Author: TACTT Group

Open letter to UKCP about their guidance regarding so-called ‘gender-critical’ views

We have published an open letter to UKCP in response to their recently published statement on the law regarding so-called ‘gender-critical’ views and its implications for the practice of psychotherapy and psychotherapeutic counselling.

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UPDATE: It has been 24 hours since we first shared this open letter and it has already been signed over 400 times by psychoherapists, counsellors, trainees and other therapeutic practitioners. Thank you. We are moved and warmed by this outpouring of support.We also know that, sadly, work of this nature can attract negative attention. But while we acknowledge that risk, we are choosing to continue to share and promote this letter as widely as possible because we can see that it strikes a chord with so many therapists – and clients – who support an affirmative approach to working with trans, non-binary and gender-questioning clients. 

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The full letter is below. If you would like to sign it, please go to https://openletter.earth/open-letter-to-ukcp-about-their-guidance-regarding-so-called-gender-critical-views-c71ce5d6

Open letter to UKCP about their guidance regarding so-called ‘gender-critical’ views

Dear UKCP,

We are writing in response to your recently published statement on the law regarding so-called ‘gender-critical’ views and its implications for the practice of psychotherapy and psychotherapeutic counselling. We are a group of over 100 registered therapists and trainee therapists, some of whom are trans, non-binary and/or gender-expansive people and some of whom are allies. We note that trans voices are palpably absent from UKCP’s statement and hope that this letter goes some way towards correcting the balance of discourse in the psychotherapy and counselling profession, which routinely discusses trans lives without centring the voices and lived experiences of trans people themselves. 

Introduction

We were concerned by the publication of UKCP’s statement, which has created confusion and fear within both the profession and trans communities. We wonder why the statement was published at this time, with no explanation of its place within or alongside the UKCP Code of Ethics and Professional Practice (2019) and the Memorandum of Understanding on Conversion Therapy (2022), of which UKCP is a signatory. 

Although not all of our members are registered to practise with UKCP, many are, and our stance outlined in the above paragraph is consistent with several points in UCKP’s Code of Ethics and Professional Practice (2019), specifically:

  • Point 3: Respect your client’s autonomy (p.1).
  • Point 24:  Understand the limits of your competence and stay within them in all your professional activity, referring clients to another professional when appropriate. This includes recognising that particular client groups, such as children and families, have needs which not all practitioners are equipped to address (p.3).

We believe that therapy which affirms trans, non-binary and gender-questioning clients has the power to save lives. There is overwhelming evidence that gender-affirming care can improve mental health and general wellbeing, whilst decreasing risk of suicide (Lawson et al, 2023). We advocate for an affirmative approach, in which the therapist supports the client’s right to define themselves. Affirmative therapy is exploratory in nature. However we are concerned that the term ‘exploratory therapy’ is increasingly being used to justify therapy undertaken by those with so-called ‘gender-critical’ beliefs. We believe that unless a therapist holds the view that being trans is one of many potentially favourable and healthy outcomes, they are not competent to work with gender in the therapy room. Any ‘exploratory’ approach that does not consider transness to be as good as any other state of being, and which seeks to uncover and possibly ‘fix’ the ‘reason’ for the client’s gender identity is conversion therapy. 

As with any marginalised client group, therapists have the task of unlearning  preconceptions or pre-decided theoretical ideas regarding a client’s identity  in order to work safely and effectively. Consider, for example, the similarities with lesbian, gay or bisexual affirming practice, where therapists are asked to examine and unlearn unconscious biases about sexuality, and to refer clients on if this is not possible (point q, section 5, UKCP, no date). It should be no different for gender identity and gender-expansive experiences. 

Simply put, we consider it exceedingly difficult for therapists to hold the dual position of having ‘gender-critical’ beliefs whilst offering genuinely ‘exploratory therapy’ with trans, non-binary and gender-questioning clients. We are concerned that this is not the view UKCP presents to its members and the general public with its new statement. To position therapists with ‘gender-critical’ beliefs as the main proponents of ‘exploratory therapy’ is highly misleading.

