Trans Hate on Sunday

I know many people’s leisurely Sunday was disturbed yesterday by another malicious piece of so-called journalism in the Mail on Sunday. I wonder if the Sanchez Manning the transphobic journalist who wrote for the third consecutive week about trans issues, this sensationalist article in the Mail on Sunday has ever sat with a suicidally depressed trans young person or bothered to explore the impact of transitioning on young trans people’s lives? Gendered Intelligence and Mermaids do masses of work in supporting young people and families in this area, and the YouTube is full of fantastic first-person accounts which offer hope and help save lives. The majority of parents of trans and gender-questioning young people are loving caring folk who are doing their absolute best to support their child.

The article referred to the new Memorandum of Understanding (MoU) which I reported on a couple of weeks ago. The MoU working group were always at great pains to ensure that therapists felt competent to have the difficult conversations about gender with their clients but to do so in a way that doesn’t privilege one decision over the other. Had the journalist and Stephanie Arai-Davies bothered to read the MoU they’d have seen that therapists need to be able to work with ambivalence and uncertainty about gender concerns without bias towards a particular outcome. Therapists support the person finding their answers to what they want to do about reconciling the conflict they feel about the gender they were assigned at birth and how they experience themselves.

The MoU stresses the importance of therapists being trained in working with concerns about gender and sexuality and seeing the quotes from Bob Withers, a member of both British Psychoanalytic Council and UKCP; it seems this part of the MoU is both relevant and necessary.  It seems like Bob Withers has a long history for expressing transphobic comments and this is particularly concerning since the clinic he co-founded in Brighton with his wife claims to work with a large number of LGBTQ clients.  Looking at his self-congratulatory posts and retweeting transphobes on his twitter timeline, I would concerned for any trans clients consulting him and wonder whether he might be in breach of the British Psychoanalytic Council and the UK Council for Psychotherapy’s Codes of Ethics for bringing the profession into disrepute?

Sanchez Manning’s interest in negatively reporting on trans issues is relatively apparent and verging on the obsessive. The week before they wrote another sensationalist piece about puberty-blockers under the headline: “We’ll give our son, 12, sex-change drugs: Parents want NHS to give their boy powerful puberty-halting treatment so he can be a girl” which probably wasn’t anything the parents said, but that didn’t seem to worry Manning, who must have missed the style guide on reporting on trans topics issued by Trans Media Watch. Oh, and publishing Alex Bertie’s photos without consent is SO not cool.

The use of anti-androgens (hormone blockers) is a standard treatment recommended by the World Professional Association for Transgender Health (WPATH) and based on best clinical practice.  It’s only used in exceptional cases after comprehensive and careful assessment, usually taking many months, and often at a time when the rapid changes of puberty make their benefit greatly diminished. The decision to use these medications is made by a multidisciplinary team (MDT) of doctors, therapists and social workers usually along with the parent’s support and the theory is that halting puberty will allow space for reflection, more significant cognitive and social development to occur. It’s not unusual to have other co-occurring mental health problems, and this is one of the reasons why an MDT is necessary. If the young person decides not to progress onto cross-sex hormones (currently at 16), they can stop the treatment at any time and puberty will continue.

Let me make this abundantly clear: An appointment with the Gender Clinic doesn’t mean someone IS going to transition, merely that they have someone who is skilled in helping them explore the issues.

The fact that someone in CAMHS refers a young person for specialist assessment could be seen as (a) how poorly trained most mainstream therapists are around these issues, (b) an entirely appropriate response to working within the limits of one’s competence or (c) a highly proper assessment and referral to specialist services. I would like to think it’s (c) because presenting with concerns about one’s gender identity is pretty standard nowadays for CAMHS staff to deal with although there is still a massive need for adequate training. The fact that a parent is unhappy with the referral needs to be worked with by the therapist, but we need to remember a 15-year-old is likely to be Gillick competent and should with all haste be referred. Research tells us that suicide attempts and self-harm rates for young trans people are running at around 50%. So we need to listen and promptly act when a young person finds the courage to come and talk to a mental health professional about their gender dysphoria.

The week before last, Sanchez Manning reported on sperm and egg preserving of trans young people before taking hormone blockers. Again, a recommendation of best practice laid down by WPATH. But Manning doesn’t seem to be that bothered about speaking to those involved in trans health care. They’re working for the Daily Mail after all which seems to revel in peddling hate and misinformation.

