By Ken Howard, LCSW, CST
In my decades of practice as a gay men’s specialist psychotherapist, I’ve seen a troubling pattern: therapists who market themselves as “welcoming to all” while quietly holding — and practicing from — non-affirming, often religiously conservative beliefs about sexual orientation and gender identity.
Sometimes, the harm is unintentional. Other times, it’s calculated. But in either case, the impact on LGBTQ+ clients, especially youth, can be profound — and devastating.
The Financial Conflict No One Talks About
There’s one uncomfortable truth I don’t see addressed enough: some non-affirming therapists knowingly keep LGBTQ+ clients on their caseloads — even when they can’t truly support their identities — simply because they don’t want to lose the income.
- They know an affirming referral would be better for the client.
- They know their own values are incompatible with affirming practice.
- But they keep the case anyway.
That’s not just poor practice. It’s an ethical breach.
The Ethical Standards They’re Violating
Under the NASW Code of Ethics:
- 1.15 – Social workers should “terminate services to clients and refer them to other professionals when it is in the best interest of the client.”
Under the AAMFT Code of Ethics:
- 1.11 – Marriage and Family Therapists “withdraw from practice when their services are no longer required or no longer serve the client’s needs or interests.”
If a therapist stays in the case for the paycheck while knowing they can’t provide affirming, non-discriminatory care, they’re in direct violation of these standards. It’s also flirting with exploitation — using the therapeutic relationship for personal gain at the client’s expense.
The “Say One Thing, Do Another” Playbook
Masking values
- The therapist’s website says “welcoming to all,” but their language frames LGBTQ+ identity as “struggling with unwanted attractions” or “gender confusion.”
- All marketing photos feature heterosexual couples or cisgender individuals — a quiet visual message about who belongs.
Subtle undermining
- In session, they frame LGBTQ+ identity as a symptom of trauma, sin, or “pathology.”
- Conversations about self-acceptance get rerouted toward “self-control,” celibacy, or “God’s design.”
- Correct pronouns are avoided or used inconsistently, even after correction.
Avoiding transparency
- They never state their stance directly, leaving clients or parents to assume they’re affirming.
Dragging out treatment
- They focus on tangential issues or endless “identity exploration,” avoiding real progress toward the client’s stated goals — while keeping the billing cycle going.
How Microaggressions Creep In
The damage isn’t always in the obvious moments — sometimes it’s in the quiet, repeated signals that a client’s identity isn’t truly accepted.
In advertising and promotional materials:
- Coded terms like “family values,” “biblical guidance,” or “traditional lifestyles” replace any direct mention of being LGBTQ+.
- Stock photos exclusively depict heterosexual couples or cisgender people.
- “Same-sex attraction” or “gender struggles” are used instead of clear, affirming terms.
In session:
- LGBTQ+ identity is pathologized or reframed as something to resist.
- Avoidance of correct pronouns, or deliberate inconsistency in using them.
- Minimizing anti-LGBTQ+ discrimination by overemphasizing “resilience” while ignoring real harm.
In clinical interventions:
- “Identity exploration” is actually a path toward heteronormative conformity.
- Suggesting “less gay” interests to help the client “fit in.”
- Treating the distress as coming from identity itself rather than from societal rejection.
- Using family therapy to pressure conformity to religious or cultural norms.
- Assigning “homework” to avoid LGBTQ+ spaces or peers.
- Recommending “accountability partners” who reinforce shame rather than affirm authenticity.
During intake or psychosocial assessment:
- Sexual orientation and gender identity questions are skipped, glossed over, or framed in stigmatizing ways (“Do you struggle with same-sex attraction?”).
- Identity is listed as a “problem” or “diagnosis” in the chart.
- Religious or “moral values” history is emphasized unnecessarily, steering the assessment toward heteronormativity.
- Asking whether the client has “tried” dating the opposite sex or changing gender expression, implying this is a legitimate intervention.
The Harm It Does
- Erodes trust in the profession when clients realize they’ve been misled.
- Increases psychological distress, especially for minors forming their sense of self.
- Delays access to competent, affirming care — critical for suicide prevention.
- Creates long-term trauma responses tied to therapy itself.
Why It Persists
- In areas with few affirming providers, non-affirming therapists can dominate the market.
- Some religiously aligned practices coach clinicians to soften non-affirming language to keep clients without losing doctrinal control.
- Minimal oversight means unless someone files a complaint, it continues unchecked. Many clients — especially youth — don’t even know they can file one.
What Clients and Parents Can Do
If you’re seeking therapy for yourself or your child, don’t be afraid to ask direct questions up front:
- “Do you affirm and support LGBTQ+ identities without trying to change them?”
- “Do you follow the APA, NASW, or AAMFT guidelines on sexual orientation and gender identity?”
- “Can you describe your work with other LGBTQ+ clients?”
Vague or evasive answers are red flags.
Closing Thoughts
Non-affirming therapists who keep LGBTQ+ clients under false pretenses are violating both ethics and trust. It’s not a small matter. The harm is real — and it’s preventable when clients are empowered to recognize the signs.
If you or someone you love needs truly affirming therapy or coaching — not the watered-down, coded kind — reach out. I’ve spent over 30 years working exclusively with gay men and LGBTQ+ clients, with a foundation of full affirmation and support.
Contact:
📞 310-339-5778
📧 Ken@GayTherapyLA.com