LGBTQ+ individuals are at increased risk of suicide. Homelessness further increases the risk, as does family-of-origin rejection. A model that combines suicidal risk factors and minority stress theory is useful in clinical practice. An openness to “hearing” the lived experiences of LGBTQ+ individuals is essential to treatment. An LGBTQ+ affirming therapeutic approach is recommended. It is also frequently helpful to rebuild family relationships and support for the LGBTQ+ individual, particularly with younger youth. Principles of practice are described and illustrated.