Guest Blog: Maz Michael

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

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

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

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

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

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

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

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

So what is Urban Tantra?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The distinction between psychological therapy on the one side and

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

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

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

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

Copyright, 2018. Maz Michael

 

BACP seen as flawed at home and abroad

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

 

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

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

Another counsellor responded:

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

Another said:

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

Some international support

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

and this one:

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

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

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

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

On the monopoly BACP seem to have with employers:

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

And another:

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

And another:

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

What could BACP be doing?

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

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

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

Dominic Davies
22 Feb 2016

Bad Language and Psychoanalysis

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I’m increasingly becoming concerned when I see language used like this: http://www.nscience.co.uk/10-feb-2016.html by colleagues in the psychoanalytic world.

What I am talking about here is the misappropriation by some sectors of the psychoanalytic community of the terms ‘sadism’ and ‘masochism’ to largely mean acting in a way which punishes others or themselves, (usually with words or thoughts rather than physical activities).

I believe it’s now pretty widely understood that in the real world, sadism and masochism refer to consensual sensation based ‘play’ (giving or receiving pain in sexualised contexts).  I think that in mainstream society this is fairly well understood and  I suspect more people understand sadism and masochism in this context than the obscure psychoanalytic one.

Language is constantly evolving and dynamic and words that for one generation were acceptable are no longer acceptable.  This continued usage is akin to us using the word ‘Coloured’ to mean Black, or ‘cripple’ to mean disabled. It’s outdated and no longer acceptable practice.

In 2012 the British Psychoanalytic Council held its first conference, Homosexuality: Moving On, reviewed here by my former supervisor and friend, the late Dr Bernard Ratigan who was sat next to me.  It really felt there was a genuine desire to apologise for the harms done to the lesbian and gay communities by psychoanalysis.  The conference had an air of the Truth and Reconciliation Commission of the post-apartheid era South Africa..  I know the BPC as an organisation are keen to no longer pathologise homosexuality, although how much progress has been made in their desire for moving on has been reflected in the curriculum of their member organisations psychoanalytic trainings or in their being openly lesbian or gay psychoanalysts as members is another question (there are several out gay psychoanalytic psychotherapists but to my knowledge not a single openly gay or lesbian psychoanalyst within BPC membership.

But what of other diverse sexualities, identities and lifestyles?  Is it acceptable to continue to pathologise members of the BDSM/Kink communities by using outdated and frankly offensive and misleading terms like sadism, masochism and perversion?

If the world of psychoanalysis wants to show it has something to offer those with diverse genders, sexualities and lifestyles and step aside from its history of pathologisation of sexual difference, and heteronormativity, then I think it would be wise to consider the impact of pathologising language on those disenfranchised members of society they might hope to help.

Dominic Davies
CEO Pink Therapy

P.S. In 2004 Pink Therapy’s held it’s first ever conference on the  subject of Queers, Queer Theory and the contribution of Psychoanalysis and Psychoanalytic thinking.  You can listen the audio recordings of the keynotes on our YouTube channel playlist

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

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

Annen, S., Roser, P., & Brune, M. (2012). Nonverbal Behavior During Clinical Interviews: Similarities and Dissimilarities Among Schizophrenia, Mania, and Depression. Journal of Nervous & Mental Disease, 200(1): 26-32.

Banse, R., Seise, J., & Zerbes, N. (2001). Implicit attitudes toward homosexuality: reliability, validity and controllability of the IAT. Zeitschrift fur Experimentelle Psychologie, 48(2): 145-160.

Barrett, K. A., & McWhirter, B. T. (2002). Counselor trainees’ perceptions of clients based on client sexual orientation. Counselor Education & Supervision, 41: 219-232.

Bowers, A. M. V., & Bieschke, K. J. (2005). Psychologists’ clinical evaluations and attitudes: an examination of the influence of gender and sexual orientation. Professional Psychology: Research and Practice, 36(1): 97-103.

Boysen, G. A. (2009). A Review of Experimental Studies of Explicit and Implicit Bias Among Counselors. Journal of Multicultural Counseling and Development, 37: 240-249.

Boysen, G. A. & Vogel, D. L. (2008). The relationship between level of training, implicit bias, and multicultural competency among counselor trainees. Training and Education in Professional Psychology, 2(2): 103-110.

British Psychological Society (BPS) (2006). Core competencies – clinical psychology – a guide. Leicester, UK: BPS.

British Psychological Society (BPS) (2012). Guidelines and literature review for psychologists working therapeutically with sexual and gender minority clients. Leicester: British Psychological Society.

Clarke, C. P. (2010). Exploring the relationship between heterosexual therapists’ attitudes toward gay men, their self-reported multicultural counseling competency, and their initial clinical judgments. Dissertation Abstracts International, 70, 12-B, PsycINFO, EBSCOhost [accessed 25 September 2012]

Davies, D. (2012). Sexual orientation. In C. Feltham & I. Horton (eds) The Sage handbook of counselling and psychotherapy, 3rd edition, pp. 44-48. London: Sage Publications.

Finkel, M. J., Storaasli, R. D., Bandele, A., & Schaefer, V. (2003). Diversity training in graduate school: an exploratory evaluation of the Safe Zone Project. Professional Psychology: Research and Practice, 34(5): 555-561.

Gawronski, B., & Strack, F. (2004). On the propositional nature of cognitive consistency: Dissonance changes explicit but not implicit attitudes. Journal of Experimental Social Psychology, 40, 535–542.

Gawronski, B., & Strack, F. (Eds.). (2012). Cognitive consistency: A fundamental principle in social cognition. New York: Guilford Press

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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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Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56: 32-43.

Jones, L. S. (2000). Attitudes of psychologists and psychologists-in-training to homosexual women and men: an Australian study. Journal of Homosexuality, 39(2): 113-132.

Kilgore, H., Sideman, L., Amin, K., Baca, L., & Bohanske, B. (2005). Psychologists’ attitudes and Therapeutic approaches toward gay, lesbian, and bisexual issues continue to improve: an Update. Psychotherapy: Theory, Research, Practice, Training, 42(3): 395-400.

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

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

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

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

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

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Steffens, M. (2005). Implicit and explicit attitudes towards lesbians and gay men. Journal of Homosexuality, 49(2): 39-66.

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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

Russia

Russia

Clearing out some very old papers at home the other day, I found some correspondance about the Russian language translation of Pink Therapy volume 1.

This is the only other language Pink Therapy has been translated into and it was done by a dedicated fan, a psychiatrist I believe, who thought it should be made available to his people.

I’m rather glad he did because I also found a second letter which came from a reader of that Russian edition who came across the book unexpectedly, and it changed her life. The original was badly copied and so has been transcribed and I’ve not tried to clear up the grammar and syntax.

When I get feedback from readers of my books, there is an amazingly gratifying feeling. Writing is a lonely project and not one that comes easily to me, but when I feel I have something to say, I generally have to say it! But one never knows whether one’s words mean much to anyone else. It’s wonderful to hear that sometimes, they do!

Given the really horrible situation most LGBT people in Russia find themselves, I am so pleased that somewhere in random book shops, they might come across Pink Therapy, or perhaps our website which has a more updated paper on Gender and Sexual Diversity Therapy translated into Russian:
http://www.pinktherapy.com/Portals/0/Downloadables/Translations/RUS_GSDT.pdf

Dominic Davies