Category Archives: GSRD

Why pronouns matter

I attended a CPD event for therapists recently and it left me questioning (again) whether therapists have really embraced gender diversity. Do therapists really understand why pronouns matter?

The gender binary is culturally specific. It’s also related to the settler-colonial imperialist project to categorise people as superior/inferior (Barker & Iantiffi 2019). Essentially certain people in society make decisions about who or what is considered civilised or not. There were disastrous consequences for those who did not fit into the ‘superior’ categories. They they either had to deny who they were or face brutal attack and death.

Gender Identity – why pronouns matter

Pronouns are part of what reflects our gender identity. For cis gender people (those whose gender aligns with the gender assigned at birth) you may not have considered whether being referred to as she/her or he/him fits. This is where gender neutral pronouns such as they/them or ze/zir become important. It really makes a difference to the individual. For anyone who struggles with gender neutral pronouns such as they/ them, remember you will be using the word ‘you’ in both the singular and plural quite naturally so it simply requires a bit of practice and willingness to try.

This also means educating ourselves about the particular ways that gender diverse people are oppressed by therapists and society. Also that we are advertising that we work with gender diverse clients that we educate ourselves about the different pathways in terms of potential hormone and/or surgical interventions that might be available via the NHS or privately so that we are not relying on our clients to teach us, especially if we are working with those with gender dysphoria. This simply isn’t fair. 

There are demands on everyone to express their gender identity in certain ways otherwise they are not woman or man ‘enough’. In some instances, clients are told they are not even trans, bi or gay enough, such are the limits of understanding. I wonder, are we perpetuating this in the therapy or supervision room?

Gender diversity – why pronouns matter

Many therapists and supervisors, myself included, advertise that we are inclusive in our practice. What changes do we actually make to incorporate gender diversity? One change we have made in my practice is to label both our single-occupancy toilets as ‘All Gender Toilets ’. This way anyone of any gender can feel comfortable using them. For those of us outside the gender binary, as for many trans and intersex people, (Viloria & Nieto 2020) public toilets can be incredibly difficult to navigate. I have personal experience of being spoken to aggressively for using women’s, men’s, and toilets for disabled users. This generates so much shame simply from using a public toilet. Most cis-gender people will not have to consider this.

Other suggestions would be to make greetings inclusive. ‘Hello all/everyone/folks’ includes everyone. Whereas ‘ladies and gentlemen’ excludes those of us outside the binary. It is also outdated, patriarchal and class-centric language. I invite you to think about how you might react if salutes constantly excluded you?

Forms could be more inclusive simply by having boxes for pronouns and other genders. Computer systems updated to incorporate the gender-neutral prefix Mx are more inclusive. I invite you to think about how you might react if forms constantly excluded you? They may already in terms of ethnicity. How might you feel if forms excluded you in both of these areas?

Something else that can help is email signatures that incorporate pronouns, irrespective of your identity, as this will help normalise the use of diverse pronouns and at no expense of anyone using normative pronouns.

The power of apology

We all make mistakes. As long as we acknowledge and apologise (and learn from it). There is something incredibly empowering for clients to hear us apologise when we get something wrong like using the wrong pronoun; it can validate who they are. If we cover it up or hope they haven’t noticed that we just used the wrong pronoun, we erase them right in front of us. This erasure is so damaging and shaming.

Potentially perpetuating trauma

We need a greater understanding of the impact on our clients of being marginalised by the use of outdated, excluding language and knowledge. To not do so risks perpetuating previous trauma and feelings of oppression, which may result in internalised shame. Some of this work is potentially difficult and challenging. If we consider that, as therapists and supervisors, we may inadvertently add to the oppression of our clients in terms of their identity – be that gender, sexual, relationship, ability, race, religion, class or any other equally important aspect. But oppression is only lessened as we recognise and acknowledge our place/s of privilege in society. We also need to continue to reflect on what we do with this knowledge, both inside and outside of the therapy room.

Someone once said to me, ‘people are simply people’. Whether you’re a counsellor, psychotherapist or supervisor I would like to think that together we could be more inclusive. Also that we enable people to simply be people, wear whatever they feel comfortable wearing, using names and pronouns that they feel most comfortable with, doing jobs and hobbies that make them feel fulfilled, loving whoever they happen to love. It’s a vision I still hold most dear but fear we as a profession are not there yet.

