Guest Blog: Maz Michael

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Talk for Pink Therapy Sex Works conference on 23rd March 2018

Welcome, my name is Maz Michael, I work as a freelance therapist in Brighton and I’m trained in Person Centred, CBT approach and EMDR modalities. It is my belief that, since the subject of embodiment (and by embodiment I mean who we are in a bodily context, particularly in relation to our sexual and gendered selves), since embodiment is typically lacking from most talking therapist training courses, this leaves talking therapists largely unprepared to engage in certain discussions with our clients for whom dialogues about embodiment could be therapeutically important.

In relation to this theme, the usefulness and relevance of embodiment training for talking therapists and clients, I occupy a number of spaces: I’m an accredited therapist, an Urban Tantra staff team member, a facilitator of bodily based breathwork practices and I identify as a non-binary trans person.

I hadn’t reflected too much on these various identities before because they feel like they naturally coexist, in the same way that the mind and the body co-exist. Yet I know that the idea of a talking therapist also being a sex positive, body positive training course member and a facilitator is somewhat contentious. Because of my own experiences of embodiment and my professional interest in this area, I have focussed this talk primarily on why I think courses like Urban Tantra (and I will explain in a minute what Urban Tantra is) why such courses could be useful for gender non-conforming people and for the therapists who work with them, although I do think that such training can be useful for many other people too.

So, this is where I’m drawing from, I work therapeutically with people in different ways, and in addition to my talking therapy trainings, I am trained as a rebirthing breathwork practitioner (rebirthing breathwork is a type of breathing that uses breath to release distress and trauma). I am also trained in facilitating an erotic breathwork practice, sometimes known as the Firebreath, as taught on the Urban Tantra program. Neither of these breathwork practices involves any touch or nudity and, as such, I do not work hands on with any clients but I have taught these breathwork practices to individuals and groups. I do not, however, offer breathwork experiences to talking therapy clients or vice versa.

In deciding how to approach this talk, I’ve drawn from my own attempts to find safe and supportive embodiment courses in which I can explore my own, sexual, spiritual self. Frustratingly, on this journey,  I’ve often been met with conventional ideas about gender, such as the assumption that genitals equal gender, i.e. that a person with a penis must be a man and a person with a vagina must a female and that there are only two genders i.e. that gender is a binary of male and female. I have sometimes felt embarrassed and self-conscious on some embodiment courses because of these simplistic assumptions about gender and my uncomfortableness and anger has motivated me to remain in that world but with the hope that my presence on some Urban Tantra training can help other gender non-conforming people to feel that they may find a place of belonging there too.

In the same way that most tantra type training fails to understand and accommodate the needs of gender diverse people, so too out in the world this is often the case. Gender non-conforming people are regularly under attack for self-defining our gender and I feel that there is something especially harsh about the fact that the very places that we might find sanctuary from the discriminatory world and experience pleasure in our bodies are too often places that further alienate. As Canadian Sexological Bodywork trainer, Caffyn Jesse, states: ‘’The massage studio can be a safe haven where a gender pioneer can relax into embodied exploration. Or it can be another piece of oppression.’’ (Erotic Massage for Healing and Pleasure.p137)

So, I believe that most talking therapist training and most embodiment training have something in common, they invariably fail to understand and to accommodate the needs of gender non-conforming people. One of the few embodiment training spaces where I have found that this is not the case is Urban Tantra.

So what is Urban Tantra?

The term was coined by American Sex Educator, Barbara Carrellas. In her workshops, professional training and books, Barbara does not especially privilege genital touch or sensation but instead looks at the capacity that the whole body possesses to experience erotic pleasure. Barbara also makes links between tantra and consensual BDSM practices as both she says utilise ‘’a powerful dynamic for erotic or spiritual purposes’’ (Urban Tantra.p 202). Barbara also teaches erotic breathwork practices that do not require genital stimulation. The focus on the breath and the whole body, as distinct from the genitals alone, as a potential source of pleasure, has obvious advantages for anyone who does not want or cannot have genitally based sex. Like with the professional therapy code of ethics, Urban Tantra similarly has a set of values that participants and graduates are expected to adhere to which include: Consent between people as an ongoing agreement which can be modified or withdrawn at any point, a strict Safer Sex protocol and the welcoming of people of all genders, sexual orientations, sexual preferences. Barbara’s interest in breathing and in the whole body, as distinct from the genitals alone, as a potential source of pleasure emerged during the 80’s when the AIDS epidemic exploded in America and, as a result, the need for a safer form of sexuality was vital; so, UT has queer roots.

