politics – Therapists Against Conversion Therapy and Transphobia

Ahead of UKCP’s meeting this evening

Ahead of tonight’s UKCP meeting members about the Board election with we wanted to give a loose timeline and comments on UKCP’s withdrawal from the MoU.

In short: UKCP withdrew citing concerns that the MoU applied to children. The MoU does not prescribe how we work, except that we must start from the premise that no one identity (cis or trans) is better than the other. The UKCP’s clarification letter then says more about this, but draws on irrelevant things to support its point (which is a concern about working with children). Then a letter from the UKCP’s board cites legal actions as a reason. We were aware of one legal action involving UKCP, which they settled early this year. We are aware of one other legal action which also does not specify children. However, the clarification letter now states legal actions (and resultant increase in insurance) as a significant reason. Whether children are covered under the MoU2 is irrelevant to the claims, as this disctinction would not have stopped either legal action (which began in 2022 BEFORE the re-signing of the MoU2). The long UKCP letter claims “we couldn’t directly engage with you all due to the content of some of the organisational risks”. NCPS also failed to engage with its members on this. However, when approached, NCPS were open about their reasons (financial). If UKCP was also struggling with the financial aspect, they too could have been transparent from the start. Pink Therapy, who were forced to withdraw from the MoU (for insurance reasons) were transparent about this aspect.

We argue that the insurance premiums, whilst perhaps a genuine concern, are a red herring for the real issue here, which is that the MoU SHOULD cover all people. We also argue that if it was explicit that children were not covered, UKCP would be facing the same issue of finances.

Conversion therapy kills. The view put forward by people describing themselves as “gender critical” is that trans people are at best deluded about their experiences and at worst, predatory. Gender critical therapists apply the term “exploratory therapy” to their work with trans clients and trans clients only, which in the context of gender critical views and the limited application of “exploratory therapy” means that this can only be conversion therapy by another, more palatable name. The legal cases mentioned by UKCP have BOTH been in place since before the UKCP re-signed the MoU in 2022. This would also mean that the insurance company would have been aware of these cases for over a year.

At length:

UKCP initially withdrew citing the following reasons:

“The UKCP Board of Trustees reached this decision following concerns it held regarding whether the MoU applies exclusively to adults, or if children and young people are included in its scope. UKCP has received clarification that the MoU does indeed relate to all ages. Upon investigation, it became evident that there are historical concerns held by a number of UKCP colleges that regulate psychotherapeutic work with children and young people relating to this subject, and which have yet to be addressed – hence our decision to withdraw at this time.” (UKCP update on conversion therapy (psychotherapy.org.uk))

It seems clear from this statement that the issue for the UKCP here is about conversion therapy and children.

Their clarification states:

“Children and young people require and deserve careful support, that is often different from what is required for adults.

UKCP has been concerned for some time that this is not reflected in the current MoU. The current MoU was drafted to apply to adults and was retrospectively applied to children and young people without consultation with the relevant bodies and child therapists with the specialist and regulatory knowledge of working with children and young people.” (UKCP withdrawal from MoU on conversion therapy (psychotherapy.org.uk))

UKCP has not raised concerns suggesting this is the case in the past. The current MoU has consistently been accepted as a document that would protect LGBTQ+ youth as well as adults from conversion therapy since its inception. In particular, UKCP as a signatory agreed to the BPS Document ‘Guidelines and Literature Review for Psychologists Working Therapeutically with Sexual and Gender Minority Clients’ as the basis for their work in relation to the MoU as early as 2012. The document incorporates adults, young people and children.

In 2015 the UKCP agreed to the following as part of the publication of MoUv1 under the section: ‘Roles and Responsibilities’ that:

“Training Organisations will refer to the BPS guidelines on working with gender and sexual minority clients when reviewing their curriculum on equality and diversity issues”.

Within this document Children and young people are mentioned in Part II.