The cost of not being our authentic self

I’ve been thinking today about the things that enable/allow/prevent us from being our authentic self and what impact this has on our minds and bodies. There is a cost of not being our authentic self.

For those of us who work heavily with attachment, we know the importance of attunement and mirroring by the primary caregiver on the developing infant and their sense of self.

Mirroring

When our primary caregiver sends the message, “I see you, I hear you, I understand you and I love you just as you are”. Well, that’s the creation of the internal world right there! As adults it becomes ‘money in the bank of resilience’. When we feel insecure, we go back to those moments of ‘it’s OK to be me’. Alternatively, with little or no attunement and mirroring we don’t learn who we are. Or that it’s OK to be us. In turn, we wrestle with, ‘I am ­____________ but I am not allowed to be this.

Fear of rejection, abandonment, ridicule, reproach can not only prevent us from being authentically us, they can have dire consequences on our resilience, our mental health and also on our physical health.

Many people I work with who have had to hide themselves, emotionally speaking and/or an attribute of their identity, end up with a mind/body disconnect. It’s the brain’s way of ‘dealing’ with constant misattunement.

Mind/body connect

We don’t really know the full cost of not being our authentic self. It can take years of unlearning and re-learning to be able to lift the mind/body separation. To allow for and learn self-attunement. The impacts can be severe. Many suffer with chronic fatigue syndromes (part of this is the body getting us to listen) and other long-term health conditions with little or no hope of the situation improving.

I am passionate about helping clients to gradually allow themselves to connect different parts of themselves. Also, in supervision, it is vital that we can be our authentic self. There’s a vast difference between affirmative therapy/supervision and something much more benign like “I am happy to work with anyone; I treat people the same”. It essentially repeats that pattern of not being attuned to and mirrored.

We can’t be all things to all people but we can learn affirmative processes for areas such as working with LGBTQIA+, BAME, disabled, neurodiverse and differently classed clients and supervisees.

I’ve experienced a number of supervisors over the years and thankfully there are only a few unhelpful moments. However, working with a queer supervisor, the difference is massive in terms of me being able to show up as my authentic self, unapologetic about my identity. Knowing I’ll be understood on that level help to free me up to think more openly about my clinical work. This in turn helps each person I work with.

Internalised shame – the cost of not being our authentic self

When we’ve lived, for any length of time, in a world that tells us that we are different/bad/wrong/sinful this is what we internalise however hard we try not to. That’s why affirmative work is so important as we are starting from minus figures essentially. We have to put something back in rather than simply be blank and bland about it.

So where do we learn affirmative therapy/supervision? Sadly I am not convinced there is enough affirmative content within therapy training programmes. So the onus is on ourselves to be accountable for what we need to learn. It isn’t enough, for example, to simply use a client’s name and pronoun as requested – we need to understand why it’s important. It’s not a level playing field. We need to understand the battle fought to get to that point; the discrimination faced. That’s what moves it from “I work with anyone” to “I see you, I hear you and I love/respect you as you are”.

Trans adolescents and adults in a therapeutic setting

Many therapists are fearful of the idea of working with trans adolescents and adults in a therapeutic setting. I was recently invited to take part in a study designed to investigate how psychologists and psychotherapists who see trans adolescents in their practices assess their clients’ capacity to make decisions about their treatment and how to approach this subject in an ethical manner. Inevitably it got me thinking…

Is gender exploration any different to any other area in therapy?

No client, adolescent or otherwise, voices questioning their gender if they are not. No one can be made trans simply by talking about possibly being trans. I approach this area as simply as I do with any other. I trust the client knows themself better than anyone. Hopefully I attune to what they are expressing. We explore together how they feel, when they first felt this way, what their understanding of themself is. I affirm who they say they are in the same way I would affirm someone who tells me they have experienced a bereavement, an assault or anything else. I educate myself so I have the most current knowledge about different identities and all the different biological possibilities.

