By Shatavisa Majumder, Clinical Psychologist

Queer affirmative psychotherapy is an approach to therapy that embraces a positive view of alternate sexual and gender identities (LGBTQIA+) and relationships and addresses the negative influences that homophobia, transphobia, and heterosexism have on the lives of LGBTQIA+ clients. It aims to provide a safe space where clients will be treated with the dignity and respect they deserve, they can be their true selves without having to fear judgment, bias, moral labels, where their lived experiences will be seen, acknowledged and validated. A queer affirmative therapist is a qualified and trained mental health professional who is equipped enough to acknowledge and understand unique life stressors which has a significant impact on a queer person’s mental health and also to cater to the specific needs and concerns of LGBTQIA+ individuals in a safe and affirmative therapeutic environment.
In this article the term queer has been used to refer to non-heterosexual sexual orientation, transgender persons, nonbinary and gender non-conforming persons.

Queer friendly and queer affirmative practices are two terms often used interchangeably. Any therapist can be queer friendly. A queer-friendly therapist may be accepting of queer people but may not have the required knowledge, skills and expertise to provide therapy and support to the queer individuals keeping in mind the specific issues faced by queer community.
A queer affirmative psychotherapist is cognizant of the lived experiences of queer people- stigma, prejudice, violence, legal battle and their effects on the queer individuals’ psyche. They are familiar with the queer terminologies. Language plays a paramount role in queer affirmative practice. Using inclusive language such as “common” or “in majority” rather than “normal”; “partner” or “romantic interest” rather than “boyfriend” or “girlfriend”, asking for pronouns, avoiding dead naming a person, can bring enormous differences in providing affirmation to the clients. Even a very well-intentioned psychotherapist might do some harm to the clients unknowingly and make them feel invalidated without knowledge of such queer specific issues. Additionally a queer affirmative therapist is well aware of the queer resources in local community where they can direct the clients when needed.

A queer client’s presenting problem may be directly related to their alternate sexual orientation and gender identity. On the other hand a queer-identified client may present for reasons that have little or nothing to do with their sexual orientation and/or gender identity for example depression, anxiety, substance abuse, suicidality, relationship and sexual issues and so on. However there are some unique life stressors which LGBTQIA+ adolescents and adults may experience.

• Confusion related to one’s sexuality and gender identity, difficulty in self-acceptance due to internalization of society’s negative attitude towards LGBTQIA+ experiences- a sense of shame, disgust, anger, self doubt, confusion, feeling dirty, low self-esteem.
• Distress related to coming out process, fear of being discovered as queer, difficulty in decision making about whether to come out as queer or transgender, when and to whom so that the likelihood of facing violence is reduced.
• Strained relationship with parents and family members after coming out, feeling trapped and misunderstood, facing emotional and physical torture, house arrest, heterosexual marriage pressure, attempt to “cure” them through conversion therapy and so on.
• Feeling invisible and isolated, being denied the privileges which are awarded to heterosexuals and cis-gender persons such as marriage, adoption and other material benefits.
• Stress due to prevalent homophobia and transphobia in school, college and workplace, discrimination and violence manifested in the form of bullying by peers, sexual violence, withholding resources and privileges and refusing equal rights.
• Interpersonal problems in queer relationships-communication and compatibility issues, disagreements, fights, and intimate partner violence. Particularly for queer people who are in heterosexual marriages have to live a dual relationship which leads to an additional stress.
• Gender dysphoria, feeling of being trapped in the wrong body, the daily struggle to be read/seen as belonging to the gender that they are, being misgendered on a daily basis, lack of gender-neutral public toilets, inaccessible healthcare often leading to depression, anxiety, self harm, substance abuse in transgender persons.
• Gender transitioning-changing one’s gender presentation or sex characteristics to match with one’s inner sense of gender identity is a long and individualised journey which poses additional stressors such as looking up trans-related resources, finding queer affirmative health professionals, obtaining certificate for gender dysphoria, changing legal documents, undergoing hormone replacement therapy and surgeries, coping with the after effects of treatment, adjusting to the society and so on.
• Family counseling for parents and other significant family members, which aims to facilitate coping with queer children’s coming out. Parents often feel a sense of loss on learning of their adult child’s sexual orientation or gender identity, do not know what LGBTQIA+ means, feel overwhelmed for not having answers to many questions, seek help from spiritual guru or doctors to “cure” their children. Therapy facilitates understanding and acceptance of queer children and gaining of correct knowledge and information about alternate sexual and gender identity.

Why do we need to talk about queer affirmative psychotherapy?

Homosexuality has been decriminalised by Supreme Court of India by reading down IPC Section 377 in September 2018. Indian Association of Clinical Psychologists, Indian Psychiatric Society and other prominent mental health governing bodies of our country have made their positions clear about LGBTQIA+ and strongly condemned the practice of conversion therapy. Conversion therapy which aims to “cure” a person by reversing sexual orientation and gender identity is harmful, unethical, non-scientific and inhuman-there is nothing to “cure” as alternate sexuality and gender identity are not disease. Despite these, practice of conversion therapy is still rampant in our society. Queer individuals are forcefully taken to these practitioners by their family members where they are inflicted with painful and traumatising unprofessional procedures resulting in further emotional scarring, adding to their already existing mental health issues and often leading to death by suicide.
It is still a struggle for the LGBTQIA+ community to live with dignity, enjoy the basic human rights, and access medical care both for physical and mental health. They are subjected to bullying, discrimination, violence in family, workplace, and society in general. The continuous pressure of living a secret life, hiding their identities and relationships, fear of losing job, fear of being found out, loneliness, helplessness, guilt of being different, feeling trapped take a toll on their mental and physical health. Often queer individuals feel apprehensive in seeking help from a mental health professional due to fear of being judged and invalidated. Queer affirmative psychotherapy aims to make mental healthcare more accessible for queer individuals and help them live a fulfilling life with dignity and respect.