The Association for Music and Imagery Code of Ethical Conduct subscribes to the common ethical principles of beneficence and nonmaleficence, as well as stating that Guided Imagery and Music (GIM) practitioners should “strive to be of benefit to those with whom I work.” As many lesbian, gay, bisexual, transgender, and Queer (LGBTQ) people seek out therapy, it is imperative that GIM practitioners understand the unique clinical needs of this population, as well as how to create an LGBTQ-affirming GIM practice, in order to provide culturally competent care. This paper covers clinical competency areas, such as basic vocabulary, cultural symbols, DSM diagnosis, inclusive language, and unique assessment needs. Additionally, specific applications for creating LGBTQ-affirming GIM sessions are discussed.