Many possibilities

My client will be one of the many possibilities in terms of biology, identity and expression. It’s our work to discover who they are at that time. Knowing that identity and expression can change during the life span along with everything else. Adolescents are rarely given the opportunity to have surgery or take cross-sex hormones before they are emotionally mature enough to make that decision. In the same way they are mature enough to make a decision to join the army, for example. Puberty blockers are designed to buy time and play a valuable role. See High Court Ruling blog.

Looking for certainty

Often, it’s parent’s and/or therapist’s attitudes that generate fear and friction. Often, they’re looking for a level of certainty that cannot be provided. Some clients will explore and decide they want to press forward with further treatments and others will decide not to. In many ways it’s really that simple. In terms of process, the long waiting lists provide copious time for reflection, pausing if needed or even halting the process altogether.

What clients need is to be heard and seen for who they are now and into the future.

Clear ethical guidance is essential in working with trans adolescents and adults in a therapeutic setting. However, there is no need for fear. Just an open mind to the range of possibilities.

Please get in touch for further information via the contact page or here.

Equality Inclusion & Diversity in the Workplace

I was talking recently with an organisation I provide professional support to about Equality, Diversity and Inclusion (EDI) within the workplace. Something struck us. The one common thread on every single job description within this varied organisation was a sentence about EDI. However, none of the staff are ever questioned about EDI performance during their annual appraisal.

Tick box exercise? – equality inclusion and diversity in the workplace

It’s got me thinking. How can we move from a position of tick box, mandatory training (that many don’t engage with) and automated assumptions to actual engagement? Essentially, a desire to increase awareness because we want to rather than because we have to?

For me, this is about moving from a place of treating everyone as the same to treating everyone as different and unique. So, wanting to understand their place of difference rather than smooth it over and pretend it isn’t there. I see this as both an individual task and an organisational one. Then what about membership bodies such as BACP and UKCP? How can they, and should they, make EDI training mandatory and accountable? How do they/we balance freedom of speech with a profession of expected non-discrimination?

EDI Awareness

My membership is with BACP and for this I complete a training expectations and outcome document annually. I have added an element to mine so that EDI awareness is there as part of my ongoing continual professional development arrangements. I don’t lose sight of it this way. Each time I’m at the planning stage I ask myself which area I feel I need more awareness of. Whilst I need to keep up-to-date on gender, sexual and relationship diversity (one of my areas of expertise), I also need to make sure that my knowledge around race, disability or sex work, for example, doesn’t get left behind.

I can’t know everything about everything connected to equality inclusion and diversity in the workplace. However, I invite myself to become better informed each year. Therefore I’m a better ally to those who are disadvantaged in different ways to me, both professionally and personally.  I actively want to know more and to understand more about the areas where I have an advantage, those areas I don’t have to think about every day.

Challenge – equality inclusion and diversity in the workplace

It can feel challenging and exposing to grapple with the idea that we have advantage over another. As therapists this can feel very uncomfortable and we can get defensive when questioned or invited to expand our thinking. I think it’s important to separate the ‘I wasn’t aware of that’ from ‘I am a bad person’. Once we have awareness we can chose to do something different. Similarly once we have awareness about a relationship or behaviour that isn’t helpful for us we can chose to respond differently. Once we have awareness that our inner critic is having a field day we can learn to be kinder to ourselves and others.  

Fear

Many therapists come from a place of early wounding, hence the phrase ‘wounded healer’. I wonder if we can learn to respond to EDI and inherent advantage/disadvantage from a place of curiosity rather than a place of fear?

You may be interested to read this blog and this blog also.

Resilience and why pronouns matter.

Luan reflects on: their ‘why pronouns matter’ article, the resilience bank, paper cuts. They share the 5 things they do to maintain their resiliency.

Luan’s article ‘why pronouns matter’ is here to help bust some of the myths around gender diversity and to demonstrate how small changes in our interactions can have a huge positive impact on those with diverse identities.

As a psychotherapist and supervisor in private practice they reflect on their experiences within the therapeutic community regarding diversity, particularly gender, sexual and relationship identity. Their thoughts can be readily transposed to any area of diversity. Their aim is to offer some insights here into how we might better serve our clients, supervisees and colleagues. All examples are anonymised.

