Guest Blog: Dr Igi Moon

We’re reproducing the speech Igi Moon made at the Parliamentary Launch for the new and revised Memorandum of Understanding (MoU) on Conversion Therapy.  This document extends the protections afforded to lesbians, gay men and bisexual people from receiving harmful attempts to be heterosexual.  This new document protects people who are gender diverse and those who are asexual from treatments from therapists.

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Parliamentary MoU2 launch event – 4th July 2018

“I am here as Chair of the MoU Coalition against conversion therapy. The coalition is made up of 16 organisations as well as advisory bodies offering clinical and therapeutic services to LGBTQIA people. Together we represent over 100, 000 psychologists, psychotherapists, counsellors and healthcare workers.

The main purpose of today’s launch is for MP’s to meet with clinicians and campaigners ahead of the Government’s pledge to ‘end the practice of Conversion Therapy’. While the media yesterday reported an outright ban, we believe a ban will simply play into the hands of organisations that want publicity.

Yesterday – was the launch of the LGBT National survey. 108,100 people responded to the survey. It is the largest of its kind in the world. That is something all LGBT people can be proud of. But while we celebrate this survey we need to take a close look at the finer details of what it is saying about LGBT lives in our society. Because some findings make very uncomfortable reading. They tell a story that is all too familiar to LGBT people who still experience significant inequalities and fear for their personal safety – inequalities and fears that may well take them to see therapists. This is why we want all clinicians in training and practice to be made aware of the range of issues presented in the survey. And for all clinicians to be able to work competently with LGBT people

It is central that LGBT people can explore their feelings and thoughts in safety whether or not it is about their sexuality and/or gender identity with a qualified psychologist, psychotherapist, counsellor, or healthcare worker.

Shockingly, this is simply not the case. In our society, some people believe (for whatever reason) that LGBT people can be ‘cured’ of their sexuality or gender identity if they are LGBT.  Through the use of Conversion Therapy (CT), also known as Reparative or Cure Therapy). More shockingly, they believe that the techniques of CT will suppress or change an LGBT person. These techniques include anything from pseudo-psychological treatments to spiritual counselling. At their most extreme, people in the survey reported undergoing surgical or hormonal interventions or even ‘corrective rape’. It is abhorrent as a practice.

Yesterday, the survey found that a total 7% of respondents had undergone or been offered Conversion Therapy and of this, 2% had undergone and 5% had been offered CT.

It is a very live issue – with young people16-24 more likely to have been offered CT than any other group.

The MoU Coalition published this MoU before the Survey results were announced because we were faced with mounting anecdotal evidence  that we needed to protect  sexual orientation including asexuality AND the variety of gender identities

Thanks to the survey we sadly find that anecdotal evidence was correct.

The survey found

  1. In terms of sexual orientation, Asexual people are the most likely group to undergo and be offered conversion therapy
  2. In relation to Gender Identity – Trans respondents were much more likely to have undergone or been offered conversion therapy more than cis people.
  3. That more trans men have been offered CT than non-binary people or trans women
  4. That more trans women have had conversion therapy than trans men or non-binary people
  5. That those most likely to have been offered CT or undergone CT live in Northern Ireland and London

So, who conducts CT to cis and Trans people?

  1. By far the greatest are faith organisations
  2. Healthcare or a medical professional is second – (with far more trans people being offered CT than cis people)
  3. Parent or guardian or family member
  4. Person from my community
  5. Other individuals or organisations

The fact healthcare and medical professionals conduct CT is a major shock and the MOU is asking that ethical practice is at the core of therapeutic work. This means practitioners must have adequate knowledge and understanding of gender and sexual diversity throughout their training before they can be accredited, registered or chartered. BUT MORE IMPORTANTLY IT MEANS ASKING LGBT PEOPLE WHAT THEY NEED – ESPECIALLY TRANS AND NON BINARY PEOPLE.

Both the BPS and BACP have published guidelines for working with gender and sexual minorities. This is a good start but not enough.

Our Training and Curriculum Development sub-Committee find that while organisations say they want to USE THE GUIDELINES AND TRAIN PEOPLE EFFECTIVELY – IN over 7 years of training, it has been found that anything between zero and 16 hours max are spent in total teaching ‘difference’. This needs to change.

Yesterday, the overwhelming statement was

   “This practice (of CT) needs to end”

The Government Equalities Office action plan is to bring an end to the practice of CT.

We want to work with the government on legislative and non-legislative options.

At present we say no to an outright ban because CT is conducted by people who are obviously not therapists in some cases and would not call what they do anything more than a cure for a sickness. It needs more than a ban – it requires education at a young age that allows young people to be who they are without fear.

