--- - |2 Abstract The clinical need for lesbian, gay, bisexual, and queer (LGBQ+) affirmative psychotherapies has been widely recognized; however, empirical research on the outcomes of such psychotherapies is limited. Moreover, key questions about whom such psychotherapies are for and what they comprise require critical consideration. We begin by offering definitions to answer these questions and delineate four key themes of LGBQ+ affirmative psychotherapies. We conceptualize LGBQ+ affirmative psychotherapies not as sexual orientation group‐specific, but rather as considerations and practices that can be applied with all clients. We then summarize our own search for studies to attempt a meta‐analysis and we discuss limitations and directions for research based on our literature review. We end by delineating diversity considerations and recommending therapeutic practices for advancing LGBQ+ affirmative psychotherapy with clients of all sexual orientations. - Journal of Clinical Psychology, EarlyView.