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From the therapy room

You're not alone: common struggles when you're LGBTQ+, Asian American, a person of color, or all of the above

What our queer, trans, Asian American and other clients of color bring to therapy most often, why it's so common, and what actually helps.

Harry Dixon, MA LPCC #4340 (CA) · LPC #C8199 (OR) · LMHC #LH60684311 (WA) · LMHC #015648 (NY)
· 14 min read

If you're reading this late at night, wondering whether something is wrong with you, I want to start here: you're not alone. The things people of color and queer and trans people struggle with are common, and they have names. Most of them make sense once you see what you've been carrying, and many of our clients carry both. About 1 in 11 U.S. adults (9.3%) now identify as LGBTQ+.1

Below are the struggles our therapists hear about most. Some come from being LGBTQ+, some from being a person of color, and many from living at the meeting point of both. For each one: what it can look like, why it's so common, how it can show up for Asian American clients and other clients of color, and what helps. Skim to the one that sounds like you.

Depression that doesn't lift

What it can look like

Why it's so common

In a national U.S. health survey, 49% of lesbian, gay, bisexual and other sexual minority adults screened positive for depression, compared with 20% of straight adults.2 Racism takes its own toll on the mental health of people of color, too. Neither is because something is wrong with who we are. It's because many of us spent years hiding, bracing for rejection, being treated as less than, or losing people we love. Sometimes depression is also covering a question about who we are that hasn't had room to come up yet.

For Asian American & other clients of color

In many families, depression isn't something you talk about. You keep it together, keep achieving and don't burden anyone. That can mean struggling for years before anyone, including you, calls it depression.

What helps

We get curious about the depression instead of only fighting it: what it's protecting, what it's been carrying, what it might be pointing toward. Read about LGBTQ+ depression therapy →

Anxiety and always being on guard

What it can look like

Why it's so common

If you grew up needing to watch what you said, how you moved or who you looked at, or how people might react to your skin, your name or your accent, your nervous system learned to stay on alert. That made sense then. The trouble is it often stays switched on long after you're safer, and it can turn into social anxiety, generalized anxiety or panic. In the same national survey, 44% of sexual minority adults screened positive for anxiety, compared with 16% of straight adults.2

For Asian American & other clients of color

Many of our clients switch between versions of themselves all day: one for family, one for work, one for queer friends. Code-switching takes constant energy, and the worry about the worlds colliding can drive a lot of anxiety.

What helps

We help your body learn that it can settle, using tools from CBT, ACT and mindfulness, while also making room for the parts of you the anxiety has been working so hard to protect. Read about LGBTQ+ anxiety therapy →

Minority stress: the tiredness you can't explain

What it can look like

Why it's so common

Psychologist Ilan Meyer named this minority stress:7 the extra, ongoing stress of living as a stigmatized minority. It isn't only the big events like harassment or rejection. It's also the constant low-level watching and bracing. Over years, that load adds up, and it helps explain why LGBTQ+ people report higher rates of anxiety and depression. The struggle comes from the stress, not from being queer.

For Asian American & other clients of color

Many of our clients carry two kinds of minority stress at once: being queer or trans, and being a person of color. Racism in straight spaces and homophobia in their own communities can mean there's no room where they fully relax. In one national survey, 54% of Asian American and Pacific Islander LGBTQ+ young people said they'd faced racial discrimination in the past year.3 Naming both is often the first relief.

What helps

Therapy gives the bracing a name and a place to set it down. We look at where you're on guard, where you can let it go, and how to build places in your life where you don't have to scan the room. Read about LGBTQ+ trauma therapy →

Internalized homophobia and transphobia: when the critic is inside your head

What it can look like

Why it's so common

Most of us grew up hearing what was wrong with people like us long before we knew we were one of them. Those messages don't leave when you come out. They move inside and start to sound like your own thoughts. Having them doesn't mean you're not proud. It means you were paying attention as a kid.

For Asian American & other clients of color

For many clients of color, the critic speaks in a parent's voice, or in the language of their faith or culture: "this is a white thing", "this isn't who we are". It can feel like accepting yourself means rejecting your family or your heritage. It doesn't have to.

What helps

We learn to notice the critic, ask whose voice it really is, and answer it with something kinder and truer. Self-compassion work and acceptance-based therapy help a lot here. Read about LGBTQ+ therapy →

Coming out and family rejection

What it can look like

Why it's so common

Coming out isn't one conversation. It's something queer and trans people do over and over, with every new job, doctor and neighbor. Each time, there's a small risk of losing something. When the people who react badly are family, the loss can shape everything that comes after.

