Author: TACTT Group

Attending Trans Pride recently, I saw a placard that read “trans joy is resistance.”

What might this mean for therapy?

Many things come to mind – perhaps starting at the thought that making space for joy can resist the idea that a trans identity is inherently joyless. As therapists, we spend a lot of time being with people as they talk about their distress, hurt and anger. But joy has an important place, too. Not as something we should all be striving towards or some sort of end point, but as part of the mix of emotions and experiences that make up being human. A recognition that joy is possible helps us get through the times when things are most difficult. It helps us imagine new ways of living, of being together. And recognising and celebrating sources of joy can be an important part of therapeutic work.

I often feel as though the narrative around trans people in therapy, and conversion therapy, assumes that trans/ non-binary/ gender non-conforming people only ever go to therapy because they are confused about their gender and want to discuss that confusion. But many, many trans people access therapy for other reasons, and their gender is not a focus. They might want to discuss a bereavement, a breakup; to think about how their early family relationships are affecting their current relationships. To adjust to a move or a job change. In short, trans people – like anyone else – might access therapy for a myriad reasons.

For those who want to discuss their gender, often it’s not about their own ‘struggles’ with this, but about other people’s reactions. Perhaps rejection by family, or their experience of discrimination or violence. I hear a lot of gender critical therapists speak as though ‘affirming’ someone’s gender means reacting to anyone wanting to explore their gender by pushing them to immediately pursue transition. There is a whole other blog in the role of exploration in therapy – for now I will just say that I know as a client how powerful it can be to have a space to explore freely, one where there is no value assigned to the outcome of that exploration. This applies to gender and sexuality, but to a host of other topics as well.

But for now I am thinking about people who come to therapy and feel settled in their queer identity. They’re not wanting to explore it; it’s a part of who they are. It might inform how they see the world or their interactions, but again it’s not what they want to focus on.

How does this connect to joy?

Because the other thing I hear clients talk about is exactly that. The joy they have found in community or accepting themselves. Sometimes that joy replaces hateful family relationships or harmful media messages. It might be what gives them the strength to pursue a dream, start a new relationship, create communities – even to come to therapy. And for me, as a therapist, being beside someone as they are able to share all of themself, as they find the sense of safety they need to begin the work they want to do – that is its own source of joy.

This blog post comes from one of our members  Karen Pollock MBACP who you can find on twitter @counsellingkaz

Let’s start with a question to all the therapists reading this –

Is it OK to be trans?

Ignore for a moment the structural oppressions, prejudice and discrimination which might make a trans person’s life more difficult; that is a different blog. Put to one side gender-affirmative medical treatments; they are part of some trans people’s experiences, but, not a part of the identity. Instead spend a few moments reflecting on whether you believe it is OK for an individual to be transgender, to know and feel that their gender is different to the one that the midwife assigned to them at birth.

Take your time; it’s a blog. I am not going anywhere; let the question filter through automatic responses, shoulds, fears and theories. Perhaps pause for a moment, gaze out of the window, put the kettle on, hold the mug in your hands, smell the coffee, feel the warmth. Let the question rise like steam.

Is it OK to be trans? 

This question lies at the heart of the current debate about conversion therapy, calls for the exclusion of trans people from participating in sport, in wider society, and indeed now, for calls to reduce the number of trans people.

The stance of the Memorandum of Understanding on Conversion Therapy (MoU) was that it was, indeed, OK to be trans, or gay, or bi, or lesbian, or asexual. This “OKness” is described as the affirmative approach; the idea being LGBTQAA is no better, or worse than being cisgender and heterosexual. Since  we cannot draw neat lines around human experience all of these identities are intertwined. You cannot say it is not OK to be one, without also, even silently, insinuating it is not OK to to be the others. Again, perhaps the topic for another blog.

The MoU is based on the agreement that it is OK to be trans, and that attempting to make someone not trans, because it is a perceived better way to be, is harmful and wrong. It also doesn’t work, as we know from all research into conversion therapy. To work ethically within the MoU we need, as therapists, to be able to believe both trans and cis are equally valid ways of being, both ok, and an acceptable way to be. 

