Prioritizing Accessible 2SLGBTQIA+ Affirming Care: How My Practice Supports the Trans* and Queer Community

Why Accessible, Low-Cost Therapy Matters

Mental health care is often inaccessible to those who need it most, especially in marginalized communities where financial and systemic barriers make it seem like an unattainable luxury. For trans*, queer, and disabled individuals like myself, the process of securing adequate support can be fraught with challenges. I know this not just as a therapist, but as someone who’s lived through the experience of being denied equitable access to care. My own story of underemployment, systemic discrimination, and the struggle to find affordable mental health services shapes the foundation of my practice today.

When I was underemployed and struggling to access therapy, I realized that mental health care should not be treated as a luxury—it is a basic human necessity. Being unable to afford treatment, particularly for those of us who are already marginalized by our gender identities, sexual orientation, or disabilities, compounds the emotional toll of isolation, discrimination, and trauma. Queer Body Power (Dennis, 2022) powerfully highlights how economic precarity disproportionately affects queer and trans* people, making access to basic services, including mental health support, a daunting challenge (p. 46). My personal experiences reflect this broader reality, so I’ve chosen to dedicate 30% of my practice to providing low-cost therapy.

This commitment is not just about accessibility; it’s about creating an affirming, supportive space for those who need it most. Offering low-cost therapy means breaking down the financial barriers that prevent marginalized people from accessing mental health care. But it goes beyond affordability—it’s about ensuring that the care offered is grounded in anti-oppressive and non-pathologizing practices. I recognize that many individuals from marginalized communities have had negative experiences with healthcare systems that have pathologized their identities or failed to address their specific needs. As Moon and Barker (2021) aptly state, “LGBTQ individuals seek support from practitioners who understand not only our identities but also the larger systems of oppression that shape our lived experiences” (p. 12). This understanding is at the core of my approach.

For me, offering low-cost therapy is a way to give back to the trans* and queer communities that supported me when I was navigating the complexities of my identity and mental health. In creating a practice that centres marginalized voices and experiences, I aim to provide care that is both accessible and affirming, because no one should be excluded from therapy due to financial barriers. It’s about creating a space where healing is available to all, regardless of socioeconomic status.

Expanding my practice to dedicate 30% of available time to sliding scale therapy also challenges the notion that mental health care is something only a select few can afford. By increasing accessibility, we can begin to address the deeply entrenched inequalities within healthcare systems, which often leave marginalized individuals to navigate their mental health alone. As Relationally Queer (Moon & Barker, 2021) illustrates, access to affirming mental health care is crucial for queer individuals who are navigating systemic oppression (p. 37).

From Underemployment to Building an Inclusive Therapy Practice: A Personal Journey

Coming out as trans* and queer marked a significant chapter in my life, one that was filled with personal discovery but also immense hardship. As I navigated underemployment, I found it nearly impossible to access consistent, quality mental health care. Discrimination, both overt and subtle, became a barrier to my professional growth. I experienced firsthand how systemic transphobia and ableism can keep qualified individuals like me from entering their chosen fields. As Essie Dennis (2022) poignantly notes, “Economic instability disproportionately affects marginalized groups, especially queer and trans people, making access to basic needs, including mental health care, extremely difficult” (p. 46). This instability was not just a theoretical concept; it was my lived reality.

At the time, I was trying to reconcile the deep emotional and mental toll of living authentically with the very real economic barriers I faced. Without a steady income, accessing mental health services was an uphill battle. Many mental health practitioners I encountered either didn’t fully understand my needs as a trans* and queer person, or they provided services that were unaffordable. Finding affirming care was a struggle. This is a reality that many trans* and queer individuals face when seeking therapy, and it’s one of the reasons I’m so committed to creating a practice that meets those needs today.

