“Life is hard''- a phrase we are all familiar with. No one can escape from the clutches of negative experiences in life as life is all about going through highs and lows and falling downs. But for people belonging to minority groups, these lows seem to be lower, and falls turn out to be harder than their counterparts. One such minority that constantly faces a barrage of emotional and mental turmoil due to their marginalization is the LGBTQIA+ community.

According to the Minority theory proposed by Meyer, LGBTQIA+ individuals live in a constant state of distress known as 'minority stress'. Minority Stress can be described as the juxtaposition of minority and dominant values and the resultant conflict with the social environment experienced by the minority group members. In his groundbreaking study on the impact of minority stress on gay men, he talked about three aspects of minority stress- internalized homophobia; expectations of rejection and discrimination; and events of actual prejudice. He pointed out that even before a person embraces their gender and sexual identity, the dominant notions prevalent in society about the unacceptability of homosexuality are so deeply entrenched in queer people that they can develop internalized homonegativity before ‘coming out'. Citing numerous psychological and sociological studies, Meyer stated that the minority’s perception of non-acceptance in their social interactions leads to a state of insecurity and hyper-vigilance. A high level of perceived stigma leads minority group members to maintain a high degree of vigilance in interactions with dominant group members, which leads to a constant state of paranoia and anxiety about being ‘found out’.

If minority stressors weren’t concerning enough. Queer and trans people are constantly subjected to major stressors in life due to the rampant homophobia and transphobia that is engrained into the fabric of social structures. According to the research done by Darrel Higa et al. from the University of Washington, when LGBTQIA+ people choose to share their identities with parents, guardians, schools, and workplaces, they are often met with rejection and discrimination. It can be seen through the higher rates of homelessness and increased unemployment rates in comparison with heterosexual individuals. LGBTQIA+ individuals are often subjected to bullying, discrimination, hostility, and physical and verbal abuse based on their sexual orientation and gender expression. Queer people either live in constant fear of dealing with the hostility and discrimination based on their gender and sexual identity, or shun their authenticity and stay in the closet to feel a sense of safety. Both of these options are equally detrimental to a queer person’s mental health. In addition to this, The Substance Abuse and Mental Health Services Administration has found that sexual minorities that face rejection and abuse from society tend to have higher rates of mental health disorders, major depressive episodes, and substance abuse issues. Even after going through copious amounts of stress and anxiety in their everyday lives, the tunnel of despair for LGBTQIA+ individuals doesn’t seem to get shorter at all. While seeking mental health care, Queer and trans folk have to go through a whole new set of hurdles and complications.

Psychology has had a complicated relationship with the LGBTQIA+ community. In the first edition of the Diagnostic Statistical Manual (DSM) released by the American Psychological Association (APA), homosexuality was classified as a mental disorder. In fact, in the second edition, DSM classified homosexuality as a mental disorder called Sexual Orientation Disturbance (SOD). This classification gave legitimacy to the idea that heterosexuality and cis-genderism are the ‘normal’ states of being, which gave way to discriminatory and harmful practices like conversion therapy across the world. Conversion therapy aims to change a person’s sexual orientation or gender identity through unethical and harmful procedures. It uses extreme measures like physical harm, shock therapy, and religious interventions like an exorcism to change a person’s sexuality or gender identity. The prevalence of these ineffective and unethical practices resulted in a lack of distrust of the queer community in mental-health practitioners. Even though the mental health space has made some strides in building back this trust, queer people still struggle to find a safe space to share their grievances without being judged. This is due to the fact that more often than not, mental health practitioners fail to use an inclusive therapeutic approach to their grievances and look at therapy from the lens of heteronormativity and gender binary. So how can we bridge the gap between the current reality of mental-health practices and the mental health care that queer people need and deserve? The answer lies in the practice of ‘Queer-affirmative Therapy’.

Queer affirmative therapy is a psychotherapeutic practice that takes on a positive view of LGBTQIA+ individuals, their identities, and their relationships. Gay Affirmative therapy was introduced by Alan K. Malyon in 1982, where he laid down the foundation of queer affirmative therapy by illustrating that queer identities are not pathologies and that homophobia and transphobia have a grave impact on the mental health of queer individuals. Queer affirmative therapy uses traditional psychotherapy practices and affirms the experiences of LGBTQIA+ people by taking an intersectional approach and understanding the effects of marginalization on their lives. Counseling for LGBTQ requires a firm understanding that queer people are not monoliths and every person has a unique experience with their gender and sexual identity. Malyon not only gave a holistic view of homosexual identities but he also outlined what the therapeutic process for queer people would be in stages. The phases he postulated were– Phase 1: building a therapeutic alliance and rapport; Phase 2: Analysing the conflicts of the clients and gaining insights into their attitudes and cognitive restructuring; Phase 3: Consolidation of identity and developing intimate relationships; and Phase 4: establishing a sense of purpose and meaning in life that is personal to one. These phases outlined by Malyon were based on the research on homosexual men who had problems with internalized homophobia, and therefore faced issues with ego-dystonic attraction, difficulty with intimacy, and cultural stigma.

Malyon’s findings served as the base foundation for the development and practice of Queer-affirmative therapy as we know it today. Queer-affirmative counseling requires a therapist to reflect on their attitudes and beliefs and recognize the biases that they may have developed as a result of living in a heteronormative and cis-gendered world. While there is no objective checklist to tick off while providing counseling for LGBTQ people, there are certain basic parameters that Queer-affirmative therapists must fulfill. Here’s how you can find out if the organization or counselor you are dealing with is queer-affirmative or not.

  • They acknowledge and honor the challenges of LGBTQIA+ clients: Mental health professionals trained in affirmative counseling should be aware of the challenges and marginalization that their clients face. Discrimination, stigma, lack of support and representation, etc and must address these challenges in therapy sessions. They must understand how socio-political contexts lead to an erosion of safety for queer and trans folk and how living in these circumstances can deeply affect their clients’ mental health.
  • They combat internalized homophobia or transphobia: Queer-affirmative therapists must check their own notions and beliefs regarding the LGBTQIA+ community and actively work on overcoming the biases that might affect the perception of their clients. Being a queer-affirmative therapist starts with checking the privilege one might bring with themselves into the therapy room and understanding that the therapy room is a political space and therefore should be treated as such. 
  • They do not judge or pathologize non-traditional identities: One of the most important tenets of queer-affirmative counseling lies in the fact that it aims to ‘support’ the LGBTQIA+ individuals rather than ‘curing’ them. Therefore, affirmative counselors must aim to make their clients more comfortable with their identity by providing a safe and non-judgemental space devoid of hostility, prejudice, and bias.
  • They provide support and resources to clients: Affirmative therapists not only support their clients by helping them deal with the stigma that they face and by offering them resources. They should be familiar with the issues and concerns of LGBTQ clients and strive for social justice and change by advocating for LGBTQ individuals outside the therapy room as well.


While the lives of Queer and trans folks are constantly shrouded with turmoil and distress, Queer-affirmative counselors can significantly improve the reality of their clients by acting as agents of change to promote an all-inclusive and safe environment for everyone.