Whilst they recognise that change is slow within wider society they feel we have a duty as counsellors, psychotherapists and supervisors to be robust enough to challenge, be challenged and expand our knowledge and understanding, rather than live in a bygone era of oppression, judgement and ignorance. LGBT+ hate crime has increased by 78% in the last five years1. It matters to clients, supervisees and supervisors. Indeed it needs to matter for change to occur. Resilience and why pronouns matter.

“People are simply people”. Whether you’re a counsellor, psychotherapist or supervisor I would like to think that together we could enable people to simply be people, wear whatever they feel comfortable wearing, using names and pronouns that they feel most comfortable with, doing jobs and hobbies that make them feel fulfilled, loving whoever they happen to love. It’s a vision I still hold most dear but fear we as a profession are not there yet.

Resources

Inclusive progressive rainbow LGBTQIA flag

High Court Ruling on Puberty Blockers

I have huge concerns over the recent High Court Ruling on puberty blockers for transgender young people. One person’s experience will set back transgender rights for all.

Keira Bell was assigned female at birth. Following several appointments with the specialist services at the Tavistock clinic she takes puberty blockers. Keira is subsequently prescribed testosterone and undergoes top surgery. At this point Keira identified as male. Later, she made the unusual decision to de-transition and now lives and identifies as female.

Longer waiting lists

As a result of the High Court Ruling on Puberty Blockers case individuals aged 16 or under will no longer have access to puberty blockers without the intervention of a further court case. For anyone on the waiting list their treatments are now paused and those already taking blockers are having their medication reviewed.

The Media

The media have reported that booking an appointment with a gender clinic is as easy as booking a GP appointment. It really isn’t. They also report that clinics actively encourage young people to transition and that puberty blockers are prescribed at will. This is incorrect information. There’s a very rigorous process involved. Individuals essentially have to prove to several practitioners that they are transgender before being offered any medication and/or surgical intervention. Assessments are carried out at every stage of the process. So the individual has ample opportunity to reflect on the changes happening to them, their body and their identity.

Over several years Keira had first puberty blockers, then testosterone and finally top surgery. At no stage did she raise concerns about the process or the ‘speed’ of the process. That she regrets her decision is heart-breaking. As yet, it is unclear why she felt unable to raise concerns along the way. This one court case will now negatively impact many transgender individuals who are absolutely sure of their need for puberty blockers, hormone treatment and surgery.

Puberty blockers are not new

The courts have given the impression that puberty blockers are new and dangerous. These drugs have been used for many years to stall early-onset puberty. The medication is simply stopped once the child reaches the age when they would more naturally go through puberty. There is only one difference with transgender people. Puberty blockers are used to gain time for the individual to explore their identity before going through irreversible procedures. Going through a puberty out of alignment is traumatic beyond belief.

The anti-trans lobby now uses Bell as a poster girl. I understand the entire case has been crowdfunded by anti-trans supporters.

Something that really concerns me is that, following this case, many will come away with the idea that somehow transitioning is a dangerous thing that should be put off into adulthood. There are some concerns here:

  1. Your child may not live to see adulthood if gender dysphoria is not recognised and treated
  2. The myth is that more people de-transition than they do and therefore we should prevent transition in the first place
  3. That therapists will, having read incorrect information in the media, support the idea that transition is wrong and will not provide the best care and support to their clients/patients.
  4. That not enough is being done within the NHS or private gender clinic arena to fully support those whose gender sits somewhere between the binary of male and female. See: https://bainesballcp.co.uk/uncategorized/thinking-outside-gender-binary/

This really useful link provides much needed information for people wanting to access gender clinic services.

Thinking Outside Gender Binary

http://www.bbc.co.uk/programmes/b07kq5sv

This Radio 4 programme got me thinking outside gender binary. We very much still engage from a binary perspective. People are encouraged to decide either/or. In my experience as a psychotherapist, people tend to identify as male, female, both or neither. Whilst this is oversimplifying that there are potentially as many genders as there are human beings.

Boy or girl?

From the moment a child is born they are presented to their parents as “it’s a boy/girl”. How can we know this until the child has told us how they feel about themselves? Babies are often put in gender binary clothing, given binary names, and expected to express the characteristics of their assigned gender. By the time they go to school they are conditioned as to what male and female roles ‘should’ look like. This is all based on what’s between their legs. No wonder there is so much confusion, fear, and shame.

