This study compares U.S. university counseling center therapy outcomes of Sexual Minority (SM) students who attend religiously-affiliated compared to SM peers who attend non religiously-affiliated institutions. Using archival data from the Center for Collegiate Mental Health (CCMH), we examined psychotherapy outcomes of 4257 SM student clients.We analyzed pre-treatment symptoms and post-treatment outcomes based on differences in Distress Index (DI) scores. We used the reliable change index (RCI) to separate outcomes into four groups based on the change in distress index level: no change, deteriorating, reliably improved, recovered from pre-treatment to post-treatment. Our participants (n = 4257) attended 34 religiously and non-religiously affiliated institutions (matched by geographical location, size, and percentage of the student body that were SM and sought therapy at the college counseling center). We found that SM students at religiously affiliated institutions had lower pretreatment and posttreatment distress scores than their peers at non-religiously affiliated institutions. Furthermore, gay students across universities consistently presented with lower distress than lesbian, bisexual, questioning, or self-identifying students. However, a larger proportion of SM students at non-religiously affiliated institutions achieved a reliable change status of recovered from their presenting distress levels, while a larger proportion of SM students at religiously affiliated institutions remained in the no change category. We found a significant effect of religious affiliation and Sexual Orientation (SO) on pretreatment distress scores, F(2, 4255) = 18.395, p < .001, and posttreatment distress scores, F(1, 4255)=15.199, p = .035), with moderate effect sizes (d=.137, and .061, respectively). Our findings emphasize the importance of culturally competent and affirming practices, ensuring that interventions resonate with the varied religious and cultural experiences of SM individuals. This is not just a research endeavor; it is a collective responsibility to foster campuses that prioritize the mental health and well-being of every student.