A Genderqueer Therapist on Rural LGBTQIA+ Care

Written by: Guest Contributor Lexi Pettengill, LSW, (she/they) | Therapist, SpringSource

Date Posted: June 30, 2026 4:01 pm

A Genderqueer Therapist on Rural LGBTQIA+ Care

I identify as a genderqueer, non-binary therapist. One of my specialties is LGBTQIA+ affirming mental health care, and I grew up in a small town in the rural Midwest, which means I hold two perspectives on this topic at once: the clinical one, and the deeply personal one. I know what the research says about rural queer mental health outcomes. I also know what it felt like to be sixteen with no words to fully describe myself, no provider who could have helped me even if I’d known to ask, and no room anywhere in my community that felt safe enough to explore my identity beyond a binary.

The data is stark and consistent. According to the Trevor Project’s 2023 National Survey on LGBTQ Youth Mental Health, non-binary youth report some of the highest rates of depression, anxiety, and suicidal ideation of any group surveyed, and rural LGBTQ+ youth seriously consider suicide at a rate of 47%, compared to 37% among urban peers. The Health Resources and Services Administration has designated vast stretches of rural America as Mental Health Professional Shortage Areas, and within that shortage, the subset of providers offering genuine gender-affirming, LGBTQIA+-competent care is vanishingly small.

What I hear most often from my rural and formerly-rural clients isn’t extensive trauma, though that exists too. It’s the quiet, grinding weight of years spent with no mirror. No GSA, a Gender and Sexuality Alliance, the school-based clubs that provide peer community and a safe space for LGBTQ+ students and their allies, no affirming teacher, no community space where they could simply be seen. By the time many of my clients find their way to an affirming provider, they have spent years internalizing the message that their identity is the issue. That is not a clinical starting point. That is damage done by a system that failed to show up.

So yes, I became what I needed. I carry that with pride and with grief in equal measure. Pride, because the work is real and the healing I witness is real. Grief, because I know exactly what it cost to get here, and I know there are people still paying that cost right now, in towns that look just like the one I grew up in, waiting for a mirror that hasn’t arrived yet.

The goal was never for me to be enough. The goal is a world where no one has to become what they needed, because what they needed was already there.

Sources: Trevor Project 2023 National Survey on LGBTQ Youth Mental Health; HRSA Mental Health Professional Shortage Area designations; minority stress theory (Meyer, 2003).

Fill out our contact form to schedule a session with Lexi. SpringSource: Eating, Weight & Mood Disorders provides in-person therapy in Northbrook and Chicago, with telehealth therapy available throughout Illinois.