What is LGBTQIA+ Affirmative Psychotherapy?

LGBTQIA+ Affirmative Psychotherapy is psychotherapeutic practice in which therapists have a positive view of those who belong to the queer community. This type of therapy also addresses the unique challenges that the individuals belonging to the queer community face such as oppression, homophobia and transphobia and tries to understand the impact of living in a heteronormative on queer clients.

LGBTQIA+ Affirmative Psychotherapy has its origins in ‘Gay Affirmative Therapy’ which was introduced by Alan K. Malyon in as early as 1980s. Based on his research on the provision of psychotherapeutic interventions for gay men, he provided an outline of the practice that consisted of 4 phases. He believed rather than on trying to convert clients from homosexuality to heterosexuality, one must affirm their identity, accept and value their sexual orientation and help them to self-actualize. 

The 4 phases of Gay Affirmative Therapy developed by Alan K. Malyon are: 

Phase I: In the first phase the therapist tries to build a strong therapeutic alliance and rapport with client. 

Phase II: Here the therapist tries to analyze the challenges and conflicts faced by the client. This is followed by the therapist trying to understand the client’s attitudes, state of mind, and starting to helping the client restructure some of their negative thought processes.

Phase III: In the third phase the therapist tries to consolidate the client’s identity and helps the client develop strong healthy intimate relationships. 

Phase IV: In the last phase of the therapy the therapist helps the client to establish a sense of personal meaning and purpose in one’s life. 

According to Malyon’s research some of the problems faced by gay men were that a majority of them had internalized homophobia and were facing difficulties with intimate relationships, cultural stigma and ego-dystonic attraction.

What is the difference between an LGBTQIA+ friendly and an LGBTQIA+ affirmative psychotherapist?

An LGBTQIA+ friendly therapist is one who shows warmth, openness and is aware about the spectrum of LGBTQIA+ identities that exists in the LGBTQIA + community, however, this alone is not sufficient to practice LGBTQIA+ affirmative psychotherapy.  Here the therapist needs to be certified in LGBTQIA+ therapy and therapists should have a sufficient number of supervised sessions with LGBTQIA+ clients before calling themselves LGBTQIA+ affirmative therapists.

What are some of the challenges that clients from the LGBTQIA+ community face?

Some of the unique challenges faced by those belonging to the LGBTQIA+ community are as follows

• Homophobia and transphobia
• Social Stigma
• Oppression
• Violence
• Discrimination
• Loss of employment, housing
• Physical and sexual assault
• Frequently at the receiving end of homophobic jokes and bullying
• Society forcing queer individuals to conform to gender norms 

The lived experiences of those from the queer community are intersectional with other factors such as caste, ethnicity, race, religion, socioeconomic status and disability. Hence therapy spaces for queer individuals have to feel safe enough for them to explore, approach, and resolve their difficulties. 

What qualities should an LGBTQIA+ affirmative psychotherapist possess?

The qualities that a queer affirmative psychotherapist needs to possess are the ability to establish a connection with their clients, aiming to ensure that clients feel safe and comfortable to talk about the issues surrounding their experiences. Therapists need to warm, friendly, validating, accepting and have a non-judgmental attitude towards different types of sexual and gender diversities. These above-mentioned qualities are those that any individual involved in providing psychotherapeutic services should possess, however, to be an effective queer affirmative psychotherapist, one must be able to put aside their experiences of being assimilated into a heteronormative society, and be able to wholeheartedly accept those belonging to the queer community. This would also require a certain degree of openness and flexibility on behalf of the therapist.

Therapists should possess the ability to reflect and identify their own negative or biased attitudes, beliefs, and assumptions that they hold in relation to the queer community. Therapists who practice reflection and reflexivity, and who use supervision well can unpick dilemmas relating to their own socialsed experiences of hetereonormativity, and hence provide more empathic and ethical care for queer clients.

Therapists should be able to normalize their client’s sexual desires and practices, make clients feel comfortable with their bodies and sexuality, validate the client’s experiences of sexuality, and encourage clients to develop healthy platonic, romantic, and sexual relationships. If clients request help with this, therapists should also be able to facilitate the coming out process, first for clients to acknowledge and accept this in relation to themselves, and then to family and friends (Lebolt, 1999). 

A queer affirmative psychotherapist should be well versed in the queer affirming language and be able to use appropriate pronouns while communicating with queer clients. Queer affirmative psychotherapists should undergo additional training in queer affirmative therapies and practices and have sufficient number of hours of supervised therapy sessions under an expert from the field of queer affirmative psychotherapy, before taking on clients from the LGBTQ+ community. Queer affirmative psychotherapy should be well advertised by the therapists who are trained in it, and these services should be made accessible regardless of socio-economic status, gender identity and sexuality.

Therapists should be intuitive enough to understand the unique challenges that clients from the queer community face in their day-to-day lives and the material they bring into the session. They should be able to make connections between the effects of stigma and prejudice, which result in oppression, harassment and bullying and its long-term impact on the client’s mental and physical health.

The key to being a good queer affirmative psychotherapist is to always remember that the queer community should not be perceived as a monolith but rather a blend of different types of sexual and gender diversities, and that each client would bring to the session an entirely unique set of experiences of belonging to the queer community.

Do I have to talk about my gender or sexuality with my LGBTQIA+ affirmative therapist?

The answer to this question is both yes and no: If a client is seeking help for a mental health issue or a current problem that requires immediate attention and intervention and does not wish to reveal the gender or sexuality then it is solely the client’s choice. However, if the client is seeking therapy to discuss specific issues regarding the challenges and mental health concerns in relation to their expeirences of belonging to the LGBTQIA+ community, then it becomes important to speak to the therapist regarding their gender and sexual identity. This can help the therapist better understand the client, which in turn will allow the therapist and client to have more open conversations linking the client’s experiences of queerness with other lived experiences, and ultimately make the therapeutic process more useful overall.  

Author: Dr. Poornima Chandrashekar, Consultant Clinical Psychologist