Mental Health & Pride: A LGBTQ-Affirmative Psychologist Tells Us Everything About Being Queer And Seeking Therapy
Everything you may have thought of asking in one place!
“Honestly, it was one of the most helpless experiences of my life,” admits Lajya Nayak, before revisiting her first time working with a queer person — a transwoman from a remote part of Karnataka, who wove a gruesome lived narrative of regular sex work on one end of a suicide hotline.
“I used to work in crisis intervention — something which we called a psychosocial helpline,” the 26-year-old consultant psychologist adds. Apart from teaching the Master’s course in Psychology at Mumbai’s KC College, she’s spent the better part of a half-decade working as a mental health professional.
She also works with a client base that’s 40 percent queer-identifying, giving her a great view into the deeply intersectional, complex nature of approaching mental health in a world of fluid genders, sexualities, and cultures.
Approaching Therapy Through A Queer Lens
The first thing to understand about queer-affirmative therapy is the idea of a queer lens – a perspective that goes beyond the boundaries of cisgender, heterosexual ideas of life, culture, media, and everything in between – especially prejudice and biases.
“It’s not just about a client being queer,” she explains. “If we’re talking about any identity that comes from a marginalized background – whether we’re talking about religious or caste intersections for instance… if you live in a society which is not supportive of a marginalized identity, then it does affect the way in which we look at clients and approach their therapy.”
Developing this understanding does, of course, require a certain level of effort from a psychologist. Psychotherapy – much like pop culture, literature, and many other evolving facets of human civilization, have had a history steeped in prejudice. Regarding the former, there’s no shortage of ‘conversion therapy’ horror stories, fuelled by homophobic narratives and still used to beat down and subjugate queer people around the world today.
“I think it’s really sad, because unless systemic change doesn’t happen, mindsets don’t change,” continues Lajya. Like in many disciplines, systemic change begins in educational institutions and the core literature of psychology. “To put it briefly, all psychologists professionally refer to the Diagnostic Statistical Manual (DSM) and the International Classification of Diseases (ICD) in order to carry out a diagnosis. This essentially helps us to know what a person’s mental health disorder is, and if it’s severe enough, which medication to prescribe.
For the longest time, psychology was homophobic because of preexistsing biases in the diagnoses. For example, while gender dysphoria has been in the manual for a long time, a psychologist today would have different reasons as to why they would apply that diagnosis to someone, perhaps to help them begin transitioning instead of pushing them towards a more cishet identity.”
India is famous for cases of conversion therapy – one notable example resulting in the tragic death of a young bisexual woman in 2020, following repeated forced attempts at conversion. While the situation is dire, with multiple deaths and cases of abuse coming to light across the country, there are organisations looking to make a change – starting with the practitioners themselves.
“There are two organisations in India today that are helping out by conducting queer affirmative counseling training – Guftagu Therapy and Mariwala Health Initiative, the latter of which I trained under.
The entire training program helps us understand what it means to be queer, what it means to have a queer lens, and what it means to be a queer practitioner. This can really change the way you approach therapy – you don’t approach popular methods such as CBT (Cognitive Behavioural Therapy) or client’s personal narratives the same way.
It’s these forms of therapy that can help change things at a very grassroots level in India. There’s a huge need for study as well, regarding queer affirmative therapy in India. While there are initiatives, they aren’t quite dominant enough yet,” Lajya concludes.
How Do You Start With Therapy If You’re Queer?
Getting to the stage of seeking therapy – with support or without – is a moment to be proud of regardless of your sexuality. However, there’s definetly a checklist that can benefit you if you’re queer and looking for mental health resources – here’s what Lajya suggests:
“One thing to start with is to ask the practitioner if they are queer-affirmative, which helps a person understand where their potential therapist is coming from.
The next thing is to ask if they have worked with someone from their intersecting population. Even if a therapist is queer affirmative, does that mean that they know what an asexual experience feels like? If you need specific perspectives to be understood, it’s reassuring to know if your therapist has helped someone similar before.
It’s also a good idea to get an understanding of preferred therapy techniques the practitioner likes using. Personally, I like to find therapists who do a lot of narrative, emotional, and intersectional work.
To me, this shows their understanding and preparedness.”
That’s just where it all begins though. While Lajya doesn’t speak for all psychologists, she does share some of the introductory techniques and conversations used to approach questions of identity, and especially coming out.
“Remember, the idea of exploring being queer can be very intimidating, because it can be quite debilitating for someone who has lived life with a lot of cishet privilige. Shame is an emotion we don’t have a lot of power over, and shame is at the core of a lot of insecurities. This is especially true within the queer community, because there’s so much shaming about the identity.
Before even talking about the identity, we can begin talking about the fear.
‘What does it mean to explore this, and maybe feel intimidated that this realisation will change the trajectory of your life?’ It’s a parallel process to explore all of this at the same time – their emotional state as well as a queer identity.
