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TATA INSTITUTE OF SOCIAL SCIENCES, MUMBAI
MA APPLIED PSYCHOLOGY CLINICAL AND COUNSELING PRACTICE
SWCB28: Queer Affirmative Mental Health Interventions
Submitted to – Dr. K.P. Ranade
Submitted by – Antara Borah
Roll no - M2024APCCP009
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Clinical Psychologists or Psychiatric Social Workers Working in a Clinical/ Hospital
Setting
Contextual Analysis of the Setting and Rationale
Based on global estimates given by Gates (2011), it is projected that 3.8% of India's
population identifies as LGBTQ+. Applying this estimate to India's 2011 census population of
1.21 billion, approximately 45.4 million individuals in India may identify as lesbian, gay,
bisexual, or transgender (Kealy-Bateman, 2018). Despite the community's significant presence,
there remains a huge lack of awareness and acknowledgment, particularly in healthcare.
In hospital and clinical settings, mental health professionals, frequently encounter
individuals from the community who seek care for a variety of mental health concerns. While
they are expected to understand and respect the nuances of diverse identities, even they are not
immune to negative attitudes toward sexual and gender minorities. More than harboring a
negative bias against the community, they instead exhibit a clear positive bias toward
heterosexual individuals (Bartlett et al., 2009; Capozzi & Lingiardi, 2003; Lingiardi & Capozzi,
2004).
According to Ramirez (2023), the rates of depression, anxiety, and suicide are far greater
in LGBT individuals than those living according to the heteronormative society. The rates of
suicidal ideation and attempts in the transgender group are extremely high. This showcases a
significant health gap, a true health inequity that is reversible. It is not a symptom of being
LGBT but an imposed social product. One would believe that this health gap is due to the
prevalence of harmful prejudices towards Transgender, Gender Non-Conforming (TGNC), and
sexual minorities, but in actuality, it is because of the lack of awareness and information about
the communities. This gap in knowledge leads mental healthcare providers to create non-
affirming environments and reinforce problematic biases, further exacerbating stressors in queer
individuals’ lives.
Being in an intimate relationship with someone from the TGNC community, I have
witnessed the discrimination and hardships that queer individuals endure that often keep them
from seeking help. Social workers and other mental healthcare providers are ethically mandated
to offer culturally competent services to the LGBTQIA+ community (Acker, 2017). The APA
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Task Force on Gender Identity and Gender Variance emphasizes the need to broaden
practitioners' knowledge and competency in providing care to transgender people (American
Psychological Association, 2009). This is why I have chosen clinical psychologists and
psychiatric social workers as the stakeholders I want to work with.
Objectives of the Session
To recognize preconceived notions (both positive and negative) about the queer and trans
communities and how they impact their approach to mental health treatment
To help them develop an understanding of the lived experiences and unique stressors
faced by the LGBTQIA+ community
To practice affirming language and clinical responses applicable in real-world scenarios
Learning and identifying strategies to create more affirming and inclusive clinical spaces
Session plan
Time Activity Description
0-10 minutes Ice-Breaker: The Name Participants will be asked to introduce themselves by
is Political sharing their name or a name they prefer, its origin,
meaning, and how connected they feel to it. Then
they will be asked to link this to the significance of
chosen names for TGNC individuals.
10-20 Psychoeducation They will be asked about what they know about the
minutes community and the various identities constituting it.
We will attempt to educate them about queer or trans
person’s identities and their experiences in a
hospital/clinical setting (e.g., misgendering,
deadnaming bias, or affirmative care). Participants
will be asked to discuss their reactions and
reflections.
20-35 Empathy-Building Each participant will be given cards with a
minutes Exercise: A Day in description of an LGBTQIA+ identity at random.
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Their Shoes After taking some time to analyse, they will be asked
to introduce themselves as the fictitious LGBTQIA+
individual and add some contextual nuances to their
introduction.
35-50 Role-Playing Affirming Participants will be divided into pairs, and both will
minutes Vs. Non-Affirming get to play the roles of a client and therapist based on
Clinical Responses a short case history provided for 5 minutes each.
Once they are done, they will be asked to reflect and
feedback will be given.
50-60 Reflections and Closing The participants will be asked to share what came up
minutes of the Session for them during the session, their takeaways, and
how they will approach their practice differently
now. They will be provided with a link to an Excel
sheet with various resources, documentaries, movies,
and organizations working for the community to
educate themselves and affiliate themselves with
working for the community.
Pedagogy Used
Experiential Learning: Narrative and immersive learning can be really beneficial in
building perspective and developing empathy towards others. McPhail’s (2022) thesis on
“The experience of empathy with the LGBTQ+ community through narrative
transportation when not LGBTQ+: a qualitative investigation” showcases how narrative
transportation or experiential learning, plays a crucial role in developing empathy.
Through activities such as, ‘The Name is Political’, ‘A Day in their Shoes’, and role-play,
participants can relate to the community and view the world from their perspective.
Group Discussion, Reflections, and Reflexive Action: To encourage perspective-
sharing and become more self-aware about one’s own biases. Through the role-play
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activity, participants can practice reflexive action as it requires them to critically examine
the situation and modify or adjust their approach based on their newfound reflections.
