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The talk will discuss 6 common clinical decision-making points in family therapy with queer and trans (QT) youth. These include: 1) How do I engage the whole family and not just mom? 2) Should there be a separate individual therapist for the parents and youth or can family therapist move between these modalities? 3) Are the caregivers "safe enough" to be in the therapy room with the QT youth? 4) I think this is about more than this kid coming out, should I continue with family therapy? 5) Dad is not engaging, now what? 6) When are the caregivers "accepting enough"? The talk will use real case examples, relational ethical decision making, and classic family therapy theories for walking through difficult clinical decisions while supporting a QT youth.