So why might training like Urban Tantra be useful for gender diverse people?

Gender diverse people inhabit bodies that are marginalised by society and more so, of course, if that gender diverse body is differently abled or a person of colour’s body or, indeed, a working-class person’s body. Trans bodies are strangely both de-sexualised and hyper-sexualised. De-sexualisation of our bodies occurs I believe when the body is framed exclusively medical terms i.e. the body as the recipient of hormones and/or surgery. Hyper-sexualisation of certain trans bodies is obvious, for example, as in porn that features ‘’chicks with dicks’’. Trans author and activist, Kate Bornstein states that the trans body is viewed with both revulsion and desire (Gender Outlaw page 93).

So, gender diverse people are both off limits and on limits, we can be asked about our bodies anytime; I once read some assessment notes in which an assessor had asked a trans person ‘what stage of transition are you at?’ when, in fact, the prospective client, who was transmasculine and had a full beard, was not wanting therapy for anything to do with them being trans. Can you imagine for one minute in a therapy assessment a cis-gendered client (that is a client whose gender identity corresponds to their birth sex), can you image them being asked out of the blue and totally irrelevant to their presenting issue: ‘What does your naked body look like, especially your chest/breasts and genitals?’

Given the societal ambivalence about trans bodies, I believe that the very decision to announce ones trans identity is a profound act of self-actualisation as is the courage to challenge normative notions of embodiment (and I will talk a little bit about that in a minute).  Typically, self-actualisation is regarded as a psychological process that is facilitated by psychological means exclusively and yet bodywork courses can help all people to self-actualise just like good psychological therapists can. I think in some ways that good embodiment trainings are good because they have the capacity and willingness to offer the Core Conditions especially that of Unconditional Positive Regard i.e. they do not judge the participant nor impose reality from the outside but rather they adopt an open, excited and inquisitive stance towards each participant and are ready to be led by them. In Urban Tantra training, Barbara Carrellas delivers an Erotic Awakening massage for gender non-conforming people. This massage is totally guided by the recipient, the recipient is asked what names if any they may have for their body parts, what body parts are off limits if any. This is an erotic touch that led by the subjective experiencing of the recipient. This approach fosters the idea that each person will be the best expert on their body and their capacity to generate and experience erotic pleasure.

Trans people are sometimes wonderfully creative beings and often we have had to be in order to find ways to navigate this societal ambivalence towards our bodies. Sometimes we challenge the very notion of the body:  we may rename our genitals not as penis and vagina but as something else completely. What we mean by genitals may not even be the physical flesh at all; for example, genitals may mean the use of prosthetics, dildoes and I have worked with a number gender non-conforming clients who have spoken about of the importance of clothing as it relates to their sense of body. For some trans people, the body may be experienced more as an energetic phenomenon than as the physical flesh.

In her 2016 survey entitled: How Trans Women, Trans Men and People of Nonbinary Gender Experience their Genitals, Barbara Carrellas found that the majority of respondents experienced ‘’energy genitals’’, that is, the sensation of having genitals in a different size, shape or configuration than the ones grown by one’s own body.

And in their book, Trans like me, academic, musician and activist, C.N. Lester, who is non-binary, trans-identified mentions the term the ‘’proprioceptive body’’ proprioception means the ‘perception or awareness of the position and movement of the body in space’’, it is a sort of ‘’sensory map’’. In other words, it refers to a body that is not physical flesh and in this regards it could be seen as a similar to the idea of energy genitals; for some trans people, the sensed body is more real than what is there in a physical form. On the subject of the body, queer author, Sassafras Lowry, states: ‘’I’ve gazed on as dysphoria dissipated under the realisation that body need not be flesh I was born with, that body need not be made of skin at all’’. In Urban Tantra training the clothed body might be understood as more congruent than the naked body for some people. So, clothing/costume/prosthetics/breathwork/energy work is welcomed and encouraged as they can all be ways of experiencing the erotic body. Within this framework, clothing becomes expression rather than concealment. This is contrary to most embodiment training that tend to privilege full or partial nudity and tactile contact over energetic arousal.

