Affirmative Therapy

What is Affirmative Therapy?

In mental health, it is not uncommon for individuals to find solace in their unique life experiences. For instance, a young adult navigating self-discovery, grappling with queries about their sexual orientation or gender identity. It can be tumultuous, and many individuals and their families struggle to understand and embrace the diversity that defines them.

This is where Affirmative Therapy comes in as a form of support for those seeking a compassionate approach to mental health. Imagine a space where one's sexual orientation and gender identity are not viewed through the lens of pathology but celebrated as integral aspects of one's identity. 

This therapeutic approach stands in stark contrast to the traditional models, such as the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), which once pathologized non-heteronormative identities. In 1973, the APA's decision to remove homosexuality from the list of mental illnesses, influenced by LGBTQ+ voices, marked a pivotal moment, dispelling stigma and correcting the misconception of an inherent link between mental illness and homosexuality. (Uyeda, 2021).

Affirmative therapy, also known as gay affirmative psychotherapy or LGBTQ affirmative counseling, recognizes the importance of understanding and embracing diverse gender identities and sexual orientations. This approach rejects the notion that being non-heteronormative is a mental disorder. Instead, it acknowledges the impact of societal norms and prejudices, aiming to address issues related to mental health that may arise from these external pressures.

Alan K. Malyon, a pioneer in this field, has significantly contributed to the development and promotion of affirmative therapy. His work emphasizes the importance of self-acceptance and challenges the concept of internalized homophobia. Internalized homophobia is the negative thoughts and feelings that lesbians and gay men experience about their sexual identity linked to cultural heterosexism and victimization (Williamson, 2000).

Through his groundbreaking efforts, Malyon has paved the way for mental health professionals to practice affirmative therapy and better support those navigating the complexities of gender diversity and sexual orientation. We will delve deeper into affirmative therapy, exploring its principles and how it can assist individuals seeking a positive and affirming approach to mental health.

How does Affirmative Therapy work?

Affirmative therapy, rooted in the understanding and acceptance of diverse gender identities and sexual orientations, follows a transformative model pioneered by Alan K. Malyon. 

Malyon's model unfolds in four crucial stages: the therapeutic alliance, the analytic phase, the identity consolidation phase, and the existential phase, each contributing to the individual's journey toward improved mental health (Malyon, 1982). 

1. Therapeutic alliance: This initial phase creates a safe space for individuals to share their experiences, providing a crucial platform for addressing mental health challenges and establishing a trusting relationship between the therapist and the individual.
2. Analytic phase: In the second stage, the analytic phase, individuals engage in introspection and self-reflection. This phase involves exploring one's gender identity, sexual orientation, and the impact of societal norms. Through this process, individuals gain self-awareness and a deeper understanding of the influences shaping their mental well-being.
3. Identity consolidation phase: Building on insights gained in the analytic phase, the identity consolidation phase focuses on integrating newfound understanding into one's identity.
4. Existential phase: The final existential phase delves into the broader context of an individual's life. Therapists guide individuals in navigating daily lives, acknowledging and addressing ongoing challenges while promoting a positive affirmative stance towards their mental health.

In 2012, Johnson addressed the ambiguity surrounding the defining characteristics of gay affirmative therapy, offering recommendations for its recognition as a culturally competent approach for LGBTQ+ clients and suggesting future research, including exploring the use of the "coming out" narrative in this therapeutic context.

Affirmative practice in health and behavioral health care, which validates and supports individuals' expressed identities, requires practitioners to celebrate identity while acknowledging oppression. Initially centered on LGBTQ+ communities, this approach, rooted in historical and cultural understanding, should now be universally valued, applied across diverse cultures, and avoid stereotyping in various healthcare settings (Mendoza et al., 2020).

Who benefits from Affirmative Therapy?

Affirmative Therapy offers support for individuals seeking a compassionate and affirming approach to mental health, with particular advantages for those navigating diverse gender identities, sexual orientations, and intersecting identities.

