Originally published on: https://www.innerbody.com/online-therapy-guide-for-lgbtq-youth
We uncover common mental health problems and causes in LGBTQ+ youth and give pointers on finding the right online therapist.
It can be difficult to find a therapist knowledgeable about LGBTQ+ needs and considerations, no matter where you live. Having a therapist who isn’t familiar with LGBTQ+ concerns often feels more like you’re teaching them than getting help. If you’re looking for a therapist who knows what they’re doing when it comes to sexual minority or trans umbrella issues, online therapy is almost always your best bet.
But even with online therapy’s expansion into a broad market for adults, the number of programs for youth is limited. Finding somewhere that accepts clients under 18 and is LGBTQ-informed can feel like finding a needle in a haystack. According to The Trevor Project’s 2022 National Survey, 82% of LGBTQ+ youth surveyed wanted mental health care, but only 40% received any.
In this guide, we’ll identify some common mental health concerns among LGTBQ+ youth, talk about why finding an LGBTQ-aware therapist is important, and help you parse through the mass of websites to identify organizations that might be able to help.
Reasons LGBTQ+ youth seek therapy
In the first five months of 2022 alone, there were 240 pieces of legislation and official public statements from government entities that profoundly affect transgender youth across 37 states. The specific focus of these laws varies, involving young people’s ability to play sports with their peers or pause puberty and, in extreme cases, socially transition or use any form of medical transition before age 25. And when 45% of all LGBTQ+ teens seriously thought about suicide in 2022, it’s clear that now more than ever, LGBTQ+ youth need adequate mental health care.
Below, we’ll go over some of the most common reasons LGBTQ+ youth look for therapy and how it can help.
Depression is one of the most common mental illnesses. More than one in seven children experience clinical depression every year. This number is higher among LGBTQ+ youth and has only been going up: in 2020, 55% of LGBTQ+ youth reported symptoms of depression, whereas 58% did in 2022, and that number includes young people up to the age of 24. 61% of youth under 18 reported symptoms of depression. Pansexual (66%), questioning (64%), and queer (60%) youth were the most likely to report these symptoms. Likewise, 60% or more of all gender minority and questioning youth reported depression symptoms. And 70% of Indigenous LGBTQ+ youth also felt these symptoms — the highest percentage noted in the Trevor Project’s 2022 National Survey.
Depression is more than just feeling sad all the time. For a clinical diagnosis, you need to experience five or more of the following symptoms for at least two weeks:
- Depressed (or irritable) mood
- Loss of interest or pleasure in activities
- Significant unintentional weight loss or gain, or a failure to make expected weight gains
- Sleeping too much or too little
- Psychomotor changes (agitated or excessively slow movement)
- Tiredness, fatigue, or low energy
- A sense of worthlessness or excessive guilt
- An impaired ability to concentrate or make decisions
- Recurrent thoughts of death, suicidal ideation, or suicide attempts
Children and adolescents may also experience different depression symptoms. Your child might start reporting feeling sick more often or refuse to go to school. Their grades might drop out of nowhere, or they may no longer be as interested in certain extracurricular activities. Depression is more common in girls during adolescence, with up to 36.1% of cisgender girls experiencing depression for the first time.
But there’s hope: therapy is a well-studied treatment for depression that yields positive results. It might be used in combination with medication like selective serotonin reuptake inhibitors (SSRIs) or on its own, but it’s thought that 60% of youth improve with therapy alone.
When anxiety comes up in conversation, most people are actually talking about generalized anxiety disorder (GAD). Those with GAD experience overwhelming, uncontrollable worry about various subjects, from familial health to school to natural disasters. To be diagnosed with GAD, you need to experience at least three of these symptoms more days than not for at least six months:
- Restlessness or feeling “on edge”
- Becoming easily tired
- Difficulty concentrating
- Tense muscles
- Difficulty sleeping
Almost 10% of all youth in the United States had a diagnosed anxiety disorder — including non-GAD anxiety disorders like social anxiety, obsessive-compulsive disorder, and panic attacks — in 2019. But the undiagnosed rate is twice as high, with up to 25% of all youth experiencing symptoms. In just two years, the number of LGBTQ+ youth experiencing anxiety symptoms has gone up 5% — from 68% to 73%. Now, 75% of all LGBTQ+ youth under 18 report these experiences. Anxiety is more common in youth who are:
- Pansexual (79%)
- Queer (77%)
- Transgender boys (79%)
- Nonbinary or genderqueer (79%)
- Questioning their gender (78%)
- Middle Eastern or Northern African (79%)
- Indigenous (83%)
Luckily, anxiety disorders are well-treated in therapy. You can take medications like benzodiazepines (such as Xanax) for anxiety, but cognitive-behavioral therapy (CBT) is the current gold standard for treatment. Only 14% of people who complete CBT and feel better end up relapsing.¹² However, only about one-third of people with anxiety disorders ever get treatment.¹³ When anxiety disorders can interfere with every step in normal childhood development, it’s critical to start therapy and find coping mechanisms for out-of-control worries.