Memorandum of Understanding on Conversion Therapy

TACTT wishes to understand why UKCP has published this statement now and what purpose it is intended to achieve. We would like to remind UKCP that, as a signatory of the Memorandum of Understanding on Conversion Therapy (MoU, 2022), you are already bound to an ethical stance on working with gender diversity:

Ethical practice in these cases requires the practitioner to have adequate knowledge and understanding of gender and sexual diversity and to be free from any agenda that favours one gender identity or sexual orientation as preferable over other gender and sexual diversities. For this reason, it is essential for clinicians to acknowledge the broad spectrum of sexual orientations and gender identities and gender expressions. (MoU, 2022, p2; emphasis added)

Indeed, point 36 of the UKCP Code of Ethics and Professional Practice (2019, p.4) specifically highlights that practitioners should be familiar with the Memorandum of Understanding on Conversion Therapy (MoU) (2022). We are concerned by the stark omission of the MoU in this statement. We are also concerned to find a discrepancy in point 30 of UKCP’s own Code of Ethics and Professional Practice:

Not allow prejudice about a client’s sex, age, colour, race, disability, communication skills, sexuality, lifestyle, religious, cultural or political beliefs, social economic or immigration status to adversely affect the way you relate to them. (UKCP, 2019, p.4)

We notice that gender is not included in these protections and wonder why? As a signatory of the MoU, UKCP is committed to the protection of gender diverse people. May we remind UKCP that ‘gender reassignment’ is still a protected characteristic under the Equality Act (2010). 

We request more clarity on how UKCP members should act on the information provided in the statement – is it guidance, or policy? How should this statement be observed and put into practice with clients whilst UKCP’s members abide by the UKCP Code of Ethics and Professional Practice and the Memorandum of Understanding? 

An exploratory approach?

We disagree that an ‘exploratory’ psychotherapeutic approach is likely to be taken if a practitioner has sympathy with ‘gender-critical’ views (Ashley, 2023). We also find UKCP’s definition of ‘exploratory therapy’ to be unclear. It has already, in the short time since the publication of its statement, created confusion and distress for clients and the wider trans community.

Whilst case law has confirmed that ‘gender-critical’ beliefs are protected under the Equality Act 2010, the expression of such beliefs is not protected if it causes harm or distress to another. The ‘gender-critical’ belief that sex is binary and immutable translates into a belief that trans identities are not valid. We agree with the MoU (2022, p.2) that ethical practice when working with gender requires clinicians ‘to be free from any agenda that favours one gender identity […] as preferable over other gender […] diversities.’ Thus, when therapists work from the starting point that being trans is not a favourable outcome and are constantly looking for an ‘explanation’ for someone’s identity, this can easily tip into conversion practices. How can a therapist, who does not believe that a trans person is who they define themselves to be, conduct therapy ‘without any preconceptions or pre-decided theoretical framework regarding the person’s gender identity’ (UKCP statement)? 

To work with gender ethically and competently, therapists must accept that being trans is a good state of being and a good outcome – one of many possible, valid outcomes, none of which is preferable to another. Furthermore, any movement towards one of many possible, valid outcomes should always be determined by the client.

While we agree that practitioners will often hold differing views on what approach is in the best interests of our clients, what is missing from this statement is any acknowledgement of what the client wants, needs or feels. Clients who are trans, non-binary and gender-questioning do not always present with ‘dysphoria’ and when they do this term means different things to different people. It is vital that we follow our clients’ lead and explore what they want to talk about. In general, therapists are not medical gatekeepers and, outside of gender services, we do not play a role in whether or not clients can or should access medical care. It is our role to support clients’ sense of agency in defining themselves. It is not our job to greenlight our clients’ gender journeys but to be with them as they figure out where they go.

Research by Hunt (2014) found that therapists’ lack of awareness and competence in working with gender can be a barrier to trans people accessing the support and space for exploration they may require from therapy. Indeed, therapists may not actually be someone their clients choose to share their gender journeys with. But the chances of this are more likely if clients feel able to bring all of themselves. Again, we emphasise that trans voices are noticeably absent from UKCP’s statement, which appears to prioritise the right of the therapist to assert an approach that ‘is in the best interest of their clients’ over the actual needs and desires of their clients.