• LGBTQIA+ individuals: Affirmative Therapy proves invaluable for LGBTQ+ individuals, offering a safe and inclusive space to explore and embrace their identities, fostering acceptance and self-understanding while addressing mental health challenges.
• Individuals facing discrimination: Those confronting discrimination based on sexual orientation, gender identity, and racial or ethnic backgrounds find solace in Affirmative Therapy. This therapeutic model not only addresses mental health challenges but also validates and confronts the impact of societal prejudice.
• Young adults in self-discovery: Affirmative Therapy provides crucial support for young adults navigating the complexities of self-discovery, especially individuals of color. 
• Families of LGBTQ+ individuals: Affirmative Therapy extends its benefits to families, including those of diverse racial and ethnic backgrounds, helping them navigate and understand the experiences of their LGBTQ+ members. 

Ten ways providers can create an affirming space for LGBTQIA+ clients

Creating an affirming space for LGBTQIA+ clients becomes pivotal, fostering a sense of acceptance and support. Here are ten ways providers can enhance mental health care for the LGBTQIA+ community:

1. Affirming stance in language: Choose inclusive language that respects diverse gender identities, sexualities, and other forms of self-expression during therapy sessions.
2. Tailor treatment plans: Tailor mental health treatment plans to address the mental health issues faced by LGBTQIA+ individuals, recognizing that issues related to sexuality may manifest differently than in other forms of therapy.
3. Cultural competency training: Take part in cultural competency training to understand the challenges faced by LGBTQIA+ individuals, ensuring a more informed and empathetic practice.
4. Trauma-informed care: Practice trauma-informed care, recognizing the potential impact of past traumas on mental health issues and substance abuse within the LGBTQIA+ community.
5. Inclusive family therapy: Extend affirmative therapy work to include family therapy, providing a space for open communication and understanding among family members and fostering greater acceptance of a loved one's identity.
6. Acknowledging intersectionality: Recognize and address the intersectionality of identities, including race, religion, and socio-economic status, understanding how they contribute to mental health experiences.
7. Creating safe spaces: Designate the therapy room as a safe space, ensuring confidentiality and privacy for clients to express themselves without fear of judgment or discrimination.
8. Addressing religious beliefs: Navigate discussions around religious beliefs with sensitivity, helping clients reconcile their spirituality with their gender identity or sexuality.
9. Early stages of gender transition: Support clients in the early stages of gender transition, offering a compassionate and affirming approach as they navigate changes in gender expression and identity.
10. Collaborating with affirmative therapists: If needed, collaborate with other affirmative therapists or professionals specializing in LGBTQIA+ mental health care to provide comprehensive and effective treatment.

The benefits of Affirmative Therapy for the LGBTQIA+ community

As previously mentioned, Affirmative Therapy does indeed offer various benefits. Here is a detailed exploration of some of them

• Validation and acceptance:  It provides a supportive environment where individuals within the LGBTQIA+ community can explore and embrace their identities, fostering a sense of validation and acceptance for who they are.
• Addressing mental health challenges: This approach is tailored to specifically address mental health challenges faced by LGBTQIA+ individuals, offering targeted interventions and strategies to navigate issues related to discrimination, stigma, and internalized homophobia.
• Promoting self-understanding: It aids in the journey of self-discovery, helping LGBTQIA+ individuals understand and embrace their sexual orientation and gender identity, fostering a deeper connection with their authentic selves.
• Empowerment and resilience: Through the therapeutic process, individuals within the LGBTQIA+ community develop coping mechanisms, resilience, and a sense of empowerment, equipping them to navigate societal challenges and discrimination.
• Enhancing relationship dynamics: Affirmative Therapy extends its benefits to relationships, offering a platform for couples and families within the LGBTQIA+ community to strengthen communication, empathy, and mutual understanding, fostering healthier and more supportive connections.

