LGBTQ+ individuals are two and a half times more likely to experience depression, anxiety, and substance misuse than their cisgender, heterosexual peers (American Psychiatric Association). Not because of who they are, but because of what the world has asked them to carry. At Turning Leaf Therapy in Old City Philadelphia, we have 11 therapists who specialize in LGBTQIA+ affirming care. Several members of our team are part of the community themselves. We also have clinicians who provide gender-affirming care letters for surgery and hormone therapy.
You should not have to spend your therapy session educating your therapist about your identity, your relationships, or your pronouns. Here, you will not need to. You can walk in and get to the thing that actually brought you through the door.
Get StartedWhat Affirming Therapy Actually Means
There is a difference between a therapist who is “LGBTQ friendly” and one who is affirming. A friendly therapist will not judge you. An affirming therapist actively understands that your identity is a healthy, natural part of who you are and brings that understanding into every aspect of your care.
Affirming therapy is guided by the American Psychological Association’s practice guidelines for sexual minority and gender diverse clients. It means your therapist will not treat your identity as something to explain, overcome, or work around. It means they understand minority stress, the unique psychological weight of living in a world that was not built for you. It means they are familiar with the specific challenges facing LGBTQIA+ individuals and can help you navigate them without starting from scratch.
It also means your therapist will follow your lead. If you are exploring your identity, they will hold space for that exploration without pushing you toward a label. If you know exactly who you are and want to work on something else entirely, they will honor that too.
Why This Matters
The mental health disparities facing LGBTQIA+ communities are real and well-documented. They are not caused by identity. They are caused by what happens to people when society treats their identity as a problem.
Psychologist Ilan Meyer’s minority stress model, the most widely cited framework in LGBTQIA+ mental health research, describes how chronic exposure to prejudice, discrimination, and stigma creates a layer of stress that sits on top of everyday life. Some of that stress is external: being misgendered, facing workplace discrimination, navigating family rejection. Some of it is internal: the messages you absorbed growing up about who you were supposed to be, the hypervigilance of monitoring how “out” you can safely be in any given room, the exhaustion of code-switching between contexts.
The Trevor Project’s 2024 national survey of over 18,000 LGBTQ+ young people found that 39 percent had seriously considered suicide in the past year. Among transgender and nonbinary youth, that number rose to 46 percent. Half of those who wanted mental health care were unable to access it. And 90 percent said their well-being had been negatively impacted by recent political rhetoric targeting LGBTQIA+ communities.
What We Help With
Coming Out and Identity Exploration
Coming out is not a single event. It is an ongoing process that unfolds across every new relationship, workplace, doctor’s office, and family gathering for the rest of your life. There is no right timeline for it, and there is no “too late.”
Some of our clients are exploring their sexual orientation or gender identity for the first time. Some came out decades ago and are still processing what it cost them. Some are coming out in their 40s, 50s, or 60s and navigating what that means for existing relationships, marriages, and family structures. All of it is welcome here.
If you are still figuring things out, therapy can be a place to explore without pressure. If you have known who you are for a long time and are dealing with the aftermath of not being able to live it openly, therapy can help with that too.
Gender Identity and Transition Support
We work with transgender, nonbinary, genderqueer, gender-fluid, and gender-questioning individuals at every stage of their journey. Whether you are beginning to explore your gender identity, navigating social transition, considering medical transition, or processing the emotional complexity of any of these experiences, our team is here.
Therapy for gender-diverse individuals is not about proving anything or meeting a set of criteria. It is about having a place where your experience is understood and supported, where you can process the grief, joy, confusion, and clarity that often come in waves during gender exploration and transition.
Gender-Affirming Care Letters
Our team includes clinicians who provide gender-affirming care letters for surgery and hormone therapy, following the WPATH Standards of Care. These letters are not about gatekeeping. They are about making sure you have the support and documentation you need for the next step in your care.
If you are already in therapy with us, your therapist can write your letter as part of your ongoing work together. If you need a letter and are not currently a client, we can discuss the process during your initial consultation.
Internalized Stigma and Shame
Growing up in a world that sends constant messages about who you should be leaves marks. Even when you consciously reject those messages, the earlier versions of them can live in your body and your nervous system long after you have come out or come into yourself.
Internalized homophobia, biphobia, and transphobia can show up as persistent shame that does not seem to attach to anything specific. It can look like difficulty accepting love, choosing partners who do not treat you well, distancing yourself from the LGBTQIA+ community, or a quiet voice that still insists something about you is not quite right.
These are not character flaws. They are the residue of growing up in a system that told you who you are was wrong. Therapy can help you separate your own voice from the one that was given to you.
LGBTQIA+ Relationships and Couples Therapy
We work with couples and partners across the full spectrum of LGBTQIA+ relationships, including same-sex couples, mixed-orientation couples, polyamorous and consensually non-monogamous relationships, and partners navigating one person’s transition.
LGBTQIA+ relationships share many of the same challenges as any relationship, but they also carry layers that a therapist needs to understand: the impact of societal stigma on intimacy, navigating different levels of outness between partners, family of origin tensions, the absence of culturally visible relationship models, and the ways minority stress can show up between people who love each other.