Suicidal ideation and attempts
Suicide isn’t an easy topic to discuss, but it’s critical to have this conversation with LGBTQ+ youth. In the last year, 50% of LGBTQ+ adolescents surveyed reported considering suicide, and 18% of those attempted suicide at least once. Rates of suicidal thoughts, feelings, and attempts map the same trends as LGBTQ+ youth depression and anxiety levels, where those who experience more depression and anxiety are more likely to have considered or attempted suicide.
On a broad scale, LGBTQ+ people are more likely to consider or attempt suicide than the general population. 82% of transgender people have, at some point, contemplated suicide, and 40% have attempted it. Most suicide attempts occur within the first five years of people realizing they are LGBTQ+, meaning there’s a disproportionate amount of suicide attempts in young people.
Suicide is the second most common cause of death in young people from ages 10 to 34 and is the tenth most common cause of death in the United States. This means that someone in the United States will die by their own hand every 11 minutes.
Ensuring that you take prompt, compassionate action when someone you love is experiencing suicidal thoughts is critical. A therapist can intervene, creating a safety plan with you to try and gain some control over the situation so that it doesn’t escalate into an attempt. They will help you determine whether or not greater mental health care, such as inpatient mental health hospitalization, is necessary.
If you’re in an acute crisis, your therapist can support you in moving through your emotions and coping with your distress. You can find more detail about suicidal thoughts, feelings, and healing in our Suicide Facts and Resources guide.
If you are currently experiencing thoughts of suicide, please reach out to someone. This could be a friend or loved one, a text or phone crisis line (text HOME to 741741 or call the 3-digit National Suicide Prevention Hotline at 988, or dial 1-800-273-8255), or your local emergency department. Remember that you are not alone — help and support are always available.
Social support and LGBTQ+ youth mental health
The number one factor influencing how well LGBTQ+ youth thrive is social support. This factor is, of course, tied with access to medical transition for transgender and nonbinary youth who want it. In a recent study, receiving appropriate gender-affirming care lowered the average odds of moderate to severe depression by 60% and suicidality by 73%. But almost 75% of LGBTQ+ youth report experiencing discrimination based on their sexual or gender minority status at least once in their lifetime. Those who experienced discrimination were more than twice as likely to attempt suicide than those who didn’t.
A recent study found that parental support directly predicted how well transgender and nonbinary children respond to life challenges. However, the Trevor Project’s survey found that less than one in three transgender and nonbinary youth benefit from a gender-affirming home.¹ Not having support at home is much more likely to predict negative outcomes, raising the risk of:
- Lowered self-esteem
- Depression and anxiety symptoms
The two most common ways that LGBTQ+ youth report a parent or caregiver could be more accepting include welcoming their friends and partners and speaking with them respectfully about their LGBTQ+ identity.
Children and adolescents spend the majority of their day-to-day life in school, so it makes sense that academic settings also have a huge impact on their mental health. Slightly more than half of LGBTQ+ youth surveyed reported that school was a positive space, while only 37% identified their home as affirming. No matter the environment, not having social support raised the risk of suicide attempts by about 50%.
In situations where LGBTQ+ youth don’t have a lot of social support, a therapist can help identify the few lines available. Since social support is well-known to directly predict your ability to bounce back from hardship, finding other people who love you for who you are is critical. Online forums and social media can sometimes be problematic, but they can also offer plenty of ways to connect with other LGBTQ+ youth in similar situations.
Why seek LGBTQ-specific therapy?
