11 January 2015

Guest Blog - Conversion therapy and the need for regulation in counselling

This is a reblog with the kind permission of ruralrover, author of thecounsellingblog.wordpress.com. This is such an important topic. Most people are aware of my campaign for the psychotherapeutic professions to be regulated (in particular, for there to be accountability for unethical behaviour which is harful to clients). This blog also looks at a very real tragedy caused by transphobia, an issue in which I believe we have a very long way to go in respect of acceptance and understanding. 
Over to ruralrover...
The tragic death of Leelha Alcorn has left many searching for answers. At 17 she decided that she could not face a life where she was denied that most basic of things, her own sense of who she was. Her parents were, it seems, unable to cope with the fact they had a daughter, not the son they thought and imposed a number of restrictions on her, cutting her off from her support networks. In their place they took her to therapy, conversion therapy, provided by a Christian counsellor who shared their transphobic views.
As a person centered therapist I have to hold at the core of my practice the belief that a client is the expert on their own life. This obviously extends to how they feel about their gender or gender identity. Sadly counselling and therapy have not always accepted this when it comes to gender and sexuality. The idea that some ways of being are deviant, and can be treated by the talking therapies persisted in the mainstream until the 1970’s.  We have however reached a consensus that someones sexuality is not a mental health issue, and that trying to convert them to heterosexuality is not only morally and ethically wrong but may be damaging. All of the UK regulatory bodies signed a statement condemning conversion therapies for LGB people (1). The BACP, of which I am a member, made its own position very clear.(2)
The British Association for Counselling & Psychotherapy (BACP) is dedicated to social diversity, equality and inclusivity of treatment without discrimination of any kind.
BACP opposes any psychological treatment such as ‘reparative’ or ‘conversion’therapy which is based upon the assumption that homosexuality is a mental disorder, or based on the premise that the client/patient should change his/her sexuality.
BACP recognises the PAHO/WHO (2012) recent position statement that practices such as conversion or reparative therapies ‘have no medical indication and represent a severe threat to the health and human rights of the affected persons’.
Unfortunately being trans is still included as a mental disorder in the DSM. Whilst gender identity disorder has been removed, gender dysphoria remains as a diagnosable mental illness.(3) Many therapists are unaware that dysphoria is not present for some trans people, or that the current medical gatekeeping structures encourage trans people to present in certain ways in order to gain treatment.
In a society which is unsure how to treat trans teenagers and young adults, which often assumes their gender is a phase, or the result of parenting failures, conversion therapy may seem like a solution when being trans is still considered a deviancy or form of mental ill-health. In fact there is consistent reporting from trans people of their first ideas of being the “wrong” gender forming at around the age of 3 or 4. This fits with theories from the psychodynamic (4) and psychosocial (5) schools where this is the age of becoming aware of gender and genitals.
Again from my person centered perspective I feel it is beholden on me to accept the truth a client presents, rather than interpreting according to my biases or belief systems. I am also committed to upholding the BACP ethical guidelines which place client autonomy as a vital to good practice (6)
Autonomy: respect for the client’s right to be self-governing
This principle emphasises the importance of developing a client’s ability to be self-directing within therapy and all aspects of life. Practitioners who respect their clients’ autonomy: ensure accuracy in any advertising or information given in advance of services offered; seek freely given and adequately informed consent; emphasise the value of voluntary participation in the services being offered; engage in explicit contracting in advance of any commitment by the client; protect privacy; protect confidentiality; normally
make any disclosures of confidential information conditional on the consent of the person concerned; and inform the client in advance of foreseeable conflicts of interest or as soon as possible after such conflicts
become apparent. The principle of autonomy opposes the manipulation of clients against their will, even for beneficial social ends
It seems clear to me therefore, that as an ethical therapist, a person centered therapist, and as a therapist committed to the values of equality and non judgemental practice I cannot treat someone for being trans.  They may need support due to the stigma, transphobia, prejudice and violence they encounter. Research consistently shows that trans people face a huge number of barriers in our society (7). These might all be reasons anyone decides to seek counselling support.
It is vital that the organisations who regulate therapists currently in the UK take the same strong stance against conversion therapy for trans people as they have for LGB people, especially when it is aimed at trans teenagers, and exceptionally vulnerable group. Moreover this, to me, highlights the need for mandatory regulation of therapy. There must be a criteria where people offering harmful therapies are not allowed to call themselves therapists or counsellors. Amanda Williamson has been campaigning for the mandatory regulation of all who offer counselling services.  (8). If we are to protect clients not only from individually abusive but from abusive forms(9) of therapy such as conversion therapies we must have a framework that is stronger than the current voluntary regulation.
I have seen much anger at the parents of Leelha Alcorn for sending her to therapists who offered conversion therapy. However whilst the profession as a whole does not condemn such therapies for trans people, and has no mechanism to stop them being offered, we also need to look at our own culpability and responsibility.

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