Decolonising Psychotherapy: Creating LGBTQ+ Affirming Therapy

Therapy should be a space of safety, validation, and growth, especially for LGBTQ+ people. Yet, many LGBTQ+ clients still find themselves in rooms where their identities are misunderstood or pathologised. To support queer people effectively, we must radically rethink psychotherapy. Decolonising psychotherapy isn’t just about using the right words—it’s about shifting how we view gender, sexuality, shame, safety, and healing.

This blog outlines what LGBTQ+ affirming therapy should look like and how therapists can better support queer clients.

Why Decolonising Therapy Matters

Traditional psychotherapy is built on cis normative, heteronormative, and white cultural assumptions. This often leads to:

• Pathologising gender or sexual diversity

• Treating “coming out” as a universal goal

• Assuming cutting off family is necessary

• Over-focusing on individual responsibility

Decolonising therapy recognises that queer distress often comes from systems of oppression...not internal flaws. It urges therapists to understand clients in the context of their wider social realities.

Names, Pronouns, and Gender Markers

For trans and non-binary people, using the correct name and pronouns is fundamental. Yet many systems still misgender clients, causing further harm.

Therapists must:

• Let clients state their names and pronouns without needing to explain

• Avoid using outdated records that deadname clients

• Understand how dehumanising misgendering and deadnaming can be

Forms, notes, and conversations should reflect who the client is—not what the system assumes.

Queer Shame and Internalised Oppression

Many queer people carry shame that stems from societal rejection, not personal identity. This may show up as:

• Internalised homophobia: believing it’s wrong to be gay

• Internalised biphobia: seeing bisexuality as confusion or greed

• Internalised queerphobia: disowning parts of the self to gain approval

Therapy should help clients name these patterns, trace where they come from, and begin to replace shame with pride and self-acceptance.

Not Everyone Can or Wants to Be Out

The idea that “out is always better” is steeped in Western ideals. For many LGBTQ+ BIPOC people, outness can come at great cost—family rejection, community backlash, or even danger.

Therapists must:

• Respect the reasons someone may stay closeted

• Help improve quality of life without requiring visibility

• Avoid pushing “liberation” that may be unsafe

Therapy can still be affirming even if a client can’t be out. Safety and dignity must always come first.

Therapeutic Practices That Affirm

1. Affirm Identity

   • Use correct names and terms

   • Avoid language like “preference” or “lifestyle”

   • Acknowledge identity with pride

2. Create Safer Spaces

   • Use inclusive decor, forms, and websites

   • Be transparent about confidentiality

   • Watch your body language and tone

3. Stay Curious and Educated

   • Follow LGBTQ+ voices

   • Take part in training

   • Don’t expect clients to teach you

4. Context Matters

   • Understand how race, faith, disability, and class shape queer lives

   • Avoid one-size-fits-all approaches

5. Validate External Struggles

   • Recognise how systems harm queer people

   • Don’t treat trauma as purely internal

Intersectionality in Practice

Queer experiences aren’t monolithic. A cis white gay man’s journey will differ from that of a disabled Black trans woman or a South Asian bisexual person navigating religion and queerness.

Affirming therapy adapts to each reality. It listens more than it assumes. It works with, not on, people.

Outness and Queer Liberation Look Different

Coming out is often framed as freedom—but for many BIPOC queer people, it’s complicated. Family, community, or cultural ties can’t always be cut without serious consequences.

Therapists must:

• Honour clients who aren’t out

• Help them navigate closeted life in affirming ways

• Understand that safety is a priority, not a sign of weakness

Liberation isn’t always loud. Sometimes it’s found in quiet resistance and survival.

Reflections

Decolonising therapy means helping LGBTQ+ clients thrive without asking them to compromise who they are. It’s about creating therapy that reflects their realities—not therapy that reshapes them to fit ours.

Let’s build therapeutic spaces where queer people feel valid, seen, and safe—whether they’re out or not, loud or quiet, proud or still healing. That’s what affirming care looks like.

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