Seriously Purple -Micro aggressions

I’ve been wanting to write this blog for a little while now and I’ve just returned from the Vigil on Old Compton Street to show solidarity with the LGBTIQ folk across the world who are facing homo, bi and trans phobia and hatred within their communities and especially with the people affected by the massacre by a man with a gun shooting over a hundred people at the weekend most of them People of Colour (49 deaths and wounding at least 53 more). But many others have written eloquently about the Massacre, and so this blog isn’t about that.

This blog is about hatred, but not the shooting-your-neighbour-and-their-friends kind of hate, but the impact of what have come to be called the ‘Microaggressions of everyday life’.  The tiny sneers, avoidant gazes and snickers at someone else expense. Being basted with a toxic marinade every day and wherever we go. It’s a very subtle form of hatred that is done to us, and we do to each other.

I think we all know by now the emotional and psychological costs of Minority Stress on the lives of Gender, Sexuality and Relationship Diverse people. The elevated rates of depression and self harm, alcohol and substance misuse, and anxiety and other major mental health problems. The research has largely focussed on LGBT people and has shown much more elevated levels of mental health distress amongst bi and trans folk. 

This is the impact of living on a planet where people are made to feel bad for who they love and how they express themselves.  Research seems to show that for many people finding ‘community’ and selectively sharing the information about one’s gender and/or sexuality, tends to have a positive effect on mental health.  There is even some evidence that being in a relationship is good for our mental health and can build resilience and have physical and mental health benefits.

But when you have found your tribe or community, and when you’ve found someone to share your life with, and maybe even marry them – does life get easier?  I’m not sure it does.  At least it’s not as simple as that.  Every time you reveal yourself IMG_7116to be who you are you’re likely to receive some forms of micro aggression.  Whenever I hold a partners hand out in public, I will almost always encounter some micro aggression or when I’m pulling on my leathers to go to a bar in town for a drink on a Saturday night and travelling on the tube or bus, or when I’m wearing something fab-u-lous like the purple hat I’m sporting here, I will encounter someone else’s negative reaction.  These micro aggressions are most common when I’m amongst the hetero-majority.   People will see that I’m queer and respond accordingly, in a microsecond.  Probably before they’re even aware they’ve responded and if you see them – you will register the tiny micro aggression and it can eat away at your soul and if you don’t feel you have a soul, it will eat away at your confidence, in time. 

When I was with a few thousand other wonderful people on Old Compton Street nobody seemed to care, but a few minutes walk away and my ‘gaydar’ detected two or three individuals who undoubtedly batted for our team and were very close friends with Dorothy, each of whom found a way to ensure I didn’t exist!

So we think by being out and proud and living our authentic life, and being our own special creation, everything is going to be fine and dandy – and most of the time they are. And sometimes they are not.  Sometimes, we can be as guilty about quietly spooning out this marinade over each other and THAT IS NOT GOOD.  We can see someone, especially someone who is looking more fabulous than we are, or behaving in a loud and outrageous manner and giving the game away and we too can ladle it out with a sneer or avoid their gaze, snicker, not want to be seen as like THAT! Not wanting to be one-of-THOSE-people. We can also do it when someone’s body-shape doesn’t match the gay or lesbian ‘ideal’, when someone is significantly older than the others in the bar or club, and when their gender presentation is outside what is considered the accepted cultural ‘norm’.  The years of having to hide, and pass and survive, leaves us all with a legacy, whereby we often, quite unconsciously, avoid acknowledging each other, we withhold our smiles of recognition and warmth for a kindred spirit and THAT IS NOT GOOD!

I think we need to continue to build community, celebrate diversity and be kind to each other and if someone is a bit more full-on or different than we are when we see them in the street, perhaps we can smile and wink and celebrate our differences and our similarities.

embracing_diversity

Dominic Davies
CEO Pink Therapy – June 2016

Today I will attend the launch of a new Memorandum of Understanding (MoU) on Conversion Therapy.  This agreement is the first time all the major UK psy/therapy organisations have worked together on a collaborative project. It’s a huge achievement for the therapy world in its relationship to gender and sexual diversities.  Check out the list of signatories to the document at the end of this blog.

MoU_cover

The MoU will be launched at the Department of Health and arose from a meeting last April with health minister Norman Lamb MP who had convened a Round Table of all the psy/therapy professional bodies to discuss whether the government should ban conversion therapy outright.  He was very concerned that vulnerable people were being offered what is known to be a potentially very damaging ‘therapy’.  The Minister had previously asked UKCP to co-ordinate a Consensus Statement which also was launched at that event.