Likewise, it is still possible in this country to call yourself a counsellor or psychotherapist as these are not protected titles.  We believe that the Government must address this issue.

Where is the MOU next?

2 areas the MOU Coalition are likely to address:

Support for the GRA review because it is a once in a lifetime opportunity for trans people to experience wide ranging social change. We must recognise the variety of gender identities as valid. As the Minister for Women and Equalities the Rt Honourable Penny Mordaunt Minister stated yesterday to a ringing round of applause:  “a trans woman is a woman and a transman is a man” and we would add that those who wish to identify in the wide range of gender identities have that option. This is because the survey clearly identified that non-binary identities are on the rise and more respondents identified as non-binary

Second, we hope the General Synod will use the survey and our MoU as an opportunity to extend protection to Trans and non-binary people

Third we all – all of us have a debt to our future young people. We must remember that a central finding yesterday was 2000 people identified starting their transition AT SCHOOL. The survey only started from age 16

The MOU Coalition have brought on board those organisations such as Gendered Intelligence and Mermaids that work with young people under 16 to offer their thoughts about protecting these vulnerable children and teenagers. We are already hearing young people are the victims of Conversion therapy – sometimes in medical settings where we would expect safety. This must be investigated as a matter of urgency. We urge the Government to find out what is happening with young people who identify as LGBT and non-binary.

On a final note,

Over 2/3 of respondents stated they would not hold hands with their partner in public. It is pride on Saturday.  I want to hold hands with the person I love. On Saturday, I want us all to be able to hold hands with those we love in public and in safety because

TO LIVE IN SAFETY IS OUR FREEDOM

AND TO HAVE OUR FREEDOM IS THE GREATEST FORM OF EQUALITY WE CAN SHARE

Thanks to Ben Bradshaw MP for hosting this event, to our speakers. I would like to thank all members of the Coalition and especially Rosie Horne from the BPS for working so hard to bring this event together.

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

BACP Signs up!

I was delighted to learn that the BACP Board of Governors decided to sign up to an inclusive Memorandum of Understanding to extend protections to trans people and asexuals.  This still hasn’t been published on their website but will be soon.BACP MoU statementI am grateful that to everyone who played a part in lobbying the Board with their views, research and concerns.  I think this has been immensely helpful in helping the Board decide that these protections are needed.

All the signatories to the MoU need to follow their due process and consider the implications for signing up and extending the protections.  BACP were doing just that.  It had been reported elsewhere that they had refused to sign, and this was a distortion of what I had been stating, that the Board were to meet in Early March and the indication I’d had was that they might decide not to sign based on “a lack of evidence & research.”  This research was then supplied and the Board of Governors were able to make an informed decision.

I’ve been mulling over whether to still resign over my broader dissatisfactions with BACP. However, I think to resign at this point might look like this queen has had a hissy fit.   

BACP ought to be well aware of the significantly higher rates of mental health problems within the LGB and T community based on research they commissioned in 2007.  However, I am saddened that they’ve not used their considerable resources to ensure that counsellors are adequately trained to support LGBT people.  Their signing up to the Memorandum of Understanding makes this an obligation and I am hopeful they will be auditing their accredited courses more closely on their attention to issues to GSRD issues.

I had hoped that having been made a Fellow in 2007 for my “distinctive service to the field”  that this might signal an opportunity to collaborate in improving the mental health of Gender, Sexual and Relationship Diversities (GSRD). BACP also published my article Not in Front of the Students about the absence of training in their journal in the same year.  But nothing has changed and I’ve felt quite dispirited. Instead, BACP have promoted workshops on treating sexual addiction which is a highly contested and controversial issue which many of us in the field of clinical sexology would dispute See Marty Klein who has blogged extensively on this or the excellent book by David Ley Ley, 2013, Flanagan 2013 and my post Davies, 2013) Sexual Addiction or Hypersexual Disorder failed to be included in the latest Diagnostic and Statistical Manual (the bible for mental health disorders compiled by the American Psychiatric Association) on the grounds of lack of robust evidence for diagnosis and effective treatment.

One of the positives that has come from my having taken stance is that MANY therapists and members of the GSRD communities have been having a conversation about therapy and it’s need to catch up with the rapid evolving field and address the mental health needs of our communities.  [Over 80 concerned therapists and sexologists signed an open letter to the Board.]

