How Do I Know If My Psychiatrist Is LGBTQ+ Friendly?

Sitting down with a psychiatrist means sharing some of the most vulnerable parts of your life with someone you've just met. If you're LGBTQ+, that can feel even heavier. There's a lot of judgment and presumption out there, and many people have learned to brace for it before they walk through the door.

If that's where you are, this post is for you. Here's what I hear from patients, what good care looks like, and how to tell whether a provider is right for you.

What patients tell me they're afraid of

Most people want the same thing from a mental health visit: to feel heard, seen, understood, and valued as a person going through something difficult. What LGBTQ+ patients often describe as their previous experience with mental health providers is the opposite. They tell me about feeling dismissed, as though their experience isn't what they say it is. They tell me about providers who never asked about their story or their life. The focus is on symptoms only, a check list of sorts, not the person.

Over time, many people start to believe this is simply what they'll get, and that finding someone who "gets it" is an unrealistic goal. It isn't. For some people, their LGBTQ+ status is part of their identity. For others, not so much. Approaching someone as a human, not a check list of symptoms, is what we all deserve and need, regardless of gender or sexual orientation.

What dismissive vs. empathic care looks like

A patient of mine, a young woman in her early twenties navigating a major life transition as a transgender woman, came to us after a frustrating experience with her previous provider. (Details have been changed to protect her privacy.) His visits were short and clipped, and they were built entirely around symptoms. He seemed uncomfortable asking about her transition, what hormone or medication changes she may have had, or how she was feeling emotionally. When she told him more than once that her antidepressant was making her tired and sleepy during the day, and that it was getting in the way of her college classes, he didn't act on it.

She arrived at our first appointment closed off and suspicious, and she had every reason to be.

I ask every new patient about their experience with previous providers, because it tells me where they need the most support. That information is what was important enough to switch to a new provider, to start over with someone completely new. We talked about what had happened, and we talked about her story and her transition. I confirmed her pronouns and how she wanted her name and information listed in her medical record. Then we adjusted her medication slowly, based on how she felt after each change.

It took a few visits, but she opened up more each time. Eventually we landed on a regimen she felt she could lean on long term. She no longer comes in guarded. She smiles now, her classes are going well, and she's excited about where her life is headed.

Nothing about our care was exotic. It was listening, asking, and acting on what she told us.

Questions to ask a psychiatrist

You don't need to interrogate anyone, but these are reasonable questions to ask before your first visit or early in it:

• Do you have experience working with LGBTQ+ patients, including nonbinary and transgender patients?

• Do you have experience with patients who are on hormones or planning to start? People on hormone regimens often wonder whether their psychiatric medications will interact with them. For the most part, they don't, but a good provider should be able to talk it through with you.

• Can you coordinate care with therapists and other providers who offer gender-affirming care?

These are baseline expectations, not special requests. A provider who is comfortable with them is showing respect for your life experience.

Green flags and red flags

Some signs are visible before you ever book. Look at a provider's website for any indication that they welcome and treat LGBTQ+ patients. A rainbow flag alone isn't proof of competence, but a website that speaks clearly about who they serve is a good start.

Once you're in the room, pay attention to what happens.

Green flags

They ask about you and your story, not just your symptoms

• They confirm your name and pronouns and how you'd like them recorded

• They answer your questions about LGBTQ+ care directly and without discomfort

• They take your side effects seriously and adjust your treatment

• You feel like you can let your walls down

Red flags

• Visits feel rushed

• Conversation is limited to a symptom checklist

• The provider seems uncomfortable or changes the subject when you talk about your identity

• Your concerns about medication are brushed aside

• You find yourself holding back parts of your life or story

If I could give you only one piece of advice, it's this: listen to your gut. If you feel like you can be open, that's a good sign. If you feel the urge to withhold things about yourself, that's a big red flag that your provider isn't listening, or isn't willing to.

(For more generalized information on what to look for in a psychiatrist, click here.)

You don't have to settle

Being a warm, understanding provider who truly listens is more art than science. It's a skill built over years of working with people, and also from simply being a human living a life with many other people. Some providers can't do it, and that's okay for them, but it doesn't mean you have to stay.

I don't want to compare a professional relationship to a friendship, but there are similarities: trust, understanding, empathy, curiosity, and support. The difference is that in a psychiatric relationship, all of that flows toward you. It isn't reciprocal, and that's exactly how it should be.

If you suspect your provider isn't hearing you, seeing you, or understanding you, it may be time to make a switch. Respect and understanding are the minimum. Real connection and empathy are out there if you keep looking, and you're not alone in that search.

At Inner Mosaic, we approach every person the same way, whether they're part of the LGBTQ+ community or not. We want to respect, understand, and connect with you exactly where you are, without judgment, and help in whatever way we can. If you're in Colorado and want to see whether we're the right fit, reach out to schedule a visit, in person in Cherry Creek or by telehealth.