Those experiences of exclusion and economic hardship were formative in shaping how I built my practice. I wanted to create a space where people like me—those who had been turned away from traditional systems of care or couldn’t afford the rising costs of therapy—could find not only accessible services but also affirming, anti-oppressive support. I didn’t want others to have to navigate the same barriers I did. As Moon and Barker (2021) state, “LGBTQ individuals often struggle to find practitioners who can offer the kind of relational, non-pathologizing care that addresses both their identity and the intersecting systems of oppression they face” (p. 37). This understanding has been a cornerstone of my practice.

Starting my online practice has allowed me to center the needs of trans*, queer, and marginalized communities in ways that traditional therapy models often fail to do. I recognized that being able to build my practice was a privilege, supported by the community around me—friends, fellow practitioners, and allies who helped me navigate the complexities of underemployment and discrimination. Without this support, the path to self-employment and building a sustainable therapy practice would have been far more difficult. This is why the concept of “by us, for us” is so central to my work. I wanted to create a practice that reflected the values and needs of our community, offering a model of care that not only understands but also celebrates the unique experiences of trans* and queer individuals.

It was essential for me to not only create a space for healing but to give back to the community that stood by me when I needed it most. The idea of reciprocity is deeply rooted in the way I approach my work. My experiences with underemployment, systemic discrimination, and the lack of accessible, quality care all contribute to the heart of my practice today. I aim to provide more than just therapy—I strive to offer a space of validation and empowerment for those who have long been overlooked by traditional healthcare systems.

Now, as a fully established therapist with a thriving online practice, I focus on accessibility and inclusion. My story informs every decision I make in my practice, from dedicating 30% of my schedule to low-cost therapy to ensuring that my services are culturally and therapeutically aligned with the values of anti-oppressive care. I am committed to creating a safe, affirming space for those who are often pushed to the margins—because I know what it feels like to be there.

Why 30% of My Practice is Reserved for Sliding Scale Clients

In most private practices, only around 5% of therapy sessions are reserved for sliding scale clients. This is the standard recommendation in the field, but I knew early on that this wouldn’t be enough to address the needs of the trans* and queer community. In my practice, 30% of available sessions are reserved for low-cost therapy. This isn’t just a number—it reflects the very real demand for accessible mental health services among marginalized communities, particularly those facing the compounded challenges of economic hardship and systemic discrimination.

For many trans* and queer individuals, economic barriers are one of the largest obstacles to accessing mental health care. Employment discrimination, wage disparities, and the additional financial burdens associated with being part of a marginalized group all contribute to this reality. As Essie Dennis (2022) highlights, “Economic instability disproportionately affects marginalized groups, especially queer and trans people, making access to basic needs, including mental health care, extremely difficult” (p. 46). This is why offering a larger percentage of low-cost therapy slots in my practice is essential—it meets people where they are and offers them a chance to heal without the added stress of financial strain.

But it’s not just about economic accessibility; it’s about ensuring that those who need the most support can access therapy from experienced practitioners who are well-versed in anti-oppressive and non-pathologizing care models. The people who often need sliding scale therapy are those navigating the complex intersections of marginalization, discrimination, and trauma. These individuals are not simply looking for someone to talk to—they are seeking therapists who understand their unique lived experiences and can provide affirming, trauma-informed care.

Many of my clients are survivors of systemic violence, whether that be through transphobia, homophobia, racism, or other forms of oppression. The lasting effects of this violence don’t just disappear—they shape a person’s mental health, relationships, and sense of self. As Fisher (2021) explains, “The effects of trauma are long-lasting, and the legacies of violence and discrimination often continue to impact survivors long after the events themselves have passed” (p. 28). For these clients, therapy must be a space where their trauma is acknowledged, their identities are affirmed, and the therapist understands the broader systems that have contributed to their struggles.

The choice to reserve 30% of my practice for sliding scale clients is rooted in this understanding. It acknowledges that many people facing the most significant barriers to care—economic, social, and psychological—also require the highest level of expertise and compassionate support. These are the individuals who benefit most from therapists who can hold space for their full humanity, including their intersecting identities and the compounded traumas they carry. As Moon and Barker (2021) point out, finding a therapist who understands both your identity and the systemic oppressions that impact your mental health can be life-changing (p. 37).