Cultural competence in LGBTQ+ issues can make or break your therapy experience. Having someone who understands you at your core — without having to explain basic concepts like “coming out” — can change your feelings of safety and acceptance in a therapeutic setting. Plus, competency training can improve both therapists’ skills and patient outcomes.
Cultural competence centers around three core understandings:
- Awareness of a therapist’s own beliefs, biases, and attitudes
- Knowledge and understanding of the cultural group, including expectations for therapy and how cultural backgrounds express themselves around pathologies
- Skills and tools that allow a therapist to provide culturally sensitive assessment and intervention
When you receive therapy from someone who is culturally competent in LGBTQ+ issues, there’s less groundwork that you’ll have to lay to get adequate support. There’s also a greater chance of working with a supportive provider that recognizes and works with your values, along with a smaller chance of running into miscommunications, such as confusing gender dysphoria with body dysmorphia or general depression. Whether or not the therapist is LGBTQ+ themselves, you’ll be able to get to the point faster and with deeper insight.
Red flags to watch for
While there’s a lot of middle ground between a culturally competent therapist and one acting unethically or unlawfully, there are some red flags (major and minor) to look out for when you’re trying to find an online therapist.
Just because a therapist claims to be LGBTQ-friendly doesn’t mean they are. While a vast majority of providers who claim LGBTQ+ competence have your best interest in mind (though you might still have to explain a few terms), not all of them do. Some signs that a therapist might not be as LGBTQ-friendly as they advertise include:
- Lacking respect for your pronouns and identity labels (such as not using your correct pronouns when referring to you or your loved ones)
- Pathologizing asexual and aromantic identities (asexual and aromantic identities are different than hypoactive sexual desire disorder)
- Using incorrect language despite being corrected or pushing back against using correct language (like “transgendered”)
- Believing all of your problems stem from your identity
- Stereotyping or assuming that all LGBTQ+ people are the same
- Not believing or understanding how mental illness and LGBTQ+ identity interact
- Lack of interest in understanding or learning more about your unique inner experiences
On a bigger scale, some therapists practice conversion therapy. Conversion therapy, also called reparative therapy, is a kind of therapy that aims to turn a sexual minority into a heterosexual person. Every major psychological organization has taken a firm stance against it. It’s currently banned in 20 states, including:
- New Mexico
- New Hampshire
- New York
- Rhode Island
- New Jersey
- Washington, DC
Some laws cover conversion therapy for both sexual and gender minority youth, while others only cover sexual minority youth. More laws ban conversion therapy for minors than for adults. Five more states ban conversion therapy only for minors:
- North Dakota
- North Carolina
Conversion therapy for transgender and nonbinary youth is sometimes called “gender exploratory therapy” and aims to find another reason for gender dysphoria to prevent them from transitioning. This might look like claiming that gender dysphoria is a maladaptive response to a traumatic incident or feelings of social isolation. While trauma and poor social support can influence our perceptions of ourselves and might play a role in how we experience and project feelings of dysphoria, it shouldn’t invalidate your experiences. In these tricky situations, trust your gut.
Some states, such as Texas, have started asking mandatory reporters (such as therapists) to disclose information about minors undergoing medical transition to the Department of Family and Protective Services. This means that telling a therapist you’re taking puberty blockers could get your parents charged with child abuse. Always keep your safety and best interest in mind. You might consider holding off on disclosing a transgender or nonbinary identity (or feelings of gender dysphoria) until you can confirm that the therapist will be in your corner.
Online vs. in-person therapy
Since LGBTQ+ lives are still a divisive topic across the United States, not everywhere has the same access to LGBTQ-competent therapy. Online therapy increases the likelihood of finding someone who will understand, broadening the potential for social support. You’ll have the opportunity to see a provider who might live on the other side of the state or, in the case of a therapist with multiple licenses, on the other side of the country. Plus, online therapy has been proven to be just as effective as in-person therapy.
Most online therapists charge the same rate for online sessions as in-person sessions. This is because you’re both still putting in the time and hard work, even if you’re separated by a screen. However, if money’s an issue, online therapy allows you greater flexibility to find someone who works in your price range.
When seeing an online therapist, you’ll have to take extra steps to ensure that the call is confidential. All therapists must legally offer secure messaging systems or “rooms” where you can send HIPAA-secured texts and images.
