Go beyond traditional counseling.
LGBTQ+ Affirmative Psychotherapy
Dr. Anthony Koch, Psy.D. is an openly gay clinical psychologist located in the Washington, D.C., metropolitan area. He offers telehealth appointments across PSYPACT states and in-person sessions in Alexandria, VA.
Psychotherapy for the LGBTQ+ Community
More Than Acceptance. An Opportunity for Understanding.
Psychodynamic psychotherapy and psychoanalysis for LGBTQ+ adults in Alexandria, Virginia, Washington, DC, and online.
Being comfortable with your sexuality or gender identity does not necessarily mean that every part of your experience has become comfortable. You might have been out for years, have supportive friends, a loving partner, and a life you've worked hard to build, yet still find yourself struggling with shame, loneliness, anxiety, or difficulties in relationships.
Sometimes these struggles are connected to experiences of growing up LGBTQ+. Sometimes they aren't. And often, the distinction is less clear than we might expect.
I'm Dr. Anthony Koch, an openly gay clinical psychologist practicing in Alexandria, Virginia. My work is informed by contemporary psychoanalysis, with particular interests in identity, sexuality, intimacy, relationships, and the ways our early experiences continue to influence our adult lives.
What do LGBTQ+ individuals need?
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Many LGBTQ+ individuals have spent considerable time explaining, defending, or justifying their identities to others. Psychotherapy should not require you to repeatedly educate your therapist about your community, relationships, or lived experiences.
Instead, therapy can offer a relationship where your identity is recognized and respected, allowing us to explore the concerns that matter most to you.
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Shame can be particularly complicated when it develops around aspects of ourselves that are central to our identity.
For some, shame originates in explicit experiences of rejection or condemnation. For others, it develops more quietly through childhood observations, cultural expectations, or the absence of recognition.
Even after coming out or developing greater self-acceptance, these experiences may continue to influence our relationships, self-esteem, sexuality, and emotional lives.
Psychotherapy can help us understand these experiences without reinforcing the belief that there is something fundamentally wrong with us.
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Being LGBTQ+ does not mean that every experience of sadness, anxiety, conflict, or dissatisfaction is related to sexuality or gender.
Sometimes relationship difficulties are simply relationship difficulties. Sometimes depression develops for reasons unrelated to identity. At other times, identity, developmental experiences, and present-day struggles are deeply intertwined.
Affirmative psychotherapy makes room for this complexity without reducing everything to one's sexuality or gender identity.
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Our earliest relationships shape our expectations of love, closeness, vulnerability, and acceptance.
For individuals who learned that certain parts of themselves were unacceptable, intimacy can become particularly complicated. We may long to be known while simultaneously fearing what might happen if another person sees us fully.
Therapy offers an opportunity to explore these patterns, understand their origins, and develop more satisfying relationships.
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Identity is not a psychological destination we reach once and for all.
Our understanding of ourselves continues to develop through relationships, experiences, losses, and transitions.
Psychotherapy can provide a space to explore who you are beyond the expectations of family, community, partners, and society.
Especially Helpful For…
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Exploring sexuality, masculinity, shame, intimacy, and the complicated expectations that can accompany being a man.
Areas of exploration may include:
Internalized homophobia and shame
Masculinity and gender expectations
Dating, intimacy, and attachment
Body image and sexual self-esteem
Loneliness and belonging
Relationships with family and chosen family
Anxiety, depression, and perfectionism
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Exploring identity, relationships, family expectations, and the experiences of navigating sexuality and gender within broader cultural and interpersonal contexts.
Areas of exploration may include:
Identity development and self-acceptance
Relationship patterns and intimacy
Family expectations and rejection
Gender roles and social pressures
Emotional boundaries and self-worth
Anxiety, depression, and life transitions
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For transgender and nonbinary adults, finding a therapist who respects your gender should be a basic expectation, not something you have to negotiate.
Some people seek psychotherapy while exploring their gender or navigating transition-related changes. Others are dealing with family conflict, discrimination, relationships, or the exhaustion of having their identity questioned. And many come to therapy for reasons entirely unrelated to gender.
I approach gender diversity as part of human experience, not as evidence of psychological disturbance. My interest is in understanding your experience on its own terms, including whatever uncertainty, conflict, pleasure, grief, or change may be part of your life.
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Not everyone knows how to describe their sexuality, and not everyone wants to.
You may be questioning assumptions you've held for years, discovering attractions you hadn't previously acknowledged, or reconsidering what you want from relationships. For some people, these questions emerge in adolescence or early adulthood. For others, they arise after years of marriage, parenthood, or living according to expectations that once seemed unquestionable.
Exploring sexuality can bring excitement alongside anxiety, guilt, or grief. Therapy offers an opportunity to think about these experiences without pressure to adopt a particular label, disclose something before you're ready, or arrive at a predetermined conclusion.
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Relationships do not all follow the same structure, and there is no single arrangement that guarantees emotional satisfaction.
I have particular academic and clinical interests in consensual nonmonogamy, including open relationships and other forms of ethically negotiated relationships.