At several points along the way and between 2012 to date there have been ample opportunities for UKCP to move from the inclusion of children and young people and they have not. Trustees of UKCP have attended and been a party to discussions within the MoU about inclusion of young people as ‘members of the public’ who might be impacted by conversion therapy. UKCP Trustees have always been party to the knowledge and decision making surrounding MoU1 and 2, and the spirit, aims, and wording of these documents were unanimously aimed at safeguarding LBGTQ+ youth from conversion therapy. This is well documented and witnessed by those in attendance as signatory members. UKCP Trustees have attended meetings and been part of the decision making process.

As late as 2019 the MoU2 released a position statement to the press, agreed by all members including UKCP, which states clearly that:

“… a legal ban should not divert our attention from the fact that education and professional training remain essential in order for practitioners to be able to work competently with LGBT people of all ages and to provide them with a safe and respectful environment in which they can explore who they are without judgement or fear”.

UKCP has always been part of the decision making process surrounding the MoU2, and have always been aware that conversion therapy involving LGBT members of the public of all ages is harmful. As a signatory to the MoU2 UKCP have previously agreed that an adequate description of the MoU Coalition submitted to Parliamentary members is that the Coalition ‘acts on behalf of’ children and young people as well as LGBT people of all ages’ as part of its brief to government consultations.

It is not clear what the concern actually is. UKCP says it is against conversion therapy and the MoU states that:

“’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.”

It also states:

“this position is not intended to deny, discourage or exclude those with uncertain feelings around sexuality or gender identity from seeking qualified and appropriate help.” And “Nor is it intended to stop psychological and medical professionals who work with trans and gender questioning clients from performing a clinical assessment of suitability prior to medical intervention. Nor is it intended to stop medical professionals from prescribing hormone treatments and other medications to trans patients and people experiencing gender dysphoria.

For people who are unhappy about their sexual orientation or their gender identity, there may be grounds for exploring therapeutic options to help them live more comfortably with it, reduce their distress and reach a greater degree of self-acceptance. Some people may benefit from the support of psychotherapy and counselling to help them manage unhappiness and to clarify their sense of themselves.

Clients make healthy choices when they understand themselves better. 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.”

It is completely unclear as to why this wording would provide a problem when working with children and young people. As therapists we should be seeking to help all clients understand themselves better. We should be able to help clients clarify their sense of themselves.

When challenged, UKCP have not been able to answer this question. Their concerns are listed as:

“No safeguarding distinctions between adults and children and young people”.

Trying to work out if you’re trans is not a safeguarding issue, if you work from the basis that being trans is not a ‘worse’ position than being cis. It simply means that you work ethically with children to allow them to explore their identities, INCLUDING the possibility that they are trans.

Applying adult-focused legislation and guidelines to children and young people which overlooks their unique developmental requirements.

There is no adult-focused legislation in the MoU. The MoU is not a legislatory document and the guidance is to remain open

Children and young people need a unique therapeutic approach that acknowledges their developmental stage and capacity for informed consent.

Agreed. However, the MoU leaves explicit space for professionals to work in the ways in which they work ethically with children. The MoU does not prescribe an approach; it says we have to work ethically.

The family and social context of children and young people, which is a vital source of information to understand the child/young person, is not taken into account.

Again – this is not what the MoU is trying to achieve here. It does not say that professionals cannot do this.

Due to the lack of child-specific guidance, child therapists face legal risks, including the possibility of lawsuits if a child detransitions in the future.

Any therapist who works with anyone is at risk of a lawsuit. We are not infallible and will make mistakes. The MoU does not say “YOU MUST TELL A CLIENT THEY ARE TRANS” it says “accept that trans is a valid identity”. It explicitly asks us to allow clients to clarify their sense of themselves.

Policy changes in the Department for Education (DfE) and the National Health Service England (NHSE) and safeguarding implications from emerging evidence and research relating to gender incongruence has not been taken into account.