For Asian American & other clients of color

Coming out to immigrant parents can mean doing it across a language gap, with no shared words for what you're trying to say. It can also mean weighing what it will cost them in their own community. That's a lot to hold, and it deserves more than "just tell them". Among Asian American and Pacific Islander LGBTQ+ young people, 41% weren't out to at least one parent, compared with 29% of LGBTQ+ young people overall.3

What helps

You decide what's next, on your own timeline. We help you sort out what you want, who's safe, and how to take care of yourself whatever the reaction. You don't have to have it all figured out to start. Read "You don't have to have it figured out to walk in" →

Cultural shame and family duty: "me or my culture?"

What it can look like

Why it's so common

In many Asian American and immigrant families, love is shown through duty, sacrifice and keeping the family's good name. Filial piety, the expectation to honor and care for your parents, can be a real source of strength. It can also make coming out feel like a betrayal. Many clients aren't choosing between being queer and being happy. They feel they're choosing between themselves and the people they love most. Only 1 in 5 Asian American and Pacific Islander LGBTQ+ young people (20%) report high support from family, and those who have it have 40% lower odds of attempting suicide.3 Family acceptance matters, and so does finding support when it isn't there.

For Asian American & other clients of color

A therapist who doesn't know this world may push you to "set boundaries" or "just tell them". A therapist who does will understand why that advice can feel impossible, and help you find a path that keeps both your identity and your family in the picture.

What helps

We don't ask you to pick a side. We sort out which family values you want to keep, which ones were never yours, and how and when (or whether) to talk with family. Read about Asian American therapy →

More on this in my post Beyond saving face: LGBTQ+ identity in Asian American families.

Religious trauma

What it can look like

Why it's so common

Many LGBTQ+ people were raised in communities that taught them, directly or quietly, that who they are is sinful or broken. Some were sent to pray it away or to conversion practices: an estimated 698,000 LGBT adults in the U.S. have been through conversion therapy, about half of them as teenagers.4 Leaving, or staying and being hidden, both come with real grief.

For Asian American & other clients of color

For many immigrant families and communities of color, the church or temple is also where language, food, friends and family life happen. Stepping away from faith can mean stepping away from community and culture too. In a national survey, 55% of Asian American and Pacific Islander LGBTQ+ young people said someone had tried to change their sexual orientation or gender identity. Of those who went through conversion therapy, 61% said their own religious leader led it.3

What helps

We don't tell you what to believe. We help you separate the fear and shame you were taught from what you actually value, so you can decide what faith, if any, looks like for you now. Read about religious trauma therapy →

Gender dysphoria and transition stress

What it can look like

Why it's so common

Since 2016, I've worked with trans and nonbinary clients at every point: questioning, early transition, years after, and choosing not to medically transition at all. What I've learned is that a lot of the pain isn't about gender itself. It's about living in a world that makes it hard to be seen, and about the gatekeeping and waiting that come with getting care. Fewer than 2 in 5 trans and nonbinary young people (38%) say their home is gender-affirming.5

For Asian American & other clients of color

Trans and nonbinary clients of color often face racism inside trans spaces and transphobia inside their own communities, along with family expectations about gender roles that can be very fixed. Finding care that understands all of that can take a long time.

What helps

Gender-affirming therapy follows your lead. It's a place to explore, plan and cope, not to prove anything. If you're seeking gender-affirming surgery, Harry Dixon also offers evaluations for clients in California, Oregon and Washington. Read about transgender & nonbinary therapy →

Loneliness, dating apps and chosen family

What it can look like

Why it's so common

Many LGBTQ+ people lose some family or old friends when they come out, and the apps and bars that fill the gap aren't built for deep friendship. Loneliness isn't a personal failing. It's often what happens when the usual ways of belonging weren't made for us.

For Asian American & other clients of color

"No fats, no femmes, no Asians." Many of our clients have seen versions of that on dating profiles. Being rejected or fetishized for your race on the apps can make queer spaces feel lonely too.

What helps

We look at what's getting in the way of connection, work on the hurt from past rejection, and help you build chosen family at a pace that feels safe. Read about the power of community →

Body image

What it can look like

Why it's so common

Some queer spaces, especially among gay and bi men, put a lot of weight on how bodies look. Add the bodies we see online and the pressure to "pass", and it's easy to feel you're never enough. If food, eating or exercise feels out of control, an eating disorder specialist is an important part of care alongside therapy.

