Tolerance vs. Affirming

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I have naturally curly hair. I am the only one in my immediate family that has such hair, which made it very hard for them to understand my hair care. I remember my grandmother trying to brush my hair while I screamed and then cried when I looked in the mirror at the frizzy mess before me. They had no idea what to do with it, and as a consequence, neither did I. I was taken to hair salons that would spend two hours trying to straighten my hair after they trimmed it, only for my hair to instantly curl back up the minute it was washed. As I grew up and muddled my way through trying to discover how to best care for my hair, I found myself able to locate salons that didn’t attempt to straighten my hair, but that was really it. No one really noticed the unique needs of my hair. It wasn’t until recently, I decided I was going to go to a hair salon that specializes in curl care. It was such a unique and wonderful experience for me. I felt understood and seen for the needs I had, and everything was all customized to me. I was able to be educated on things to better help my hair, and I left with a sense of pride in this part of me. I felt more confident and empowered. Why do I share that story on a blog post about Pride Month? The answer is simple: to help us recognize the differences between tolerance and affirming and why it is important to understand these differences. Many already know that intolerance is a bad thing. However, we think it’s enough to just say, “Oh you’re part of the LGBTQ+ community? Cool!” The reality is that this is far from enough. To start, we need to look at what tolerance is. If you were to do a quick Google search of the word “tolerance,” you would find that it is defined as the willingness to tolerate something “in particular the existence of opinions or behavior that one does not necessarily agree with.” It is often described as an ability to endure something painful or unenjoyable. The essence of tolerance in the LGBTQ+ community is this: it sends a message that the individual makes us uncomfortable. There are many people out there that will go, “I’m okay with you being gay or whatever, but I would prefer you to not discuss that.” Imagine being on the receiving end of that for just a minute. Imagine going to a doctor, going on a date, or just any encounter with a person where you start talking about something important to you. Maybe you bring up your family, your job, a hobby, or anything else you love and enjoy. As soon as you bring that up, the person you are talking to becomes visibly uncomfortable. Two things would likely happen: 1. You would never bring up that part of you that is essential to you and keep a wall up or 2. You will make efforts to avoid seeing this person again. Many health care professionals, including therapists, fall into this category of tolerance citing that they do not believe it is necessary for treatment. These professionals are often left wondering why their patients stopped showing up to appointments despite doing what they believed was effective treatment for their patient’s needs. The reality is that a clinician in this mindset did more harm to a patient by promoting a sense of shame and guilt. As mental health professionals, it is important for us to remember we are to be culturally competent clinicians who embrace a comprehensive, biopsychosocial approach that meets the individual needs of a patient seeking services. When there is an aspect of a patient’s identity or culture that is not welcomed into the time together because it makes the clinician uncomfortable, then that clinician has failed to uphold best practice standards. The definition of affirming is simple: offering someone emotional support or encouragement. That’s like Therapy 101, isn’t it? We know taking this approach is what can help our patients believe that they are capable of growth. An affirming approach with the LGBTQ+ patient is an approach that invites that part of their identity to be part of the conversation with welcome arms. “I would love to hear more about your relationship. How long have you two been together?” “I go by Jordan, and my pronouns are she/her/hers. What name and pronouns do you go by?” In these moments, we can show we welcome that part. This is a place you can talk about that piece of you and what it means. This is important because as therapists, we should recognize that many systems can contribute to stressors as well as protective factors and resources. The harmful culture of tolerance and the effectiveness of affirmation is evident in research. In 2014, a study conducted Durso and Meyer found that 39.3% of bisexual men, 32.6% of bisexual women, 10% of gay men, and 12.9% of lesbians did not share their sexual orientation with health care providers. Another article written in 2015 by Sabin, Riskind, and Nosek found that stigma, lack of cultural sensitivity, and reluctance to address sexuality may hamper effectiveness of care. A study in 2006 by Steele, Tinmouth, and Lu found that positivity and inquiry about sexual identity led to disclosure, and disclosure led to regular health care use. Tolerance alone is not enough and could potentially cause more harm, particularly in a health care setting as it could lead to patients disengaging from services. If we want to keep patients engaged in treatment, we must embrace an attitude of affirmation. If we want to be a better ally to our friends and family, we must embrace an attitude of affirmation.