Evidence supporting Affirmative Therapy treatment outcomes

In the 2021 study by Medley, the advocacy for integrating Accelerated Experiential Dynamic Psychotherapy (AEDP) with affirmative therapy for gay men is highlighted. The focus is on addressing the influence of minority stress and heterosexism on attachment models. Proposing the combination of AEDP with a gay affirmative approach, the study suggests that this integration serves as a method to address trauma, offering a corrective emotional experience and fostering secure attachment. This concept is exemplified through a detailed case example.

Furthermore, Millar et al. (2016) conducted a study exploring the impact of internalized homonegativity (IH) on the effectiveness of a cognitive–behavioral intervention for young gay and bisexual men dealing with symptoms of depression and anxiety. The findings underscored that individuals with higher implicit IH levels experienced more significant reductions in depression, anxiety, and risky behaviors. This emphasizes the crucial consideration of internalized attitudes when implementing LGB-affirmative psychotherapy.

Why should affirmative therapists use Carepatron as their practice management software?

Carepatron is a practice management software for therapists seeking to make a meaningful impact. Telehealth, a vital component of contemporary therapeutic practice, seamlessly integrates into Carepatron's user-friendly interface, enabling therapists to connect with clients effortlessly. This feature ensures that therapists can extend their reach beyond geographical constraints, especially in mental health challenges, where accessibility is paramount.

Clinical documentation and scheduling, often considered tedious tasks, are streamlined through Carepatron, allowing therapists to focus more on their clients and less on administrative hassles. Carepatron provides a platform that not only facilitates effective therapy but also contributes to a broader mission of raising awareness and destigmatizing issues such as self-harm, sexual health, and sexual identity.

For affirmative therapists, Carepatron offers specialized tools catering to diverse needs, from family therapy to gender expression and clinical psychology. The platform provides a supportive environment for therapists working with same-sex partners, bisexual clients, and individuals within the sexual and gender minority spectrum.

Joining the Carepatron community goes beyond mere functionality because it aligns therapists with a community that fosters greater acceptance and understanding.

References

Johnson, S. D. (2012). Gay affirmative psychotherapy with lesbian, gay, and bisexual individuals: Implications for contemporary psychotherapy research. American Journal of Orthopsychiatry, 82(4), 516-522. https://doi.org/10.1111/j.1939-0025.2012.01180.x

Malyon, A. K. (1982). Psychotherapeutic implications of internalized homophobia in gay men. Journal of Homosexuality, 7(2-3), 59-69. https://doi.org/10.1300/j082v07n02_08

Medley, B. (2021). Recovering the true self: Affirmative therapy, attachment, and AEDP in psychotherapy with gay men. Journal of Psychotherapy Integration, 31(4), 383-402. https://doi.org/10.1037/int0000132

Mendoza, N. S., Moreno, F. A., Hishaw, G. A., Gaw, A. C., Fortuna, L. R., Skubel, A., Porche, M. V., Roessel, M. H., Shore, J., & Gallegos, A. (2020). Affirmative care across cultures: Broadening application. FOCUS, 18(1), 31-39. https://doi.org/10.1176/appi.focus.20190030

Millar, B. M., Wang, K., & Pachankis, J. E. (2016). The moderating role of internalized homonegativity on the efficacy of LGB-affirmative psychotherapy: Results from a randomized controlled trial with young adult gay and bisexual men. Journal of Consulting and Clinical Psychology, 84(7), 565-570. https://doi.org/10.1037/ccp0000113

Uyeda, R. L. (2021, May 26). How LGBTQ+ activists got "Homosexuality" out of the DSM. JSTOR Daily. https://daily.jstor.org/how-lgbtq-activists-got-homosexuality-out-of-the-dsm/

Williamson, I. R. (2000). Internalized homophobia and health issues affecting lesbians and gay men. Health Education Research, 15(1), 97-107. https://doi.org/10.1093/her/15.1.97