It always surprises non-counsellors when I tell them that in what can be between a three to seven year training to become a therapist there is virtually no training in basic human sexuality and relationships let alone in working with people whose sexuality is different to the mainstream. Unless one trains to be a sex therapist, one is unlikely to be able to engage in explicitly sexual conversations.

Perhaps all of this activity over the past few weeks can pave the way for a closer dialogue between all of us who are concerned to see better mental health for our communities. We’ll see!

Dominic Davies
CEO/Founder Pink Therapy

50 Shades review

Ok, in the words of a few colleagues and friends I “took one for the team” by actually going to see the film rather than sit on the sidelines commenting from afar.

The controversy and hype on Social Media has been intense over the past few days.  The jokes and spoofs have also brought a smile to my lips and I was prepared for a challenging couple of hours so I booked two tickets for the studio cinema of the Genesis which has a bar in the cinema and super comfy sofas and ordered a large glass of Shiraz.  I took a good friend, performer and wit Ernesto Tomasini in one of his rare nights off in London and we settled down for a giggle and a groan!

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Top line: I certainly didn’t feel the film was as bad as the hype,  Jane Fae’s review seemed fair and totally on point.  I read it before and I read it afterwards and it strikes me as the fairest and most balanced. Check it out as it says all that needs to be said.  Allowing ME to focus here on my own perspective and trying to say something that hasn’t been said already.

Christian Grey was a clearly mixed up guy who could use some therapy to heal his emotionally damaged childhood  trauma, but he did seem redeemable and in fact he shifted a fair bit on his “I don’t do romance” by taking her on a joyful and completely gratuitous glider flight and during what was a very empowered “business meeting’ to discuss his submission contract, agreeing to a weekly Date Night.

Ana came across as increasingly empowered and strong character who exited the relationship when she found out at her own request how bad Grey’s punishment might be (six of the best, which was actually pretty mild by most people’s idea of CP play).

In fact his ‘punishment’ scene looked like it hurt him as much as it did her and her punishment of him (withdrawal) was much more severe (as it often is).  She portrayed a much stronger person and not the defenceless weak woman I had expected from the reviewers.

Grey appeared more of a ‘Service Dom’, focussing on her sensual arousal and awakening rather than abusing her and she did seem to be consenting. He was not sadistic or cruel or a self centred lover. There were no skull fucking scenes until she gagged and vomited and he didn’t send her back to her room with her face covered in semen. The sex was sensual, tender, and really very tame and Grey used condoms!  

Lifestyle BDSM in a Dominant/submissive relationship often does involve controlling the submissive’s diet, well being, clothing etc.  It probably wouldn’t be rushed into like it was in the film, and especially not with a virgin ingenue like Ana, and so the laments by the BDSM community (most of which haven’t actually seen the movie when asked to comment) that it’s not accurately representing BDSM are missing the point a bit.  It’s a movie, not a documentary!  I actually think we under estimate people’s ability to recognise that movies are different to real life.

We have so few representations of our lives in film I think community members want to see highly accurate portrayal and that may not make for great drama.  I remember  a few decades ago the uproar when Al Pacino played the gay leather clad lead in a film called Cruising. The gay community had no positive representations of our lives that this disturbing film presented us in the worse possible light. Virtually every gay film for decades contains tropes and stereotypes and we know life isn’t quite like that!

Maybe we need the equivalent of the highly effective Trans Media Watch campaigning for accurate BDSM content? This is something that NCSF and CARAS are doing and there are now lots of opportunities for teaching all the neophytes to BDSM lots of things about consent and safety!

I read one extensive post where virtually no one had seen the film (and most hadn’t appeared to have read the books either), but when asked for a soundbite all managed to come up with something to educate the readership (and promote their websites)!  

Two things did disturb me about his stalking really was the most outrageous and scary aspect but we’ve seen that trope of the boy chasing girl in many movies before and not been labelling it as abusive. I also recall Judi Dench as M waiting in James Bond’s hotel bedroom.  It is always jarring when someone surprises us like that.

Is it the BDSM context for this movie which is actually the subject of most criticism, but that it’s being presented  intimate partner abuse?

One thing that seems to have gone un commented upon so far, I found the early ‘Are you gay?’ joke both unnecessary and offensive.

Bottom line: I’m glad I saw the movie myself, I don’t regret doing so and I feel pleased I had a chance to come to some views of my own.

Dominic Davies
Psychotherapist, Clinical Sexologist

If you’re a therapist have you booked for our Beyond the Rainbow conference which will amongst other things explore BDSM on 21 March 2015 in London

Sober Sex – some ideas for moving forwards

Dominic Davies speaking at Gay Sex & Drugs

Dominic Davies speaking at Gay Sex & Drugs

I want to talk about Sober Sex which is I know from my clients is a huge challenge for many guys who are trying to stop or recover from Chemsex.