I wonder how a fringe group, Transgender Trend is telling a ‘story’ about youngsters being forced by the NHS into transition when quite the opposite is true. I’ve often felt the process of access to treatment (which may include hormone blockers, but more often simply involves psychological support) is incredibly slow, taking account of waiting times for a referral and then the process of assessment to determine suitability. If it’s agreed the young person should go on blockers, there is a further wait for the endocrinologist to see the young person and assess physical suitability (there is one paediatric endocrinologist working alongside the Tavistock GIDS). It has been known to take up to two years. Physical intervention isn’t a rushed process, and by the time someone starts (depending on where they were in their puberty when they entered the system), the impact of the hormone blockers could be very negligible.

What should concern parents is the bullying of gender-diverse young people.  Stonewall recently reported LGBT Bullying which is still rife in schools despite some progress being made in recent years and schools are doing better to address it.  However, 8 in 10 trans pupils are bullied, 4 out of 5 trans young people report self-harming and 1 in 10 receive death threats, there is clearly much more to do and I wonder whether Sanchez Manning and Transgender Trend think they are contributing to this problem?

The current best practice is to respect where the child or young person is at, to believe them, to help the parents support their child. Yes, some many children will change their mind about their gender after a period of social transition, but they will feel loved and respected whatever they decide to do. Childcare has moved on from the authoritarian days of the pre-1950’s where one was supposed to obey one’s parents at all costs to a more collaborative model of consent led mutual respect and where unconditional love is at the centre of ethical parent-child relationships.

Dominic Davies
CEO – Pink Therapy

 

New Partnership

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I’m pleased to share with you all, that Pink Therapy is partnering up with another online training organisation which therapists who want to specialise in working with the BDSM/Kink Communities.  Kink Knowledgable‘s co-founders Caroline Shabbaz and Peter Chirinos are hugely experienced clinicians and have built a comprehensive series of training courses to help raise the quality of mental health support available for people within the Kink communities.  They are also authors of a brilliant book on Becoming a Kink Aware Practitioner which I recently bought for my iPad Kindle App.

While we will continue to offer some essential BDSM awareness within our curricula, Kink Knowledgeable’s programme will be the place to go for those therapists who aim to specialise in this growing area.

Our partnership means Pink Therapy students will get discounts on undertaking the KK programmes.  We will also augment Kink Knowledgeable’s great faculty with some of our UK Kink Faculty and offer coaching and mentorship to some of their UK and European students.

It will also mean that some of our training courses may be eligible for American Psychological Association (APA) Continuing Education Units (CEU’s)

We plan to collaborate in various ways together, and more announcements will follow on from this one.

Here’s a short video announcement of our partnership:

Leading UK psychological professions and Stonewall unite against conversion therapy

It’s been a very long time in coming and it’s really hard to understand why we had such a battle to extend the provisions of the first Memorandum of Understanding to include people who are gender diverse and asexual.  It has caused ructions of which I’m unable to speak, but I am indebted to the Pink Therapy representatives on the working group: Pam Gawler-Wright, Meg-John Barker and Kris Black.  I also want to name check our allies in COSRT (Julie Sale) and the British Psychological Society (Igi Moon) for their endurance and commitment to ensuring this document comes to light.

It has caused ructions of which I’m unable to speak, but I am indebted to the Pink Therapy representatives on the working group: Pam Gawler-Wright, Meg-John Barker and Kris Black.  I also want to name check our allies in COSRT (Julie Sale) and the British Psychological Society (Igi Moon) for their endurance and commitment to ensuring this document comes to light.

“This document has the potential to change the way therapy is delivered in the UK for future generations, as it requires therapists to be trained to work with gender and sexual diverse clients.”  Dominic Davies – CEO Pink Therapy

The official and agreed media release is below:

An updated memorandum of understanding (MoU) against conversion therapy has been launched today, which makes it clear that conversion therapy in relation to gender identity and sexual orientation (including asexuality) is unethical, potentially harmful and is not supported by evidence. 

Conversion therapy is the term for therapy that assumes certain sexual orientations or gender identities are inferior to others, and seeks to change or suppress them on that basis.

The primary purpose of the 2017 MoU is the protection of the public through a commitment to ending the practice of ‘conversion therapy’ in the UK.  The 2017 MoU updates one released in 2015 at the Department of Health, which focused exclusively on sexual orientation, and is endorsed by the lesbian, gay, bisexual and transgender charity Stonewall.

