2SLGBTQ+ Affirmative Therapy and Coaching: What It Is and Why It Matters

Kaitlyn Boudreault
Jun 6
6 min read

Updated: Jun 8

You may have heard the terms heteronormative or cisnormative before. These worldviews still dominate many schools, clinics, workplaces, and even traditional therapy settings.

But you are likely wondering what these words really mean and how a mental health clinic can disrupt these norms to offer truly 2SLGBTQ+ affirmative support.

The 2SLGBTQ+ flag that can be displayed in 2SLGBTQ+ therapy and coaching

Let’s delve more into what 2SLGBTQ+ is, the experiences of the 2SLGBTQ+ community, and what 2SLGBTQ+ affirmative care looks like in practice.

Understanding Heteronormativity and Cisnormativity

While Canada has made important progress, including legalizing same-sex marriage, expanding human rights protections, and improving public acceptance, heteronormativity and cisnormativity still persist in daily life.

This suggest that society views heterosexuality and cisgender identity as the “default,” “normal,” or even “superior” ways of being.

This marginalizes individuals who don’t conform to those norms.

As a result, many 2SLGBTQIA+ people continue to face:

Discrimination
Micro- and macro-aggressions
Chronic invalidation
Barriers in healthcare, education, and employment

These experiences can lead to elevated rates of anxiety, depression, trauma, and low self-worth among 2SLGBT+ people, especially for those who intersect with racism, ableism, classism, or neurodivergence.

2SLGBTQ+ affirmative therapy and coaching seek to flip this script, so that sexual and gender diversity are viewed as strengths, not problems to fix.

What Does 2SLGBTQ+ Mean? A Quick Refresher

Awareness for 2SLGBTQ+ identities has grown throughout the past several decades.

As language and awareness evolve, so does the need for clarity around the 2SLGBTQIA+ acronym. Here's a breakdown:

2S: “Two-Spirit”—A culturally specific term used by some Indigenous Peoples to describe a person who embodies both masculine and feminine spirits.
L: Lesbian—Women who are emotionally, romantically, or sexually attracted to other women.
G: Gay—Men who are emotionally, romantically, or sexually attracted to other men.
B: Bisexual—Individuals who are emotionally, romantically, or sexually attracted to more than one gender.
T: Transgender—Gender identity differs from sex assigned at birth
Q: Queer—An umbrella term for non-cis, non-hetero identities
Q: Questioning—Exploring gender and/or sexual identity
I: Intersex—A person whose sexual anatomy or chromosomes don't fit the markers of male or female.
A: Asexual—A person who feels little or no sexual attraction to others. Asexuality is a spectrum, and the level of sexual attraction varies from person to person.
+: Plus—Represents all other gender identities and sexual orientations outside cisheterosexual (e.g., nonbinary, pansexual, genderfluid)

Language changes over time and has evolved quickly, so it’s crucial for therapists and coaches to stay informed about this evolving language. Using outdated or pathologizing language can harm the therapeutic relationship.

The Mental Health Impact of Cisheteronormativity

When society treats cisgender and heterosexual experiences as the norm, people outside those norms often feel excluded, unsafe, or othered.

This can take a psychological toll on LGBTQ+ folks and result in

Increased risk of anxiety, depression, and trauma symptoms
Low self-esteem
Social isolation
Barriers to affirming healthcare

These challenges are compounded when identities intersect (e.g., BIPOC, disabled, neurodivergent, or immigrant 2SLGBTQ+ folks).

Affirmative therapy and coaching must acknowledge and support all aspects of identity and the full spectrum of lived experiences.

What Is 2SLGBTQ+ Affirmative Therapy?

2SLGBTQ+ Affirmative Therapy affirms the client’s identity and celebrates diverse expressions of gender and sexuality.

Unlike past harmful practices like conversion therapy (now illegal in Canada) that perpetuate cisheteronormative, 2SLGBTQ+ affirmative therapy:

Affirms sexual and gender identity as valid and worth celebrating
Acknowledges systemic oppression and how it impacts mental health
Creates a space to heal from internalized stigma and identity-based trauma
Promotes therapist humility, by centering the client as the expert and promoting client autonomy and identity exploration
Positions the therapist as a collaborator, not a fixer

This approach creates space for authentic self-expression, self-acceptance, and empowerment.

Neuroqueer: The Intersection of Neurodivergence and Queer Identity

Coined by Dr. Nick Walker in 2008, neuroqueer refers to individuals who identify as neurodivergent and queer.

There is some research to show that ADHD, autism, dyslexia, borderline personality disorder, and other neurotypes intersect with gender and sexuality at high rates.

Research increasingly shows strong overlap:

Autistic people are 3x more likely to identify as trans (Weir et al., 2021)
Autistic people are 8x more likely to identify as asexual (Weir et al., 2021)

The reason for such a strong overlap between neurodivergent and LGBTQ+ identities is not exactly known, but there are some theories to suggest that this intersection may arise because both neurodivergent and queer individuals:

Experience otherness
Challenge societal norms
Are more likely to reject binary or rigid definitions of gender, attraction, or behaviour

These shared experiences of marginalization often build strong community bonds

across neurodivergent and queer spaces.

