Walking the tightrope: Being a queer therapist in a system built to erase us

Being a queer therapist often feels like walking a tightrope, balancing high above a circus built by a system that was never meant for people like me to perform.

The rope is taut, the stakes are high, and below is a crowd that has, at times, cheered for me to fall. On other days, I am the ringmaster of my quiet revolution, shaping the show, choosing the music, and refusing to let the system dictate the script. In truth, I am always a bit of both; I move between survival and defiance, between navigating oppressive structures and reimagining them entirely.

The mental health system, as it exists, was not designed for us. Its history is deeply tangled with harmful practices and oppressive policies. Homosexuality was classified as a mental disorder until 1973, in the lifetimes of many practicing clinicians today. Gender diversity remains medicalized and subject to gatekeeping. Conversion therapy, a practice condemned by every major medical organization, is still legally practiced and promoted in many U.S. states. These are not distant relics; they shape policies, insurance coverage, and the way many still think about queer and trans lives.

The failure of the mental health profession to protect our clients has left blood on our hands.

The field itself is rooted in white, cisgender, heterosexual norms—frameworks that have long framed queerness as deviant, dangerous, or defective. This history is not a neutral backdrop but the ground we walk on. Even now, "healthy" and "normal" are often defined in ways that exclude us.

When I walk into the therapy room, I do so knowing that the profession I practice has a history of labeling my very existence as pathological. I am a queer, neurodivergent, cisgender woman trained in institutions that, up until recently, sought to erase people like me. That contradiction lives in me. I do not try to shed it; I use it. It keeps me alert to the harm my clients carry. It fuels my commitment to build spaces where they do not have to fight to be seen.

For me, therapy is not neutral work. It is an act of reclamation.

To practice LGBTQ+ affirming therapy is to push back against decades of pathologization, exclusion, and control. It is to stand in the face of a system and say, with clarity: We are not broken. The system is. After more than a decade of working in nonprofit and community mental health in New York City, I knew I wanted to create something different. I had seen too many clients forced to fit themselves into narrow definitions of care, explaining and justifying their identities to providers who should have been safe. My clients had been tokenized and ostracized simply for being who they were. I didn't want to merely critique the system; I desired to change it. I wanted to build a new kind of space.

And, so, I did.

LGBTQ+ affirming therapy is built on the right to be seen, not fixed. It rejects the idea that healing means conforming to cisheteronormative standards. Instead, it validates identities, desires, and ways of being as inherently worthy, not despite queerness, but because queerness is part of our wholeness.

In this space I've carved, therapy becomes more than coping skills and symptom management. It becomes a place to rest from the constant negotiations of daily life, to rewrite internalized narratives, to explore pleasure without shame. It becomes a space where survival is honored, but not at the expense of the ceiling. Where thriving, dreaming, and imagining new futures are equally part of the work.

Genuine affirming care is trauma-informed, consent-based, and intersectional. It holds that mental health cannot be separated from systems of oppression or from the ways race, gender, class, disability, and sexuality intersect. It honors chosen family as legitimate kinship, celebrates resilience as much as it grieves loss, and understands that joy itself can be a form of resistance.

The shift from "treating" queer and trans people to affirming them is more than a professional stance. It is a political one. It interrupts the legacy of harm by refusing to replicate it. It acknowledges the history of psychiatry and psychology as tools of control. It insists instead on using them as tools for liberation.

And this work is not just for my clients. It is for me, too. Each time I sit across from someone and affirm the fullness of who they are, I reclaim a piece of my own belonging in this profession. Each time we acknowledge that the harm resides in the system, not in us, the playing field shifts slightly.

Being a queer therapist means holding history in one hand and possibility in the other. It means balancing on that tightrope, aware of the danger, while also daring to step into the ring and change the show entirely. It means building something worth inheriting: a space where queerness is not just tolerated or accepted, but celebrated and at the center.

This is what keeps me walking, even on the days when the rope feels impossibly thin. Because every step is a refusal to disappear. Every session is an act of resistance. And every life affirmed here is proof that the system can be remade one client at a time.

Whitney C. Coulson, LCSW, is a licensed clinical social worker, writer, and founder of Moodlab Psychotherapy, a boutique group practice specializing in affirming care for LGBTQ+ populations, individuals with neurodiversity, and those from marginalized backgrounds.

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