We all wanted to get beyond just fine words and look at how we can ensure therapists know what to do when someone presents for help over conflicts with their same sex attractions. All the professional therapy organisations already had individual statements condemning conversion therapy and attempts to ‘cure’ same sex attraction and their existing ethical codes are robust enough to deal with infringements by their members who might think this is acceptable. 

It was the felt by all attending that making conversion therapy illegal would be impossible to enforce and unhelpful to single out one rogue ‘therapy’ amongst all the other dubious therapies which exist for special treatment would be unhelpful.  Conversion therapy as an overt practice is almost exclusively delivered in the UK by a small group of religious fundamentalists (from both Evangelical Christian and Orthodox Jewish groups) who are likely to claim persecution for their religious beliefs. They are a powerful lobbying force but it’s clear to pretty much everyone Conversion Therapy goes against all the existing ethical frameworks for professional therapeutic work and our understanding of best practice.

However, my concern has always been that Conversion Therapy in the UK as practiced by a relatively small number of vociferous religiously motivated ‘therapists’ was more of a red herring.  What concerned me more was that research published in 2009 (Bartlett et al) revealed that an alarming 1 in 6 secular professional psy/therapists (members of BACP, UKCP, BPS and the RCPsych) had at some point either practiced to change a client’s same sex attractions or referred a client to a practitioner who would. Much of this harmful practice may be attributed to the historical and existing deficiencies in qualifying training to equip therapists to work in informed, competent and non-discriminatory ways with people from gender and sexual minorities.

So what centrally concerned us, was not to scare therapists off from responding to what are often very distressed clients presenting for help. Expectations, or explicit requests, that therapy will change sexual attraction or gender identity by clients struggling in managing their sexuality conflicts in what can often be experienced as life threatening situations (suicide and self harm rates are much higher amongst LGBT people). Intersectionality issues, such as religious, cultural, socio-economic and body type circumstances also may intensify a client’s anguish and isolation, also presenting further real threat of violence, enforced marriage, “corrective rape”, illegal incarceration and even execution.

If our attempts to inhibit incompetent or abusive therapy result in a therapist saying “I can’t talk to you about this” for fear of disciplinary action and complaint then we have reduced supportive safe spaces for that vulnerable person rather than protected and helped them. 

So in the relatively easy step of gaining publicly shared consensus against conversion therapy across the psy/therapy bodies, it is really important that we invest in the harder, less glamorous and more committed work of ensuring therapists are adequately trained and culturally safe and competent. This does not just include knowing that agreeing to requests to change a same sex attracted person into a happy heterosexually oriented one is much more likely to result in harm than success, but also safely holding and supporting the client through this early stage of psycho-education and further in their journey in finding their way to own their sexuality with self-worth and integrity.

Now the work can really begin.  In this document the psy/therapy bodies commit to ensure that all therapists are trained to a high level of cultural competence in working with LGB clients so that they know how to respond when a client presents in distress over their sexuality conflicts.  It’s not enough to just ban Conversion Therapy, it’s important that therapists feel confident in knowing how to work with requests for change in the wider context of that client’s life.

Very few therapy training courses in the UK adequately prepare therapists for working with LGB people (let alone all the other gender and sexual diversities that will be coming through their door).  This document gives a clear mandate that they should be and that the professional associations which regulate therapists will be supporting and monitoring this process.

Therapy is increasingly becoming a highly regulated profession.  Although such regulation is a highly contested area, (we might want to reflect for a moment on the licensing of human compassion), and I don’t want to get into the pros and cons of this in this particular blog.

Some people are concerned that therapists should be state licensed and they are worried that anyone can set themselves up as a ‘therapist’ and offer psychological treatment and help. This is true, but it would be virtually impossible to protect every title of support.  ‘Counsellor’ for example is being used by so many different trades and businesses, and loopholes would soon be found to get around any protected title that got enshrined in law.  We already have several national voluntary Registers which are being regulated by the Professional Standards Authority (PSA) and the major therapy bodies are all well into the process of getting their members on those registers. Furthermore, state licensing does not prevent Doctors from abusing their patients, there is no evidence that it would prevent unethical practice by therapists.  

