Beyond the Rainbow Sticker: What "LGBTQIA+ Affirming" Actually F*cking Means.

By Liz Wooten, LPC

About the Author: Liz Wooten, LPC, is the founder of Enlitens and a rebellious academic dedicated to dismantling the broken mental health system. As an AuDHD therapist with years of front-line crisis experience, she brings a deep, lived understanding to her work. Read Liz’s Full Story Here

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 and practiced. 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 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. It sells safety as a product while outsourcing the labor of education to the very clients it is supposed to be serving. It is a profound ethical failure that places the burden of a clinician’s ignorance on the shoulders of the most vulnerable.

“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.”

Use this checklist 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 their role is to support you, not to be your sole source of community.

Being misgendered is not just an “insult” or a “mistake.” It is a neuroceptive threat. Your brain’s threat-detection system (the amygdala) registers it as a small act of social annihilation—a signal that you are not seen and you are not safe. This triggers a physiological cascade of cortisol and a sympathetic nervous system response. Your therapist’s “slip-up” is a biological injury. True trauma-informed care understands this.

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.

Go Deeper Down the Rabbit Hole

If You're Looking for a Blank Slate...

A manifesto on why we reject both the performative ally and the cold, distant “expert” in favor of real humans.

It's a Nervous System Injury.

The foundational science of trauma and why microaggressions like being misgendered are real, biological injuries.

The 15-Minute Vibe Check.

The perfect, no-risk way to use the Competency Checklist and vet a therapist before you commit.

*The information here is meant to guide and inform, not replace the care of a qualified healthcare professional. If you have questions or concerns about a medical or mental-health condition, please reach out to a trusted provider. The examples shared are based on general personas—no personal health details are used. At Enlitens, your privacy is a top priority, and we fully comply with HIPAA regulations to keep your information safe and confidential.

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Take one second. That’s all I’m asking.

Do not try to “calm down.” Do not try to “fix it.” Do not listen to the voice screaming that you need to do something right now.

Just be here, with me, for one single breath.

My name is Liz. I’ve spent years working overnight in the ER, sitting with people on what was often the worst night of their entire lives. I have sat in the eye of the hurricane, and I can tell you with absolute certainty that the chaos you feel right now is not the truth.

It is a storm in your nervous system. And a storm is just a weather pattern. It is not you. It is not permanent. And you do not have to navigate it alone.

Right now, your brain’s alarm system is screaming. The logical part of your brain has been taken offline. That is a normal, brilliant, biological survival response. But you and I are going to bring it back online, together.

We are going to do one, simple, physical thing. This is not a bulls*hit mindfulness exercise. This is a direct, manual override for your nervous system.

Place your hand on your chest.

Can you feel that? The rise and fall. The rhythm. That is the anchor. That is the proof that you are here, in this moment, and you are alive.

Keep your hand there.

Now, we are going to make one choice. The storm is telling you there are a million overwhelming things you have to do. That is a lie. There are only three choices right now, and you only need to pick one.

If you or someone else is in immediate, physical danger and you need help on site, right now:

This is the button you push when you need the paramedics or the police to show up. This is the “bring the fire truck” button.

If you are having thoughts of suicide and you need to talk or text with a human, right now:

This is the national, 24/7 lifeline. It is free, it is confidential, and it is staffed by trained counselors who are ready to listen without judgment. This is the “I need a lifeline” button.

If you are in St. Louis, you are not in crisis but you are in deep distress and need to talk to someone local:

Behavioral Health Response (BHR) is our community’s lifeline. They provide free, confidential telephone counseling and can connect you with local resources. This is the “I need a local guide” button.