Very often, clients are unable to accept their own sexuality and may request a change. There would be others forced by or pressurized by family to seek cure/change. When MHPs are faced with such clients, it is important that we recognize that a request for‘cure’or‘change’is a reflection of clients’inability to accept their non-heterosexual sexuality. There are invariably stressors or life events (in the immediate context or long drawn) that underlie this request. GACP would focus on these underlying reasons; in the environment as well as within the client in the form of internalized homophobia. In other words, it would be an ethical choice
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to respond to requests for conversion treatment by initiating a process of self-acceptance.2
This ethical choice is grounded in two realities. There is extensive research on conversion treatments that asks serious questions of these forms of treatment both on the grounds of efficacy and ethics (Haldeman1994). These treatments are not only known to not work but to produce harmful effects on individuals who are subjected to the same (Smith et al. 2004). The Yogyakarta principles on application of international human rights law in relation to sexual orientation and gender identity considers any efforts at treatment, cure or suppression of sexual orientation and gender identity as medical conditions to be a form of medical abuse under Principle 18 (Yogyakarta Principles 2007). Furthermore, GACP advocates that the use or supporting the use of any method that attempts to‘change’,‘cure’sexual attractions or orientation is unethical. Trying to find causes for sexual orientation is again upholding the belief that there is something that went wrong and the person deviated from the standard norm of heterosexuality. Asking sexual minorities why they are homosexual is like asking straight people what caused their heterosexuality.
However, this does not mean that MHPs send away clients who seek change/cure. That would be more damaging for the client. Also internalized homophobia is often so deeply ingrained that clients may seek out another prac- titioner who would be willing to‘cure’them and as we know there is no dearth of practitioners of all shades and hues, who may provide unethical treatments. So the choice is then to provide information to clients about the inefficacy of conversion treatments, while simultaneously addressing their motivations to seek change and working towards self-acceptance. In order to facilitate self-acceptance and ferret out the negative feelings clients may associate with their sexuality, the practitioner needs to know about some of the impediments to self-acceptance. These include, IsolationGrowing up in a heterosexually constructed world would mean that clients often grow up feeling that they are the‘only one like this’. They may not know that same-sex desires are normal and that there are others like them who feel the same way.
Invisibility The silence and invisibility around homosexuality means that clients may not see their lived reality reflected anywhere around them. They may not see people like them, resources for them, images that celebrate their reality, or any sort of experience that makes them believe that, ‘it’s possible to live like this, with dignity and respect’. Often, even the language to address themselves and their desires in a positive manner is missing from their lives.
Internalized homophobiaNegative messages, stigma and rejection by society are often internalized by clients, such that they start believing these messages to be true for themselves, their sexual desires and their relationships.
2Also see Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Available at:www.apa.org/pi/lgbc/publications/.
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DenialMany clients may not be able to recognize or articulate deep-seated feelings of homophobia and rejection.
InstitutionsMany religions and religious leaders ‘ban’homosexuality deeming it unnatural. Marriage is another institution that puts huge amounts of pressure on lesbian and gay individuals. The pressure to marry and produce children to continue the name and family lineage or to continue appearing‘normal’in the eyes of society is high.
Thus, institutions such as the family, marriage as an institution, law, education, religion often condemn homosexuality, which makes self-acceptance an arduous task.
Individual lossesFollowing from the above idea that most social institutions favour heterosexuality and condemn homosexuality, clients may have to give up many benefits that come from being heterosexual if they decide to accept themselves the way they are. The loss of heterosexual privilege or not being able to live the heterosexual script may result in many individual losses, big and small.
A GACP practitioner needs to be aware of these to be able to help clients work on barriers to self-acceptance as well as understand client resistance for the same.
Some of the other steps involved in working on self-acceptance include
• ValidationCounselling spaces are often one of thefirst few spaces where the client is talking about his/her same-sex desires. Hence the responses that the client receives here are extremely vital in the future journey of the client. If the client experiences prejudice, discomfort or stigma then it is likely that the cli- ent’s process of self-acceptance will receive a severe setback and the client may feel further driven into the closet. On the other hand, if the first experience is validating, where the client feels accepted, is assured that he/she is not alone, is not pathological, is given information on resources for gay people, then the client’s process of self-acceptance is likely to be accelerated.
