LGBTQ+ and Gender Identity

Being lesbian, gay, bi, trans or questioning is not a mental health condition. Every major UK therapy body has signed a document that says so.

What can hurt is everything around it. A family that went quiet, a workplace that got the pronoun wrong again, a waiting list measured in years. Those are things a professional can help with.

Nobody wants to spend the first three sessions explaining the basics. This page is about finding a professional who already knows them.

Source: BACP: conversion therapy

What affirming means

An affirming professional starts from the position that your sexuality and gender are yours to know. It is not theirs to assess. They will not try to change either, or hint that one answer would be easier than another.

The Memorandum of Understanding on Conversion Therapy sets this out. It requires practice free from "any agenda that favours one gender identity or sexual orientation as preferable". Ethical practice, it says, needs "adequate knowledge and understanding of gender and sexual diversity".

Signatories include the British Association for Counselling and Psychotherapy. Others are NHS England, NHS Scotland and the Royal College of Psychiatrists. Any professional working under one of those bodies has agreed to it.

Source: BACP: conversion therapy

What the memorandum does not mean

Affirming is not the same as having a script for you. The memorandum says it does not exclude "those with uncertain feelings around sexuality or gender identity" from seeking help.

So you can arrive unsure. You can arrive with a faith that complicates things, or a marriage that does. You can arrive not wanting a label at all.

The professional's job is to help you understand yourself better. The memorandum puts it plainly: "Clients make healthy choices when they understand themselves better".

Source: BACP: conversion therapy

You might find support helpful when

• Coming out, or not coming out, is taking up more of your head than you would like
• A parent, partner or child has reacted badly and you are carrying the fallout
• You are questioning your gender and want somewhere safe to think it through
• You are transitioning, socially or medically, and the practical strain is wearing you down
• You are on an NHS waiting list and the wait itself has become the problem
• Your sexuality or gender is fine, and you want help with something else from a professional who gets that

The last one matters. Most LGBTQ+ people looking for a therapist want help with anxiety, grief or work. They simply do not want to be a learning experience for the person helping them.

The numbers behind the strain

In the 2021 Census, around 1.5 million adults in England and Wales identified as lesbian, gay, bisexual or similar. That is just over 3% of the adult population. A further 262,000 people said their gender identity was different from their sex registered at birth.

Being a minority carries a cost. In Stonewall's 2018 health survey, half of LGBT people said they had experienced depression in the previous year. That was a survey of people who chose to answer, so read it as a loud signal.

Sources: ONS: sexual orientation 2021, ONS: gender identity 2021, Stonewall: health 2018

Gender identity and the NHS route

If you think you may have gender dysphoria, the NHS advises seeing a GP. A GP can refer adults to the adult gender referral support service. It arranges assessment at an NHS gender dysphoria clinic.

The NHS says itself that waiting times for that assessment are currently very long. Its advice for the wait is to seek support for your mental health in the meantime.

A professional here works alongside that route, never instead of it. They cannot prescribe or refer within the NHS. They can help you hold the wait, the doubt and the people around you while it happens.

Source: NHS: gender dysphoria

Who to look for

Look for a profile that names LGBTQ+ or gender identity work, not one that lists "all welcome" and moves on. Ask how much of their caseload it is. Ask what training they have done on it, and when.

Some people want a professional who shares their identity. Others want the opposite, so the room is not about that. Both are reasonable, so say which when you first talk.

The relationship itself might be the thing under strain. Our couples page is written for every kind of couple.

Helplines that already understand

Sometimes what you need tonight is a person on the phone, not an appointment next week. These lines are staffed by people who will not need the basics explained.

LGBT Helpline Scotland

16 and over Scotland

Emotional support and information from volunteers trained around LGBTQ+ identities, run by LGBT Health and Wellbeing.

Tue to Thu noon to 9pmSun 1pm to 6pm

Call Email

Galop

LGBT+ adults

Support for LGBT+ people experiencing abuse or violence, including from a partner or family, from an LGBT+ charity.

Closed 1pm to 2pm and at weekends. Closes at 3.30pm on the first Thursday of each month.

Mon and Tue 9.15am to 8pmWed to Fri 9.15am to 4.30pm

Call

You do not need to have it all worked out before you start. Tell us what is going on. We will find a professional who already understands the rest.