Given that individuals at the intersection of these identities are at an increased risk of discrimination, mental health issues due to hate, and societal misunderstanding, there is a need for affirming mental health support that understands both identities simultaneously.

What to Expect in 2SLGBTQ+ Affirmative Therapy or Coaching Sessions

A truly affirmative experience will include:

Safety & Consent: Clear confidentiality policies around identity and expression
Inclusive Intake Forms: Open-ended fields for gender, pronouns, and family-structure
Strengths-Based Focus: Building on protective factors you already use to thrive.
Tailored Modalities: CBT, DBT, EMDR, or somatic work, customized for queer experiences
Community Referrals: Trusted trans funds, LGBTQ+ support groups, peer spaces
Celebratory Endings: Sessions that end by honouring reflection, wins, and next steps

Therapy vs. Coaching in 2SLGBTQ+ Affirmative Support

The primary goal of affirmative therapy and coaching is to provide a safe space for 2SLGBTQ+ people to explore their identity and to provide unconditional affirmation of sexual/gender diversity and intersectional identities.

But there are some differences in how each of these is approached.

Therapy	Coaching
Clinical and regulated	Non-clinical and non-diagnostic
Addresses co-occurring mental health challenges, such as anxiety, depression, and trauma.	Cannot use therapeutic modalities to treat complex mental health challenges. Skills based, goal-setting.
Uses therapeutic modalities like DBT, CBT, EMDR, narrative therapy, somatic therapy, and Brainspotting therapy	Uses goal-based strategies, self-advocacy, planning
Often addresses internalized shame, grief, or minority stress	Often focuses on confidence, relationships, advocacy
Psychotherapists and other mental health professionals must be licensed. Regulated by the college in their area.	Coaches are certified but not regulated like therapists

Many people choose to receive a blended model so that they can process past wounds with a therapist and partner with a coach to build skills.

Unique Challenges Faced in 2SLGBTQ+ Therapy

While 2SLGBTQ+ individuals seek help for common issues like anxiety, grief, depression, low self-esteem, or relationship challenges, they often face additional challenges such as:

Family rejection or estrangement
Being outed without consent
Religious or cultural trauma
Internalized shame or self-blame
Identity invalidation
Lack of safe, affirming spaces
Past harm from non-affirming therapists

These intersect with other identities, like race, class, neurotype, disability, and must be supported holistically.

Hallmarks of a 2SLGBTQ+ Affirmative Practitioner

Creating a 2SLGBTQ+ affirmative space isn’t something that happens overnight. It involves the continuous prospect of learning and growing. If you’re a mental health provider or coach aiming to offer affirming care, here are best practices:

Use Inclusive Language: Update forms, bios, and materials to reflect all genders and orientations. Remove binary options.
Celebrate Identity: Don’t just tolerate. Instead affirm and uplift clients’ lived experiences.
Name Oppression: Privilege, and intersectionality should be named explicitly. Don’t ignore systemic issues. Seek to learn and challenge your own biases and deconstruct any internalized cisheteronormative views that you may hold.
Visibly Signal Safety: Display Pride symbols, welcoming signage, and inclusive art indicating your space is affirming.
Collaborate, Don’t Control: Let clients lead their journeys. View the client as the expert on their story. You are a co-pilot, not a gatekeeper.
Pursue Ongoing Education: Be proactive in your learning. Attend workshops, follow queer educators, read current research.
De-pathologize Identity: Do not pathologize sexual orientation and/or gender identity. Language matters. Swap “preferred pronouns” with simply “pronouns.”
Protect Confidentiality: Never out someone without explicit, informed consent.
Client-Led Goals: Sessions hone in on the client's priorities: coming out, navigating faith communities, gender affirmation surgery prep, workplace advocacy.
Respect Boundaries: Don’t rely on clients to educate you. But if your client is willing to provide feed, listen to your clients without defensiveness.
Honour Intersectionality: Be mindful of how race, disability, neurodivergence, and queerness overlap
Respect Lived Experience: Be open to listening to the LGBTQ+ community.

This is not an exhaustive list. Providing affirming care for the 2SLGBTQ+ community is not a mere checkbox system. It involves a continuous practice of learning, listening, and adapting your practice to the needs of the community.

Canadian 2SLGBTQ+ & Neuroqueer Resources

LGBTQ+ Youthline—Text-based peer support for ages 16-29
Pflag Canada—Family and ally education, local chapters nationwide
Trans Lifeline—crisis & micro-grant support by and for trans people
It Gets Better Canada—Story-based empowerment for queer youth

Global and Community-Based Neuroqueer Resources

Sonny Jane & Lyric Rivera—Neuroqueer creators, books, workshops, and consulting
Blue Sky Learning Neuroqueer Group (18+) – A virtual space for LGBTQIA+ and neurodivergent folk.
Rainbow Reading Room (Discord) – A virtual queer book club and community

How Can Blue Sky Learning Support You?

Blue Sky Learning is a neurodiversity-affirming and LGBTQ+-inclusive practice grounded in lived experience, identity, and healing, equity, accessibility, and compassion.

Whether you’re navigating identity exploration, coming out, intersectional trauma, or neurodivergent challenges, our affirming therapists and coaches will walk beside you.