Perception of Clinical Authority in LGBTQIA+ Mental Health Service Users: An Exploration Through Projective Storytelling and Experiential Narratives

Abstract

Background: There is a tendency to use projective assessment to single out intrapsychic vulnerabilities of LGBTQIA+ individuals in mental health literature, without giving due weightage to their marginalized contexts. Additionally, their experiences in accessing mental health services are often nonaffirmative due to dominant pathological discourses in mainstream settings, even though scientific-clinical consensus has been explicit about depathologization. Objectives: The current study aims to understand implicit perceptions and attitudes toward clinical authority in a sample of 10 self-identified LGBTQIA+ mental health service-users in Kolkata. It also aims to contextualize the same against their lived experiences of mental health-care use. Methodology: Qualitative method was used in the current study. Data was collected with the help of sociodemographic questionnaire (for identifying social locations of participants), semi-structured interviews (for eliciting lived experiences of clinical relationships in mental health care), and projective storytelling with the help of TAT Cards 1 and 12M. Results: Analysis of projective storytelling reveals predominantly negative perception of clinical authority with prominent themes of being overpowered by authority, dilemma regarding clinical outcome, passivity, sexual violation, and extreme perceived hostility from environment. Such perception is explainable in the light of lived experiences of discrimination in mental health care, personal vulnerabilities, lack of wholesome interpersonal relationships, and being victims of dominant pathologizing discourses in mental health sciences. Conclusion: Mental health-care praxis needs to direct its attention to discriminatory experiences of service-users from gender and sexual minorities. Practitioners must be encouraged to develop specific competency in this regard, and be mindful of their own biases and prejudice when interacting with clients. JEL Classification: