The following is a two-paper exploration of queer affirmative therapy. The first paper is a historical analysis of the pathological clinical discourses targeting queer clients. There has been a long history of pathological clinical frames in working with queer clients. Most notable have been the pathologizing of queer identities in the DSM and the practice of conversion therapy. Yet, these frames come from a broader socio-political history that precedes the development of the DSM and continues in our current time in a range of different ways. This paper traces these discourses of pathology across time. It pays particular attention to analyzing clinical papers from before and after the creation of the DSM. By bringing attention to this history and pointing to the ways that it continues to impact clinical frames in the present, this paper invites the readers to reflect on this history of oppression that the mental health field has reinforced as a point of entry for conceptualizing queer affirmative alternatives. The second paper is a qualitative study that explores queer affirmative approaches with queer-identified clinicians. According to the available literature there is a lack of queer affirmative training for clinicians. As a result, queer people struggle to find clinicians who are prepared to help them resist systemic marginalization and who address the reproduction of dominant discourses in the clinical room. Queer-identified clinicians’ expertise is a significant and untapped resource to explore how to counteract frames of pathology and contribute to the fostering of a therapy that is responsive and affirming of the variety, fluidity and intersectional experiences of queer peoples’ lives. This study examines the experiences of 8 queer-identified clinicians who have a range of experiences working with queer clients. The findings of this study are used to develop principles as a guide to provide queer affirmative therapy.