Until we can simply allow children to express their gender identity as they are experiencing it, we are creating heartbreak. For an individual who identifies as trans, non-binary, gender fluid etc. it’s a very confusing world. For those that don’t identify in this way it can be equally confusing to relate to those that do. Couldn’t we help society as whole if we facilitated children just being that; to explore, to play, to express? This way each person could evolve naturally into who they are, male, female, both, neither. They can then express themselves in a way that is natural for them. In the Radio 4 programme, one of the parents voiced that their child who was assigned female at birth had played with dolls, wore pink etc. So they had no idea that the child identified as a boy until a 12th birthday party ended in tears. 

Fixed ideas about gender

We are not taught that boys and girls can wear whatever they like and be interested in whatever strikes a chord with them. Maybe parents who don’t see it are not looking for anything outside the small box that gets passed from one generation to the next? If we are told ‘this is a girl’ and have a fixed idea of what ‘girl’ means we project all this onto the child. We are not asking them what their idea of being a girl might be.

What feelings are evoked in us if we meet someone who identifies in a way that appears to challenge the male or female binary? Does this projection of gender binary expectation mean  some trans people think they need major surgery? Clearly, for many people, surgery is the only answer. I wonder if some feel they have to physically transition in order to be accepted. Perhaps at the expense of being supported in discovery of their own unique gender identity. Maybe not all would need to if we embrace the idea of gender uniqueness.

Sexuality is different to gender identity. However, there is a similarity here. Too many lesbians are told they “don’t look gay” simply because they have long hair and wear a dress. Similarly if a gay man is not wearing a vest and tight trousers.

Fear keeps us from thinking outside gender binary

I wonder if the crux of this is fear. Historically, it was important to segregate men and women so they each knew who was the oppressed and who was the oppressor. This fear belongs to us all and it could help everyone if we could be brave and think it through in a safe, yet challenging, environment. 

In an educated world, I’d like to think that we could enable people to simply be people, wear whatever they feel comfortable wearing, using names and pronouns that they feel most comfortable with, doing jobs and hobbies that make them feel fulfilled, loving whoever they happen to love.

If you would like to explore your thoughts about gender identity in a safe environment please get in touch by whatever means is most comfortable for you. 

Homophobic attacks must stop

Homophobic attacks must stop. Two dear friends of mine were on the receiving end of a homophobic verbal assault over the weekend as they walked arm-in-arm through their Leicestershire village. Two young men shouted at them from the safety of their car – a cowardly act. In these kinds of situations the young men feel entitled to use another person’s (assumed) sexuality for their entertainment, often with misogynistic overtones if not hatred.

Be proud of who you are

First, I’m sad and concerned for my friends. People shouldn’t have to put up with this kind of behaviour from others. It has the potential to induce shame and make those on the receiving end shrink into silence and erasure – which is why I am speaking out on their behalf. They are proud of who they are.

It also made me wonder about the state of mind of the two young men hurling the abuse. Similar thoughts crossed my mind regarding the two recent nationally reported cases of homophobic attacks on women. How in control, powerful and overpowering might they feel? Why the need to express their feelings in such an unfiltered way? Equally, how inept, insignificant and inadequate might these young men feel to carry out such a cowardly act? As a society, how can we protect the vulnerable, those who are oppressed or marginalised? How can we also help to educate those in the majority that they also harm themselves in the process of attacking those different to themselves?

Increase in hate crime

As you can see, I have far more questions than answers but these homophobic attacks must stop. Some of my concern lies within the context of the current political landscape where tolerance and cohesion are seemingly being rejected in favour of power-play and one-upmanship. Since the EU Referendum there has been an increase in hate crime and sadly we are not seeing it decline any time soon. So I add my voice to those speaking out and declaring that it’s not OK to verbally, physically or mentally abuse another person simply because they are a bit different to you and you feel intimidated by this difference.

JK Rowling’s open letter

I have some thoughts about the recent media row between JK Rowling’s open letter and some trans activists…

Fear seems to be at the heart of the argument. Fear of difference, fear of the unknown, fear of harm and fear of erasure.