Misleading and contradictory 

We found UKCP’s statement to be misleading and contradictory in several ways. First, we are concerned that by leading with a reference to the interim Cass Review and its implications for UKCP members, and then continuing to reference medical interventions for children and young people, it replicates a hyperfocus on trans children and young people which excludes their voices whilst contributing to public hysteria. Furthermore, therapists who are not informed about the Cass Review and its specific emphasis on children and young people may, having read UKCP’s statement, now take this as direction to hold a particular stance in relation to providing psychotherapeutic support to adult clients. 

Secondly, we find that overall UKCP’s statement conflates working psychotherapeutically with being directly involved in any medical care trans clients may wish to consider and access. Psychotherapists and psychotherapeutic counsellors are not medical professionals. Outside of specific Gender Identity Clinics, therapists are not involved in any decision-making about gender-affirming medical care. This is the case regardless of whether we find ourselves supporting children, young people, or adults. This continues to be the case even if a client self-defines as experiencing gender dysphoria (in whatever language they may use), has a medical diagnosis of gender dysphoria, or may be seeking a gender dysphoria diagnosis for any number of reasons.

However, thirdly, this statement unnecessarily centres the concepts of gender dysphoria and medical intervention, as though these are the only experiences of being trans in the world. It is incorrect, disrespectful, and reductionist to regard all trans, non-binary and gender-questioning clients as experiencing gender dysphoria and/or seeking gender-affirming medical intervention. Doing so dismisses the incredible diversity of what it means to be trans, non-binary or gender-expansive, and to experience oneself authentically and euphorically. This statement reads as though it has been written by people who have never worked with trans, non-binary and gender-questioning people. As per point 29 of UKCP’s Code of Ethics and Professional Practice (2019, p.4), we urge you to expand your knowledge of transness, to honour the diverse narratives of trans people, and to make space for other experiences, such as gender euphoria and trans joy.

Reductive and pathologising

We find the UKCP Chair’s use of the term ‘gender issues’ in this statement to be reductive. By placing this alongside ‘mental health conditions and emotional issues such as depression, eating disorders and relationship difficulties’, UKCP treats gender diversity as problematic and pathological and ignores the creativity, potentiality and joy that can be found in working with trans, non-binary and gender-questioning clients. The Chair further reduces working with gender to ‘questioning’, which in our experience is only ever part of a vast, kaleidoscopic landscape of what it means to work with gender in therapy. Many trans people in therapy already know what their gender is; it is living in a world which denies their existence and does violence to their bodies which causes them psychological distress and harm. 

We also wish to remind UKCP that trans people may seek therapy for all the reasons anyone seeks therapy and it is important that therapists do not assume clients are only seeking support for gender identity or transition. We work with clients on family issues, sex and relationships, work, bereavement, isolation, anxiety, depression – all the things any client may bring to therapy. 

The Chair’s assertion that a ‘thorough exploration’ of gender ‘can take time, and sometimes a very long time’ is highly alarming, and redolent of the potentially harmful concept of ‘watchful waiting’. It suggests that therapists have the power to decide how long a ‘thorough exploration’ should take, all the while clients are held in a place of discomfort and dis-ease. How will the therapist know when enough time has passed? What will tell them that any exploration is ‘sufficiently thorough’? Again, this argument appears to prioritise the approach of the therapist over the agency of the client. As Saketopoulou (Acast, 2022) suggests, “This seems to have more to do with the person who wants to do the watching, rather than the person that is doing the waiting.”

We believe the Chair’s reference to medical interventions has no place in guidance published by a UK psychotherapy body. As we have stated, in the UK, psychotherapists and psychotherapeutic counsellors are not medical gatekeepers; it is not our responsibility to determine ‘risk’ in seeking gender-affirming medical care. UKCP’s statement risks generating panic amongst practitioners and clients by suggesting that it is the therapist’s place to sanction a client’s access to gender-affirming care. 

For UKCP therapists who are interested but inexperienced in supporting trans, non-binary and gender-questioning clients, such panic prevents them from learning and offering appropriate psychotherapeutic services. Thus, the pool of competent, safe therapists available to such clients becomes ever smaller.

Furthermore, medical intervention is not the only choice open to trans and non-binary clients, and this reductionist statement does nothing to help wider public understanding of the complexity and nuance of what it means to explore gender or to be trans in the world.