The MoU also intends to ensure that:

  • The public are well informed about the risks of conversion therapy
  • Healthcare professionals and psychological therapists are aware of the ethical issues relating to conversion therapy
  • New and existing psychological therapists are appropriately trained
  • Evidence into conversion therapy is kept under regular review
  • Professionals from across the health, care and psychological professions work together to achieve the above goals.

Sexual orientations and gender identities are not mental health disorders, although exclusion, stigma and prejudice may precipitate mental health issues for any person subjected to these abuses. Anyone accessing therapeutic help should be able to do so without fear of judgement or the threat of being pressured to change a fundamental aspect of who they are.

You can download the document here.

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Fuming about Funding

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This blog is going to be a rant. It’s based on my observations over the last couple of decades as our sterling third sector organisations (they were called ‘Vol Orgs’ back then) have faced more and more hurdles to survive. The Chief Executives spend the majority of their time writing funding applications late into the night and over the weekends, chasing smaller and smaller grants. That’s less time on strategic planning of service development and even less time supporting the development of their staff and volunteers. It’s all become about chasing the elusive pot of gold at the end of the rainbow.

I was talking with a colleague over the weekend whose community mental health project is looking likely to be losing its funding. The project has been around for decades and is well-established and highly respected. But the process of Clinical Care Commissioning has decided in its infinite wisdom to award funding to a new project based on the medical model. Essentially the privatisation of mental health services – diverting money away from the vital third sector which has worked over the years to build solid relationships with their local community.

I’ve seen this happen time and time again – the most significant examples have been in HIV services in London where well-established organisations like PACE and GMFA lost their funding because capricious HIV Commissioners decided to try innovative (untested) new ways to reach out to at-risk communities. Thriving groupwork programmes at both charities were cut to train volunteer peer health educators to go into gay male social spaces (pubs and clubs) and try to engage them in conversations about their sexual practices and prevention strategies.

Over recent years, the NHS has gone through so many restructures that it’s hard to keep up with the changes. Funding became devolved from one source to another. Projects often need to apply for grants to their Local Councils and the Clinical Care Commissioning Groups and various charitable trusts. Each award comes with its criteria for auditing and monitoring of the relatively arbitrary and frequently unachievable targets that are set. This means that staff have to spend a great deal of time working on the quarterly reports to demonstrate how they’ve met (or otherwise) the targets. I am not arguing against auditing and monitoring of how taxpayers money is spent. Of course, this is necessary. It’s just that it can be so bureaucratic and laborious that it diverts skilled workers away from actually doing the work and creates another layer of paid bureaucrats doing the monitoring!

When the new project fails to meet the targets, funding is withdrawn. By the time this happens the previously well-established group has folded, or staff have moved on, and so our communities are left without the vital work, which had been identified and recognised, undone. Projects are often unable to speak publicly about their funders due to confidentiality clauses, and the threat of having their funding withdrawn makes them as compliant as the man whose dominatrix has a hand firmly gripping their balls.

One of the principal reasons I’ve never applied for external funding is because of the strings attached make one a puppet which dances for many masters. Chasing an ever decreasing pot of gold, competing against well-established services – and ruthlessly undercutting them. I just didn’t have the stomach for it.

We need to speak out and support our third sector organisations and the innovative work they do and challenge cuts to services.

Please support the work of the LGBT Consortium http://www.lgbtconsortium.org.uk/ 

Dominic Davies
CEO – Pink Therapy
16 October 2017

Gay Essentials: A NEW weekly meeting group/workshop in London – for Men Who Love Men!

Good luck to colleagues Nick Field and Gian Montagna and all the men who participate in this interesting group

Nick Field Counselling, Central/South West London

Word Art (1)-1I have recently got together with a colleague of mine, Gian Montagna, to set up and facilitate a new weekly meeting group in London, for gay, bi, trans or questioning men.

Run every Monday evening over a period of 3 months (12 sessions), Gay Essentials will be a weekly space to experiment with and explore connecting in deeper, more open and authentic ways with other gay/bi/trans men.

Gay Essentials will also be an opportunity for men who love men to experience their own rite-of-passage into a more authentic, sexual and relationally diverse adulthood, whilst also sharing this journey with others, in a safe, contained and holding environment.

The issue of a [lack of] proper initiation and rite-of-passage into manhood is particularly relevant for men who have sex with/desire/have romantic or platonic relationships or want to experience a more authentic intimacy with, other men today: From the environment we grew up in, to the…

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The Hijra community and the complex path to decolonising gender in Bangladesh

A really helpful article making some important distinctions about Hijra and Trans.

