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Sexual and gender minoritized adolescents (SGMA) are at higher risk for self-injurious thoughts and behaviors (STB), such as suicide and nonsuicidal self-injury, compared to their heterosexual and cisgender peers. This study explored treatment experiences, barriers, and facilitators to treatment for SGMA at risk for STB. Participants were 18 SGMA, aged 13-19 years (M = 16.8; SD = 1.89); 61% were transgender or nonbinary; 61% plurisexual; and 78% White, non-Hispanic/Latine. Participants completed a semistructured interview, including questions about their experiences seeking mental health treatment for STB. Several themes emerged for negative treatment experiences (e.g., overemphasis on identity, invalidation), positive treatment experiences (e.g., affirmative work), barriers to treatment (e.g., shame, structural barriers), facilitators to treatment (e.g., family support), and recommendations to mental health professionals. The findings of this study provide insights into the varied STB treatment experiences of SGMA at risk for STB. These results underscore the importance of SGM-affirmative clinical practice and have significant implications for research and clinical interventions for SGMA. Additionally, our findings provide useful recommendations from SGMA to help guide mental health professionals in developing SGM-affirmative interventions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).