I come to this topic as a clinical sexologist – which means I’ve studied a wide range of sexualities and worked with a lot of people over my 30+ year career as a therapist, helping them with a range of sexual problems. I’m also coming to this topic as someone who has been a sexual adventurer exploring alternative sexual practices and lifestyles from the inside.

It was quite shocking to read this morning that Crystal Meth gives someone 1250 units of dopamine compared to the 200 units released during sex. It got me thinking…. how do they measure this? I’ve had plenty of mind blowing sex and it’s really hard for me to imagine the high that Meth would give me that could beat that.

I’ve also occasionally had some very mediocre sex. I wonder if the 200 unit measure was from the kind of very ordinary mundane sex, the kind that you want over and done with so you can get to sleep as you have an early start in the morning.

But the point of the article was more about the down-regulation of the dopamine receptors as a result of having been overloaded with Meth and how it’s hard to feel normal happiness and pleasure again.

I’m quite an optimist and I am wondering if that’s actually true and permanent or if that can be fixed?  I’m wondering whether nutritional therapies like Tyrosine which is an amino acid and works as a precursor to dopamine could increase Dopamine and restimulate the neurochemistry?  So perhaps it’s worth consulting a Clinical Nutritionist for advice.

I’m also wondering if some of the forms of sexual intimacy and sexual healing that exist out there might help people discover sexual intimacy sober. I’m thinking of some of the work done by  Gay Tantra masseurs or Kundalini yoga teachers, by the practitioners at Authentic Eros and Gay Love Spirit or the upcoming Quintessential Queer Hearted festival or in October the Love Spirit festival happening later this year and people skilled with playing with sexual energy at Queer Conscious Sex.  There is also playing with power and sensation through consensual BDSM. You might also want to consider erotic hypnosis which can create altered states of consciousness and mindfulness meditation too. All of these I’ve found to be able to change the experience of sex and one’s relationship to one’s body.

I’d encourage those of you struggling to have sex sober to explore these kinds of things. I’d also urge queer practitioners of any of these different disciplines to offer their services to build a body of knowledge and experience of what works.  I’d really love to hear more about this from anyone on the journey.

Intense, intimate and passionate sober sex IS, I believe entirely possible.  It may not have the intensity of being super high masturbating to porn at a Sex Party with four guys on Grindr, one obsessively polishing the bathroom mirror and another passed out in a G-hole, but I am hopeful there could be some amazing experiences ahead if you want to explore what sober intimacy and sexual energy can do.

I’ve no direct connection to the groups I’ve linked to here, other than knowing they exist and having met some of the people involved as well as some of the people who’ve benefitted from the experience.

Dominic Davies
Director

This is a version of the open mic contribution I made at the Facebook event Let’s Talk about Gay Sex and Drugs on 9 June

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

Dermod Moore interviews Dominic Davies in Dublin

This is an interview Dominic gave Dermod Moore when in Dublin earlier in the year where they discussed sex, sexuality and psychotherapy in the social context of Ireland. 

Dermod Moore: Thinking back to the time the Pink Therapy books were first published – a lot has changed since then!

Dominic Davies: Yes, Pink Therapy as an organisation has been around 14 years. It feels like it’s gone in the blink of an eye.

DM Do you have a sense that what you are doing is more mainstream, now?

DD I think that’s true. It’s now becoming a legitimate source of study and to work in. It’s being recognized by the professional associations too, which is really good. They’re not doing very public or explicit things regarding GSD issues, but I have a sense now that my voice will be heard, that, for example, my letters tend to be published in full. It’s quite a nice degree of power to have.

For example, the European Association for Psychotherapy has a draft document which is proposing the necessary professional core competencies for psychotherapists – it managed to avoid mentioning awareness of sexuality in its requirements.

I mean, how did you miss that out in the first place, people? What is going on? You list all these other “-isms” but you don’t list sexuality? Is that heteronormativity? Or is that homophobia? Because it should be ingrained in people’s awareness by now. When this was pointed out to me, I sent off a few emails to various people saying how appalling it was, and then someone in UKCP drafted a correction,* which was submitted to the EAP competency committee. It makes me think – it’s not benign for that to be missed out. The situation for European queers is pretty appalling, especially for some Central and Eastern Europeans – and for therapists practicing there, if it’s not enshrined in the competency codes that they need to account for sexuality, they could easily not do so, or pathologise, or institute reparative therapy. Given how Russia is treating gays at the moment, the fact that the EAP is meeting in Moscow is important.

