When words matter

We start this with a caveat: the language and definitions of terms are correct as of Dec 2023. This may change in future.

As therapists we work with people from all types of backgrounds and may encounter those of a different race or ethnicity to us, those with a different class, sexuality, gender, those who are (differently) disabled, as well as those who are trans.

Although most UK counselling membership bodies (including BACP, NCPS, UKCP and ACC) have signed up to the memorandum of understanding on conversion therapy (that is – conversion therapy is bad and the evidence overwhelmingly suggests that it has a risk of suicide, there is a current discussion around language and semantics that feels important to unpick.

In light of the UKCP’s statement around exploratory therapy and their response to TACTT’s open letter, this blog sets out a brief overview of key terms as used by gender critical (GC) therapists (which are often in direct opposition to the definitions used by non-GC therapists).

Gender critical: To be ‘gender critical’ (or ‘GC’) exclusively refers to those people who don’t believe that trans is a valid identity. A GC person believes that there are only two sexes, that people can’t change sex and that sex is the axis that matters. Gender critical people do not believe that “trans women are women” and “trans men are men” (and non-binary people exist), but that trans people are at best delusional, and at worst, predatory (‘men aiming to access women’s spaces’ for example). It is of note that the term ‘gender critical’ originally meant almost the opposite of what ‘gender critical’ now means, and therefore it is easy to understand why someone who is critical of gender norms and stereotypes, but who is accepting and welcoming of trans identities, might call themselves ‘gender critical’, not realising they are aligning themselves with a very different way of being.

Conversion therapy: Conversion therapy attempts to explain gender and sexuality divergence as a failure to be cisgender, heterosexual etc., and sees “success” as a client’s embracing of the preferred norms. Conversion therapy is “an umbrella term for a therapeutic approach, or any model or individual viewpoint that demonstrates an assumption that any sexual orientation or gender identity is inherently preferable to any other, and which attempts to bring about a change of sexual orientation or gender identity, or seeks to suppress an individual’s expression of sexual orientation or gender identity on that basis.” (MOU) It can include an attempt to ‘change’ a person’s gender identity by suggesting they were abused, or are actually autistic or gay (etc.), and are therefore this means they are not trans, and that other gender identities outside of the white binary don’t exist. Conversion therapy is at best, ineffective and at worst, actively dangerous.

Affirmative therapy: GC therapists will state that affirmative therapy is actually conversion therapy ( that affirming is ‘telling’ someone they are trans) and that exploratory therapy is the only way forward. A non GC-therapist would usually use the word affirmative to affirm the client in their right to explore and to use words that are right for their identity (with the therapist having no preference for the client to hold any particular identity). In the same way that we do with clients who discuss childhood abuse for example– we don’t presume to speak over a client and tell them they were or were not abused; we provide space to allow them to come to what labels (or none) and understandings of their experiences work for them. We affirm their right to do this exploration of self in a non-judgemental space. We do not seek to convert, or to act in accordance with our personal beliefs. The GC-therapists’ claim is that ‘affirmative therapy’ is “telling a client they are trans” and affirmative therapists are pushing those clients towards that identity. This would be tantamount to conversion therapy, were it happening. However, allowing an affirmative space for a client to explore all aspects of their identity, is not the same as trying to convince them of one aspect. Affirmative simply means that we do not think it is a worse outcome if a client decides, for themself, that they are not cisgender.

Exploratory therapy: Exploratory therapy is being cited in the UK as being contra to the (GC) definition of affirmative therapy. Florence Ashley writes a brilliant paper on a GC definition of exploratory therapy and why it is a terrible idea, and is essentially equivalent to conversion therapy. Proponents of exploratory therapy are reluctant to accept trans identities (particularly in young people) and instead look to find the reasons a person may be saying they are trans (such as childhood trauma etc.) to resolve these and ensure a person moves to a cisgender identity. This approach situates transness as pathology, meaning that it is in direct contravention of the MoU, which states that neither being trans nor being cis are inherently better than the other. Of course, if our clients have a trauma history they are looking to explore then we would look to do this. This is not the same as looking at trauma as ‘the reason’ someone is saying that they are trans.

A gender-critical therapist who believes that sex is immutable and more important than ‘gender identity’, will practise exploratory therapy in order to try to find (and fix) the reasons someone says they are trans – there is no therapeutic neutrality here as pathology is assumed. A therapist who believes that trans identities are valid may seek to practise in an affirmative way that does not aim to tell a client what their identity is, but provides space for the client to find their own language. Exploratory therapy (in the way the term is increasingly used) begins from a place of pathology, but although trans people are more likely to have suffered abuse/trauma, this is not the cause of our transness. To attempt to search this out and resolve something where no cause exists, is conversion therapy.