4 Keys to Start Strong in LGBTQ+ Couples Therapy

Working with LGBTQ+ couples and relational clients is deeply rewarding, and also complex. Unlike individual therapy, there are multiple nervous systems in the room, and the relationship itself is the client. When you add the realities of LGBTQ+ identities such as marginalization, safety concerns, systemic oppression, the work becomes even more layered.

A strong start isn’t about winging it; it’s about putting intentional structures in place so you can feel grounded in your leadership. Below are four key areas to focus on when beginning with a new LGBTQ+ couple or relational client.

1. Build the Alliance

The first sessions are all about building trust—both with each partner individually and with the relationship as a whole. You might even say something like, “In this work, I’m on each of your sides—and I’m also on the side of the relationship you’re building together.”

This means creating space for both partners to feel seen and heard, even if one tends to dominate and the other retreats into silence. It also means noticing and naming the larger forces at play, such as homophobia, transphobia, racism, or family rejection. When you name these realities, you signal to clients that you see the context they are navigating and that their challenges don’t exist in a vacuum.

Part of building an alliance is also identifying each partner’s growth edge. You’re not labeling one partner as the “problem.” Instead, you’re helping both partners clarify the ineffective coping strategies they use and preparing them to try something different.

Alliance tips to remember:

• Name systemic realities early and often
  
• Use micro-validations (“That makes sense,” “Thank you for saying that out loud”)
  
• Signal that you’re on each partner’s side and the side of the relationship
  
  

These small but powerful practices can be profoundly healing for LGBTQ+ clients who may not have had this kind of attunement before.

2. Stoke Motivation

Most couples come to therapy because they’re in pain. One of your early jobs is to clarify what they want to be different and why that matters to them. This creates a “North Star” that can guide the work and keep hope alive even when things get hard.

It’s also important not to collude with the protective part of a client. When one partner is angry or withdrawn, it’s tempting to align with their frustration, but that only entrenches stuck patterns. Instead, remind them that focusing on what their partner needs to do leaves them powerless.

You might say:

“If we only talk about what your partner should do, your progress depends on someone you can’t control. Let’s keep your power with you.”

When you help clients connect with the part of themselves that truly wants change, you build momentum for the work ahead.

3. Do a Proper LGBTQ+ Affirmative Assessment

Affirmative assessment begins before the first session. Even your paperwork can set the tone. Intake forms should invite clients to define themselves in their own words, asking open-ended questions about pronouns, identities, or relationship structures. Small shifts in language can communicate inclusion and safety.

In session, explore queer developmental milestones. Ask about their coming-out experiences, early lessons about love and safety, or how gender exploration has shaped them. These conversations give you invaluable context and help clients feel fully seen.

And don’t forget to map resilience. Ask:

• Where do you feel most alive as a couple?
  
• Where do you experience belonging?
  
• What moments of queer joy have you created together?
  
  

Balancing trauma with joy not only builds rapport but also gives you strengths to draw on when sessions get difficult.

Finally, always follow the couple’s lead with language. Use the words they use for their relationship and identities. Remember their pronouns, and if you make a mistake, repair it quickly and move forward. For LGBTQ+ clients, these details are not small—they’re foundational.

4. Set Self-Focused Goals

When therapy feels murky or stalled, it’s often because the goals are other-directed: “I need her to…” or “If only he would…” Self-focused goals are the antidote. They keep clients empowered and focused on their own growth.

Be transparent with clients about why you’re shifting the focus. You might say, “I’m going to help each of you build two skills: learning how to manage your state when you’re triggered, and practicing how to communicate needs clearly without attacking or shutting down. Does that sound like a good place to start?”

From there, work with them to set concrete, actionable goals such as:

• “When I get flooded, I’ll ask for a pause instead of disappearing for a week.”
  
• “When I feel anxious, I’ll tell you I’m craving reassurance instead of shutting down.”
  
  

Normalize that this process takes time. Revisit the goals regularly—not to blame, but to recalibrate. Even small shifts matter when couples are building new relational muscles.

You Don’t Have to Feel Your Way in the Dark

Therapists often feel uncertain at the start of couples work, especially when LGBTQ+ dynamics are involved. The good news is that there are roadmaps.  I teach and use the Bader/Pearson Developmental Model because it orients you to growth edges—differentiation, tolerance for anxiety, the dance between autonomy and connection—and gives you stage-appropriate interventions. It helps you stop chasing content and instead coach process, which is where real change lives.

When you have a framework, you feel more confident, your clients feel more held, and the work becomes more transformative.

Want More Support?

If you're curious about applying the Developmental Model in LGBTQ+ couples work, we've created a free mini-course just for you. In 25 minutes, you’ll learn the foundations of the model and a worksheet you can start using with clients right away.

Access the free mini-course here.

And to go deeper into starting strong with LGBTQ+ couples, check out the companion video on YouTube linked below.

Your care and presence matter. The work you’re doing changes lives.