One of the things that was coming out of today’s workshop was a sense that it was the first time that such a workshop was held in Ireland. Why did the professional associations not do this sort of thing?

DM Actually, Stephen Vaughan has presented workshops for IAHIP (Irish Association for Humanistic and Integrative Psychotherapy) and IACP (Irish Association for Counselling and Psychotherapy) over the years, with others doing work for the HSE/GMHP.

I know, Dominic, that you’ve been working recently on emotional and psychological safety for sex workers in London, can you say a bit more about this aspect of your work?

DD Clearly, there are people who are exploited and trafficked, and that needs to be stopped, that goes without saying. For people who want to make a conscious choice to go into it as a profession, or as a part-time occupation, or as a way to pay their way through college, earning good money, and if they’re comfortable doing that, then I don’t think the state should be intervening in that. I think it’s their body and it’s their right to do with it as they want to. I also think there are also issues around access to sex, – for example, people with disabilities who might want to have sex. Sex workers often play a really vital role in the psychological and mental wellbeing of disabled people. Whether that’s just company, or self-esteem, or sexual touch, it seems to me that they are providing a compassionate service – and to criminalise it is appalling. I was lucky enough to meet sex workers in Australia and helped inspire an organisation that is largely staffed by sex workers to work with disabled people; training them how to safely lift people, how to deal with catheters etc; how to work with people with cerebral palsy, or speech impediments, or those who might spasm. How to help them practice their kissing skills, learn to flirt – sex workers are fantastic at flirting! They are very proficient teachers of the art of lovemaking. That was a really exciting project to be involved in.

A lot of the people using sex workers are very big into power play and degrading and using, and they may be nervous, difficult, trying to get it on the cheap, or try to exploit in other ways – and if you’re on the receiving end of that you may end up feeling quite contaminated with all this baggage. I was teaching them – both practicing and aspiring sex workers – Thought Field Therapy, an energy psychology, which is one of the most effective psychological treatments I’ve ever come across.

DM – I can hear, listening to you, how you are always de-problematising sex – always asking, “what’s wrong with sex?” In the Irish context, there’s often a long journey to leave behind a lot of shame about matters sexual, there’s such a strong message of “you’ve got to be careful, protect yourself”.

DD Of course I want people to protect themselves, while they are having incredible sex! I want them to be emotionally healthy! I’d want them to feel that what they are doing is liberating and exciting and a healthy and positive way of expressing themselves. And if they manage to remember the name of the person that they’re having sex with, and leave them both with a smile on their face, that counts as healthy sex!

DM There are regular radio ads in Ireland for a clinic offering treatments for all sorts of addiction, including sex addiction.

DD I don’t buy it, sex addiction. I don’t believe sex, which is a natural biological drive and urge, can be classified as an addiction. I think it’s dangerous and foolish to do so. I think Dr David J. Ley’s new book, The Myth of Sex Addiction spells out the case very eloquently, and if there is anyone who thinks there is such a thing they really ought to read his book. Yes, there are some people who have a problem with sex, who use it in a compulsive way, whose sexual activity masks other, more serious psychopathologies, such as bipolar depression, or borderline personality disorder, or narcissistic personality disorder. But if you are diagnosed as a sex addict, the treatment is perhaps to go on a chastity contract, or work The Steps; it focuses entirely on sex and your sexual history, that fits you in to a paradigm that says you were abused, or traumatised in some way. Who has not had a childhood that could not be seen as traumatic, through a particular lens? The sexual acting out is likely to be a symptom of something else that’s going on. It’s just a symptom, like a tic; and that will go away if you deal with the other stuff. In over 30 years of practice, I’ve never yet met a “sex addict.” I don’t think other people diagnosing you is ethical. The APA, doesn’t accept sex addiction exists; the DSM-V committee refused to include hypersexuality as a disorder. There’s no agreement that the diagnosis exists.

It is, basically, shame. And I have a paper in mind, that I want to write. It’s framed in DSM language: a diagnostic criteria for a new sexual disorder. And it’s called Sexual Shame Disorder. It would mean that these clinics could continue to charge money to treat people for something – but they might have to change the framework they’re using!

People who are presenting with sexual shame need treatment for it. And if they are calling themselves sex addicts, then, as long as we screen out the disorders I’ve mentioned, then what’s left is sexual shame. And that is treatable! I treat that all the time!

DM Someone from that clinic was on the radio recently with a client talking of how he had become addicted to porn, and broke his wife’s heart.

