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!

IMG_1306

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

closed cuffs

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.

MoU_cover

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dominic Davies
Founder – Pink Therapy

Signatories to the Memorandum of Understanding on Conversion Therapy include:

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

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

Authentic sexual needs

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

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

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

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

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

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

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

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

Olivier Cormier-Otaño MBACP Accred, AASDT
Clinical Associate

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

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

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

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

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

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

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

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

 References

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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.

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

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

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

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

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Steffens, M. 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

An introduction to Gender and Sexual Diversity Psychotherapy

A Pink Therapy Summer School in London, July 8-12, 2013

Editor’s note: this is a guest post from André Helman, MD; a relational psychotherapist from Paris.

Pink Therapy is an independent therapy and training institution devoted to LGBT people and to gender and sexual diversity. Located in London, it was created by Dominic Davies, a psychotherapist and sex therapist, who runs it together with a team of fifteen or so therapists and trainers.

I was lucky enough to take part in an international summer school about Gender and Sexual Diversity Therapy (GSDT). Exploring this concept, which was brand new to me, as well as its implications was an opportunity for dramatic breakthroughs and broadening of my field of thought. That is the experience I wish to evoke in this paper. It is not an in-depth reflection about GSD (many books were published about it, and many are still to be written), only a brief report where the author’s subjectivity is freely invited.

The GSD concept

Gender and Sexual Diversity (GSD) and Gender and Sexual Diversity Therapy (GSDT) concepts were elaborated through the recent years by Dominic Davies and his colleagues. The initial book, Pink Therapy, which gave its name to the institute, was directed by Dominic Davies and Charles Neal, and first published in 1996. It dealt with affirmative therapy for gay men. Progressively, the wording evolved: gay affirmative therapy turned into gay and lesbian affirmative therapy, and then sexual minority therapy, until the current term GSDT. Indeed, it appeared that the LGBT concept – even when adding an I for intersex or a Q for queer – would not allow to include all patients who were addressed by this therapeutic approach. For instance, this term excludes asexuals, kinksters, swingers, polyamorous, non-monogamous, flexible heterosexuals, fetishists, “objectum sexuals” (people who experience a romantic attraction to an object), the approach would not be consistent if it added an exclusion to those it intends to stand together with.

Every person related to any aspect of GSD suffers a social oppression, with different degrees and specific forms, which induces an internalized oppression, as an identification to the “norm”, and a counter-oppression, as a reaction. For example, the fight against misogynous oppression – wrongly named sexist – generated diverse types of counter-oppression, among which misandry is a major one.   The common oppression suffered by all GSD persons can be resumed with five injunctions: meet someone of the other sex, get married, have children stay together for your whole life, be faithful… But “the award for conformity is that everybody loves you… but you”. Within the LGBT(IQ…) “community itself, discrimination and difference rejection are common practice. To be oppressed does not prevent you from being an oppressor.

Group dynamics



Our group consisted of twelve persons, originating from 11 countries: Benin (West Africa), Catalonia, Denmark,  Finland, Ireland, Italy, Poland, Scotland, USA and France – and representing many diversities : gays, lesbians, bisexuals, asexuals, flexible heterosexuals, transmen… All of them where psychotherapists, either active or about to complete their training, all of them were very motivated and involved in the process. The course was presented by the same pair every morning (Pamela Gawler-Wright and Olivier Cormier-Otaño), while a different trainer intervened every afternoon, according to the topic.

As soon as the group met first for the time, the leading pair, tactfully and lightly, installed a climate of confidence, mutual respect and freedom of speech which greatly contributed to the quality and profoundness of our sharing throughout the course. Their interventions were rich with information and experiences. Together with the proposed exercises they both inflamed me and confronted me with my limits, my questioning, my fears. Each afternoon trainer, in their own special way, contributed to these dynamics. 

Each participant was invited to share in how they experienced the exercises as well as their own personal and professional experience, as related to the discussed topics. They all did so with a great sincerity, which allowed me to discover some aspects of GSD, I knew nothing about, to be confronted to my own stereotypes and prejudices, and, eventually, to dramatically change my viewpoint about some of them.

The course main lines

Many issues were developed, discussed and deepened through practical exercises. Below, I mention the main ones and what I experienced when tackling them.



Stereotypes and prejudices


As with everybody, our patients carry all kinds of stereotypes and prejudices, which partly contribute to generating and/or maintaining their unwellness. Therapist do too! This contributes to narrow our vision of our patients, our capacity to accept them fully as they are and, consequently, the quality of our support. Without taking the expression “The cobbler’s children go barefoot” at face value, we all should continue to explore and challenge our own stereotypes and prejudices, aiming at getting free from them. As far as I am concerned, this course greatly helped me in this respect. Work is still in progress…

Is my therapist GSD?