However, the PSA has no interest in addressing the standards of training in psy/professions as they only regulate the voluntary regulators themselves, not their registrants or training organisations. Therefore there remains tremendous discrepancy in how much quality and assessed training a psychotherapist or counsellor on a PSA registered register has actually undertaken. Only the psy/therapy training bodies can step up to ensuring adequate training in working with LGBT clients as a “voluntary duty” and the registering bodies show action consistent with their words by resourcing these developments in competency standards.  This is a task we’re actively involved in as the next focus is to ensure therapists are adequately trained!

We felt it was therefore also very important is to raise public awareness that any person being consulted for help should be a member of a professional body which has a complaints procedure and a code of ethics and that the professional has had specific training to undertake the work they’re seeking to do and that they are registered, insured and culturally competent and safe to be undertaking the work.

So far, the working group has focussed on Conversion Therapy as it pertains to sexuality change since this had been the major focus in the United States and the UK and was addressing the brief given to us by the DoH.  However, the tragic death of Leelah Alcorn   at the end of last year shows how important it is to ensure that we include gender variance in the definitions of what we mean by Conversion Therapies because trans kids are also being sent to therapists for their gender non conforming behaviour.  Again, this is largely within fundamentalist Christian families as was the case with Leelah, but some years ago Dr Ken Zucker, a fairly well respected Canadian psychiatrist came under criticism for offering conversion therapy to gender non-conforming children attending his clinic.  https://en.wikipedia.org/wiki/Kenneth_Zucker.  

As I understand it, Zucker’s point for trying to discourage gender non-conformity and cross gender play (with all the binary notions that plays into) was that Richard Green and others at the Tavi who did some research some 20-30 years ago on how many kids who expressed gender atypical behaviour in childhood and a desire to change gender, later into adolescence and adulthood didn’t ‘persist’ and ending up identifying as gay.  

However, we’re increasingly seeing larger numbers of gender variant young people feeling able to speak out about their gender dysphoria and services and support for gender variant young people are growing all the time. It would be interesting to see if more young people emerge from childhood and adolescence with a secure trans identity wherever they place themselves across the spectrum.  My own reading of the situation is, there will be many more ‘persisters’ rather than ‘desisters’ if the environment feels safe enough for them to be themselves, and not all will feel that a full and permanent transition of their gender in necessary.  I think we’ll be seeing more non binary and genderqueer identities as gender will be more of a spectrum, than the binary we’ve been seeing it as.

The MoU focused, (at the request of the DoH) on sexuality.  However, as psy/therapy bodies we shall be meeting on a regular basis over the next year to review the implementation of the recommendations and I and many others will be working to ensure that gender variance will be included in its implementation and explicitly included.

I’ve worked my entire career to try to raise the standard of culturally competent and safe therapeutic support for gender and sexual diversities. Often it’s felt like a cry in the wilderness, but finally it seems the therapy world is playing catch up and interested to listen to what we have to say and I am hopeful together we can improve the quality of care and support available for all gender and sexual diversities. 

Dominic Davies
Founder – Pink Therapy

Signatories to the Memorandum of Understanding on Conversion Therapy include:

Association of Christian Counsellors (ACC), British Association for Behavioural and Cognitive Psychology (BABCP), British Association for Counselling and Psychotherapy (BACP) British Psychoanalytic Council (BPC), British Psychological Society (BPS), Gay and Lesbian Doctors and Dentists (GLADD), National Counselling Society (NCS), NHS England, Project for Advice, Counselling & Education (PACE) Pink Therapy, Royal College of General Practitioners (RCGP), Royal College of Psychiatrists (RCPsych), Relate, Stonewall, UK Council for Psychotherapy (UKCP).

Curing the gays

Yesterday, I was invited to meet with Norman Lamb the Minister for Care and Support and the heads (or their representatives) of most of the major psy/therapy organisations (BACP, UKCP, BPS, National Counselling Society, British Psychoanalytic Council, Relate, BABCP, Assoc of Christian Counsellors, Chair of GLAAD representing the Royal College of GP’s) PACE and Stonewall. The topic of this ’round table’ was Conversion Therapy which the Minister told us he was very concerned about and wanted to establish what was happening and what the government might do about it.

Professor Michael King was there representing the Royal College of Psychiatrists and both he and I were invited to make presentations – him on the evidence of efficacy and harm and me, on the training needs for therapists and what the professional bodies should be doing. I’d been waiting for an opportunity like this for my entire career!

David Pink from UKCP gave some background to the issue as UKCP have been taking the lead on this for a while now and recently produced a booklet commissioned by the Government for the NHS Choices website.  Pink Therapy had a hand in this and it seems an important step at the Government making it clear that Conversion Therapy has no place in ethical health care for LGB people.