By offering low-cost therapy to 30% of my clients, I’m not just addressing an economic need—I’m addressing a systemic one. Mental health care is a fundamental right, and it’s vital that we, as therapists, make space in our practices to support those who face the greatest barriers to receiving care. Until we see significant changes in how our healthcare systems prioritize mental health—alongside other essential services like dentistry and long-term care—we must step up. This is why my practice is structured the way it is: to ensure that those who need affirming, trauma-informed care have access to it, regardless of their financial situation.

Together, We Can Offer More Low-Cost Resources for the Community

Even with 30% of my practice reserved for sliding scale clients, I recognize that the need for affordable therapy often exceeds what one practice can offer, particularly within the trans* and queer communities. This is why I’ve made it a priority to provide additional low-cost mental health resources on my website, connecting individuals to other valuable options throughout Canada. These resources are vital in bridging the gap, offering support for those navigating financial constraints while seeking affirming, anti-oppressive care.

Qmunity: Navigating Waitlists for Affirming Support

Qmunity, a Vancouver-based LGBTQ2SAI+ organization, offers low-cost and free counselling services, providing an invaluable resource to those unable to afford full-cost therapy. Their low-cost program includes ten sessions ranging from $60 to $120, depending on individual circumstances. While this service provides access to Registered Clinical Counsellors and Registered Social Workers trained in LGBTQ2SAI+ competency, the demand is high, leading to long wait times. Signing up for their free program can result in waitlist times between six to eight months, while the low-cost counselling waitlist often sees a three-month delay before appointments become available.

For many clients, the wait can feel insurmountable. However, the value of Qmunity’s services lies in its culturally competent, non-judgmental approach to mental health care. These counsellors are trained to create safe, productive spaces where clients can explore their identities and the life changes they’re working through. As Moon and Barker (2021) remind us, “For many LGBTQ individuals, finding a therapist who not only understands their identity but also offers a non-pathologizing approach can be life-changing” (p. 37). Qmunity’s services, although limited by capacity, offer that crucial affirming support.

Catherine White Holman Wellness Centre: Free Services for Trans and Nonbinary Individuals

The Catherine White Holman Wellness Centre offers essential, community-based mental health services, free of charge, to all Two-Spirit, transgender, and gender non-conforming individuals in British Columbia. Their focus on hormone and surgery readiness assessments helps trans* individuals gain medical access to hormone replacement therapy (HRT) and gender-affirming surgeries, a critical service for many in the community.

This trans-led wellness centre provides a safe and welcoming environment where individuals can access necessary care without the financial burden that often accompanies private health services. Their work is particularly valuable in addressing the needs of trans* individuals who may not have the financial means to access private assessments for gender-affirming care. The availability of free services at Catherine White Holman Wellness Centre speaks to the importance of community-led initiatives in ensuring that mental health care remains accessible, particularly in provinces like British Columbia.

Vancouver Black Therapy & Advocacy Foundation: Culturally Competent, Affordable Care

For Black Canadians, particularly those navigating the intersections of race, gender, and mental health, accessing culturally competent care can be a challenge. The Vancouver Black Therapy & Advocacy Foundation (VBT&AF) offers both free and low-cost counselling services tailored to Black individuals and families. Their free counselling program provides recipients with ten sessions, connecting them to an all-Black team of therapists. VBT&AF prioritizes those who identify as low-income, 2SLGBTQIA+, new to therapy, or living with disabilities, ensuring that marginalized members of the Black community have access to vital mental health support.

In addition to their free program, VBT&AF also offers a low-cost initiative launched in 2023, operating on a sliding scale from $60 to $120 per session. This initiative aims to break down barriers to accessing mental health care, particularly for Black individuals facing systemic oppression. The culturally competent care provided by VBT&AF ensures that clients are working with therapists who understand the nuances of their lived experiences, which is a crucial factor in trauma-informed, anti-oppressive therapy. As Dennis (2022) writes, “Marginalized groups, especially queer and trans people, face systemic challenges that make access to mental health care even more difficult” (p. 46). By providing affordable, culturally responsive therapy, VBT&AF helps dismantle those barriers.

