LGBTQIA+ affirming therapy – what is it and why’s it important?
February is LGBT History month (in the UK). This history will impact us in different ways, depending on our positionality as well as, for the queer community specifically, the circumstances, place(s) and time we grew up in and/or came out in (or didn't). So, I thought I’d write a blog with some history and mental health facts, and about being LGBTQIA+ affirmative in the therapy room and why this is important.
Before I start, I want to acknowledge the fact that celebrating LGBT history one month a year can feel a bit tokenistic, like with any group that is offered a month for their history – we don’t exist for only one month so really, all histories should be embedded into our everyday as standard.
With that said, here are some historical and current facts relating to mental health in the LGBTQIA+ community.
So, what is an affirming therapy practice and why is it important?
Being LGBTQIA+ affirming is the acknowledgement and acceptance of a client’s sexual orientation and identity. A client might not be coming to therapy to discuss this specifically, but as our identities crucially shape how we experience the world, affirming theirs is important. (It’s worth noting that this is also applicable to other aspects of someone’s identity, like gender and race which is why I refer to myself as identity-affirming.) When historically, the queer community has been unaccepted, criminalised and generally made to feel ‘less than’, it seems clear why acknowledgement and acceptance would be important. However, I think being affirming is more than just tolerating – it’s working to unlearn the deep-seated notion that mainstream heterosexual and cis-gender culture is the default. Just as clients (and counsellors) might have struggled at some point in their lives to accept this, and possibly still do, as the people supporting them, we must constantly do this (un)learning as well.
An LGBTQIA+ affirming therapist will…
1. Allow clients to bring any issue affecting them without fear of discrimination, shame or invalidation because of their identity
2. Help clients build confidence and self-acceptance
3. Facilitate clients' exploration of their gender identity and/or sexuality in a safe, understanding space (if this is what they're bringing to the session)
4. Believe clients about their sexuality and gender – no need for them to justify themself
5. See and accept clients' whole self by recognising the intersections of their identities
6. Understand different sexualities, gender identities and relationship styles without clients needing to explain it to them first.
Isn’t a lot of that about Unconditional Positive Regard, which is central to many therapists’ work?
Well, I’ve increasingly been musing about Unconditional Positive Regard (UPR) – Carl Roger’s key stone of therapy – and how / if counsellors can show UPR if they don’t, for example, believe trans people do or should exist or think bisexual people ‘just haven’t decided yet’.
Unconditional positive regard is the notion that therapists show clients complete support and acceptance no matter what they say or do, and with no conditions on this acceptance. So how can you hold someone in positive regard if you don’t accept their identity? If you don’t believe they should be able to exist as who they are? Or if you only believe in a certain part of their identity? I’m really not sure you can, not genuinely and congruently anyway. I imagine some will be thinking, but you don’t have to have the same views as your clients to be affirming and show them UPR. No, you don’t. But disbelieving someone’s identity and not seeing eye to eye on something are totally different. The latter is a disagreement or different point of view (which is fine, we aren’t expected to agree with our clients and whether we do or not is irrelevant to us being able to support them); but the former is oppressive to their very existence.
If you don’t believe in someone’s identity – identity being something so central to who we are as people and how we’ve experienced our lives – how can you affirm them?
My therapy room – virtual and actual – will always be a place where clients will be welcomed as their full selves, including if they’re not sure who that is yet or have never been allowed space to explore it.
 Positionality is the social and political context that creates our identit(ies) ^
 I’m aware some people don’t like the use of the term ‘queer’. I use queer as an umbrella for ‘not straight’ but will always refer to clients and their communities in the way(s) that they prefer. For more on why I use it, see this article, in particular the section starting ‘It is a word we use with respect and love’. https://www.tolerance.org/magazine/is-queer-ok-to-say-heres-why-we-use-it ^
 © Mind. This information is published in full at mind.org.uk. https://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problem/#collapse41728 [accessed 15 January 2021]
 https://www.stonewall.org.uk/media/lgbt-facts-and-figures [accessed 15 January 2021]