Family of Origin and Chosen Family
Family rejection is one of the strongest predictors of mental health difficulties for LGBTQIA+ individuals. Research from the Family Acceptance Project found that youth from highly rejecting families are eight times more likely to attempt suicide than those with accepting families.
If your family of origin has been a source of pain around your identity, therapy can help you grieve what you deserved and did not receive, set boundaries that protect your well-being, and build the relationships that actually sustain you.
Many of our clients have built chosen families, networks of friends, partners, mentors, and community members who provide the belonging and support that biological family could not. These relationships matter deeply, and they carry their own joys and complexities. We honor them fully.
Grief and Loss in the LGBTQIA+ Community
LGBTQIA+ grief often goes unrecognized. The partner who was called your “friend” at the funeral. The years spent hiding parts of yourself. The community members lost to violence, to the AIDS crisis, to suicide. The family relationships that ended when you came out.
These losses are real, and they deserve to be mourned. Our Grief and Loss Therapy page goes deeper into how we approach grief work, including disenfranchised grief, the kind of loss that the world does not give you permission to mourn openly.
Intersectional Identities
We understand that your LGBTQIA+ identity does not exist in isolation. It intersects with your race, ethnicity, disability, faith background, immigration status, socioeconomic reality, and every other part of who you are. For BIPOC LGBTQIA+ individuals, the experience of navigating racism in predominantly white queer spaces and homophobia or transphobia in communities of origin creates a specific kind of isolation that requires specific understanding.
For clients who carry religious trauma alongside their identity, therapy can help you integrate your faith and your selfhood, or grieve the spiritual community that could not hold both.
We do not treat identities in silos. We treat whole people.
Rooted in Philadelphia’s LGBTQIA+ Community
Philadelphia has one of the largest and most historically significant LGBTQIA+ communities in the country. The Gayborhood in Washington Square West, with its rainbow street signs and crosswalks, is one of the most recognized LGBTQ neighborhoods in the United States. Philadelphia was the first major city to add black and brown stripes to its Pride flag, a statement about inclusion that reflects the city’s values.
Our office in Old City sits from Mazzoni Center (which has served the LGBTQ+ community since 1979 and hosts the world’s largest Trans Wellness Conference), and from the William Way LGBT Community Center.
We are part of this city’s fabric. And we believe that affirming, high-quality mental health care should be accessible, not just to those who can pay out of pocket.
Format
In-person at our Old City Philadelphia office (123 Chestnut St) or telehealth for anyone located in Pennsylvania.
Insurance
Aetna, BCBS plans, United Healthcare, and Optum Behavioral Health. Out-of-network support offered.
Fees
$130 to $200 per session for self-pay clients, depending on the therapist. Superbills provided.
Frequently Asked Questions
Affirming therapy is a clinical approach that recognizes LGBTQIA+ identities as healthy, natural variations of human experience, not something to be fixed, managed, or worked around. It is grounded in the American Psychological Association’s practice guidelines and informed by the minority stress model. Your therapist will understand the unique challenges facing LGBTQIA+ individuals and will not require you to educate them about your identity.
A friendly therapist will not judge you for your identity. An affirming therapist goes further: they actively understand LGBTQIA+ experiences, are trained in the specific mental health challenges facing queer and trans communities, and incorporate that understanding into your care. Affirming is the clinical standard recommended by the APA.
No. You do not need to have anything figured out before you begin. Therapy can be a safe place to explore questions about your identity, your sexuality, or your gender at whatever pace feels right. Your therapist will follow your lead.
Yes. Affirming care is about training, understanding, and clinical practice, not solely about the therapist’s own identity. That said, several of our therapists are members of the LGBTQIA+ community, and we are happy to match you with a therapist who feels like the right fit.
Yes. Our team includes clinicians who provide letters for gender-affirming surgery and hormone therapy in accordance with the WPATH Standards of Care. If you are already a client, your therapist can write your letter. If you are new to the practice, we can discuss the process during your consultation.
Yes. We work with couples and partners across the spectrum of LGBTQIA+ relationships, including same-sex couples, polyamorous and consensually non-monogamous relationships, and partners navigating gender transition.
Yes. We accept Aetna, Blue Cross Blue Shield, United Healthcare, and Optum Behavioral Health. We also provide superbills for out-of-network reimbursement. There is no separate billing code for affirming therapy. It is covered as standard mental health treatment.
Anything you bring to therapy. Common concerns include anxiety, depression, relationship difficulties, coming out, gender identity exploration, internalized stigma, family rejection, grief, trauma, and the cumulative toll of minority stress. Your identity may or may not be the focus of your work. That is entirely up to you.
At Turning Leaf, session fees for self-pay clients range from $130 to $200, and we accept multiple major insurance plans. Many LGBTQIA+-focused practices in Philadelphia are private-pay only, which can create a significant barrier to care.
Look for therapists who list LGBTQIA+ care as a specialty (not just a checkbox), who use inclusive language on their website and intake forms, who display pronouns, and who have specific training in affirming care. During your first session, notice whether you feel like you can be yourself without performing or explaining. That feeling is the signal.
Take the First Step
You have spent enough time in spaces where you had to shrink, translate, or explain yourself to be understood. Therapy does not have to be another one of those spaces. Here, you can bring your whole self.
Start Your Journey