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

Some thoughts on why Chemsex is increasing in London.

I was invited to speak for five minutes at a community outreach initiative on Chemsex at the Manbar tonight.

Some thoughts
I’m a psychotherapist and a sex therapist – who has worked with our communities for over 30 years. I’m Director of Pink Therapy which is the UK’s largest independent organisation to work with our the LGBTQ and Alternative Sexualities communities.

Currently, around half my practice is working with guys who are using or have been involved in Chemsex. It wasn’t like that even two years ago. Whilst there have always been clients who use drugs recreationally in a sexual context, the current situation of Chemsex (specifiCrystal_crack_pipecally Meth, Meph and G) is producing some unique challenges and situations.

I’m learning all the time, from my clients, my friends, my sexual partners and my colleagues about what’s going on here and I’ve been wondering why this has become such a big issue so quickly.

Everyone’s story is of course unique which is why I love my work and have never got bored, and I won’t be breaching any professional confidences here tonight. There are clearly lots of reasons why this is going on.

I have been reading the new Sigma research report which came out on Friday with keen interest and I am seeing what they found in my own practice.

A number of people who have got into trouble with Chemsex have had psychosexual performance difficulties: for example, problems with rapid ejaculation disappear on Chems and men can have sex for hours. This in fact can lead to the opposite problem, not being able to cum and so having to find more guys to have sex with in the hope that they will eventually reach a happy ending.

Concerns about bodies, dick size, what they see as their shameful kinky sexual desires all fade into the background when people get high.

Others report trauma over HIV disclosure and rejection from negative guys who don’t realise what ‘undetectable’ now means.

Most guys do it because sex on Chems feels great,. But then find they can’t remember how to have sex sober, or tell me they’ve never had enjoyable sex sober.

More depressingly they don’t believe anyone would want to have sex with them sober, so prevalent is the availability of Chemsex in some parts of London, and sometimes of the day/night that it’s hard to use sexual networking apps and find guys who aren’t high.

Some men hope to meet someone they really connect with, find a boyfriend and leave the party scene. The drugs give them a sense of intimacy and connection but they find that closeness and connection hard to sustain when they come down.

I’m concerned that by inconsistently taking their anti-retroviral medication many positive guys might well think they’re undetectable because they were when they last had their bloods checked 6 months ago, but the virus has been replicating and unwittingly they might be passing the virus on to a new generation – where smart people understand that a a stable and undetectable viral load means they’re pretty safe to fuck without condoms, but still we see the figures of new cases of HIV climbing through the roof. On average 20 new cases of HIV diagnosed a week in London, and where are the support groups for this many guys, THT?

But the thing that concerns me most though, is how the Benefits Agency are closing in on Long Term Survivors.

Many HIV +ve guys have been on fairly substantial disability benefits for decades awarded at the beginning of the AIDS epidemic when everyone expected them to die.

In the 90’s getting high levels of disability benefits was relatively easy. Unlimited tube and bus travel, perhaps a new Motability car every few years, and Carers allowances meant they could afford not to worry about returning to work when their health stabilised. These benefits will not only be lost once they get reviewed and reassessed as fit for work. They may face fraud investigations for not advising of a change in circumstances.

These men probably, in their 40s-50’s have been out of the workforce for such a long time and may have little chance of finding work especially as we’re in the middle of a recession.

How easy it would be to just take a larger dose of G and end it all – maybe alone, maybe at a party in an ‘accidental’ overdose. This is a frightening prospect.

David Hoyle refers to gay men as being The Greatest Suicide Cult in History. Perhaps THIS is what we’re seeing in the increasing use of Chems and sex? A bunch of gay guys about to lose their benefits and with little prospect of work. Why wouldn’t they be dancing on the Titanic?

What is our multimillion pound HIV charity doing to prepare and support these long term survivors and offer help and hope?

Dominic Davies
Director

Second Alumni Event, December 14 2013

We were treated to a wonderful paper by Pete Palumbo at our second Alumni event – based in part on a book he’d come across called Flying without Wings by Dr Arnold Beiser, and partly on his own Gestalt practice and theoretical base. It would be difficult to summarise here, but some themes were:

  • being born in captivity (heteronormativity) and the effect on one’s sense of support in the world
  • how needs become shame in the face of non-attunement by a care-giver (or therapist)
  • how autonomy arises in relation to others, not just from inside oneself  – “dependent on smoothly functioning interdependency”

etcetera….. too much to condense, but wonderful prompts to the mind, and we are hoping Pete will publish his paper.  He finished with the question, “Do we attend enough to the suffering situation, or only to the suffering individual?”

After discussion, there was much sharing of our personal and professional issues in the GSD field.  It is a measure of the trust within Pink Therapy, I think, that we were ready to disclose thoughts, feelings and some non-PC beliefs in the group, without worrying about judgment.

Damian McCann has offered to present something at the next Alumni event in March.  We’re adopting a pattern for the afternoon of starting at 2 pm with drinks and biscuits, having a lengthy introductory round followed by the ‘presentation’ and discussion; then a break, and finally a free-floating group discussion, until 5.30 pm.  It seems to be working fine.

At just £10 for 3.5 hours, it’s a great way to keep in touch with Pink Therapy people and ideas.  Next Alumni event, Saturday 15 March 2014.  Open to all who’ve done the longer PT trainings.  Do come.