DD I’ve not fully formed my ideas on porn. The impact of porn on young people, particularly on young men, can be quite damaging. Clinically, there are more reports of erectile dysfunction, young men who have been masturbating to porn all the time, and then they find that real sex, when they finally get laid, doesn’t match up. It’s not as fast, it’s not as intense, they can’t find the fast-forward button on their partner to get to the exciting bits! So, their erection diminishes, and they feel shame, and they feel bad. It can all be undone and relearned. But it takes time. The neurochemistry of the brain is that they’re harnessing all the dopamine and the adrenaline, but what they’re not accessing is the oxytocin. And if they withdraw from 2-4 weeks, from all of that intensity, and understand more about the process, psycho-education, and then are given some opportunities to do other horny activities, the body and the brain reprogramme, and you can have a more balanced sex life. But I think porn has its place, it’s a great way for people to get sex education, you can become more creative in your imagination, with things that you find hot.

DM But isn’t (heterosexual) porn all about viewing, from a feminist point of view, women as objects, there for the pleasure of men?

DD There are plenty of women who like porn. Plenty of women who like sex, the carnality of it, who like sex without any connection, or romance, who just want a good hard orgasm and plenty of them. And they want someone with the stamina and the skill to give it to them. And let’s celebrate those women too, and not marginalise them and play into a stereotype that women don’t like sex and it’s men’s sexual desires that give them some sort of exclusive biological privilege that they should do whatever they like. They shouldn’t do what they like! It’s too convenient for a man to say “I couldn’t help myself because I’m a sex addict” – that’s the ultimate cop out. It’s much better to say “I did it because I wanted to.” “I did it because I’m horny.” Or, “I did it because you haven’t wanted to have sex with me for the last three months.” Whatever the reason, men are responsible for their sexuality and women are responsible for their sexuality. We need to take responsibility. Sex itself is not a bad thing. It’s how it’s used, what people do with it. That’s where the conversation needs to begin.

Dermod Moore is a psychotherapist in Dublin and  teaches the ‘Sexuality and Gender’ modules at the Psychosynthesis Education and Trust http://dermod.tel

Dominic Davies, a fellow of the BACP, lecturer, supervisor, psychotherapist, sex therapist, co-editor of the Pink Therapy series of books (with Charles Neal, 1996-2000), writer and activist, spoke to Dermod Moore on his recent visit to Dublin. He was co-training a workshop “Working with Gender and Sexual Diversity” for  Oakleaf Counselling, for 26 counsellors and psychotherapists working with Lesbian, Gay, Bisexual or Transgender clients or anyone who would like to improve their understanding of working with Gender and Sexual Diversity. (GSD).

PS:   Amanda Middleton and Dominic Davies will be off to Dublin in February 2014 with their Introduction to Psychosexual Therapy. Check out the link for the syllabus

Again, Anita Furlong is producing the event and dealing with admin. Places are limited and it’s booking up fast! http://www.oakleafcounselling.com/workshops-and-seminars.html

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

Communicating with gay clients with mental health needs: how psychologists’ personal characteristics can get in the way

At a time when Lesbian and Gay (LG) equality rights are still being debated by the United Kingdom (UK) Parliament and by several religious organisations, worldwide attitudes towards same-sex relationships remain controversial and ambivalent (Pew Research Centre, 2013). Previous research has identified the existence of such ambivalent attitudes amongst the general population (Herek, 2009; Herek, Gillis & Cogan, 2009), in particular when unconscious (implicit) attitudes are measured and do not always match people’s self-reported (explicit) attitudes (Banse, Seise & Zerbes, 2001; Nosek & Banaji, 2009; Ranganath & Nosek, 2007; Steffens & Jonas, 2010). Equally, attitudes in psychologists seem to follow similar trends (Boysen & Vogel, 2008; Boysen, 2009) where explicit attitudes tend to be positive while implicit attitudes tend to be ambivalent or negative. Such discrepancy between explicit and implicit attitudes can cause internal conflicts in people between their thoughts about, and their behaviour towards, LG people. This can make people come across as ambivalent, distant, and negative (Gawronski & Strack, 2004; 2012) when interacting with LG people. 