Interactive Session: Rather than passive lectures, participants will actively engage in
activities.
Resource Materials
I. Identity descriptions for ‘A Day in Their Shoes’
1. You are a cis-gendered closeted man and a lawyer. You are married and have two sons.
2. You are a stealth transgender woman trying to make it as an actress, but despite not
disclosing your identity, you aren’t getting many opportunities because you don’t meet
the conventional beauty standards set for women.
3. You are a teenager realising that you feel more comfortable in masculine clothing despite
being expected to wear feminine clothing as you are a female assigned at birth (AFAB).
4. You are a bisexual woman in a long-term relationship with a cis man, but you feel
invisible within the queer community.
5. You are a lesbian woman in the closet and your family is trying to set you up with a man.
6. You have recently come out as a trans man but your family and friends keep
misgendering and deadnaming you.
7. You are a gender-fluid individual who feels really uncomfortable using public restrooms
due to the fear of judgment and confusion regarding which restroom to use.
8. You are a trans man and you face a lot of ridicule and judgment as you like to dress up
femininely.
9. You are a polyamorous individual and you are afraid to discuss your relationships due to
societal stigma.
10. You are an intersex individual and you were operated on as a child without your consent
and now you are questioning your gender identity.
11. You are a trans individual with a disability and you are struggling to find inclusive spaces
and communities that acknowledge both of your identities.
12. You are a demisexual individual who is tired of the hook-up culture.
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13. You are an asexual individual and you were forced to get married. You are currently
facing great distress and passive abuse from your partner due to your refusal to engage in
sexual intercourse.
14. Your parents have found out that you are queer and now forcing you to go to a Tantrik to
get “fixed”
15. You are a pansexual man and your identity is constantly dismissed as “confusion” or just
a “phase”
16. You are a trans man struggling to adapt to societal expectations of masculinity while
grappling with the stark differences in how men and women are treated.
17. You are a trans man in a committed relationship struggling to engage in sexual activities
due to gender dysphoria.
18. You are a closeted lesbian woman and you are worried that being open about your
identity will lead to discrimination at work or forced to quit.
19. You are a bisexual woman experiencing a lot of hate online after making your
relationship with a man public.
20. You are a non-binary teenager and you are being forced to wear a skirt in school and this
is making you feel dysphoric.
II. Case for Role-Play
Aayan, a 22-year-old trans man has been feeling increasingly isolated and anxious since
starting testosterone 5 months ago. Despite progressing in his transition, he is grappling with his
gender dysphoria, societal expectations for masculinity, strained relationships, constantly being
misgendered and deadnamed by family, and his old friends treating him differently. He feels
stuck between wanting validation as a man but also struggling with societal expectations and
how disorienting it is to be perceived differently, making him doubt his identity.
III. Resources
WPATH (World Professional Association for Transgender Health) Standards of Care
https://www.wpath.org/publications/soc)
APA Guidelines for Psychological Practice with Transgender and Gender Nonconforming People
https://www.apa.org/practice/guidelines/transgender.pdf)
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National LGBTQIA+ Health Education Center Resources for Mental Health Professionals –
https://www.lgbtqiahealtheducation.org/)
Ranade, K., Chakravarty, S., Nair, P., & Shringarpure, G. (2022). Queer affirmative counselling
practice-a resource book for mental health practitioners in India. Mumbai: Mariwala
Health Initiative.
LGBTQ India Resource: Your one-stop to India's queer stuff!
https://lgbtqindiaresource.in/
Naz foundation
https://www.nazindia.org/
Mariwala Health Initiative: MHI
https://mhi.org.in/
Humsafar Trust
https://humsafar.org/aboutus/#:~:text=The%20Humsafar%20Trust%20(HST)%2C,for
%20more%20than%2030%20years.
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References
Ali, E., M, C. K., Hussain, A., & Akhtar, Z. (2018). THE EFFECTS OF PLAY-BASED
LEARNING ON EARLY CHILDHOOD EDUCATION AND DEVELOPMENT. Journal
of Evolution of Medical and Dental Sciences, 7(43), 4682–4685.
https://doi.org/10.14260/jemds/2018/1044
European International University, Blog. (2024, September 17). Inclusive Education for Children
with Learning Disabilities in India- A Report - European International University | Blog.
European International University | Blog - Learn Anytime , Anywhere.
https://blog.eiu.ac/2024/09/17/inclusive-education-for-children-with-learning-disabilities-
in-india-a-report/#:~:text=According%20to%20recent%20UNESCO%20data,more
%20specific%20than%20the%20others.
Gates, G. J. (2011, April 1). How Many People are Lesbian, Gay, Bisexual and Transgender?
https://www.escholarship.org/uc/item/09h684x2
Huston, A. C. (1991). Children in poverty: Child Development and Public Policy. Cambridge
University Press.
Kealy-Bateman, W. (2018). The possible role of the psychiatrist: The lesbian, gay, bisexual, and
transgender population in India. Indian Journal of Psychiatry, 60(4), 489.
https://doi.org/10.4103/psychiatry.indianjpsychiatry_83_17