Chris Kell

Dermod Moore interviews Dominic Davies in Dublin

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How we got shortlisted for the National Diversity Awards

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The first step in our nomination for the National Diversity Awards was when Andrea Roth who translated two of our recent papers into her native German as part of our Translations Project submitted our name.  Andrea joined our team of volunteer translators a couple of years ago and we’re now covering almost all the major languages of the world. Her nomination was completely unsolicited and unexpected.

We then ran a small social media campaign asking for support of the nomination and the next we heard was we were asked to submit to the judges some background on the organisation and what we do.  The text below is what we sent in.

National Diversity Awards 2013 Nomination

Pink Therapy is the largest independent therapy organisation to provide information and therapeutic support to the LGBTIQ+ communities. We see our role as not to duplicate direct service provision through the voluntary sector in offer centre based counselling, but rather to provide a wider framework, training counsellors and therapists of all sexualities and genders to better understand LGBTIQ+ communities, and to contribute to the debate about service provision and commenting on issues of concern for our communities from a sex-positive perspective.  Our website and social media work are important points of contact with the LGBTIQ+ communities.

We look beyond the more regular LGBT sector and take a wider view of gender and sexual diversity, providing therapy and training around other disenfranchised and marginalised groups including Asexuality, BDSM/Kink, Intersex and those in consensually non monogamous relationships of all sexualities and genders.  We’ve provided a support group for asylum seekers and refugees and offered training for therapists on this issue too.

Funding and Staffing
Our work is largely done by the goodwill of a couple of part time volunteers/interns and the work of our Founder and Director, Dominic Davies. We receive no grants or external funding and is funded from the small profit on course training fees and client fees from Dominic’s private practice.

Services to the Communities
Our website contains a fairly extensive knowledge base of websites and self help books which can help people who can’t afford therapy or where clients in therapy can engage in bibliotherapy to augment and enhance the therapeutic process.

Our Directory of Pink Therapists offers a national online database of therapists of all gender and sexualities who offer non-pathologising therapy.  We hope to expand this to include complementary therapists who understand some of the specific challenges of LGBTIQ+ health issues

Pink Therapy’s founder and director has gathered a team of highly skilled Clinical Associates who contribute to raising the standards of therapy available to the LGBTIQ+ communities through offering consultation and clinical supervision of other therapists as well as contributing to our world renowned and highly respected extensive training programme. Our clinical associates have generally all contributed to the field through publishing, speaking at conferences and are recognised in their own professional fields as leading the development of raising the quality of services to the LGBTIQ+ communities

International Development
We were invited to become members of International Lesbian and Gay Association.  We’re also members of the World Association for Sexual Health and World Professional Association for Transgender Health.

We’re very committed to working internationally to help the mental health   of LGBTIQ+ overseas through training therapists and psychologists.  In the past two years our Director has visited Colombia Dublin and Malta and will be visiting Hungary and Brazil in the next two months.

For the past four years we have fundraised and run a week long International Summer School with therapists coming from  Benin (West Africa) Brazil x2, Columbia, Croatia, Eire x3, Denmark x2, England x4, Finland, France, Hungary, Italy x3, Northern Ireland x2 Poland x2, Portugal, Scotland x2,  Serbia x2, Singapore x3, Spain x2, Turkey, USA x2.  One each course we offer a bursary to a trans* counsellor and have been very active in supporting trans* people.

With help from a team of volunteers have translated some of our recent publications into a range of languages.  Now covering about 80% of the world.

We are active in social media and print media, responding to requests from journalists and editors and recognise our wider experience and expertise.  We recently appointed an intern Press office who’s written about some of our achievements on our Press Release page We’re on Facebook with almost 1200 likes. We’re on Twitter with 1500 followers. LinkedIN 1,146 connections and recently began this blog.

We then heard we were shortlisted from over 4k applicants to be one of three LGBT community organisations up for an award.  Amazing!

We were asked to submit a short 60 second video on why we should win (click link or see below)

Pamela Gawler-Wright and I will attend the awards ceremony and find out how we did on 20 September.  We’ve never been externally recognised by anyone before like this and so it’s exciting to have even got this far!

Wish us luck!

Dominic Davies
Director

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.

Omissions in the Core Competencies

With the recent events in Russia over the state of LGBT+ rights and acceptance, we thought it might be interesting to point out a recent event which caused some concern.

During the revision of the Professional Competencies for Psychotherapists in Europe being drafted by the European Association for Psychotherapists (EAP)  it was noted by one of our Directory members, psychologist Dr Greg Madison that the extensive document held in it no mention of sexual minorities as ‘stimagtised’ groups. For a relatively sizeable ‘minority’ this appeared to be a glaring omission.

And it was. On closer examination it was confirmed that no mention of sexualities was given, although issues of gender had been. Pink Therapy founder, Dominic Davies contacted Tom Warnecke Vice Chair of UKCP to express his concern and an amendment was quickly proposed.

The issue itself is worth commenting upon, not simply because of the state of LGBT+ rights in Europe as of global interest, but for the concern raised when the sexualities are excluded from information that creates more understanding therapeutic support for stigmatised groups.

The Executive Council of EAP meeting occurs this month in Moscow, in which the amendment, which has now garnered additional support from the Irish Council for Psychotherapy, will be reviewed.

It is hoped that the location of this meeting will not affect the outcome of this particular amendment, and in the new Competencies there will be due consideration of sexual minorities.

Jack Flanagan