• MirroringMirroring is an important process in development of the‘self’. All of us need to see positive images of ourselves being reflected back to us by significant people in our lives such as our families, our friends, neighbours, communities and so on. However, most gay individuals may have missed this in their growing up years, especially with regard to areas where they may not be conforming to the norm. This can cause a lot of insult and trauma to the developing ‘self’. Therefore, providing affirming, validating mirroring experi- ences to gay clients in counselling spaces with respect to their sexual and gender expressions is very important. This can provide the clients with an emotionally corrective experience that may be vital in self-acceptance.
• Shift from ego-dystonicity to social-dystonicityHelping clients’to place the onus of their problems due to a heteropatriarchal, homoprejudiced society outside of themselves onto this very society is useful. It is like saying to the client,“That you are homosexual is not your fault, but that you are having trouble being a happy, healthy homosexual is because of the situation you are in”. In this sense the locus of the problem is not inside the clients that they have to be ashamed or embarrassed about, it is located elsewhere and clients need not feel like they are the problem.
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• Therapeutic groupsTherapeutic groups are another effective strategy to enhance self-acceptance in clients who have high degree of internalized homophobia.
Group sessions help to reduce isolation that many clients may have faced while growing up. They also provide safe ventilation spaces. Listening to each other’s stories of struggle and resilience can be cathartic as well as healing. Such group sessions, if conducted by a skilled counsellor, can provide for spaces for emotionally corrective experiences, cohesion and a feeling of community and support among its members.
• Use of expert positionPsychoeducation plays an important role in counselling, in general. In this context, providing basic information about homosexuality, which is non-pathological, normalizing, affirmative and informative about resources for gay people, is very useful. Given the level of isolation of some of our LG clients and their family members, providing information on websites, pamphlets, support groups and so on can be very useful. Over and above this, counsellors, just like doctors, are seen as being in a position of authority and as subject experts. It may be useful sometimes to use this authority/power to guide LG clients and their families to affirmative and scientific information and help them avoid unscientific and unethical information about conversion treatments that maybe available in the market (see Ranade2015afor information on use of conversion treatments by practitioners in India).
• Awareness and exploration of sexual minority stress Homoprejudice, stigma, discrimination, internalized homophobia and difficulties with self-acceptance is a vicious cycle. The more the number of negative life events and experiences of violence and discrimination related to one’s sexuality, the more the individual is likely to be isolated, feel ashamed, inadequate and unsupported and the more the number of difficulties with self-acceptance. It is important that counsellors recognize this cycle and help their client’s make the linkages between stigma and their mental health status in counselling sessions. Making these linkages explicit to gay clients and exploring the same in context of life span, i.e.
childhood, adolescence and so on is an important component of GACP. For instance, several gay and lesbian individuals recount stories of ways in which their non-normative gender and sexual expression was pointed out and corrected in contexts of family, friend circle, playmates, school, college and so on. These corrections included messages about normative ways of dressing, play, man- nerisms as well as acceptable sexual interests and expressions in the opposite sex. These corrective responses may range from being merely advice giving about normative behaviour to teasing, to coercion as well as violence and punishments. Exploring the emotional impact of these early corrective responses and their role in impeding self-acceptance is crucial.
• Connecting clients to gay affirmative resources In the context of isolation, helping clients to know more about other gay people and their lives through magazines, websites, fiction and non-fiction literature, meeting LG persons, knowing about support groups for LG persons, events including social events such as parties is all very useful in the process of self-acceptance. The role of the MHP here is twofold. Firstly, if MHPs are working with LG clients they should
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collect basic information on resources for LG clients and make that available at their clinic/set-up. Secondly, the therapist must judge when the client is ready to explore this gay world. Some clients may be struggling with a lot of internalized homophobia and may have several stereotypes about LG persons. A virtual or direct connect with LG individuals maybe overwhelming for the client. Thus, this process has to be done in a phased manner checking with client about their readiness.