MADISON, Wis. — For some patients, walking into a doctor or therapist's office is relatively simple: describe your problems and leave with a prescription, some instructions or insight.

But for members of marginalized groups like the LGBTQ community, therapist Chelsea O'Neil Karcher said, appointments can be an exercise in "bracing yourself and preparing for the worst."

"You just don't know what's going to show up, whether it be an offhand comment or an inappropriate, uncomfortable question or they suddenly start telling you about how they've struggled so much to accept their own brother who's gay, that happens," she said.

"There's always a process of trying to look for clues and figure out, am I going to be safe? Are you going to know what I'm talking about? Are you going to be okay with what I'm talking about or are you actually going to say mean, terrible things to me, or are you going to physically hurt me? I don't know."

O'Neil Karcher, who identifies as queer, and her partner Owen Karcher, who identifies as a queer transgender man, have their own list of experiences like this, and knew there weren't many mental health providers specializing in the LGBTQ population.

So the pair started their own counseling practice, the Center for Community Healing, in 2017 and they've just begun their second year, the Capital Times reported. The vast majority of their clients are in the LGBTQ community, and everything about the office — from the website to the pillows to the paint colors — was chosen to ensure everyone, especially the frequently marginalized, feels safe there.

O'Neil Karcher, a licensed professional counselor in training, and Owen Karcher, a licensed professional counselor, both earned master's degrees in art therapy from Naropa University, where they met.

Physical and mental health care is especially important for the LGBTQ community, which already suffers from many health disparities. But a 2014 national survey of the LGBTQ community found over 50 percent had experienced discrimination in medical settings including harsh language, being blamed for their health or refusing to care for the patient.

Those same bad experiences show up in Dane County. In the Dane County 2016 LGBTQ+ Health and Wellness Profile, examples of insensitivity and discrimination included "denial of service due to a person's gender expression or sexual orientation," and "denial of access/visitation of family members in hospital or surgical centers."

In Karcher's work as co-founder of the Wisconsin Transgender Health Coalition, the group surveyed trans individuals about their needs, and the number one answer was "competent providers," Karcher said.

"If you tell somebody you're queer or trans . they don't really understand, one, how that's relevant to your mental health care or health, or two, how to serve you," Karcher said.

While there are other individual counselors and therapists in the area who specialize in providing services to LGBTQ clients, the Center is the only clinic the pair knows of in Wisconsin specializing in LGBTQ mental health. About 95 percent of the Center's clients are in the LGBTQ community and 90 percent identify as transgender or gender non-conforming, serving kids as young as 5 to clients in their 60s.

Word has traveled fast and far about the clinic, bringing clients from Iowa and Illinois, because "especially in rural communities, they're feeling like they just don't have anyone," O'Neil Karcher said.

Located on Grand Canyon Drive, Karcher and O'Neil Karcher took the time to make sure anyone who walks in the clinic — adorned with "Black Lives Matter" and "We Welcome Immigrants" signs — is welcome. Their dog Pekoe is available to cuddle clients, and they charge for services on a sliding scale. They thought through everything from chakras to the texture of the couch, constantly re-asking the question "How do we want people to feel when they walk in?"

And beyond decorations, clients can experience the comfort of knowing they don't have to justify their lifestyle or educate their therapist, the pair said. If they need to discuss something like grief, clients know they won't first have to explain their identity before getting "to the thing they actually need to talk about," O'Neil Karcher said.

Thanks to grants from the Trans Justice Funding Project and Public Health Madison & Dane County, the pair has been able to provide counseling and referral letters to trans individuals seeking hormone therapy or surgery at the accessible cost of $25. (The Group Insurance Board recently voted to restore insurance coverage of transgender surgery for Wisconsin state workers, a move O'Neil Karcher called a "wonderful step forward.") O'Neil Karcher performs at least one of these evaluations a week.

"Almost every time people are just so grateful and relieved that it was an easy process," O'Neil Karcher said. "Usually we're the second or third stop on somebody's journey, where they've had really miserable experiences leading up to that."

When Karcher was growing up, he didn't even have the language to describe what he was going through, he said, and didn't know that being queer or trans was really a "thing," until he met queer individuals in high school.

"I don't know what it would have been like to come to a place like this, probably really life changing," he said.

When he needed an evaluation to receive hormones, he basically wrote his own letter for his therapist to sign, he said.

"I felt like I had to represent my identity in a very narrow way . I actually held back some of my doubt and some of my worry and some of my questions I was holding, because I was afraid she wouldn't sign off on this letter," he said.

O'Neil Karcher also didn't have anyone to talk to, and didn't understand where she fit, because neither "straight" nor "gay" described her.

"I still feel incredibly grateful to come to this space every day, even as the provider . To know that there are just more people out there that we connect with is a gift, it's a powerful thing," she said.

The pair is passionate about providing services to clients of color, who make up almost half their client base. Karcher speaks Spanish and is a social justice consultant, and social justice was a common concern that first drew them together, O'Neil Karcher said. They continually witnessed white, straight and cisgender providers serving LGBTQ people and communities of color.

"There was this power dynamic that didn't quite sit with us. It didn't feel right that it was always an expert role of the therapist," O'Neil Karcher said.

They work hard to "kind of level that relationship so it feels more like two equals sitting across from each other instead of someone who's kind of there to have all the answers," she said.

And they aren't content to just serve the LGBTQ individuals and clients of color within their walls; they offer training and consulting to area health providers and schools, and throw themselves into activism whenever they get a chance; speaking at City Council meetings, using their center as a place to sign petitions and call legislators, and joining protests.

"If you come in and I help you work through all of your experiences around racism . and then you go out into a racist world, you're going to be re-wounded, and you're going to come right back to therapy," O'Neil Karcher said.

That's a lot for two people to take on, and they have to be careful with boundaries and burnout, turning to self-care like gardening and their own art. But therapy isn't all "sad and hard and angry," O'Neil Karcher said.

"The bottom line is, if you come to therapy it's because you want something to change, so there's hope in that," she said. "It is really hard and sometimes it is very sad, but there's a lot of laughter and a lot of hope."

An AP Member Exchange shared by The Capital Times.