After Mike King gave some background on the history of conversion therapy and the lack of evidence for its benefit and plenty of evidence for it’s harm, I had around 20 minutes to present my own thoughts.

This is a slightly tidied up version of what I said:

Dept of Health Round Table on Conversion Therapy

Training & Policy

Whilst I’m concerned about religiously motivated Conversion Therapy and have been professionally active on this issue for over two decades, I’m much more concerned with Professor King’s data about 1:6 mainstream therapists of your organisations agreeing to contracts to reduce SSA or cure people. Most of these people are not overtly religiously motivated and so might not feel your Conversion Therapy policy statements apply to them.

These were well meaning mainstream and secular therapists who were poorly trained and inadequately prepared to know how to respond to a highly distressed client. Training in understanding what is different about working with gender or sexual minorities is either absent or patchy in most British therapy training courses and so therapists don’t know how to respond and often have little cultural competency in understanding the social contexts in which their clients live. Noble humanistic concepts about the clients right to self determination are in conflict with what might be a lack of choice over the gender of their sexual partners. The people presenting for ‘gay cure’ are generally likely to be those who have a fixed and enduring sexual identity (Kinsey 6’s) and whereas sexuality can be quite plastic for many people and there are plenty of examples of situational homosexuality amongst heterosexuals in single sex environments and sexual fluidity over a lifespan for many LGB and T people, the people seeking ‘cure’ are unlikely to be those people who feel unable to change.

In some contexts (lesbian and gay Muslim especially) lesbians and gay men may be facing honour killings from family members or alienation from their community and families. They maybe literally pleading for their lives. 

I’m also interested to know how those organisations which have Christian Counsellors or Pastoral Counsellors like Assoc Christian Counselling and BACP’s Association for Pastoral and Spiritual Care Counselling will monitor whether conversion therapy is being undertaken organisations?  Changing policy and forbidding something doesn’t make it go away. 

I’m interested to hear what other colleagues are doing to ensure their Policy Statements are translated into action and how they propose to train their members in ensuring they can respond appropriately to requests for change.

However, it goes wider than this in delivering culturally safe and appropriate mental health services. An example is that whilst we now have full equality in Gay Marriage, we should bear in mind that research shows that between 50-80% gay male couples are are not sexually exclusive. So whilst Relate has become less heteronormative over the years, it is still virtually impossible for a gay couple to get help in opening up their sexual relationship, when the training of the therapists in Relate has been about helping couples maintain sexual fidelity and keeping families together. 

Research is showing that Bisexuals get offered conversion therapy from mainstream counselling organisations too! Some therapists feel they should just help the bisexual pick one identity and either be heterosexual or gay. (Ref: Bisexuality Report and Richards and Barker, 2013)

My recommendations

  1. Accrediting a course, should mean the course gets audited for what they are teaching about working with gender and sexual diversity clients. I’m interested in therapists being culturally safe to offer therapy to sex minority communities. So that LGBT people are afforded dignity to live within their own values and norms. Such training in understanding developmental theory, life stages and relationship models etc should be integrated and run throughout whole curriculum and not be an optional add on for a single workshop. The BPS Guidelines for working therapeutically with gender and sexual minority clients are most helpful and I’d like courses seeking accreditation to be asked to embed these guidelines in their training of therapists so that throughout the curricula therapists are learning how to work with diversity.
  2. Post Qualified counsellors faced with requests for change need CPD to help them better handle these issues. A big stick or forbidding conversion  therapy is not helpful.  You have a duty of care to your members to support them in know how best to effectively respond to genuine distress and requests for ‘cure’.
  3. Therapists and supervisors need training in how to work with the issues. Our own workshops for supervisors were frequently cancelled due to low take up, it seems supervisors (who may well have been trained at a time when homosexuality was still classified as a mental disorder) feel they are above or beyond the need for training in how to supervise therapy with LGBT clients.
  4. Specifically with regard to Requests for ‘Cure’, I recommend a training pack be produced – with video, experiential exercises and some theoretical material and resources which addresses how to work with these issues. We should then offer to train counsellor trainers in how to use the pack so that they can then deliver training to their students.  It would be good if the Dept of Health could help us produce this material – making a video with a Muslim actor playing a gay client who is conflict with his cultural and faith beliefs and sexual orientation.

