When Therapy Misses the Mark: How Mainstream Therapy Often Fails Marginalized Clients

Mainstream therapy often presents itself as a one-size-fits-all approach — but when it comes to working with marginalized clients, that approach can fall painfully short. In our recent episode of My Therapist is Out!, I sat down with therapist Ernesto Martinez (he/they) to discuss the ways mainstream therapy can fail LGBTQ+ and BIPOC clients — and how we can move toward more inclusive, affirming care.

The Problem with Identity-Blind Therapy

One of the biggest issues we see in mainstream therapy is the identity-blind approach. This is the idea that a therapist can treat everyone the same, without considering race, gender identity, sexual orientation, or cultural background. While this might sound like equality, it often leads to erasure. The therapist can be telling themselves they are using a “person-centered” approach –but that doesn’t mean that they actually are taking the time to decolonize their own biases enough to do so.

If a therapist ignores the lived experiences of marginalized clients, they miss the vital context that shapes those clients’ mental health. Systemic oppression, discrimination, and intergenerational trauma all impact well-being — and therapy that doesn’t acknowledge those realities risks misdiagnosis and harm.

Reflection Question: Has your therapist ever dismissed or overlooked your identity when discussing your mental health? How did that make you feel?

Power Dynamics in Therapy Spaces

Therapy is often seen as a space for vulnerability — but that’s only possible when clients feel safe. Ernesto shared how mainstream therapy often replicates harmful power dynamics. When therapists position themselves as the expert and clients as passive recipients of care, it leaves little room for collaboration.

For marginalized clients, this can mirror the same imbalances they face in society. Therapists who fail to acknowledge their own privilege or who dismiss cultural knowledge can unintentionally reinforce systems of oppression in the very space meant for healing.

Reflection Question: Do you feel empowered in your therapy sessions? Are your therapist’s methods collaborative, or do they feel one-sided?

The Danger of Pathologizing Difference

Mainstream mental health care is often rooted in Western, white, cisnormative perspectives. This can lead to the pathologizing of behaviors and coping mechanisms that are deeply tied to cultural survival and resistance.

For example, someone’s guardedness around authority figures may not be “paranoia” but a reasonable response to lived experiences of discrimination. Queer and BIPOC clients often have their resilience framed as dysfunction, simply because it doesn’t fit into mainstream diagnostic models.

Reflection Question: Has a mental health provider ever labeled a part of your identity or survival strategy as a symptom? How did you respond?

Creating Affirming and Accessible Care

So what does truly inclusive therapy look like? Ernesto and I talked about the importance of community-centered and non-traditional approaches. Healing isn’t always verbal — sensory experiences, movement, and collective spaces often offer deeper restoration for people who’ve been marginalized.

Therapists must be willing to meet clients where they are and respect the wisdom that clients bring about their own experiences. By creating spaces where clients define their health and wellness, we move toward collective healing.

Reflection Question: What kind of support feels most nourishing to you? Are you getting that in your current mental health care?

If mainstream therapy has ever left you feeling unseen or misunderstood, know that it’s not a reflection of your worth — it’s a sign that the system needs to change. You deserve care that honors the fullness of your LGBTQ+ identity and lived experience. And if you’re searching for that care, we’re here to help.