We find the Chair’s closing argument troubling. It creates further concern about UKCP’s stance on how its members should work with gender diverse clients:

Regardless of viewpoints, all professional psychotherapists and psychotherapeutic counsellors who work with gender dysphoria or gender-identity want the best for the person who is struggling and needs help. If this is always kept in mind, these vitally important conversations, however difficult, can take place in a healthy and supportive manner, allowing us to ensure our clients’ and the public’s best interest and safety remain paramount. (UKCP statement)

Can UKCP clarify why safety is a concern for the public in relation to transgender, non-binary, and gender non-conforming people seeking therapy? How will psychotherapists and counsellors know what is ‘best’ for clients? Who defines ‘best interest’? Does this mean respecting our clients’ autonomy? How will UKCP act to protect trans, non-binary and gender-questioning clients from therapists whose ‘gender-critical’ beliefs cannot be bracketed and unduly influence what they believe is in the best interest of the client? 

It cannot be said with any certainty that all psychotherapists and psychotherapeutic counsellors who work with gender dysphoria or gender identity want the best for those who are struggling and need help. By definition, therapists who hold ‘gender-critical’ beliefs already disagree on what trans, non-binary and gender-questioning people define as best for themselves. 

Overall, UKCP’s statement grossly misunderstands the reality of working with trans, non-binary and gender-questioning clients who seek psychotherapeutic support. There is nothing ‘difficult’ about being allied with our clients’ views on how they feel about themselves, or their expressions of identity in ways that are fulfilling and meaningful. Doing so is simply part of offering psychotherapeutic support in an ethical manner, making space for difference and diversity along the way.

Conclusion

We ask that UKCP clarifies its original guidance and responds to the questions and points we have raised throughout this letter. 

We invite you to further your own education on trans experiences and centre trans voices in any future public commentary on trans lives. This can be achieved by consulting with trans and non-binary therapists, as well as practitioners who are undertaking affirmative therapy with trans, non-binary and gender-questioning clients. There are many practitioners in TACTT and beyond who would generously share their experiences in the interest of making emotional and mental wellness a human right for trans people.

Finally, we urge UKCP to reflect on how a ‘gender-critical’ therapist could reasonably, ethically, and legally be able to offer psychotherapeutic support to trans, non-binary and gender-questioning people. We see nothing but risk of harm in this approach.

We fear that if UKCP continues down this path, the council and its members will be considered by clients to be synonymous with being ‘gender-critical’. Indeed even in the short space of time since this statement was published, we are already seeing this fear shared amongst trans people. Many practitioners train for a long time to achieve UKCP membership and registration; it is disappointing that those of us who are trans-affirmative are starting to question our place in the organisation.

We invite other psychotherapists and psychotherapeutic counsellors who support this letter to sign below. 

Yours sincerely,

Therapists Against Conversion Therapy and Transphobia (TACTT)

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References

Acast. (2022). ‘Exposing Transphobic Legacies, Embracing Trans Life’ with Dr Jules Gill-Peterson & Dr Avgi Saketopoulou. Couched (Podcast) 24 June. Available at: Episode 3, Season 3. iPlayer, 17 February 2023. Available at: https://couchedpodcast.org/exposing-transphobic-legacies-embracing-trans-life/

Ashley, F. (2023). ‘Interrogating Gender-Exploratory Therapy’. Perspect Psychol Sci. 18(2): 472–481. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10018052/

Bachman, C. L., & Gooch, B. (2018). LGBT in Britain: Health Report. Stonewall. https://www.stonewall.org.uk/lgbt-britain-health 

Hunt, J. (2014). ‘An initial study of transgender people’s experiences of seeking and receiving counselling or psychotherapy in the UK.’ Counselling and Psychotherapy Research Journal. 14 (4): 288-296. Available at: https://onlinelibrary.wiley.com/doi/10.1080/14733145.2013.838597 

Lawson, Z.,  Davies, S., Harmon, S., Williams, M., Billawa, S., Holmes, R., Huckridge, J., Kelly, P.,  MacIntyre-Harrison, J.,  Neill, S.,  Song-Chase, A., Ward, H.,  & Yates, M. (2023). ‘A human rights based approach to transgender and gender expansive health.’ Clinical Psychology Forum 369.