Do they know anyone who has faced discrimination before? What kind of bias are they anticipating – not just from others but also from themselves? Do they have any concerns about presenting that they have not explored before?
We generally start off with exploring these questions, and take it from there.”
How Does Personal Bias Play In?
Apart from the basics, Lajya notes how biases can affect any psych professional, and it’s important for your therapist to be frank and aware about these shortcomings.
“One of the biggest biases that I’m still working on relates to ‘guessing’ if someone is queer or not. There’s a collective assumption that people ‘look’ queer or are queer-presenting, right? Maybe it’s the hair color, or the number of piercings you have, or the books you read… that’s actually not true!
Most older queer people that I come across, for example, don’t really fit into the popular contemporary idea of how a queer person presents. Also, I sometimes fool myself because as a psychologist or just a person, I’ve surrounded myself with plenty of queer people – and this might result in me forgetting just how homophobic people really are.
We may approach things from the perspective of an ‘open space’, but inherently, these things are primed within us.”
The Intersectionality of Age and Sexuality
Speaking of older people – there’s another part of the LGBTQIA+ spectrum that remains curiously absent from contemporary culture, often leaving older queer folk unrepresented and forgotten in today’s age of rainbow capitalism.
“When we think of older individuals, most of them have spent the majority of their lives conforming under the idea that they are helpless to express themselves authentically.
Imagine a small baby elephant tied to a pole – when it tries to break free, it can’t do so. Eventually, the baby elephant grows up. Even though it’s strong enough to break apart from the pole, the memory of its helplessness convinces the elephant that breaking free is impossible.
When you have lived for so long in secrecy, coming out doesn’t just mean coming out as queer – it also means that everything in your life might change completely. For a lot of people in this situation, the fear of losing their relationships often feels much bigger than expressing their identities authentically.
People assume that coming out is the ‘ultimate goal’ of being queer – that unless you come out to everyone around you, you’re not a ‘real’ queer person – which is such a cishet narrative. Who does it benefit – who is this narrative really convenient towards?”
In a more contemporary sense, queer culture has a long way to go, but has certainly made a big difference in acceptance – atleast within younger populations and certiain socioeconomic groups.
“I think when comparing older and younger clients, we need to take the generational gap into account. While there are problems in pop culture queer representation today, atleast the representation exists.
One of my older trans clients didn’t know what the word ‘trans’ meant until she was thirty, and it was only after then that they decided to have a talk. In comparision, younger people have a much stronger idea of what being queer is, and how being queer is different for different people.
On the other hand, atleast for people from an upper-class background, being homophobic isn’t ‘cool’ anymore, in a global social context. That definetly changes the way an upper-class queer person experiences life, compared to someone from a poorer background who may face homophobia more commonly.
This, combined with queer-representive media and literature, helps them experience more freedom and acceptance of their identity, even while in the closet so to speak.
Coming Out To Parents – The Bad & Good
Generational trauma is possibly one of the most common problems experienced by individuals in India – represented through everything from helicopter parenting to psychological and physical abuse. With post-millennial lifestyles growing far apart from their parents’ views on sexuality and relationships, how does a therapist navigate through the challenge of coming out to them?
“Honestly… (laughs) it’s a mixed bag, but it’s been mainly really bad,” admits Lajya.
“I think it’s important to acknowledge that for the parent, it may be a deep loss they’re going through, since it’s so important for them to be the ‘perfect parent’. If you raise a child – no matter how independently – most parents have hopes and dreams for their kids. Finding out that your child is queer often means giving up a lot of those hopes and dreams, which can be a little painful. Grieving that loss takes time.
Whenever we talk about grief, we also talk about denial, anger, bargaining, depression – asking their kids to ‘be straight’ in order to be loved, or be gay but remain closeted. A lot of people don’t realise that this is mostly the grief talking. Acceptance takes time, and it all tends to be a cyclical process.
The idea of a ‘perfect parent’ who accepts their child all in one go is a myth.
All this said, Lajya feels proud of her accomplishments. “I have quite a lot of positive stories – as I said, letting go of shame can do quite a lot for a person!”
Here’s a story from a client I’m currently working with. She was assigned male at birth, and was in a relationship with a woman – which was very confusing for her. ‘How can I be in a relationship with a woman and identify as female?’ – even if you’re queer, you still look at the world through a somewhat cishet lens.
When she first came to me, she felt that she could never, ever explore this part of herself. Now, she’s reached a stage in her therapy where she is moving to the UK to follow her dreams of becoming the first transperson in the UN.
She’s now got a scholarship to do that, but more importantly, she is on the verge of coming out to her parents, and the place she’s coming from is:
“I am not ‘coming out’ to them, I’m letting them into my life.”
(We encourage anyone interested in queer-affirmative therapy to check out Guftagu Therapy and Mariwala Health Initiative’s List – a comprehensive list of practitioners who have completed a queer-affirmative course.)
(Featured Image Credits: Lajya Nayak)