What is Affirmative Therapy?
“LGBT+ Affirmative” therapy is a modality of therapy that is popping up all around us. As much as 15-20% of Gen Z (those born roughly between the mid 1990s and the mid 2000s) identify as queer and 2-5% identify as transgender or gender non-conforming. Therefore, the demand has grown to provide specific care for people in this community. We hear of many clinicians identify as an “affirmative” therapist, but what exactly does this mean. Shouldn’t all therapists be “affirmative”?
Although all therapists can be affirmative that certainly does not mean that they are. Fundamentally, I believe that Affirmative Therapy is therapy that celebrates and advocates for the authenticity and integrity of LGBT persons and their relationships. It is not a simple tolerance or acceptance of queer lives into a larger heteronormative society, but a true celebration that there is meaning and potential in the nuanced and beautifully unique lives of all LGBTQIA+ individuals.
Affirmative therapy is one where the client does not need to educate or explain their identity or life to their therapist, but one in which the therapist shows up educated and knowledgeable about topics and issues related to the community.
The affirmative therapist must still take cues, definitions, and lived experiences directly from the client’s words and not from biases, stereotypes or preconceived notions. However, the therapist should be able to understand these experiences through the lens of broader cultural implications for members of the queer community.
Affirmative Therapy can be broken down into the following categories:
Acceptance and Non-Judgment
Therapists provide an accepting and non-judgmental environment where clients feel safe to explore their identities, experiences, and concerns without fear of discrimination or condemnation. This takes cues from Carl Rogers ideas on unconditional positive regard for clients but expands to remove any stigma or personal bias against those that identify as a sexual minority.
Understanding and Validation
Therapists seek to understand the unique experiences and challenges faced by LGBT+ individuals, validating their feelings, experiences, and identities as legitimate and important. Whether they are in therapy for issues related to identity or not, their identity and the way they move in the world as a member of the LGBT+ is relevant to the therapeutic environment and deserves attention and understanding.
Empowerment
Therapists empower clients to embrace their authentic selves and make decisions that are in line with their values, goals, and identity, rather than conforming to societal norms or expectations. Therapists are aware of safety considerations and focus is on internal sense of self-esteem, self-compassion and ego strength. Part of the focus in therapy may be centered on queer joy, offering reparenting and corrective emotional experiences including joy – early crushes, excitement, expectations and hopes, exploring gender and sexual euphoria as well as dysphoria.
Cultural Competence
Therapists are knowledgeable about LGBT+ issues, including the impact of societal stigma, discrimination, and minority stress on mental health. They understand the diversity within the LGBT+ community and respect each client's individual experience. Affirmative therapists have unique training and understanding of microaggressions, internalized shame and internalized homophobia/ transphobia, sexually transmitted diseases, HIV/ AIDs history, safety and prevention, trans-affirming health care, identity development models and comorbid mental health considerations. They are knowledgeable about Prep, Pep and safe sex practices, complicated family systems and navigating unsupportive families, as well as understanding of gender and sexuality from non-western ideals including two-spirit and indigenous frameworks.
Affirmative Language
Therapists use affirming language that respects and acknowledges clients' chosen identities, pronouns, and expressions, promoting a sense of dignity and respect and an inclusive and safe environment. Therapists allow clients to lead with their own definitions and labels and ways to identify.
Exploration of Identity
Therapy may involve exploring one's sexual orientation, gender identity, and expression, helping clients to better understand themselves and develop a stronger sense of identity. Therapists may use standard models of identity development like that of Vivienne Cass and affirm the exploration that a client is going through, meeting them where they are instead of having an agenda of their own.
Addressing Minority Stress
Therapists help clients navigate the stressors and challenges associated with being a member of a marginalized group, such as dealing with discrimination, family rejection, or internalized stigma. The affirmative therapist knows that internalized homophobia is often the result of how one was made to feel, not any indication of flaw in character. Minority stress is a result of societal injustice rather than personal deficits.
Support for Coming Out
Therapists assist clients who are exploring or navigating the process of coming out to themselves, family, friends, or society, offering guidance, resources, and support. Often, affirmative therapists understand the difference between privacy and secrecy and can help reframe the coming out process for clients instead as an “inviting in” process. One in which not everyone has earned the right to hear their story or have the privilege of knowing who they are. This includes maintaining safety should it not be appropriate to tell certain family members even if one is “out” to everyone else.
Relationship and Family Support
Therapists may work with LGBT+ individuals, couples, or families to address relationship issues, communication challenges, or family dynamics in a supportive and affirming manner. The therapist is cognizant of how minority stress or systemic discrimination impacts family systems and relational dynamics.
Advocacy and Resources
Therapists may connect clients with LGBT+ affirming resources, support groups, or community organizations to further support their mental health and well-being.
The LGBT+ affirmative therapist provides a specific experience of mirroring, validation and empathy for queer clients where the entire purpose of therapy is to honor and celebrate their unique lives without being boxed in, dismissed or judged based on who they are as a person, especially in comparison to their cisgender or heteronormative counterparts.
For many members of the LGBT+ community, shame becomes a primary issue in therapy and becomes the responsibility of the therapist to deconstruct. Shame may be responsible for depression, substance abuse, self-harm, secrecy, perfectionism, inferiority and low self-esteem, loneliness and isolation.
Additionally, affirmative therapy may address homonormativity, or the idea that there is only one way to be queer, a “right” way or “passable” way. Therapists can break down stereotypes, judgments or barriers that come from within the community itself. For example, some gay men may struggle with substance abuse feeling that the only acceptable type of gay community can be found in bar culture.
Overall, LGBT+ affirmative therapy aims to create a therapeutic environment where LGBT+ individuals feel understood, accepted, and supported in their journey toward self-discovery, self-acceptance, and emotional well-being.