The need to understand gender as a spectrum must include non-Western identities and a move towards decolonising queerness. Ibtisam Ahmed explores the history of the Hijra community in Bangladesh.


Ways of exploring and experiencing queerness are extremely diverse, and this is being accepted by a growing number of people in recent years. It is an encouraging development but it still carries its pitfalls. One of the biggest challenges that is still being faced is a false equivalence of conceptualising all types of genders and sexualities through a strictly Western lens. In particular, there is often a misconception in cisgender activist circles of misunderstanding non-Western third gender identities.

In Bangladesh, the third gender identity is known as Hijra. The community is an indelible part of not only queer culture but of the national social fabric. Centuries before Bangladesh was even conceived as a modern nation state, and even before the…

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Pride in London and my Queer journey – a personal perspective and response to @LondonLGBTPride

A brave and open account of the intersectionality of identities and how we all have a responsibility to fight for true diversity and inclusion of the more marginalised in our communities.  How we white cisgender men need to recognise our privilege and make space for others.  So much respect for Edward Lord here in speaking his truth.

Source: Pride in London and my Queer journey – a personal perspective and response to @LondonLGBTPride

My journey as a gay man with depression

A helpful blog about the challenges of depression

Guest writer, Peter Minkoff, recounts his very personal journey with depression as part of our mental health month.


There was a time in my life when I absolutely loathed the word ‘depression’. Whenever someone is having a bad day, they nonchalantly throw around the phrase ‘I’m depressed’ – no, you’re not, you’re just having a sucky day. I felt so frustrated with people around me because they had no clue what real depression is. I, on the other hand, did. You’ve probably heard this story a thousand times, but no depression story is the same, and each and every person fighting depression is different, their experience is different. It took a lot of self-convincing for me to share my story, but I’m doing it because I truly hope that my voice will be heard and that some struggling gay person will take away something positive from it.

The beginning

Let me…

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Running a culturally competent service

I co-run a person-centered generalist counselling service that has a specialist focus on those who are GSRD – that is, their gender, sexuality or relationship styles are diverse (or divergent) from cisgender, heterosexual, monogamous etc. Clients who want to come to counselling don’t need to be talking about any of these topics, but should they wish to, we hope to meet them with a higher level of cultural competency than most counselling services in the UK. The service is based in a small city in the midlands that is lucky enough to have at least two universities (and other colleges) offering courses in counselling, which means we get a lot of enquiries from trainees who want to do a placement with us. This counselling service has always had a specialist GSRD focus, and the one thing we knew was that we needed culturally competent counsellors. To do this, we applied a somewhat unconventional method of sifting through applications: we created a series of vignettes.

 

Since we started this approach, we have had 12 applications to the service. Four have gone to interview, and two have been taken on. Two others are not yet at the stage in their course of being ready to see clients and are completing our in-house training sessions to help them become culturally competent counsellors. I want to share some of the responses with you. I haven’t sought permission from any except our current trainees, so I will portmanteau the responses rather than quoting verbatim- and ‘quotes’ are paraphrases.

 

There are five vignettes for applicants to follow. The first asks for thoughts and responses to a bearded client with a name usually considered female, such as ‘Elizabeth’. The next asks how a bisexual client’s identity might be linked to her impulsivity and difficulty making decisions. The third asks for your first and second internal responses to a man telling you he is in multiple ethical relationships. The fourth is a woman who identifies as a submissive who hesitatingly tells you she enjoys receiving pain, and are asked how you feel about this relationship, and how you react internally and externally, and finally there is a 17 year old who is genderqueer and has just come out to their mum. you had seen them for a number of sessions and not known this. where do you go? All these are required answers, with an optional last space for other thoughts. This is our entire application process. We require nothing else until we get to interview (which is in part a 30 minute triad where applicants meet a trans client). We select people out based on their answers. We don’t require everyone to be very competent at all answers, but we look for at a minimum, a lack of judgement based on the responses, and some level of understanding that our client group requires a level of competency that might be different to mainstream counselling.

What interests me is the sheer number of respondents who feel that ‘simply being person-centered’ is enough. There are many responses especially to the first question that state things like ‘this is a client like any other client’. And of course, in one way, they are. But in other ways they are not. They will have unique ways of being in the world. And just responding about the client requires you to make linguistic decisions. Do you choose ‘he’ for the beard? ‘she’ for the name? ‘they’ (or another gender-neutral pronoun) for the ambiguity of the situation? Most responses assume ‘female’. Some responses (including our two trainees) speak of a possible trans identity or genderfluidity, and a willingness to understand and know the client’s experience, some speak to the possibility of a cis woman with an endocrine imbalance, but many, when asked what it would be important to ask, gloss over this completely. It seems that gender has become the elephant in the room. Of course, it is the client’s right to talk about what they want to talk about, but (and I have cheated a bit here) in our service, clients are asked for their pronouns at their assessments. This is a basic component without which counselling cannot proceed authentically, but respondents seem to ignore this in the hope that that will be ok.