Choosing a therapist one considers as heterosexual or, on the contrary, as identically oriented is not neutral. It’s worth exploring what such a choice implies. For instance:

  • The fear a GSD person may experience about confiding in a heterosexual therapist may come from their own heterophobia: to believe a heterosexual therapist is deductively unable to support a GSD patient; conversely, the belief that choosing a same GSD oriented therapist is a sufficient condition is limiting too: it cannot be the only criterion for a successful therapy.
  • As regards a same oriented therapist, there is a risk of collusion (I understand them as I experienced the same thing as they do) or identification (I experience the same thing as they do so what they say relates to me personally).
  • To say or not to say whether I’m GSD: it was very helpful for me to participate in a discussion about this issue. Is it right to answer the patient’s question “Are you gay?” and how to do it?

Lesbianism and lesbophobia

Through “life stories” of Anglo-Saxon lesbian celebrities, illustrated by animated and musical presentations, Pamela Gawler-Wright lightly introduced us to the yet awful word of social persecutions which lesbians experienced since some of them started to claim their visibility and right to be themselves.

Coming out

Half a day was devoted to the coming-out issues. In particular, the following topics were addressed:

  • 
Coming out is multiple: one experiences as many coming outs as there are situations and persons one has to face throughout one’s life; thus, it’s repeated many times, in a different way every time.
  • 
As the consequences of coming out are unknown, it necessarily makes the person feel unsafe.
  • It’s hard to resist the belief “It should be known” (transparency as a moral value).



Shame, vulnerability and internalized oppression

Another half-day permitted to develop and deepen this issue, through exercises in which participants got very involved. As far as I am concerned, it was overwhelming and it taught me a lot. In particular, it presented me with an opportunity of experiencing a real breakthrough about the self-maintained process of superego injunctions.

I feel internalized oppression is a core issue for many of our patients, specially – but not only – our GSD patients. It’s likely to be one the most widely shared psychological processes. Even white heterosexual men cannot escape it (at least not all of them…): many of them have internalized the oppression of sexual performance obligation or that of aggressive machismo as inseparable from their manhood (a young male, smart, open-minded patient recently told me “if I climb stairs behind a woman – as any gallant man should do – and she wears a miniskirt, what will she think about me?”)

For many GSD persons, social oppression is very deep as it is rooted in gender difference. Internalizing it induces the shame of being oneself as well as radical judgements about one’s own desires, thoughts and acts. This shame causes vulnerability and hypervigilance regarding anyone or anything that could question this aspect of the person’s identity. But to be vulnerable does not mean to be weak: on the contrary, accepting one’s vulnerability is a major strength which contributes to coming out of shame and of internalized oppression.

In any case, the psyche authority that judges and pronounces irrevocable condemnations – whether you call it cruel superego or “top dogs” – plays a major part in maintaining shame, especially by justifying it endlessly. If we consider it as a major target of the therapeutic process, it can only benefit to our patients.

Asexuality


Discovering asexuality was one of the highlights of the course for me, particularly as we could take advantage with direct testimonies. Furthermore, Olivier Cormier-Otaño presented us with an enthralling study he conducted via a questionnaire that reached 310 persons considering themselves as asexual. In our hypersexual society, asexuality stands as a very strange, incomprehensible phenomenon.  For us, psychotherapists, it shocks our “knowledge” about sexuality and its issues… where it finds no place. It’s our responsibility to give it its right place if we want to be able to support asexual persons along their way to feel at peace with themselves and get integrated in their environment.

Transsexuality

Here again, direct testimonies were a major contribution to the course. I had already read books and articles on this topic, but coming to meet persons who experience transsexuality is irreplaceable. 
We heard a presentation about the activity of the Tavistock Clinic service dealing with children and teenagers who question their gender – the only service of this kind in the UK. It threw light on how to welcome and answer their questioning, both on a human and medical level.

“Help me not be gay!”

Conversion therapies, even though in loose momentum, still exist in Anglo-Saxon countries – maybe in France, as well, I don’t know. Without going so far, all of us may have to face a person whose request is to help them stop experiencing feelings and emotions related to GSD. How should we meet this request? How can we support them in their quest for an inner harmony, without letting ourselves being carried away by a “pro-GSD” ideology?

Behind such a request, as behind any request concerning identity, there are beliefs, grounded on stereotypes, and which appear to the person as truths, as certitudes. The suggested approach aims at helping the person to see truths as beliefs and to realise that beliefs are not the truth (my simplification…).

As a provisional conclusion

A word imposes itself to me after this experience: empowerment. I could say, feeling confident and deeply free, because of the recognition of my responsibility towards GD persons and my capacity to face it.

I never so clearly realised the pressing urge to acknowledge, accept and welcome human diversity, whatever its form and expression, as well as to challenge the stereotypes and prejudices it inevitably reveals to me.

The GSD concept is just emerging. It’s hardly starting to contribute redesigning the outlines of our ‘community’ and to influence the way we look at our patients, and perhaps at our practice. Meeting GSD persons who embody some GSD aspects I didn’t know, or about which I had rather bulky prejudices, helped me a tremendous lot in accepting them better, hence feeling better with myself and more open to my patients.

André Helman, MD; a relational psychotherapist from Paris.