I want to talk a bit about self-pleasure, masturbation…

I have worked with gender non-conforming clients who have talked about how self-pleasure, is hugely therapeutic for them. Sometimes clients talk about depression and anxiety lifting as a result of self-pleasuring and that they feel more human, less dysphoric, I need to be able to dialogue with such clients there in their expression; masturbation can be an act that promotes personal well-being and I as a therapist should not stand in the way of this client’s exploration by avoiding such conversations. As Latinx activist and artist, Ignacio Rivera states: ‘’Positive or radical sexuality begins from within…it is the sexual place that allows you to feel comfort, have agency..this is radical because it is reclaiming one’s body that has been probed by society and the state. It is power and that transcends into supporting mental health, healthy relationships and self-esteem.’’.

A unique feature of UT is that it encourages participants to create from the material of their own lives, to develop erotic spaces and practices based on our own needs and own imaginations rather than to follow a prescribed formula. After I got frustrated at the narrowness and exclusivity of embodied workshops and trainings I didn’t want to keep feeling excluded and self-conscious but also wanted to experience some kind of sharing of erotic space with my fellow queers. As such, I had the idea of starting a non-binary trans self-pleasure group with a number of friends of mine because I couldn’t find what I wanted out in the world of embodiment courses because of the assumptions made about my gender. One of the many realisations from this group is that how we experience self -pleasure is as varied as the number of us in the group. What has happened in this group is that we have learned to trust our expression of our sexuality in the company of each other. I think such groups, which are not really new, (Betty Dodson started masturbation workshops for women back in the 1960s) such groups can help people, particularly people from marginalised intersections, to let go of what we carry in the world at least for a time. Such groups can act as a stepping stone for erotic intimacy with another or just be complete in themselves. Urban Tantra courses typically create for a short time a similar space a queer-affirming space and the support for participants to then go forward and to birth into the world what we envision based on our own knowledge and experience.

I wonder how we can talk about depression or anxiety, as it may manifest for anyone, without also considering that person’s embodied reality and their relationship to their sexuality or asexuality? As for talking therapists, if we are not willing to explore embodiment with our clients, I believe we are severely limiting our therapeutic usefulness to many clients, especially many trans clients. I am not saying that all trans clients will always have a problematic relationship with our bodies, but I am saying that whilst the body is present for everyone and will inform everyone’s narratives about who we are to a greater or lesser extent, it is more a point of reference for trans clients because of the creative inter-relationship between the mind and the body that is a defining feature of trans experience. Embodiment is a hugely significant factor in trans experience and, as such, this calls for us as psychological therapists to move beyond the notion of only allowing themes of sex and embodiment into the therapy room if it’s about sexual abuse, sex addiction or sexual dysfunction or indeed if we are trained specifically as psychosexual therapist. At the time of writing this, I glanced at the latest copy of Therapy Today (the BACP monthly journal) to see if there were any references to sex. This is what I found: one ad. for ‘Sex and Porn Addiction training’, one ad. for ‘Workshop for survivors of sexual abuse..’, and two ads for training in Psychosexual therapy. What I think is missing is an atmosphere in the psychological therapy world in which pleasure in our embodiment and pleasure in our erotic arousal is regarded as a key therapeutic feature for many people.

I want to talk now a bit about why courses like UT could potentially be useful for psychological therapists. I’ve already identified the bias that I see within the therapy world, that of sex and embodiment as typically discussed only in relation to abuse or addiction. I know from my own experience and from what I’ve heard from others that most counselling training courses do not even teach about sexuality or embodiment unless they are specifically psychosexual trainings. I think that attending an Urban Tantra course could be personally and professionally very useful to a practising therapist. Last year I staffed at the UT professional training program in Sweden. The group comprised of approximately a 50/50 split of cis-gendered and gender non-conforming/nb/trans participants. Virtually all of the cis-gendered participants expressed their awareness of ways in which their sense of their own gender and embodiment had been informed by societal normativity and that when, as a result of the Urban Tantra training, they had had an experience of imagining other gender possibilities for themselves they found a profound sense of freedom. Barbara teaches what she calls the Gender Walk (it was invented by Barbara and her life partner Kate Bornstein). It involves taking a slow, very conscious walk from one side of a line over to the other side and into imagining a different gender experience. The gender walk plus spending 6 days with gender non-conforming people thinking about and experiencing embodiment exercises changed people’s assumptions about what gender is and can be. Gender is not, of course, only a theme for trans people, an exploration of our gendered selves (as well as other identities we claim) can be hugely beneficial for most people I feel. I also think that an exploration of our own sexual/erotic selves in a safe, supportive space can help us both personally and professionally as therapists.