For Asian American & other clients of color

Beauty standards in many queer spaces are built around white bodies. Clients of color often describe feeling invisible, or wanted only as a type, which can make body image struggles even heavier.

What helps

We work on where these standards came from, how they live in your body, and how to treat your body with more kindness and less scrutiny. Read about LGBTQ+ therapy →

Relationship strain

What it can look like

Why it's so common

Queer couples get fewer models for how relationships can work, and fewer people who support them through hard times. Many of us are also building relationships while still healing from what we went through growing up.

For Asian American & other clients of color

Intercultural couples can have very different ideas about family duty, money, holidays and how much to share with relatives. When one partner's family doesn't accept the relationship, both partners feel it.

What helps

Couples therapy gives you both a place to slow down, hear each other and find new ways through old patterns, with a therapist who doesn't need your relationship to look like anyone else's. Read about couples therapy for LGBTQ+ couples and couples of color →

ADHD that was missed

What it can look like

Why it's so common

Many LGBTQ+ people got good at masking early: hiding who they were to stay safe. That same skill can hide ADHD for years. Anxiety or depression is often what brings people in, and the ADHD underneath gets missed.

For Asian American & other clients of color

In families where struggling in school meant you just needed to try harder, ADHD can go unnamed for a long time. Some clients also worry a diagnosis will be seen as a weakness or a label that reflects badly on the family.

What helps

Therapy can help you understand how your brain works, drop the shame, and build systems that actually fit you. We don't prescribe medication, but we can work alongside a prescriber if you have one. Read about ADHD therapy →

Sex and intimacy worries

Worries about sex are very common and hard to talk about: trouble with erections, low or mismatched desire, pain, or shame that shows up during or after sex. For many LGBTQ+ people, those worries are tied to everything above, from religious messages to body image to old fears about being found out. Sex therapy with an AASECT Certified Sex Therapist is a place to talk about them openly, without judgment. Read about gay & queer sex therapy →

Racism in queer spaces

What it can look like

Why it's so common

Queer spaces aren't free of racism just because they're queer. Many of our clients describe never fully belonging anywhere: not with family, not in mostly white LGBTQ+ spaces, and not always in their racial or cultural communities either. Research shows how the two stack up. LGBTQ+ young people of color who faced no discrimination in the past year had a suicide attempt rate of 6%. With one kind of discrimination, it rose to 15%. With both racism and anti-LGBTQ+ discrimination, it was 24%.6 That kind of in-between can be lonely and exhausting, and it often goes unnamed in therapy with someone who hasn't lived it.

What helps

You shouldn't have to explain your whole world before therapy can start. Working with therapists who understand being queer and a person of color means you can bring all of yourself from the first session. Read "Lost in Translation" →

When it's time to reach out

You don't need a crisis, or the right words, to start therapy. It may be time if:

Our therapists are LGBTQ+ clinicians and clinicians of color who see clients online. Harry Dixon is licensed in California, Oregon, Washington State and New York. Amelia Choi Freeman, MA, Registered Associate Professional Clinical Counselor (Registration No. APCC #23278), supervised by Harry Dixon, LPCC #4340, and employed by Rainbow Connection Counseling Collective, sees clients in California only. Her work centers women of color, Asian Americans and children of immigrants. Read more about our values and how we work.

Figures marked "young people" are about ages 13 to 24.

  1. Gallup, LGBTQ+ Identification in U.S. Rises to 9.3% (2025, 2024 data).
  2. Miller et al., Depression and Anxiety Among Sexual Minorities in the United States, Cureus 16 (2024); data from the CDC's 2022 National Health Interview Survey, 26,311 adults.
  3. The Trevor Project, The Mental Health and Well-Being of AAPI LGBTQ Youth (2022).
  4. Williams Institute, UCLA School of Law, Conversion Therapy and LGBT Youth: Update (2019); adults ages 18 to 59.
  5. The Trevor Project, 2024 U.S. National Survey on the Mental Health of LGBTQ+ Young People.
  6. The Trevor Project, The Intersectionality of Discrimination and the Mental Health of LGBTQ+ Young People of Color.
  7. Minority stress: Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697.

Related on our site: LGBTQ+ therapy · Asian American therapy · Depression therapy · Anxiety therapy

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Harry Dixon, MA, LPCC #4340 (CA) · LPC #C8199 (OR) · LMHC #LH60684311 (WA) · LMHC #015648 (NY), is the founder of Rainbow Connection Counseling Collective and a Certified Sex Therapist (CST), a certification rather than a state license.

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