We would argue again that this is irrelevant. Whatever NHS and DfEE policy say, this does not mean that counsellors/psychotherapists cannot allow clients the space they need. To suggest this is to suggest that we are in some dystopian future where thoughts should be policed. Stopping a person from having space to fully explore their identity will not stop people from coming out as trans. It *will* potentially lead to poorer mental health outcomes when children are being pushed into one particular outcome (“not trans”)

In a lengthy email to UKCP Members on 11th June, the focus shifts from instead of leaving because of safeguarding concerns (although this is still mentioned) to UKCP being named in legal action and this being expensive. UKCP suggests they could not consult with members in advance.

This may be true. However, there is nothing in any of the minutes available online for trustee meetings in 18 months that even mentions the MoU, leaving us to wonder just how important this was, when the UKCP has been named and implicated in legal action across that entire timeframe.

However we feel about whether or not UKCP should remain in the MoU (and of course, it is TACTT’s position that they should), the UKCP has not engaged in its stated objectives – the organisation should be consulting with members. It should have a clear narrative on why it has done what it has done. It seems clear that when faced with the backlash, the focus of the UKCP’s story has slowly changed to reflect a more palatable version of the reasons why. This is unacceptable and not how a board of trustees should be acting.

Final response to UKCP

On 2nd November 2023, UKCP published “guidance regarding gender critical views” for their members. We were very concerned by this guidance and wrote an open letter detailing our concerns which has been signed by over 1,000 therapists, trainees and other professionals. There followed an exchange of statements with UKCP, which you can read on our blog and as updates to the open letter. We are now publishing this as our final update, inviting UKCP into dialogue in the hope that the Council may yet find understanding, compassion and empathy for trans life, and that we can work together to protect and support trans clients. At the end, we also address all psychotherapists and counsellors; trans and gender-expansive therapists and trainees; and our current and future trans and gender-expansive clients.

Dear UKCP,

Thank you for your response, published on 15th December 2023, to our open letter about your guidance regarding so-called ‘gender-critical’ views. This will be our final written response in this series of communications, although we otherwise remain open to dialogue with UKCP on this matter. We are using this written response to expand upon points made in our holding statement published in early December, as they were not adequately addressed in your response to us.

We do not wish to volley written statements back-and-forth with UKCP; our concern is making therapy safe for our trans and gender-expansive clients. We would welcome an opportunity to meet with UKCP and discuss how the Council too can support this work.

At this stage, we would like to highlight our continuing concerns with the statements published by UKCP, both in your original statement and in your response to our open letter, before addressing other therapists and any clients who may be reading:

Once again, this latest response from UKCP entirely fails to explain how it will protect trans and queer therapists, trainees and clients. Indeed, any mention of what trans clients might want from therapy is entirely absent. UKCP is speaking over the people who are most impacted by their statements and creating an atmosphere of fear and confusion. There appears to have been no consultation with trans and queer therapists or clients. This is regrettable given UKCP has shown some effort in the past to include and listen to marginalised groups.

TACTT is concerned that this statement either doesn’t understand or misrepresents what affirmative therapy actually is. Affirmative therapy means the therapist supports the client’s right to define themselves. The splitting of ‘exploratory therapy’ from affirmative therapy is now being used to justify a form of therapy based on so-called ‘gender-critical’ beliefs. We cannot stress enough that all good therapy should be exploratory in nature, but weaponising affirmative therapy to make way for so-called ‘gender-critical’ praxis is blatantly unethical and, we believe, amounts to discriminatory practice. The play on language does not hide the unethical attempt at trans-erasure.

We note UKCP’s imperative to remind us that so-called ‘gender-critical’ beliefs are protected under the Equality Act 2010; we remind UKCP that trans people are also protected under the same legislation. We are not seeking to discriminate against people who hold so-called ‘gender-critical’ beliefs. However, if a practising member of UKCP does not believe in the legitimacy of trans life then, according to UKCP’s own Code of Ethics and Professional Practice and the MOU on conversion therapy in the UK, said practitioner would be ethically bound to refer on to competent colleagues.

As practitioners committed to trans-affirmative therapy, we now find ourselves in an uncertain and increasingly unsafe professional environment, where anti-trans activism is emboldened. Those of us who are trans and queer professionals and trainees find ourselves isolated and left to advocate for ourselves against institutions with far more power. The available pool of truly competent and safe therapists for trans and non-binary clients is already small. UKCP’s guidance does nothing to help this.

