Is Queer Affirmative Therapy necessary?

The month of June is globally observed as Pride Month, a month that is used to bring attention to the need to sensitize oneself to the unique struggles that members of the LGBTQIA+ community may face, and find ways to understand and accept that identities exist across the spectrum. From a mental health/therapeutic perspective, this brings about the concept of Queer Affirmative Therapy, and begs the question- what exactly is it, and why do we need it?

Queer Affirmative Therapy is therapy that is culturally relevant and responsive to LGBTQ+ clients and their multiple social identities and communities and is informed by the social inequalities they may face. It helps them build resilience and coping, foster autonomy and helps to reduce the barriers to mental,  physical, and sexual flourishing.

But why do practitioners need to be especially queer affirmative?

The answer lies in the unique set of struggles that many people who are part of the LGBTQIA+ community still face. Homophobia (which can be internalized as well) is known to lead to bullying, ragging, abuse and molestation. Moreover, the victimization of LGBTQIA adolescents’ at school is strongly associated with mental health related issues, such as depression, suicidality, and substance use or abuse (Birkett et al., 2009; Higa et al., 2014; Russell et al., 2011), and more than 87.3% of LGBTQIA+ adolescents experience school bullying and harassment (Kosciw et al., 2018), leaving an incredibly high number of children at risk for the above -mentioned consequences.

Queer clients also have more concerns and fears about coming to therapy than heterosexual people do (Alexander, 1998). This can be due to many reasons, but the case often is that many clients (46%) face homophobic clinicians and others (34%) may meet clinicians who do not acknowledge their gender or sexual orientation, leading to a rejection of a part of their identity (Nystrom, 1997).

Everyone deserves an equal chance at therapy, everyone deserves a clinician who understands the type of life that one may lead and its associated problems, or at least endeavors to do so with kindness and acceptance, and that is why Queer Affirmative Therapy is especially needed.

Some elements of Queer Affirmative Therapy or some elements that can supplement it include the therapist understanding the full effects that homophobia can have, waiting until the client mentions their sexuality to focus on it, helping clients overcome any internalized homophobia, helping clients understand sexuality as a continuum and thus explore their choices to ‘come out’, and most of all, having a positive relationship with the client and helping to alleviate some of their distress.

As a result of helpful Queer Affirmative Therapy, clients usually feel more positively about their relationship with the therapist, they are able to acquire new skills, improvement in their quality of life and reduction in feelings of loneliness. When the client and therapist together are able to safely explore the client's sexuality, it is more likely to result in greater self -awareness, self -acceptance. The client is likely to show positive behavioural change.

On the other hand, factors that harm instead of help in this kind of therapy include assuming and addressing a person by a given pronoun (especially if they've indicated otherwise), treating homosexuality as a disorder of any kind, viewing any other problem that they might have as a result of their sexual orientation, imposing one's own values and judgment on them, the therapist not being or feeling prepared to deal with their complex identities and struggles, and the client-therapist relationship being fraught with mistrust and coldness.

The consequences of this can be drastic- clients may stop attending sessions or therapists themselves may cancel them, leading to the client’s symptoms worsening, a decrease in their belief of therapy,  worsening or further damaging of their relationships and a negative impact on the process of coming out. The client is less likely to self disclose and as a result the relevant issues will never be discussed and resolved.

Overall, the client cannot progress in therapy.

What are some things that therapists can do to be more affirming?

Sometimes, self-disclosure is the answer. As a therapist, sharing one’s own identity and experiences (when judged to be appropriate) can greatly help clients relate and hear more perspectives and outcomes. The greater visibility and representation may help the clients feel as though they belong and that their situations are normal.

• Taking its history into account:

It's important for therapists to have in depth understanding of the history of homosexuality in the DSM. Since it was treated as a disorder, it becomes important to be able to identify approaches that may have undercurrents of this view. Only by knowing the history and complexity of it can they change and improve the current treatments.

• Avoiding assuming their sexuality/gender 

It is important for the therapist not to assume the client's sexuality and thus refrain from asking questions about their romantic lives that assume monogamy. They must also refrain from assuming clients’ gender, instead allowing the client to share by themselves. One way of inviting them to do so is by sharing one's own pronouns and asking them theirs.

• Advocating for Social Change

Therapists form a huge collective of the mental health frontline. They must understand and challenge policies and legislation in order to further the cause of inclusion and acceptance and strive to extend awareness and education.