and educate others.

Critics of ally culture observe how allies can be noncommittal or performative in their allyship. Critics of Washington and Evans’ chapter note how their language focused on the hardships and benefits for heterosexuals helping LGBTQ+ people, rather than the LGBTQ+ community itself.

In retrospect, the conversation at that time was how heterosexual allies could convince intolerant people to accept non-heterosexuals. Since then, more and more ally trainings are facilitated by LGBTQ+ people, who have evolved both the tone and overall message.

To be an ally in the 21^st century is to be an accomplice in social inclusion efforts, like helping to change policies, defend equality, and create access to affordable LGBTQ+ healthcare.

Gender Specialists

Gender specialists are licensed mental health counselors whose graduate, post-graduate, or doctorate level training specializes in gender dysphoria, gender identity development, and gender self-actualization. There is an overlap between gender specialists and affirmative therapists, though they’re not synonymous, since not all affirmative therapists are trained in gender-based healthcare, and not all gender specialists are trained in affirmative therapy.

As a focus, gender specialists are more likely to be versed in both the lived experience of transgender and nonbinary people, as well as practical information pertaining to transition, hormone regimens, gender confirmation surgery, and the letters required to procure them.

There are many criticisms of the gatekeeping medical model, both from clients and counselors alike, which means even gender specialists are not uniform in their professional and ethical perspectives. Some may align with the client’s need for autonomous self-actualization, whereas others may be more critical and by-the-book.

The APA and ACA lean heavily on the Standards of Care established by the World Professional Association for Transgender Health (WPATH), which states that in order to procure hormones or chest surgery, one letter of recommendation is required from a mental health counselor. The counselor in question does not have to be a gender specialist, per se, they just have to be licensed.

In order to procure genital surgery, however, WPATH stipulates that two letters should be written following a twelve-month real-life experience (RLE), living continuously “in the gender role that is congruent with their gender identity.” One of these letters can be from the client’s primary counselor, but the other must be from an evaluating mental health professional, which is one of the many reasons a client may seek out a licensed gender specialist.

LGBTQ+ Counselors

LGBTQ+ counselors, queer therapists, and queer counselors are mental health professionals who are also members of the LGBTQ+ community. These are self-referential terms used to increase visibility and are not a credentialed title.

Ethically, all mental health counselors must examine their personal and professional boundaries, which is why some counselors are very personable, and others are very private. That said, it is not uncommon for LGBTQ+ counselors to integrate aspects of their identity with their practice in order to provide guidance and mentorship as visible members of their community. While this kind of role modeling is not required in any capacity, there are many passionate LGBTQ+ counselors in the field today who take it upon themselves to provide ally trainings, support groups, and LGBTQ+ youth programs.

It’s important, however, to challenge the stereotype that LGBTQ+ mental health professionals are inherently specialists in sex, sexuality, or gender-related issues. While said counselors certainly have an informed perspective from their life experience, they may choose to focus their training on a different aspect of psychology.

It’s also worth noting that a counselor is not automatically an ally to everyone, just because they’re also a sexual or gender minority. Some may favor a binary view of sex and sexuality, excluding bisexuals, pansexuals, asexuals, as well as trans, nonbinary, and queer people. Additionally, an LGBTQ+ counselor may or may not be familiar with polyamorous or alternative relationship dynamics.

Those who are inclusive or trained to work with diverse sex, sexual, and gender populations, will no doubt put this in their bio by using inclusive acronyms like LGBTQ+, or LGBTQIA, or GLBTQ. The internet has also made it easier for LGBTQ+ counselors to advertise their presence and collaborate with each other in order to make appropriate referrals. Naturally, LGBTQ+ counselors are in high demand.

While further research is required to examine the therapeutic benefit of LGBTQ+ clients being served by LGBTQ+ counselors, the ability for clients to connect with out-and-proud professionals is a huge testament to social progress.