You will see I’ve used the concept of Cultural Safety.  This arose in Nurse Education in New Zealand and here’s a short explanation:
Cultural safety relates to the experience of the recipient of nursing service and extends beyond cultural awareness and cultural sensitivity. It provides consumers of nursing services with the power to comment on practices and contribute to the achievement of positive health outcomes and experiences. It also enables them to participate in changing any negatively perceived or experienced service. The Council’s definition of cultural safety is:

The effective nursing practice of a person or family from another culture, and is determined by that person or family. Culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual belief; and disability

The nurse delivering the nursing service will have undertaken a process of reflection on his or her own cultural identity and will recognise the impact that his or her personal culture has on his or her professional practice. Unsafe cultural practice comprises any action which diminishes, demeans or disempowers the cultural identity and well being of an individual. 

http://nursingcouncil.org.nz/content/download/721/2871/file/Guidelines%20for%20cultural%20safety,%20the%20Treaty%20of%20Waitangi,%20and%20Maori%20health%20in%20nursing%20education%20and%20practice.pdf [emphasis added]

After the meeting, I had warm and encouraging approaches from the National Counselling Society and the British Psychoanalytic Council who want us to advise them on what they can be doing. Also within hours the Chief Exec of Relate emailed me asking me to meet with their Head of Training.  Interestingly, the representative from BACP remained silent throughout the meeting and afterwards.  I hope I shouldn’t be reading too much into this.

There are plans for a follow up meeting and maybe a Memorandum of Understanding which we will hopefully agree.

This is the first time I’ve seen these professional associations coming together on an issue. They are essentially rivals and many competing for members. It was good to see them in agreement about Conversion Therapy and open to hearing my proposals.

Dominic Davies
Director

Authentic sexual needs

Our work as therapists can at times be about helping our clients discover, explore and express their needs. Like the need to be loved, supported or understood for instance. And so, we stay in the moment, with what it means to have needs and to acknowledge their authenticity and realness.

When it comes to sexual needs, how can we stay with the authenticity and realness of what the client brings? Indeed have we confronted our shadows around sex, or do we jump into trying to determine what makes sexual needs appropriate, moral, pathological… Have we found the special ruler to measure a piece of string? Who can establish that one’s sexual needs are problematic but the person themselves (sometime after long exploration).

Yet hypothesis or “diagnosis” of sexual addiction are becoming main stream and money earners for some ‘specialists’. Whilst diagnosis of hypo sexual desire disorder are undermining and patronise the asexual population. How helpful or accurate are these formulations?

Looking at couples, infallibly their own level of sexual desire will differ and may vary with time. Which one has the right level? The one who wants more sex or the one who wants less? ‘Sex specialists’ state that a six months period with no sexual activity is problematic. Peer pressure to have sex is also rife, specially within sexual minorities where a sense of identity and belonging is often built upon ‘sexual identity’.

So we are trapped between a cock-measuring attitude (who has the most of it) and a normative approach (average, statistics and research).

How can we affirm our clients authentic sexual needs, whether they’d rather hold hand and cuddle their partner in front of the TV with a nice slice of cake or have fun in sex clubs and saunas twice a week?

Dominic Davies and TIm Foskett explore the misconception of sexual addiction in Gay and Bisexual men in their training day “I am too sexy” (16 November 2013) whilst on the following day I will explore our understanding of low sexual activity and desire across sexual preferences on a day called “Asexualities: intimacy and desire” (17 November 2013).

So why don’t you join us in this learning, get your rulers out and break them.

Olivier Cormier-Otaño MBACP Accred, AASDT
Clinical Associate

Russia

Russia

Clearing out some very old papers at home the other day, I found some correspondance about the Russian language translation of Pink Therapy volume 1.

This is the only other language Pink Therapy has been translated into and it was done by a dedicated fan, a psychiatrist I believe, who thought it should be made available to his people.

I’m rather glad he did because I also found a second letter which came from a reader of that Russian edition who came across the book unexpectedly, and it changed her life. The original was badly copied and so has been transcribed and I’ve not tried to clear up the grammar and syntax.

When I get feedback from readers of my books, there is an amazingly gratifying feeling. Writing is a lonely project and not one that comes easily to me, but when I feel I have something to say, I generally have to say it! But one never knows whether one’s words mean much to anyone else. It’s wonderful to hear that sometimes, they do!

Given the really horrible situation most LGBT people in Russia find themselves, I am so pleased that somewhere in random book shops, they might come across Pink Therapy, or perhaps our website which has a more updated paper on Gender and Sexual Diversity Therapy translated into Russian:
http://www.pinktherapy.com/Portals/0/Downloadables/Translations/RUS_GSDT.pdf

Dominic Davies