Inclusive Therapists: A Safer, Simpler Way to Find Care

Inclusive Therapists is another valuable resource for those seeking culturally responsive, 2SLGBTQ+ affirming therapy. This platform aims to simplify the process of finding mental health care for people in marginalized communities, particularly for those whose identities and experiences have often been misunderstood or pathologized by traditional healthcare systems. Inclusive Therapists offers a directory of therapists who celebrate the full identities of their clients, providing care that is affirming, inclusive, and trauma-informed.

For individuals seeking low-cost options, this platform is an excellent starting point. By connecting clients with therapists who align with their cultural, gender, and sexual identities, Inclusive Therapists helps reduce the emotional labour that often comes with searching for a therapist who “gets it.” It is crucial that therapy spaces feel safe, affirming, and validating—spaces where clients don’t need to explain or justify their identities before diving into the work of healing.

While these resources are essential, they come with limitations. Many are bound by waitlists or capped sessions, reflecting the overwhelming need for accessible mental health care in marginalized communities. The demand far exceeds what any single organization—or even multiple organizations—can provide. This is why it’s so important for therapists, like myself, to dedicate a portion of our practice to sliding scale clients, ensuring that we’re doing our part to meet the growing need for affordable, affirming care. As Moon and Barker (2021) emphasize, creating spaces where clients can access non-pathologizing, affirming mental health care is essential in supporting their overall well-being (p. 59).

The Need for Experienced Practitioners in Low-Cost Therapy

Trans* and queer individuals, especially those who have faced systemic oppression and marginalization, deserve access to therapy that meets the complexity of their experiences. Navigating daily discrimination—whether in the workplace, social spaces, or within healthcare systems—can create layers of trauma that require a deep understanding of both identity and the broader forces at play. Working with an experienced therapist becomes essential, not just for surface-level support, but for facilitating meaningful healing, growth, and change.

One of the key challenges that marginalized communities face is the impact of compounding trauma. As Janina Fisher (2021) notes, “Working with trauma requires an understanding of how oppression and marginalization can compound the psychological effects of traumatic experiences” (p. 46). This highlights why seasoned practitioners are necessary—they possess the clinical expertise and nuanced understanding of how systemic forces, like racism, transphobia, and ableism, intersect with personal trauma.

Therapists with lived experience, especially those who are trans* or queer themselves, bring an additional layer of empathy and understanding to their work. Clients often seek out practitioners who not only understand their struggles clinically but can also relate to them on a personal level. Lived experience offers a vital bridge of connection in therapy, creating a space where clients feel truly seen and understood, which is foundational to the therapeutic process. This is why it’s essential for low-cost therapy to include options for experienced therapists who have the skills and empathy to navigate the complex terrain of trauma, oppression, and identity.

For many clients, particularly those from marginalized backgrounds, the therapist’s role is not just about offering support—it’s about holding space for the client’s full humanity in a world that often denies them that recognition. Student therapists and practicum placements can provide valuable care, but when someone is grappling with trauma that intersects with their marginalized identity, they need more than a generalist approach. They need someone who can hold the weight of their lived experience with the necessary clinical expertise to guide them toward healing.

Consider, for example, a trans* client who has experienced repeated medical discrimination or a queer individual facing workplace harassment. Both may carry deep layers of internalized oppression, compounded by the day-to-day realities of navigating a world that does not fully accept them. As Moon and Barker (2021) explain, the therapist’s role is not just to help clients process their individual experiences, but to recognize and address the broader systems of oppression that impact their mental health (p. 37). Experienced practitioners are better equipped to do this in a way that is both affirming and healing.

For these reasons, my practice is committed to ensuring that experienced practitioners are available for low-cost therapy. Offering anti-oppressive care means recognizing that clients need more than someone who is simply well-intentioned—they need someone who has the lived experience, training, and clinical expertise to navigate the complex layers of their identity and trauma. Until our healthcare systems fully address the disparities in access to mental health services, it’s critical that we, as experienced therapists, step forward to offer accessible, expert care.

