Affirming counselling for LGBTQIA+ people: what to expect

Many LGBTQIA+ people put off counselling because they worry about being judged, misgendered or having to explain their identity from scratch. Those worries are understandable, and you deserve support that feels safe.

LGBTQIA+ affirming counselling starts from the view that your sexuality, gender and body are valid. This guide explains what affirming care looks like, what happens in sessions and how to find a counsellor who is a good fit for you.

What does affirming counselling mean?

Affirming counselling is support that respects and validates who you are. Your counsellor accepts your sexuality, gender identity and sex characteristics as real and valid. They do not try to change them, question them or treat them as the cause of your problems.

In practice, affirming care usually means your counsellor:

• uses your chosen name and pronouns, and checks if they change
• does not assume your sexuality, gender or relationship structure
• understands common experiences in LGBTQIA+ communities, such as coming out, family rejection or dysphoria, without you having to explain everything
• recognises the impact of discrimination and stigma on mental health
• follows your lead on what you want to work on

The Australian Government’s National Action Plan for the Health and Wellbeing of LGBTIQA+ People 2025 to 2035 calls for care that is person-centred and affirms a person’s identity and lived experience.

This article is general information. Please speak with a qualified health professional about your own situation.

Why affirming care matters

LGBTQIA+ people are as varied as anyone else, and many live happy, well-supported lives. However, research shows higher rates of mental health concerns across these communities.

The Australian Bureau of Statistics reports that nearly three in five LGB+ people aged 16 to 85 (58.7%) had a mental disorder in the previous 12 months, compared with 19.9% of heterosexual people. The ABS links poorer mental health to higher rates of stigma, discrimination and exclusion.

Healthdirect explains that experiences of homophobia, transphobia and abuse, whether from institutions, other people or negative beliefs we absorb, can lead to stress, isolation and shame. Over time, this can contribute to anxiety, depression and self-harm.

This is sometimes called minority stress. It helps explain why a counsellor who understands your context can make a real difference. Feeling you have to hide or defend your identity in therapy adds to that stress.

Counselling can also build on strengths. Many people draw support from chosen family, friends, community groups and pride in who they are. A good counsellor will help you notice and grow these sources of support, not only focus on problems.

Common reasons people seek support

People come to counselling for many reasons. Some relate to identity and some do not. Common topics include:

• anxiety, depression, stress or burnout
• exploring or understanding your sexuality or gender
• coming out, or deciding whether, when and how to come out
• family relationships, including rejection or strained contact
• relationships, dating, intimacy and sex
• experiences of discrimination, harassment, bullying or violence
• faith, culture and identity
• gender affirmation, including social, legal or medical steps
• intersex experiences and medical histories
• grief, trauma and life changes

You do not need a big reason to book. You can also bring concerns that have nothing to do with being LGBTQIA+, such as work stress or study pressure. An affirming counsellor will not make everything about your identity.

Support for partners and families

Partners, parents and other family members sometimes want support too. They may be adjusting to news, wanting to understand a loved one better, or working through their own feelings. Affirming counselling can help families communicate and stay connected, while keeping the LGBTQIA+ person’s wellbeing and choices at the centre.

Young people

If you are under 25, Kids Helpline offers free counselling for young people aged 5 to 25 on 1800 55 1800. Healthdirect also lists headspace for young people aged 12 to 25.

What happens in a session

Before your first appointment

You may be asked to complete intake forms. Inclusive forms give you room to write your name, pronouns and gender in your own words. If a form does not fit you, you can raise this, and a good service will want to know.

The first session

Your counsellor will explain confidentiality and its limits. In general, what you say stays private. The main exceptions are if there is a serious risk to your safety or someone else’s, or if the law requires disclosure.

They will ask what brings you in and what you hope to change. You decide what to share and when. You never have to disclose details about your body, medical history or relationships unless you want to and it is relevant to your goals.

Ongoing sessions

Counselling might involve talking things through, learning skills to manage anxiety or low mood, planning difficult conversations, processing painful experiences, or building self-acceptance and connection. Sessions can be in person or by telehealth, which some people find easier for privacy or comfort.

Conversion practices and the law

Change or suppression practices, often called conversion practices, try to change or suppress a person’s sexual orientation or gender identity. They are harmful and are not part of ethical care.

In Victoria, the Change or Suppression (Conversion) Practices Prohibition Act 2021 came into effect on 17 February 2022. The Victorian Equal Opportunity and Human Rights Commission explains that supporting a person to explore or develop their identity, or to express their gender identity, is not a change or suppression practice. Laws differ in other states and territories.

If a practitioner suggests your identity needs to change, you can stop seeing them. You can also contact the Commission or the relevant health complaints body.

Finding a counsellor who fits

It is reasonable to ask questions before you book, such as:

• What experience do you have working with LGBTQIA+ clients?
• How do you stay informed about issues affecting our communities?
• Have you worked with people with experiences like mine, for example trans, non-binary, intersex, bisexual or asexual people?
• How do you handle names and pronouns in your notes and systems?

If the first person is not a good fit, it is fine to try someone else. Feeling safe with your counsellor matters.

For free, anonymous peer support, QLife offers LGBTIQ+ peer support and referral by phone on 1800 184 527 and by webchat, daily from 3pm to 9pm. If you are in danger, call 000. For 24-hour crisis support call Lifeline on 13 11 14.

How Invictus Health can help

Invictus Health has LGBTQIA+ affirming counsellors who support individuals, couples and relationships of all kinds. Sessions are available in person at our Preston clinic in Melbourne or by telehealth anywhere in Australia.

We also offer relationship counselling and talk-based sex therapy. You can use our practitioner matching page to find someone who suits you.