Research has found evidence that psychologists and psychologists-in-training can show such ambivalence to LG people too (Finkel et al., 2003; O’Brien, 2003; Scher, 2009), including anxiety and avoidance (Gelso et al., 1995), and emotional and social distance (Barrett & McWhirter, 2002; Jones, 2000). Equally, vulnerable clients belonging to minority groups may often be at the centre of unintended discrimination, through ambivalent behaviours, when professionals’ attitudes about clients’ identity are negative or biased. Studies also revealed that psychologists would show less concern for gay clients when their attitudes towards LG people were more negative (Clarke, 2010), consider LG clients riskier and more likely ‘to harm other people’ (Bowers et al., 2005), propose more controlling interventions with gay clients (O’Brien, 2003), be less willing to work with gay clients in therapy (Barrett et al., 2002), regard LG identity as more pathological, and support the use of therapy to change a client’s sexual orientation (Kilgore et al., 2005). 

These findings are particularly relevant for clinical psychologists who increasingly may have to see in clinic LG people with psychological and social needs, and to offer them support through direct and indirect clinical work, consultancy and training, supervision and research, and academia-related activities (British Psychological Society, 2006; 2012). Psychologists’ attitudes about clients are then particularly relevant to clinical communication. This is due to the recognition of the potential bio-psycho-social impact that discrimination and prejudice can have on people belonging to minority groups (Meyer, 2003; Davies, 2012). Nonetheless, communication and attitudinal research is a recent emerging phenomena among healthcare professionals (Steffens, 2005; Steffens & Jonas, 2010), remains scarce and is further needed at the centre of clinical psychology practice.

The current research investigated communication patterns on a sample of UK clinical psychologists-in-training toward simulated ‘gay clients’ (professional actors), and how participants’ demographic characteristics and attitudes towards LG people may be related to their behaviour in session with a ‘gay client’ either with depression or with anxiety. The study also looked at changes in clinical communication over time, so each 10-minute ‘session’ was video-recorded to be analysed with two communication measures. ‘Gay clients’ also provided their satisfaction score at the end of each session for each psychologist. Results suggested that the current sample of psychologists-in-training show discrepancy between positive self-reported (explicit) attitudes and slightly negative and ambiguous unconscious (implicit) attitudes towards LG people. The attitudes of the current sample were equivalent to those found in earlier studies (i.e. Boysen et al., 2008; Banse et al., 2001) thus showing a prevalence of unconscious social prejudice and distance towards sexual diversity. These attitudes did not change after six months of clinical training and placement experience. 

Furthermore, clinical communication scores revealed that participants interacted professionally with ‘gay clients’ but showed less empathy and interest in client’s concerns and worries. ‘Clients’ also felt overall dissatisfied with their sessions and did not feel a connection with their ‘psychologist’. In particular, psychologists who had more avoidant characteristics had more difficulty in communicating with ‘clients with depression’, did not explore clients’ feelings as often, and gave ‘clients’ less opportunities to speak about their worries. Whenever clients gave hints to the psychologist that they wanted to talk about their concerns, most of the time these were not noted or followed-up by the psychologist.  ‘Clients with depression’ felt less satisfied with their session than ‘clients with anxiety’ and findings were similar after six months of clinical training and placement. However, after six months of training, psychologists’ communication scores improved slightly and ‘clients with depression’ felt slightly more satisfied with their session.

These findings are important since previous research has found that practitioners often struggle more when working with clients with depression (e.g. Gonzalez et al., 2013; Annen et al., 2012; Lyons & Janca, 2009). These clients are often perceived as unmotivated and disengaged, and consultations are more difficult to conduct. However, most of the time clients with depression are unsure if they can trust their therapists with their problems and just want to be asked the right questions. When applying such results to LG clients, a study by Newman and colleagues (2010) uncovered that gay men with depression often withheld information about their worries and concerns until they feel that their therapists are trustworthy, ethical, encouraging, knowledgeable, supportive and, most of all, are open and clear. These are important areas to highlight, due to the dual stigmatisation that gay men may face when also diagnosed with a mental illness. 

Quality of life, therapeutic outcome and client satisfaction can be greatly improved when there is tailored client participation and decision-making and good clinician communication skills (Vogel, Leonhart & Helmes, 2009). So there is an urgency to ensure that psychologists are trained to provide therapy in a safe and affirmative environment with the right communication skills, even if at first they may feel deskilled to working with LG people. There is also a need for psychologists to revisit their assumptions of sexual orientation through specific sexual diversity training, to prevent cultural and personal bias from transpiring to the therapeutic relationship. In particular, future research could explore the impact of such training on attitudes and clinical communication with gay clients with depression when comparing to heterosexual clients with depression to evaluate if there is any difference in the interaction.

 References

Annen, S., Roser, P., & Brune, M. (2012). Nonverbal Behavior During Clinical Interviews: Similarities and Dissimilarities Among Schizophrenia, Mania, and Depression. Journal of Nervous & Mental Disease, 200(1): 26-32.