In making space for seasoned therapists to provide low-cost therapy, we are ensuring that clients receive the care they deserve—care that is grounded in a deep understanding of identity, trauma, and systemic oppression. This approach not only fosters healing but empowers clients to move toward a place of self-acceptance, resilience, and growth.

A Call to Action: More Experienced Practitioners Offering Sliding Scale

The need for affordable, affirming therapy for trans* and queer folks is growing at a rate we can no longer afford to ignore. This is not just a call for compassion—it’s a call for action. To my colleagues in the field, especially those of us who are trans* and queer, I urge you to step up. Dedicate more of your practice to sliding scale or low-cost therapy. We are in a unique position to offer both lived experience and clinical expertise, and now more than ever, our community needs us.

Each of us has the capacity to make a difference, whether by setting aside a larger portion of our schedule for low-cost clients, collaborating with organizations that serve marginalized communities, or simply ensuring that our work is rooted in anti-oppressive care. We need to create more spaces where our communities can access mental health care that is not just affordable, but also deeply affirming and attuned to the lived realities of trans* and queer individuals.

As Moon and Barker (2021) remind us, “We must create spaces where clients can access mental health care that is not only affordable but also deeply affirming of their identities and experiences” (p. 59). This is about more than providing a service—it’s about being part of a movement. A movement where our community can turn to us, knowing they will be met with understanding, respect, and a commitment to their healing.

Until Canada’s healthcare system treats mental health as a fundamental right for all, especially for marginalized groups, it is on us to fill the gap. We must be willing to offer the kind of care that uplifts, heals, and empowers. For too long, trans* and queer individuals have been overlooked or pathologized by systems that were never designed with us in mind. Now is the time for us, as experienced practitioners, to change that narrative.

If you’re a therapist reading this, I invite you to lean in and reflect: How can you contribute to making mental health care more accessible for trans* and queer folks? Whether it’s offering more sliding scale slots, volunteering with community organizations, or collaborating with other practitioners, there is so much we can do—together. Let’s act. Let’s be the ones who build the affirming, anti-oppressive spaces that our communities need and deserve.

The time to step up is now. Together, we can ensure that trans* and queer individuals receive the therapy they need with the lived experience and clinical expertise they deserve. Because healing is not a privilege—it’s a right.

Conclusion: A Commitment to Accessible, Affirming Care

Providing low-cost therapy is not just an act of service—it’s a personal commitment to giving back to the trans* and queer community that has been my lifeline. I believe that mental health care should be a right, not a privilege. No one should be denied support simply because they can’t afford it. As Dennis (2022) beautifully puts it, queer empowerment is about “having access to the resources we need to live full, authentic lives” (p. 101). It’s about more than just survival—it’s about thriving.

By dedicating 30% of my practice to sliding scale therapy and actively connecting my clients to other affordable resources, my hope is to create a ripple effect. Together, we can ensure that those who are often pushed to the margins have access to affirming, anti-oppressive care that honors their lived experiences. My commitment is to create spaces where healing is not just possible, but where it’s encouraged, supported, and celebrated.

It is through this dedication that I aim to build a community of care—one that helps people move beyond mere survival into spaces of empowerment and growth. Let’s continue to build this together, because every individual in our community deserves the chance to thrive.

Let’s Continue the Conversation

If the ideas in this blog resonate with you, I warmly invite you to connect with me. Whether you’re a therapist seeking guidance on providing accessible care or someone navigating mental health challenges and looking for support, I’m here to help. You may book individual therapy sessions or peer consultations online. Be sure to bookmark this blog for future insights, reflections, and updates.

References

Dennis, E. (2022). Queer body power: Finding your body, your joy, and yourself. Jessica Kingsley Publishers.

Fisher, J. (2021). Transforming the living legacy of trauma: A workbook for survivors and therapists. PESI Publishing & Media.

Moon, L., & Barker, M. (2021). Relationally queer: Radical, sexual, and gender politics in therapy. Routledge.