For the bisexual and impulsive client I am really pleased that the large majority of respondents don’t make any immediate connection between sexuality and decision-making, although there is a sizeable minority who theorise that the client is ‘confused’ about her sexuality, or that somehow, feeling attracted to ‘both’ genders is out of the client’s control (unlike compulsory heterosexuality?).

Moving on to the multiple relationships question, I loved that one of my trainees immediately assumed that the client was a gay man, and then immediately caught that assumption. That ability to reflect honestly in the application was one of the first indicators that may me feel I wanted to interview him. My other trainee immediately noticed that she would want to be taking care to make good use of supervision when working with a relationship style outside of her own. Other responses tended to comment that ‘if the client doesn’t have a problem with his relationship style, why does he feel the need to talk about it? perhaps this IS a problem, after all’ (paraphrased). This smacks of ‘why do gays have to flaunt themselves?’. Another typical responses to this question is ‘why does he feel the need to have multiple relationships?’, to which I have the question ‘why do you as the counsellor feel the need to (presumably) only have one at a time?’. Somebody suggested that they would tell the client that that information wasn’t relevant to the session. So much for not judging…

The submissive masochist gives perhaps the most intriguing responses. My all-time favourite response has been something like ‘I would feel the client’s pain’. Other responses have been around safeguarding, concern about safety, feeling anger and upset for the client. Judgemental responses have included ‘I would like to know why the client chooses to stay in this type of relationship rather than work through her abusive past’ (no abuse is detailed as part of the vignettes). Positive responses have been around recognising the client’s hesitation as a fear of being judged, and not wanting to judge. Internal feelings and responses TO the client involve feeling that this is violent and controlling and TELLING the client that, that it’s ‘not right’ to be in this style of relationship and that person would work to ‘get the feelings of hurt to surface’, but other internal and external responses have been about recognising that this is not the counsellor’s own personal preference (no-one has thus far said ‘yeah – I get it’), but that consenting adults can consent. Some have mentioned that they would like to check out whether there was informed consent and as long as there was, then all would be fine.

In the genderqueer scenario, responses range from merely ‘thanks for telling me’, to long and considered thoughts about wondering whether the counsellor had missed anything in the six previous sessions; whether they could have acted differently; how to make the space as safe as possible for the client to continue; a desire to explore exactly what a genderqueer identity might mean, rather than rely on a label as a placeholder.

Finally, the final thoughts for our applicants aren’t obligatory. two people have chosen not to respond so far. But many of the other ten gave honest and thoughtful answers, about how these scenarios had caused applicants to think about topics they wouldnt have considered, how they would wish to have further training, something that it seems is not (or not really) covered. It was good to note that even in the sometimes clumsy responses from people (because none of us is an expert across all responses at all times), that people had a genuine desire to try, and to get things right, and to further their knowledge. It was disappointing to see intimated that from those who are current students (I am certain of at least six looking for a trainee placement), there is no real training on these topics at their institutions. Students who claimed knowledge often did so from their own vantage points (usually as gay or lesbian or having a G/L family member, and this gave them an insight into other minorities), but no-one mentioned having any knowledge from their courses.

All in all, this is a really interesting process for us, and has proven very useful in helping to ascertain whether someone would be a good fit for our service. It suggests that there are many trainees out there however, with significant ‘blindspots’ in their understandings, which will probably go unchallenged up to and including the moment when a GSRD client walks into their counselling room. Whilst some of these applicants will clearly rise to the challenge and make good use of supervision and self-reflection, my concern rests with a number of people who judged my theoretical clients as somehow ‘lacking’ and weren’t afraid to tell the clients that they were making that kind of judgement.

 

 

References:

Davies, D. (2007) Not in Front of the Students Therapy Today Vol 18 (1) http://www.therapytoday.net/article/show/1573/not-in-front-of-the-students/

Davies, D and Barker, M J (2015) How gender and sexually diverse-friendly is your therapy training. The Psychotherapist (61) https://issuu.com/ukcp-publications/docs/61_the_psychotherapist_autumn_2015/8