Available at: https://explore.bps.org.uk/content/bpscpf/1/369/91 

Memorandum of Understanding on Conversion Therapy in the UK: Version 2 – Update March 2022. (2022). Available at: https://www.bacp.co.uk/media/14985/memorandum-of-understanding-on-conversion-therapy-in-the-uk-march-2022.pdf 

UKCP. (2019). Code of Ethics and Professional Practice. Available at: https://www.psychotherapy.org.uk/media/bkjdm33f/ukcp-code-of-ethics-and-professional-practice-2019.pdf 

UKCP. (no date). Guidance on the Practice of Psychological Therapies that Pathologies and/or Seek to Eliminate or Reduce Same Sex Attraction. Available at: https://www.psychotherapy.org.uk/media/hhxle33g/guidance-on-psychological-therapies-that-pathologise-and-or-seek-to-eliminate-or-reduce-same-sex-attraction.pdf 

SCoPEd and the EDI impact assessment – a review

Last week saw the announcement from BACP that ‘all partners’ had decided to adopt SCoPEd and would be in touch with members with regard to ‘next steps’. What it will eventually mean is that according to your training you will enter at one of three points A, B or C (originally these columns were called ‘counsellor’ ‘psychotherapeutic counsellor’ ‘psychotherapist’). Jobs will likely be stratified according to at least the competencies listed in the columns, if not clearly by the columns themselves.

Elsewhere you can read views that SCoPEd is divisive and discriminatory, and we’d like to concentrate here on both the EDI assessment itself, and the impact on LGBTQIA+ practitioners and trainees as we move forward.

We will use the term ‘therapist’ here to cover anything that we would consider either ‘counselling’ or ‘psychotherapy’ in that whatever you call it, we are all aiming to be of some kind of therapeutic benefit when working with our clients.

Your TL;DR is: Without Membership Body (MB) data, we do not know if those in ‘protected characteristics’ will be discriminated against, and there is no MB data (and currently no suggestion that this will change). Without the ability to move between (up through) columns post-training, it is likely to impact those with less ability to pay for a longer/more expensive training. There is no ability to move between columns. Six therapists were consulted, none who were trans (because the people carrying out the consultation didn’t look hard enough), and there is no discussion of what the qualifications of those consulted are, to talk about ‘EDI’. Despite there being very little actual EDI work in this EDI impact assessment, and the results suggesting that there will be at least some impact on those more marginalised, the EDI assessment suggests we make a start on SCoPEd as it is and trust that the rest is worked out along the way.

The EDI impact assessment

We believe that as a process, this EDI impact was flawed. There are six member organisations that have signed up to SCoPEd. Whilst there will be a percentage of people who are in multiple organisations, the membership for NCS sits at over 9000, the membership for BACP sits at over 50,000, UKCP sits at over 11,000. That’s half the memberships listed, and although we expect BACP to be the largest, if we assume even 5000 for the others, that’s about 85,000 therapists (the SCoPEd announcement says 75,000), and more joining every year.

An ‘EDI impact assessment’ was commissioned to (one presumes) look at the impact of SCoPEd across all demographics. This impact assessment was conducted by a company called Eastside Primetimers, who state: “The strategic objectives that the Partners set for SCoPEd draw our attention to the dependency of its success on equality, diversity and inclusion (EDI) considerations”. 

Before they started on this project, Eastside Primers were calling SCoPEd a ‘groundbreaking project’ and a ‘pioneering project’. We wonder how easy that would be to turn back on if you were to find significant issues with the project. We don’t know – we’ve never been in that position.

The report states that it has struggled to get any information about those who might be in protected characteristics from the membership bodies (MBs) and they state at the start of the document that they cannot say (yet) what the impact on those people who might experience less privilege will be. None of the data collected is cited as being race/ethnicity, cis/trans status or sexuality, or disability (pg 13). In those where gender was collected, the average number of men in the profession is 16%. The report suggests (pg 11) that should SCoPEd NOT go ahead, that this will disadvantage people who have less privilege.It does not seem clear on why this is so.