Psychotherapy can help individuals explore jealousy, boundaries, attachment, intimacy, communication, and the sometimes conflicting needs for autonomy and connection.
The purpose is not to privilege monogamy or nonmonogamy, but to understand how your relationships function and what they mean to you.
Themes Often Explored by LGBTQ+ Affirmative Psychotherapy
Identity and Self-Acceptance: Developing a more integrated sense of self while navigating the expectations of others.
Minority Stress: Understanding the emotional consequences of discrimination, stigma, concealment, and chronic vigilance.
Internalized Shame: Exploring painful beliefs about oneself that may persist despite conscious self-acceptance.
Family Relationships: Navigating rejection, acceptance, estrangement, loyalty, and complicated family expectations.
Relationships and Attachment: Recognizing recurring patterns involving closeness, dependency, trust, and vulnerability.
Sexuality and Intimacy: Developing a more satisfying relationship with desire, sexual expression, and emotional connection.
Body Image and Self-Esteem: Examining the relationship between appearance, desirability, self-worth, and belonging.
Anxiety and Depression: Understanding psychological distress in the context of both personal history and current circumstances.
Life Transitions: Navigating coming out, relationships, separation, aging, parenthood, and changing understandings of identity.
Belonging and Community: Exploring loneliness, social comparison, chosen family, and the desire to feel recognized by others.
Common Psychological Dynamics and Patterns
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When aspects of ourselves are experienced as unacceptable, we may learn to conceal them from others and eventually from ourselves.
This concealment can become a way of preserving attachment and avoiding rejection. Over time, however, it may contribute to a sense of disconnection from one's emotions, desires, and identity.
Even after coming out, the expectation of rejection may persist.
One of the tasks of psychotherapy is to understand how these early adaptations once protected us and whether they continue to serve us in the present.
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We develop our sense of self partly through the recognition we receive from important others.
When our experiences are misunderstood, dismissed, or rejected, we may struggle to feel that we are fully knowable or worthy of affection.
Some individuals respond by becoming exceptionally accomplished, agreeable, or self-sufficient. Others may become intensely sensitive to criticism or rejection.
Psychotherapy offers an opportunity to examine the longing for recognition and the sometimes painful strategies we develop to obtain it.
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There can be a profound tension between wanting to be close to another person and fearing what closeness might expose.
For some LGBTQ+ individuals, early experiences of concealment or rejection may contribute to the expectation that being fully known could threaten an important relationship.
This can appear as emotional withdrawal, difficulty trusting partners, fear of dependency, or repeated involvement in relationships that feel familiar but unsatisfying.
Exploring these patterns can create greater freedom in how we experience intimacy.
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Some individuals learn to manage feelings of inadequacy by becoming exceptionally capable, successful, attractive, or accommodating.
Achievement can become a means of securing recognition or protecting against anticipated criticism.
Although these adaptations may lead to considerable success, they can also leave a person feeling exhausted, anxious, or unable to experience satisfaction.
Psychotherapy can help us consider what it has meant to feel that love or acceptance must be earned.
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External judgments can become part of our internal psychological world.
Over time, the expectations of family, religion, culture, or society may be experienced as our own critical voice.
We may find ourselves judging desires, emotions, or aspects of identity that we consciously recognize as acceptable.
Psychoanalytic psychotherapy helps us become curious about these internal conflicts, including whose expectations we continue to carry and how they shape our relationship with ourselves.
My Approach to LGBTQ+ Affirmative Psychotherapy
As an openly gay clinical psychologist, I understand that finding a therapist who is genuinely familiar with LGBTQ+ experiences can make an important difference. You should not have to spend your sessions explaining the basic realities of your identity, community, or relationships.
My clinical approach draws primarily from contemporary psychoanalysis, psychodynamic psychotherapy, relational theory, and self psychology. I am interested in how your relationships, developmental experiences, and unconscious emotional patterns shape the way you understand yourself and engage with others.
We may explore the ways experiences of acceptance or rejection have influenced your sense of self, how early relationships continue to shape present-day expectations, or why certain emotional experiences and relational patterns seem to repeat themselves. I am also attentive to the therapeutic relationship itself. The ways we experience trust, vulnerability, shame, closeness, and difference can emerge within psychotherapy, providing opportunities for understanding and change.
Although insight is important, I believe meaningful psychological change also occurs through new emotional and relational experiences. Therapy offers an opportunity not only to understand old patterns, but also to encounter ourselves differently. My approach is collaborative, exploratory, and individualized. We will consider your concerns within the broader context of your life without assuming that your sexuality or gender identity is necessarily the source of your distress.
I have particular experience working with gay men, LGBTQ+ adults, relationship difficulties, and consensual nonmonogamy. My doctoral dissertation explored open relationships, an area that continues to inform my clinical interests. Ultimately, I hope to offer a therapeutic relationship where curiosity is welcomed, complexity is respected, and aspects of yourself that have been difficult to acknowledge can gradually become more available for understanding.
"It is a joy to be hidden, but a disaster not to be found." — D. W. Winnicott (1963)
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