Inclusive language

In the initial Tweet, Rowling takes umbrage with the inclusive language “those who menstruate” which includes trans men and non-binary individuals who are not women but who may still menstruate. It’s hard (for me) to see why the inclusion of these groups seems to undermine a sense of ‘woman’ for those who were assigned female at birth and feel that’s the right category for them (cis-gender).

Rowling has clearly had some awful experiences in the past. However, she seems to be confusing all trans women (those assigned male at birth) as predatory and male as though these are linked. They are not. People of all genders can be predatory and abusive. Rowling talks about being ‘triggered’ and it sounds like she might need some additional support for that so she isn’t assuming all men are evil or trans women might want to harm her. One point she seems to miss completely is the vast majority of trans women feel shame around certain parts of their bodies. The last thing on their minds is to expose themselves others.

Binary thinking

It appears she is also operating from a binary male/female perspective in terms of sex which is long outdated and incorrect. Whilst the two most common categories for sex characteristics and chromosomes are male/female, there are also a number of intersex categories. This is aside from any sense of gender identity which is more of a felt experience rather than something that can be ‘tested’ for. What it immediately highlights is that sex and gender is not a binary system, much as it might be safer to think in these terms.

Equality for all genders

Far from eroding the category of woman, supporting equality for all genders adds weight to equality for women. First we need to widen the legal definition of sex so that intersex individuals are included rather than excluded. This will undoubtedly complicate areas of research where so much focus is placed on the binary sex marker. I have no doubt that what we’d see is simply variation within any given category.

JK Rowling’s open letter voices concern re safeguarding children as though by being more inclusive of trans rights we somehow make children less safe; this is simple scaremongering tactics based on her own fears. We are all entitled to our own opinion; we also need to understand the emotion behind the position. It’s no wonder Rowling feels so strongly given her early experiences. Trans individuals feel equally strongly because of the oppression they face day after day.

De-transition rates

Rowling talks about de-transition rates. There will always be people who find it wasn’t the right approach for them. Many of these might be non-binary rather than trans. The more support we can give these individuals the less regret we might see. However, the de-transition rates remains very low. Currently the system still favours those who transition from one side of the binary to ‘the other’ rather than enabling the freedom to simply be whoever they are with all their complexities. Rowling also talks about people transitioning rather than living with the oppression of being gay/lesbian. Surely our efforts need to focus on making it OK to be gay/lesbian rather than to further oppress a particular group?

Is it OK to disagree with Rowling? Sure. Is it OK to be hounded with death-threats? Quite frankly, no! She is entitled to her opinion. Whilst it’s one I do not share, behaving in an abusive way towards her simply feeds the negativity. It also confirms for her that trans women are indeed scary beings who want to harm her. As someone with such a high profile I do think she has a duty of care to better educate herself and to be more aware of the impact of her comments on those who face oppression. Her books have given many people the hope that love and respect will win in the end. Even though not a single character of hers was trans or non-binary.

Transition rates

JK Rowling’s open letter speaks about being concerned about the increase in people seeking transition. It is inevitable that the numbers will increase as people see that it is a possibility for them. Surely this is a positive step; to know that people previously desperately unhappy are now able to receive the support and interventions they require.

Rowling suggests she might have become a man herself “to turn into the son her father always wanted”. Like that’s the reason people are transitioning and would be supported by the health care system. The suggestion is that transitioning is an easy process! Perhaps she is not aware of the incredibly lengthy, and oft times humiliating hurdles that need to be overcome to arrive at a point of transition. Particularly if medical and/or surgical interventions are required.

The way forward

So, I’m left wondering what the way forward might be. We have a situation where some women are deeply frightened of being attacked by someone they have placed into a non-woman category. We also have trans and non-binary people needing safe spaces. Especially to go to the toilet and use changing rooms without being attacked. Instead of attacking each other, how can we work together with an understanding that both groups feel the terror of oppression and abuse?

I’m back to thoughts around fear and erasure. The way forward is surely in ensuring visibility and equality for all? In terms of equality, it might be difficult for women to think of themselves as both oppressed and privileged. Oppressed by men and also with privilege that trans and non-binary individuals don’t yet have. With greater visibility for women (including trans women) and non-binary people, there’s a greater sense of empowerment for all. It’s important to know where we have privilege and where we experience oppression. Together we are stronger.