It’s best to find a safe environment to take your video or phone calls where others can’t overhear your therapeutic work. This is especially important for LGBTQ+ youth, who might not have supportive parents (or are working with their parents to help them understand and might vent frustrations to a therapist). A white noise machine can help ensure confidentiality since the additional noise makes it harder to eavesdrop. Make sure you block off a designated time and location for your session. It may also be helpful to let loved ones or roommates know that you’ll be unavailable during that time.
Still have questions? Check out our comprehensive FAQ about online therapy — answered by a licensed family therapist — for more information.
Finding an online therapist
Even with the explosion of online therapy amid the COVID-19 pandemic, finding an online therapist is more complicated when you’re a minor. In most scenarios, your best bet is to look for individual practicing therapists, counselors, social workers, and psychologists who:
- Are taking on new cases
- Treat minors
- Use teletherapy
- Are licensed in the state you’ll be calling from
- Accept your insurance if you have it or want to use it
Not sure what the difference is between those titles and degrees? We’ve broken it down for you. When looking for a mental health professional, starting with a major online directory with substantial filters can help you narrow your search to explicitly LGBTQ-friendly therapists who work with minors. Some of these directories include:
- American Psychological Association’s Psychologist Locator
- Association for Behavioral and Cognitive Therapies’ CBT Directory
- American Academy of Child and Adolescent Psychiatry’s Psychiatrist Finder
- GLMA Provider Directory
- Medicare.gov’s healthcare provider tool
Locally, you might find that there are low-cost community mental health clinics available. Your local university’s psychology graduate program may run a low-cost clinic for students working toward certification hours. Your or your guardian’s employer might also have an employee assistance program (EAP) to connect you more directly with a therapist. Finally, if you are in junior high or high school, your school may provide students with access to an on-site therapist (or refer you to a provider who works locally with students).
LGBTQ-specific programs, like The Trevor Project and Trans Lifeline, also have the resources to help you narrow your search. Check out our list of resources for more information.
Don’t be afraid to ask a friend, either — If one of your LGBTQ+ peers sees or has seen a therapist, ask how they liked their care. You might be able to walk away with a phone number.
Keep in mind that every state has different rules about the treatment of minors, particularly when it comes to confidentiality laws. You may be able to consent to your own care without a parent’s permission. But in some cases, a parent will need to consent to your treatment. And if your parents are divorced, both parents may need to consent for therapy to begin. You can always ask a therapist during your initial consultation if you’re unsure about the process. They will be able to outline the state laws and discuss what will and won’t be disclosed to your parents during your treatment.
The benefits of individually-practicing therapists don’t wholly discount larger organizations. Companies like Pride Counseling are great for adults with flexible payments and convenient matching services, but they often don’t treat people under the age of 18 (and those that do mainly start at age 13, so your 11-year-old cousin might not find success). A handful of large companies offer broader counseling services for teens and older children; all are LGBTQ+ friendly, but none specialize in LGBTQ+ youth.
Free resources available
There are several free resources available for LGBTQ+ youth in Canada who are seeking online or in-person therapy. Here are a few options:
LGBT Youthline: LGBT Youthline offers a toll-free helpline, online chat, and email support for LGBTQ+ youth across Canada. They provide peer support, information, and referrals to other services. Visit their website at youthline.ca for more information.
Kids Help Phone: Kids Help Phone is a 24/7 helpline for youth in Canada. They offer confidential support via phone, text, or online chat. While they don’t specialize in LGBTQ+ issues, they provide a safe and supportive space for all youth. Visit their website at kidshelpphone.ca for more information.
Canadian Mental Health Association (CMHA): The CMHA has branches across Canada that offer mental health services, including counseling and therapy. They may have specific programs or resources for LGBTQ+ individuals. Visit the CMHA website at cmha.ca to find your local branch and inquire about their services.
Rainbow Health Ontario: Rainbow Health Ontario provides resources and information on LGBTQ+ healthcare and mental health. While they don’t offer direct therapy services, their website includes a directory of LGBTQ+-friendly healthcare providers, including therapists, across Ontario. Visit their website at rainbowhealthontario.ca for more information.
Remember to check with these organizations for specific details on their services, availability, and any potential changes due to the ongoing COVID-19 pandemic.