From Silence to Self: Therapy, Shame and the Lives of LGBTQ+ Clients

In the quiet of the therapy room, something powerful can happen, not always loud or dramatic but something deeply felt. A shift. A softening. The relief of being understood without needing to explain every part of yourself. For many LGBTQIA+ people, this feeling is rare — and when it happens, it matters.

As a therapist who works affirmatively with LGBTQIA+ clients, I often sit with people who are navigating the long echo of experiences that left them feeling unsafe, ashamed or unseen. Sometimes those experiences are easy to name; bullying, rejection, trauma. Other times, they're harder to put words to: the everyday effort of hiding parts of yourself, the slow drip of invalidation, the silence in spaces that should have offered care. These aren’t just personal struggles, they’re reflections of something wider.

I work in a way that is not just inclusive but actively affirming of LGBTQIA+ identities, honouring the full range of gender, sexuality and expression my clients bring.

Recent UK research continues to highlight what many of us already know. LGBTQIA+ people, particularly trans and non-binary individuals face significantly higher rates of mental health difficulties than the general population. According to the LGBTQ+ Mental Health Review (2024) by MindOut, LGBTQIA+ people are more than twice as likely to experience depression and anxiety. A study by Stonewall (2023) found that 52% of LGBTQ+ individuals had experienced suicidal thoughts in the past year, rising to 67% among trans respondents. Non-binary people were found to be nearly five times more likely to live with long-term mental health conditions compared to their cisgender peers.

These numbers are sobering, but they mirror what I see in the therapy room every day.

These aren’t just statistics, they’re stories. And in therapy, I’m interested in the story. I work from a person-centred experiential perspective, which means I don’t bring a set programme or agenda to the room. Instead, I bring myself alongside curiosity, care and a belief in the value of meeting people where they are. That approach matters, especially when working with LGBTQIA+ clients. Because so often, what’s needed is not a fix or a formula, it’s a relationship that says: I see you. I’ll stay with you. Let’s make sense of this together.

For many, shame is part of the story. Not as a flaw but as a survival strategy, something learned through years of being told, directly or indirectly, that they were wrong or too much or not enough. This kind of shame isn’t abstract. It lives in the body. It shows up as anxiety, hyper-vigilance and disconnection.

Research from the University of Liverpool (2021) identified internalised shame as a significant contributor to poor mental health outcomes among LGBTQ+ adults, particularly those who had experienced homophobic bullying during adolescence. It can be hard to unpick and harder still to trust that there’s something on the other side of it.

Therapy, at its best, makes space for that trust to grow. It offers something that LGBTQIA+ people are too often denied: an experience of being met without judgement. It’s not about putting people into boxes or chasing diagnostic labels, though those things can have their place. It’s about listening, really listening to what the person in front of me needs.

There’s something deeply healing in being allowed to show up as you are. To say what hurts. To not have to defend or justify your existence.

In my own academic research, I explored literature on the therapeutic experiences of LGBTQ+ clients, particularly in relation to shame, identity and the value of person-centred therapy. What emerged across the studies was clear: the importance of being truly seen and understood cannot be overstated. One client once said to me, "It was the first time I didn’t have to explain who I was before I could talk about how I felt." That line captures so much, the weight that many carry, and the difference it makes to be met with openness from the start.

And while this blog isn’t about my personal therapy journey, I do know what it feels like to be met in a way that brings relief. That kind of presence changes people, not overnight but slowly, gently. In therapy, it’s not uncommon to hear someone say, "I’ve never said this out loud before" or, "I didn’t know I was allowed to feel that."

This is what therapy can offer: not a promise to erase pain but a space to be with it, to make sense of it slowly in a way that honours the person you are. For LGBTQIA+ clients, this isn’t a luxury. It’s often a lifeline.

So if you’re reading this and wondering whether therapy might help, whether it’s too late or too early or whether your pain is "enough", please know: you deserve to be met with care.

You deserve to be heard.

And if you’d like to explore that with me, I’m here.