Looking for the right therapist can be like finding a needle in a haystack. One needs someone who is well-trained, experienced, and effective at treating the particular issues presented in therapy. You need someone who ‘gets’ you and creates a space where you feel safe, understood and supported. And then there’s the whole other issue of accessibility and affordability. Given the long-standing history of discrimination, health disparities, and ‘conversion’ treatments that have made therapy downright dangerous for LGBTQIA+ people, finding the right therapist is no small feat. When one adds the number of people who have been subjected to inhumane procedures like conversion ‘therapy’— a disproven, discredited, and dangerous method— the importance of finding a safe and affirmative counselor becomes even more important.
Unlike the west, we only have a couple of studies related to LGBT counselling in India, whereas the actual number of LGBTQIA+ individuals isn’t even available. However, a few studies over the decade have presented estimates of the prevalence of various mental health conditions among LGBTQIA+ individuals. In one study, 52.9% of Gay men were found to have some psychiatric morbidity. Another study about qualitative study with sexual minority women found that isolation, anxiety, high substance abuse, and suicidal thoughts were common themes in these women’s experiences. Although the varied prevalence rates and methodologies make comparisons difficult, prima facie depression and suicide rates in LGBTQIA+ people are higher than the population estimates for non-LGBTQIA+ individuals in India.
The numbers and estimates are grim enough. But the most concerning issue of it all is that in spite of the high prevalence rates of suicidal thoughts and depression, not a single gay man in the study with mental health issues reported engaging in any current treatment (Sivasubramanian M, Mimiaga MJ, Mayer KH, et al. Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample). Some transgender individuals reported that they avoid accessing free government health care services and prefer self-medication or private health care. Sexual minority women reported that they typically avoid mental health services due to the stigma of mental illness, fear of negative medical interventions, and previous unfavorable experiences of these services. All of this could be boiled down to the extent of marginalization, inadequate knowledge and sensitivity of health care professionals toward LGBTQIA+ people, active discrimination, and perpetuation of violence by them that act as the contributing factor to health care barriers.
Interviews and focus group discussions with Queer and trans folk across the country have revealed that LGBTQIA+ individuals experience actual, felt, and internalized stigma. They are subjected to family enacted violence and lack of family acceptance, pressure to marry, violence from peers and partners, institutional violence, discrimination at schools and workplaces, and experiences of discrimination in employment, housing, and health care services. In one study, third-fourths of respondents felt that it was important to keep their identity a secret (An in-depth understanding of men who have sex with men in Chennai, India: a qualitative analysis of sexual minority status and psychological distress).
There are various aspects of one’s identity that may be stigmatized. Participants in studies have described the influence of heteronormativity in their lives and how that causes a great deal of distress to them. Alternatives to heterosexuality were limited for many participants in these studies. Most of them describe growing up assuming that being attracted to different sex had to be part of their sexuality. With this assumption of heterosexuality, most of the participants negotiated the expectation (with themselves, their families, and others) that they would marry a different gender and have children. Stigma against gender and sexual minorities is still paramount- one’s sexual identity as a homosexual is highly stigmatized. This leads to either internalized homophobia and distress of fitting into a heteronormative narrative or accepting one’s identity and having to deal with the constant stress and discrimination from others because of it. While accessing health care facilities, Queer and trans folk often report facing additional forms of stigma such as stigma about being HIV positive, stigma related to engaging in sex work, and stigma related to having mental health issues. All of these reasons make LGBT counselling in India a dire need of the hour.
LGBTQIA+ affirmative therapy is an approach to therapy that embraces a positive view of Lesbian, Gay, Bisexual, Transgender, Queer and Questioning, Intersex, and Asexual (LGBTQIA+) identities and relationships, and addresses the negative effects that homophobia, transphobia, and heterosexism have on the lives of LGBTQIA+ clients. This approach to psychotherapy is focused on the empowerment of LGBTQIA+ individuals in all areas of life and relationships. Therapists working from an affirmative approach seek to honor and accept the unique challenges faced by LGBTQIA+ individuals and help them navigate the challenges effectively. One of the most important characteristics of LGBTQ counseling is that it is not a special technique or set of skills, rather, practicing affirmatively includes an awareness of how LGBTQIA+ people are similar to other clients with respect to clinical issues, but also may have minority stressors or other pressing concerns that call for particular attention and awareness.
Queer-competent counselors are incredibly important to foster open discussion and disclosure of LGBTQIA+ client identities. So where does one even begin searching for them? A good place to start searching for LGBTQ+ counselors is to start by asking yourself about what you want to accomplish in therapy. Having clarity about your mental health goals can save time and money and can also help in locating a therapist with the right skill set. One’s success in therapy is largely in part shaped by the ‘therapeutic alliance’ between them and their therapist. Various research shows that when you and your therapist share a clear understanding of your treatment goals and how you wish to achieve them, you’re more likely to participate actively in therapy to achieve those goals. When you feel a sense of empathy from your therapist, you are more likely to find therapy sessions rewarding, successful, and engaging. Researchers say that with the right therapist, one may feel as if their therapist is ‘sharing the emotional load’ with them.
This positive connection between a client and their therapist is especially important for LGBTQIA+ people pursuing therapy. Discrimination, microaggressions, and health disparities are already a part of the daily experience of most Queer and trans folks, and a good ‘therapeutic alliance’ can serve as the place of safety and reprieve in their lives where they can finally address and deal with their harsh experiences without any judgment or sense of danger. Another important thing to consider while choosing a therapist to consider your list of must-haves and deal-breakers like:
- Do you want a therapist with expertise and training in a particular type of therapy such as affirming cognitive behavioral therapy?
- Do you wish to work with a therapist with specific gender identity?
- Do you want to work with a therapist who is experienced in treating certain conditions like PTSD, recovery from sexual assault or abuse, etc?
- Do you want a therapist who is a member of the LGBTQIA+ community and can understand some of your experiences firsthand?
- Whether you’ll feel comfortable working with a therapist who is not LGBTQIA+ but is an educated and culturally aware ally?
- Do you wish to work with a therapist who shares other aspects of your identity and understands intersectionality?
No matter what your answers to these questions are, in the end, you ultimately need a safe space where you can tackle your mental health struggles and concerns and feel understood and supported. Founded by Aanchal Narang, Another Light Counselling which specializes in trauma, gender, sexuality, addiction, and kink-affirmative therapy, is one such organization that is working at the forefront of providing quality LGBT counselling in India. Aanchal Narang is a psychologist who holds a Master’s in Applied Psychology (Clinical) from Tata Institute of Social Sciences, Mumbai, and has trained over 3000+ people in the nuances of queer-affirmative and trauma-informed therapy. With a team of highly specialized and trained counselors, this organization incorporates the principles of intersectionality and trauma counselling to provide quality mental health care to their clients, so that no matter the gender, sexuality, caste, class, or socio-economic background, each and every one of their clients feels understood and supported. Another Light Counselling not only works to help its clients meet their mental health goals but also aims to empower and support them outside the four walls of a therapy room.