Banse, R., Seise, J., & Zerbes, N. (2001). Implicit attitudes toward homosexuality: reliability, validity and controllability of the IAT. Zeitschrift fur Experimentelle Psychologie, 48(2): 145-160.

Barrett, K. A., & McWhirter, B. T. (2002). Counselor trainees’ perceptions of clients based on client sexual orientation. Counselor Education & Supervision, 41: 219-232.

Bowers, A. M. V., & Bieschke, K. J. (2005). Psychologists’ clinical evaluations and attitudes: an examination of the influence of gender and sexual orientation. Professional Psychology: Research and Practice, 36(1): 97-103.

Boysen, G. A. (2009). A Review of Experimental Studies of Explicit and Implicit Bias Among Counselors. Journal of Multicultural Counseling and Development, 37: 240-249.

Boysen, G. A. & Vogel, D. L. (2008). The relationship between level of training, implicit bias, and multicultural competency among counselor trainees. Training and Education in Professional Psychology, 2(2): 103-110.

British Psychological Society (BPS) (2006). Core competencies – clinical psychology – a guide. Leicester, UK: BPS.

British Psychological Society (BPS) (2012). Guidelines and literature review for psychologists working therapeutically with sexual and gender minority clients. Leicester: British Psychological Society.

Clarke, C. P. (2010). Exploring the relationship between heterosexual therapists’ attitudes toward gay men, their self-reported multicultural counseling competency, and their initial clinical judgments. Dissertation Abstracts International, 70, 12-B, PsycINFO, EBSCOhost [accessed 25 September 2012]

Davies, D. (2012). Sexual orientation. In C. Feltham & I. Horton (eds) The Sage handbook of counselling and psychotherapy, 3rd edition, pp. 44-48. London: Sage Publications.

Finkel, M. J., Storaasli, R. D., Bandele, A., & Schaefer, V. (2003). Diversity training in graduate school: an exploratory evaluation of the Safe Zone Project. Professional Psychology: Research and Practice, 34(5): 555-561.

Gawronski, B., & Strack, F. (2004). On the propositional nature of cognitive consistency: Dissonance changes explicit but not implicit attitudes. Journal of Experimental Social Psychology, 40, 535–542.

Gawronski, B., & Strack, F. (Eds.). (2012). Cognitive consistency: A fundamental principle in social cognition. New York: Guilford Press

Gelso, C. J., Fassinger, R. E., Gomez, M. J., & Latts, M. G. (1995). Countertransference reactions to lesbian clients: the role of homophobia, counsellor gender, and countertransference management. Journal of Counseling Psychology, 42: 356-364.

Gonzalez, A. V., Siegel, J. T., Alvaro, E. M., & O’Brien, E. K. (2013). The Effect of depression on physician–patient communication among Hispanic end-stage renal disease patients. Journal of Health Communication: International Perspectives, Feb 14. DOI:10.1080/10810730.2012.727962

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Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56: 32-43.

Jones, L. S. (2000). Attitudes of psychologists and psychologists-in-training to homosexual women and men: an Australian study. Journal of Homosexuality, 39(2): 113-132.

Kilgore, H., Sideman, L., Amin, K., Baca, L., & Bohanske, B. (2005). Psychologists’ attitudes and Therapeutic approaches toward gay, lesbian, and bisexual issues continue to improve: an Update. Psychotherapy: Theory, Research, Practice, Training, 42(3): 395-400.

Lyons, Z., & Janca, A. (2009). Diagnosis of male depression – does general practitioner gender play a part?. Australian Family Physician, 38(9), 743-746. 

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129: 674-697.

Newman, C., Kippax, S., Mao, L., Saltman, D., & Kidd, M. (2010). Roles ascribed to general practitioners by gay men with depression. Australian Family Physician, 39(9), 667-671. 

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Steffens, M. (2005). Implicit and explicit attitudes towards lesbians and gay men. Journal of Homosexuality, 49(2): 39-66.

Steffens, M. C., & Jonas, K. J. (2010). Implicit attitude measures. Journal of Psychology, 218(1): 1-3.

Vogel, B., Leonhart, R., & Helmes, A. (2009). Communication matters: The impact of communication and participation in decision making on breast cancer patients’ depression and quality of life. Patient Education & Counseling, 77(3), 391-397. doi:10.1016/j.pec.2009.09.005

Miguel Montenegro
Trainee Clinical Psychologist, University of Liverpool

September 2013

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:

Click to access RUS_GSDT.pdf

Dominic Davies