Tag Archives: lesbian

Guest Blog: Dr Igi Moon

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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.

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

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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

Herek, G. M. (2009). Understanding sexual stigma and sexual prejudice in the United States: a conceptual framework. In D. Hope (Ed.), Contemporary perspectives on lesbian, gay and bisexual identities: the 54th Nebraska Symposium on Motivation (pp.65-111). New York: Springer.

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. 

Nosek, B. A., & Banaji, M. R. (2009). Implicit attitudes. In P. Wilken, T. Bayne, & A. Cleeremans (Eds.), Oxford Companion to Consciousness (pp. 84-85). Oxford, UK: Oxford University Press.

O’Brien, K. (2003). Patient sexual orientation and clinical intervention: A study of psychoanalytic psychologists’ biases and countertransference enactments with the gay male patient. Dissertation Abstracts International, 63, 7-B, PsycINFO, EBSCOhost [accessed 25 September 2012].

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Ranganath, K. A., & Nosek, B. A. (2007). Implicit attitudes. In R. Baumeister & K. Vohs (Eds.), Encyclopedia of Social Psychology (pp.464-466). Thousand Oaks, CA: SAGE.

Scher, L. J. (2009). Beyond acceptance: An evaluation of the safe zone project in a clinical psychology doctoral program. Dissertation Abstracts International, 69, 10-B, PsycINFO, EBSCOhost [accessed 25 September 2012]

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