We are dismayed that much of our effort to communicate with UKCP has involved having to remind the Council of its own core values, pointing to the Code of Ethics and Professional Practice and its position as a signatory of the MOU on conversion therapy. UKCP still has not acknowledged that its position on so-called ‘gender-critical’ beliefs, which may cause harm to transgender clients, contravenes its position as a signatory to MOU. We fear that, at best, this will cause significant confusion for members and, at worst, harm to clients.

As stated, we do not want to get into an interminable correspondence with UKCP. Rather, we would like to invite UKCP to a roundtable discussion with members of TACTT to address our concerns. We seek dialogue, not to call out our colleagues, but to invite you to join us in finding understanding, compassion and empathy for an extremely vulnerable client group.

Alongside this, we will continue to work to improve therapy for trans and gender-expansive people through advocacy, education and campaigning. We ended our open letter by stating that those of us who are UKCP members or training in UKCP-accredited organisations are starting to question our place within the Council. If UKCP is unwilling to engage on these questions, you are likely to continue losing the trust of your members who work in a trans-affirmative way, as well as the trust of clients.

Yours sincerely,

TACTT

We now turn our attention to the different audiences reading this letter.

To all psychotherapists and counsellors:

We urge you to expand your knowledge and learning on trans-affirmative therapy, and specifically, seek training and education from trans and non-binary practitioners.

We encourage self-reflection on your own process around gender, transness and affirmative therapy. We further encourage you to seek out appropriate supervisory guidance if you are unsure about any aspect of your work. If you do not feel comfortable or equipped to work supportively and openly with trans and non-binary clients, it is ethical to refer them on to competent colleagues. We suggest a search on the Pink Therapy and Gendered Intelligence therapist directories for such practitioners.

We encourage you to examine your culturally inculcated reactions and responses to this topic and invite you to begin to challenge and work on them, in just the same way you may work on unconscious bias across all the other axes of oppression.

We also remind you that trans and gender-expansive clients seek therapy for all the reasons anyone of any gender might come to therapy. By engaging in these processes of reflection, you will be better placed to support these clients with matters such as depression, anxiety, bereavement, relationship issues etc. without bringing an unwanted and unnecessary pathologising focus to their gender.

For those who are allies and who have already spoken out on behalf of trans clients, thank you. Any therapist who would like to use their voice for change is welcome to join TACTT.

To trans, non-binary and gender expansive therapists and trainees:

We see you. We know that the continued attacks on trans rights – both within and outside the therapy profession – create an emotional burden which you are shouldering while helping your clients to navigate the same environment. We oppose transphobia across the therapy profession and will continue to work to ensure the voices of trans, non-binary and gender expansive therapists and trainees are heard.

To our current and future trans and gender-expansive clients:

We want you to know that you are welcome in the therapeutic space, that you belong here. We want you to feel safe accessing therapy, no matter what you come to therapy for – whether that is support through transition, gender questioning or indeed any other issue not related to your gender. We want you to have competent, supportive, knowledgeable and, above all, safe therapists to work with.

We want you to feel empowered to question a prospective therapist about their stance on trans life to ascertain if they are safe for you to work with.

Guidance such as the Pink Therapy guidance on how to choose a therapist is likely to be helpful. We also suggest asking a therapist if they have experience in working with trans and non-binary people and whether they have either lived experience or extra training in the subject. You can state you are looking for an explicitly trans-affirmative therapist and ask if they consider themselves to be so.

Remember, exploration is an important part of any therapy. But the term ‘exploratory therapy’ is being increasingly weaponised by those who hold anti-trans beliefs, so ask your therapist what they mean by any terms they use.

Ask for word-of-mouth referrals from trans and non-binary communities. We also suggest searches on directories that are explicitly trans-inclusive, such as Pink Therapy and Gendered Intelligence, and to use trans-affirmative or inclusive search terms when seeking a therapist.

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.