The Psychological Society of South Africa has embarked on a process of developing affirmative practice guidelines for psychology professionals working with sexually and gender-diverse people, inclusive of, but not limited to, lesbian, gay, bisexual, transgender, and intersex concerns. Towards informing the guidelines, we explored self-identified lesbian, gay, and bisexual people’s experiences of psychotherapy and counselling in South Africa. A total of 15 qualitative in-depth interviews were conducted with selected participants. Among others, positive experiences entailed receiving unconditional positive regard, acceptance, and non-judgement from counsellors and/or psychotherapists. This included the counsellors and/or psychotherapists positively affirming participants’ sexual orientation by, for instance, viewing same-sex attractions, feelings, and behaviour as normal variants of sexuality and seeing sexual orientation as one aspect of the person, not the only aspect. Negative experiences were almost exclusively ascribed to the counsellors and/or psychotherapists being disaffirming of the client’s sexual orientation. Findings provide a potential basis for future affirmative practice guidelines and indicate that taking a stance affirming of sexual orientation was considered to be important.