Equally acceptable might be a sticking point for some. What Califia described as the “charity f*ck” of human rights, sees LGBTQ people as poor unfortunates who cant help the way they are, and rights conferred from a place of pity and power over.

Pity has no place in the therapy room.

Is it ok to be trans? 

Pause again, ok, what does that mean? Not better, not best, not above, just, OK, 

 All correct, all right; satisfactory, good; well, in good health or order. In early use, occasionally more intensively: outstanding, excellent. Now frequently in a somewhat weakened sense: adequate, acceptable. OK by (someone): fine by (a person), acceptable to (a person). Chiefly predicative. OED 

Is it acceptable to you for someone to be trans? 

If it is not, should that have a space in the therapeutic relationship? If a therapist believed it was not acceptable for a client to be divorced, or gay, or black or disabled would we give that belief space? We can of course have many different beliefs, personally, but professionally we must be able to separate what we believe is or is not acceptable and leave it outside of the room. 

The MoU makes clear that exploratory therapy is allowed under the premise that there is no more or less acceptable outcome. To put it very bluntly, that in the exploration you have no preference for the destination, trans or cis. 

Why then are the proponents of conversion therapy claiming a ban would prevent this exploration? The answer is simple, because, when asked that question, is it OK to be trans, they cannot answer yes. It is not the exploration they want but the power to decide the destination.

As therapists our job is to follow where the clients lead. It is the first principle. We do not decide the outcomes for them. A client wants to decide if they stay in their marriage or not. Whether it is OK to stay, or go (assuming there are no safeguarding concerns) is up to the client, not us. Another client wants to decide if they change jobs. A third if they have an abortion. The next whether they leave their university course. Another whether they are cis, or trans. 

First principle -we go where the client wants to go, not where we believe they should want to go. 

​No matter what kind of therapist you are, you will probably be registered with BACP, NCS, UKCP BABCP or HCPC. 

Having read the ethical framework for all of them, they all mention the care of clients. The first four are much clearer on some form of non-maleficence than HCPC who only say ‘you must encourage service users (where appropriate) to maintain their own health and well-being’, where each of the others specifically mentions avoiding harm. 

The majority of people reading this are registered with one of the above groups. 

As a therapist bound by a code of ethics that says you must not harm a client, you are bound not just by the memorandum of understanding on conversion therapy (which some ‘gender critical’ therapists have argued is “confusing”), but by your ethical framework itself to basically ‘do no harm’, and many of them also have a note on beneficence (do good).

The government, in considering this law, commissioned Adam Jowett and colleagues at Coventry University to do some research for them on this topic. Jowett et al’s research (activate link here) found no research of good quality that showed that ‘conversion therapy’ works, and no evidence that undergoing ‘conversion therapy’ has any benefit to clients. Their research also finds that LGBT people who have undergone such ‘therapy’ also have higher suicidal ideation and more suicide attempts, suggesting that not only does ‘conversion therapy not help, but that it actively harms.

I suggest that this means that you cannot be an ethical therapist under the main counselling-related bodies and participate in ‘conversion therapy’, whether this is requested by an over 18 year old who ‘consents’, or whether it’s because of being trans (the same evidence applies).

If you offer conversion therapy, you risk harming your clients, upto and including the risk of being directly responsible for their deaths, as well as losing your own ethical body membership, and the risk of being sued. 

If you’d like to join TACTT, please activate this link to fill in our form

In the light of the government’s decision to allow some forms of conversion ‘therapy’ despite acknowledging that it doesn’t work (they do not seem to acknowledge the damage that research tells us it does) we have penned an open letter to Liz Truss, which we invite you to join with us in signing if you are a therapist who cares about client work in any way. 
One cannot consent to coercion, and this act as it stands is dangerous to people both cis and trans (and those who a) don’t know or b) are neither). 
https://openletter.earth/open-letter-to-liz-truss-about-the-proposed-ban-on-so-called-conversion-therapy-2d220900

Won’t you join us to save countless people being harmed?