Let's be absolutely clear. "LGBTQIA+ Affirming" is not a feeling.
It is not a marketing buzzword. It is not a rainbow sticker you slap on your website to signal virtue during Pride Month.
It is a baseline, non-negotiable, professional competency. It is a set of skills that must be learned, practiced, and continuously updated. And if your therapist doesn't have it, they are not qualified to treat you. Period.
You've been there. The therapist with the pronouns in their bio who still stumbles over yours in week six. The one who calls your gender identity a "journey" as if it's a charming vacation and not who you fundamentally are. The one who asks invasive questions about your body that have nothing to do with your anxiety.
You leave the session not feeling helped, but feeling exhausted. You have just spent another hour paying to be a patient and a diversity, equity, and inclusion consultant at the same time.
The Research Names What You've Always Known
The mental health industry is rife with performative allyship. It has learned the language of affirmation but has not done the deep, ongoing work of embodiment. And the research names the damage with surgical precision:
Epistemic injustice is a significant and direct cause of mental health inequities for marginalized groups.
Epistemic injustice means your knowledge about your own experience is systematically dismissed, overridden, or invalidated by the person who holds institutional power in the room. When your therapist treats your gender identity as a "topic to explore" rather than a settled fact, that is epistemic injustice. When they frame your sexuality as a potential "source of trauma" rather than a core part of who you are, that is epistemic injustice. When they ask you to explain what non-binary means instead of doing their own homework, that is epistemic injustice.
And the harm compounds: the damage of epistemic injustice is multiplied by intersectionality — race + gender + disability + sexuality layering on top of each other. If you are a queer, neurodivergent person of color, the number of ways the system can fail you isn't additive — it's exponential. Each identity you hold that the therapist doesn't fully understand becomes another axis of erasure.
"You should not have to educate your therapist. Their job is to have already done the work. Competency is the bare minimum. You deserve a co-conspirator, not just a well-meaning ally."
Being Misgendered is a Biological Injury
Let's talk about what happens in your body when your therapist gets your pronouns wrong. Because this is not about "feelings being hurt." This is neuroscience.
Neuroception — the body's subconscious process of detecting safety, danger, and life threat — determines which autonomic state is active. Being misgendered is a neuroceptive threat. Your brain's threat-detection system registers it as an act of social annihilation — a signal that you are not seen and you are not safe. This triggers an immediate physiological cascade:
Cortisol floods your system (stress hormone)
Your sympathetic nervous system activates (fight-or-flight)
Your prefrontal cortex goes partially offline (reduced capacity for complex thought)
Your therapeutic window closes
Your therapist's "slip-up" just shifted your entire autonomic state from safety to defense. And the autonomic nervous system operates on a predictable three-level hierarchy — Ventral Vagal (safe engagement), Sympathetic (fight-or-flight), Dorsal Vagal (shutdown). A single misgendering can drop you from ventral vagal safety straight into sympathetic activation. Repeated misgendering can push you all the way to dorsal vagal shutdown — the flatness, the dissociation, the "I don't even care anymore" that isn't apathy but is your nervous system's last-resort survival strategy.
True trauma-informed care understands this. It doesn't treat pronoun mistakes as social gaffes — it recognizes them as clinical events that require immediate repair.
The Masking Tax You're Already Paying
And here's the compound bill: masking causes exhaustion, burnout, and a loss of personal identity. If you're queer and neurodivergent, the masking load is staggering. You are masking your neurotype at work, masking your sexuality at family dinners, masking your gender identity in conservative spaces — and then you walk into therapy, the one place that's supposed to be safe, and you have to mask there too because your therapist doesn't have the competency to hold all of who you are.
Emotional masking is a costly but necessary adaptive strategy that leads to burnout, affective dissonance, and identity fragmentation. The therapy room should be the one place on earth where every single mask comes off. If your therapist can't hold that, they are not just failing you — they are actively contributing to the fragmentation.
Your Competency Checklist
Use this to vet your next therapist. This is not a list of "nice to haves"; it is the absolute floor for affirming care.
☐ They ask for and correctly use your name and pronouns from the very first contact, without making a big deal out of it.
☐ They don't treat your gender identity or sexuality as a "symptom" to be analyzed or linked to your trauma.
☐ They have specific training and knowledge about the needs of the trans, non-binary, and queer communities.
☐ When you correct them on a mistake, their immediate response is "thank you," not a defensive explanation.
☐ They understand the concept of intersectionality and how multiple marginalized identities compound clinical complexity.
☐ They understand their role is to support you, not to be your sole source of community.
☐ They can explain the difference between "affirming" and "tolerating" without needing to Google it.
You are not asking for special treatment. You are demanding competent, ethical care that you are paying for. Stop paying people to educate them. Fire the well-meaning allies and hire a trained, competent professional. It's time to find a therapist who has already done the work so you can finally focus on your own: Start your search here →
Part of: Community Support Hub → | Related: Our Fit Manifesto · The Cost of Masking