The EDI report acknowledges that the framework is not a public-facing document so it asks ‘a small number’ of the public (12 people who’d had experience of counselling) to consult with it about SCoPEd. They approached six counsellors, 3 of whom were men (meaning that men proportionally have more of a voice as a reflection of the profession here), five were white, five didn’t identity as disabled, and none stated any LGBTQIA+ identity. There is no suggestion of their socio-economic status either. Four people interviewed were in private practice. Again an interesting choice, as those in private practice are potentially least likely to be impacted by SCoPEd. 

They gathered six people for interview. There is no suggestion that, in this ‘equality and diversity impact’ consultation, they interviewed six people who might be qualified to speak about these topics. In fact, their report states “Some communities (such as those identifying beyond the gender binary) are not represented due to factors, such as not responding to the invitation to interview or not meeting the survey criteria in some way, such as not being a member of a registered professional body” (pg15).  Dominic Davies from Pink Therapy, “the UK’s largest independent therapy organisation working with gender, sex and relationship diverse clients” has stated that he was not contacted for any help, and that had he been so, he would have facilitated the reaching out. There are over 200 people listed on the Pink Therapy directory who have a specialism in LGBTQIA+ topics, and 45 of these have ticked the ‘trans’ box as part of their own identity, suggesting that at a minimum there were 45 people listed with an MB who might have been open to being contacted. We do not know for certain that BAATN or Black Therapy Matters had a similar experience, but we’re willing to take a guess. This EDI ‘consultation’ didn’t try very hard to find a trans person (or any LGBTQIA+ person), interviewed ONE disabled person, and ONE person from a racialised background, and gives no real impact on what SCoPEd might mean for therapists with marginalised identities.

We do not really see any EDI impact in this 27 page document until pg 19 when we find  “There is a risk that Partners’ membership data systems do not facilitate EDI-relevant analysis of progress in widening access to and progression within the profession, and so in turn ensuring that the framework does not exacerbate barriers to access and progression”. This says to us that there is no way that we can know if SCoPEd will have an impact on the most marginalised counsellors because MBs don’t collect that data.

Page 20 of the EDI assessment suggests that without the ability to move between columns with further training (rather than only ‘core training’, which would require a qualified counsellor to start again as if untrained), that this will compound the difficulties those therapists with ‘protected characteristics’ hold, and make higher columns inaccessible.

Despite the information given above, this consultation sees no reason why SCoPEd can’t go ahead as it stands and we can iron out the details later. We believe however, that a profession based on expertise, especially in one’s own process should never be mediated by privilege. It is an impoverishment of the profession as well as injustice to practitioners with marginalised identities.

There is an interesting point in the data, which is that single women are less likely to support SCoPEd than partnered women, and we cannot help but wonder if this is part of the reason that SCoPEd votes are going through – that if you think it doesn’t affect YOU, PERSONALLY, you don’t necessarily consider the impact on other people. Those who are in a relationship will generally (we know, not always) have a second income coming into the family. Those who only have one income coming in have to be much more aware of SCoPEd and how this might impact. This ‘awareness of how all counsellors might be impacted is, in our opinion, what an EDI assessment would do, but does not.

This EDI assessment says (in short): as SCoPEd stands, you can’t move across columns without investing in more training; those who are more marginalised can’t afford more training; some organisations have already said they will start to stratify therapists according to columns, thus ensuring that column A therapists can only do ‘lesser’ qualified roles (which presumably one then gets paid less for, or the the process that we CURRENTLY see, which is that someone is ‘good enough’ to volunteer, but not good enough to be paid in the same role), thus meaning that those therapists earn less money and therefore have less income to be able to afford more training that might push them across columns. But please, feel free to get started and iron out these ‘small’ details later.

Trans folk, queer folk, disabled folk, folk with racialised identities, folk who are working class, will all find it difficult to move into the top two categories and are at risk of being pushed into lower paid jobs as a result, and kept there. For those people who are multiply marginalised this will be even more more likely and this ‘EDI impact assessment’ does not recognise intersecting axes of oppression in its report whatsoever.

We demand a rethink, and a proper EDI analysis that ensures that the impact on those who are least able to join ‘column C’ but who can be brilliant therapists in their own rights is considered.

Trans joy is resistance

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.

First principles

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. 

Non-maleficence and ‘conversion therapy’

​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

Open letter to Liz Truss

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?