BACP seen as flawed at home and abroad

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There continues to be a lot of support for my stance and criticism not only of BACP but the training organisations that are accredited by them:

 

I’m in my second year of a Diploma in Therapeutic Counselling with an Integrative approach in London. Your post about leaving the BACP over their LGBTQ diversity issues worries me as a trainee. As I’m told at every stage I need to be BACP registered and Accredited. I’m so glad I received today the link from you and a hard copy of Therapy Today on this issue. It is so true that there is a lack of training regarding this. In our institution we have had a days session and if it wasn’t delivered from my colleague who is Trans and myself and aware of your work and other material on Gay Affirmation therapy and how Counsellors / Therapists should work with clients presenting these issues. I would hate to think what would have been delivered. We only presented to one class of three! It really seems a token gesture and not taken seriously for those in current training to challenge their own views and prejudices! 

Not sure why the lecturers didn’t deliver it? Perhaps they aren’t trained or up to date with this??? Needs to be rolled out to all institutions!

Another counsellor responded:

This is so familiar, so many people here delivered the only LGBT component of their course, as students, often having to balance outing themselves with tackling prejudice and outdated notions

Another said:

I qualified as an Integrative Counsellor in 2008. We had no training whatsoever concerning LGBTQI clients. I researched myself and went on a couple of courses with Pink Therapy. Sad to hear it seems much the same in 2016!

Some international support

I read of your resignation from the BACP today. I think you are doing the right thing, and someone of your stature doing this may possibly effect some shift, certainly makes people take notice. I am a fellow psychologist; I resigned from APA years ago due to the terrible issues around torture, failure to take treatment efficacy seriously, and also the foolhardy drive to attain prescription privileges. Better to stand apart, in my opinion, than to be associated with an unethical herd. The issues around conversion therapy are quite serious and real, and no responsible psychologist should ignore it.

and this one:

This morning I read about your resignation from the BACP, and I just want to say thank you so much.

I am lucky to be a young queer woman in Boston, where the atmosphere of most places is somewhere between tolerant and accepting. But in my experiences of mental healthcare, I’ve seen a completely different world. So many psychologists and counsellors are uneducated and untrained about LGBT+ matters, and I’ve seen so much damage done to my queer community because of it. 

I am graduating from high school in a few months, and as I head into college to major in mental health counseling and social work, I feel like it’s important to have faith in the mental healthcare world that I want to work in. It’s really hard to have that faith when I’ve already seen so many problems with the system, especially in the treatment of LGBT+ people. But actions like yours give me hope– I read your statement and remembered that systems can be changed, and the people who choose to work in the counseling world do that work because they genuinely want to help others. 

Thank you so, so much for reaffirming that for me, and thank you for the work you’re doing. I imagine it’s not easy to speak out against a group like the BACP. The LGBT+ world is lucky to have you.

On the monopoly BACP seem to have with employers:

FFS. That leaves me in a very bad situation. It’s not like I have much choice of professional organisations to belong to.

And another:

I’m not sure where else I can go in terms of membership organisations. Makes me feel angry at the conservatism of the BACP.

And another:

I’m a referral counsellor for a therapy centre based on my BACP accreditation, it would mean losing my livelihood unless I could persuade the therapy centre to accept the National Counselling Society.

What could BACP be doing?

Some people have asked me what specifically could BACP be doing to support the LGBT communities better. Here are a few suggestions to be going on with:

  1. Develop some core competencies on Equality and Diversity related issues that take account of the complexity of intersectionality.
  2. Ensure therapists receive some basic sexuality awareness training so that they can discuss sexual issues with their clients.
  3. Ensure Gender and Sexual Diversity issues are woven throughout the therapy training and not just a tokenistic add on.
  4. Closely audit the courses BACP accredit to ensure they are meeting these requirements.
  5. The training should be delivered either by faculty if they feel competent, or by external trainers. Students enrolled in the programme should not be delivering this training.
  6. As the major UK therapy organisation and therefore the wealthiest, BACP could be funding a researcher to produce an FAQ on Conversion Therapy  and develop some training materials on this subject as a resource for all of the signatory organisations and their members.
  7. Actively support people from disadvantaged and underserved communities to train as therapists.  In particular, increase the availability of  therapy from Black and Minority Ethnic (BAME) and Trans and Gender Diverse counsellors.  Both groups are significantly economically disadvantaged in society and yet also have poorer mental health and so we need to ensure training isn’t only affordable by wealthy people. This is why we’re offering a couple of training bursaries for our own two-year PG Diploma in Gender and Sexual Diversity Therapy to Trans and BAME therapists.  It’s estimated that basic therapy training costs between £20-£80k and for those people who then want to go on and specialise in working with Gender, Sexual and Relationship Diverse Clients it’s going to add another £5k.

In one of my earlier blogs I mentioned how both BAATN and ourselves have set up volunteer led mentoring schemes to support those members of our communities who are training to be therapists in what can be quite alienating and hostile environments.

Dominic Davies
22 Feb 2016

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

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

The obligatory 50 Shades post

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Many people within the Kink community quite rightly objected to the portrayal of the relationship as abusive and challenging deeply held norms within the Kink community around play being ‘Safe, Sane and Consensual’.

However, the book, has resulted in more people learning about Kink, attending munches (social meetings in regular pubs) and going to kink-oriented clubs and buying more fetish gear and toys.  They’re has been an enormous explosion of interest in BDSM and Kink.

In my view this has been very helpful, it’s helped to reduce the shame that many people have held about their fantasies and desires for power exchange based sex (Dominance and submission) and for certain levels of restriction and restraint (bondage) or certain kinds of pain based play which increases endorphins and can be intensely pleasurable for some (masochism).  These are all entirely normal and very common fantasies and desires and now many people are feeling empowered to legitimately incorporate them into their sexual relationships.  These then get added to their repertoire of existing preferred sexual behaviours and can lead to enhanced communication with their partners and deeper intimacy and connection.

But what about the consent issue?  Christian Grey is clearly abusive and engaging in intimate partner violence and this is being presented as BDSM.  However, whilst we’ve seen a huge increase in interest in BDSM, I haven’t heard of a similar increase in presentations at Domestic Violence charities or to the Police where people are stating the abuse occurred in their relationship because of the 50 Shades phenomenon.  I think the readership of what are, by all accounts really poorly written books are intelligent enough to see that Grey is abusive and to separate out the hot exchange of power and sensation (the two core elements of BDSM) from the non consensual side of things.

Having said this, Consent IS a big issue for those of us in kink community and a large scale research project by the National Coalition for Sexual Freedom is underway and lots of conversations about non consensual experiences are being had within the community.  An education campaign is being undertaken by many activists in the community to try and address these issues.  But these consent issues predated the 50 Shades phenomena and has been an issue in our community with people often being afraid to speak out or worried they won’t be taken seriously.

I think the Kink community IS attending to this issue and the newcomers to the community need education about what IS and isn’t safe and good practice in incorporating these powerful techniques into their lives.  I’d like to encourage readers to check out and follow the blog of one of our Clinical Associates Dr Meg John Barker, author of the excellent book Rewriting the Rules who has been been blogging about BDSM in the run up to the movie being released.

Dominic Davies
CEO Pink Therapy
Psychotherapist and Clinical Sexologist

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dominic Davies
Founder – Pink Therapy

Signatories to the Memorandum of Understanding on Conversion Therapy include:

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

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