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Children and young people who present as queer are overrepresented in mental health settings and experience higher levels of mental health difficulties than their heterosexual counterparts. As this presumably means that queer patients are also overrepresented in consulting rooms, the author explores why there is a lack of literature on this patient population in the Journal of Child Psychotherapy and considers what contributions can be made to the knowledge base in order to better understand the potential reasons for this gap. The author investigates the complex social stigmas typically encountered by queer people and connects these experiences to the mental health issues queer youth typically face. The literature on homosexuality within the British Psychoanalytic Society is reviewed, demonstrating the ongoing interplay between social politics and psychoanalytic theory. The author explores some of the particular issues queer individuals commonly present with and considers some difficulties that may arise in therapeutic relationships between queer patients and their psychotherapists, as well as in clinical supervision. Clinical vignettes from the author’s work with queer patients are used throughout to illustrate these themes.