“This is how your client walks in the room,” Ms. Fuller said. “Fully exposed. All their fears up front about stereotypes you’ve heard. Everything they fear you think about them,”

Ms. Fuller, herself a clinical social worker, had begun class an hour before by clarifying that she is a “male-identified, African-American lesbian.” On her shirt, she had written: “lazy,” “loud,” “angry.” Around the room, students were looking at one another’s handiwork with sheepish curiosity, waiting for someone to break the silence.

“Let me just speak first,” said Bradlisia Dixon, a petite woman with close-cropped hair and big hoop earrings. “I didn’t do the shirt because it was very triggering for me. I even brought the shirt to work with me, and it sat in my purse, and I was like, I kind of need to do this shirt, and I kind of don’t want to do this shirt. And that happened for days in a row, and finally I said, I’m not doing the shirt.”

“I appreciate your being honest about that,” Ms. Fuller told her. “Thank you. I support that.”

Started in 2006, Antioch’s program is, to its leaders’ knowledge, the country’s first and only graduate-level L.G.B.T.-affirming clinical psychology specialization. Yet it is part of a growing trend in highly specialized psychotherapy, which in recent years has become especially pronounced with regard to lesbian, gay, bisexual and transgender patients.

“Our working hypothesis is that L.G.B.T. people are born that way, with their own psychology, their own framework, their own needs,” said Doug Sadownick, who is one of the founders and was the director of the program until earlier this year. “That maybe there is something in the makeup of gay and lesbian and bi and trans people that is unique to them, that is psychologically gay, psychologically bi, that is psychologically trans and queer. That is not going to be understood through any lens but that lens.”