In preparing this talk, I’ve been aware of my own working-class based anxieties throughout the process. My first thought, which has endured throughout this process, was fear that I’m not an academic, I can’t face a crowd of people and deliver something with academic soundness; but then I realised that I wasn’t being asked to deliver an academic paper but to speak at a conference called Sex Works and about the relationship between embodiment therapies and psychological therapies. Then another fear emerged, how would my therapy colleagues see me? Would I tell my work colleagues that I was doing this? How would they react? With embarrassment? Ridicule? Humour? Contempt? Then I realised that this was also related to being trans and of feeling other. Would I be viewed as a therapy freak for agreeing to do it? As I have said, I think we can’t really separate tension and anxiety from inhabiting bodies that are subject to oppression. As the queer photographer, writer and body image activist, Vivian McMaster, states of queer people ‘’We live tensely’’ as a result of our marginalised identities.

At the end of the day we are all trying to understand each other so being open to moving beyond the mind versus body binary is a step in that direction. Kate Bornstein states:

I think its time for us to use our status as Third (by which she means not simplistically male or female) to bring some harmony in the world. Like other border outlaws, trans people are here to open some doorway that has been closed off for a long time. (p127 gender outlaw).

The distinction between psychological therapy on the one side and

the embodied therapy on the other side is another false binary. I’ll end with two quotes from the excellent Queer Body Love interview series (and if you haven’t checked out QBL please do, it’s the creation of Elizabeth Cooper): the first quote is from that series and is from author, artist and activist: Sonia Renee Taylor: ‘’radical self-love is the unencumbered understanding of my worth, health and divinity, the thoughts that counter that are not mine and I am not obligated to keep them’’.

The second quote is also from the Queer Body Love interview series and is a self-defined Somatic Teacher of Erotic Possibilities and social justice warrior, M’kali-Hashiki, on challenging the theme of self-care as simply indulgence:

once society tells you that it is not safe to be in your body then what’s the benefit to being in the body? I don’t want to be a target. Maybe I get some relief from enjoying this targeted body

I believe we all have the right to enjoy our bodies and that embodiment training and workshops can be equally therapeutic to most people. I hope that this talk has been useful.

Copyright, 2018. Maz Michael

 

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

 

Trans Health Care by GP’s

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I’ve recently learned that it’s not uncommon for a trans person, who has had a diagnosis of Gender Dysphoria and requested their GP to enter into a shared care plan with the GIC or specialist treating the person to be declined hormones or shared care by the GP.

It would appear that this could be an offence worthy of reporting to the General Medical Council as it goes against advice from the Royal College of General Practitioners and the GMC.  UPDATE 15/3/2016: The GMC have recently issued this guidance to GP’s

UPDATE: 6/4/2016: Dr James Barrett from Charing Cross GIC has written to the British Medical Journal “Doctors are failing to help people with gender dysphoria.”

I appreciate that some GP’s may feel unqualified to treat trans patients and so decline hormones.  I doubt this lack of confidence gets applied to patients presenting with depression that the GP feels they must refer to a psychiatrist rather than prescribe anti-depressants!  There is a very helpful online e-Learning programme made by GIRES which can bring a GP up to date on how to treat a trans or gender diverse person.

I have it on good authority that NHS England knows about this problem but has so far been ineffectual in addressing it.  This is remarkable given that NHS England commissions each General Practice in England!  They have contract non-compliance powers and they often fail to instigate them equality matters.  If these GP’s are failing their trans patients they are probably also discriminating in other areas (failing to provide teenage girls with contraception or treating their LGB patients with sensitivity).

Some years ago the Lesbian and Gay Foundation (now the LGBT Foundation) produced quality standard for practices ‘Pride in Practice’.

In addition to the links above, I’ve put together a list of useful documents to help trans and gender variant people inform their GP and negotiate for better health care:
Royal College of Psychiatrists guidelines for the assessment and treatment of adults with gender dysphoria

Guidance for GP’s and other clinicians on the care of gender variant people

A guide to hormone therapy for trans people

Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guidelines (US Document)

GMC Good practice in prescribing and managing medicines and devices (2013)

There is also this excellent health guide for Trans men, trans masculine and non binary people

Finally, since most people can’t afford to consult private therapists, there is this excellent guide written for trans and gender variant abuse survivors on accessing therapy

Dominic Davies
CEO Pink Therapy