Queering Psychotherapy

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The actions arising from our new equality, diversity and inclusion (EDI) strategy, which was developed this year with the help of a group of our members, are an important element for our future. LGBTIQ+ people are more likely than cisgender and heterosexual individuals to suffer with mental health issues, yet often have poorer therapeutic outcomes. Mainstream Eurocentric psychotherapeutic theories, developed largely by heterosexual, cisgender and white theorists, tend to see LGBTIQ+ as a singular group through this othered lens. Despite the undeniable value offered by many of these theories, they and those who use them - queer therapists included - can often pathologize, marginalize, misunderstand and diminish the flourishing and diversity of queer experience. Several responses suggested a split along modality lines, with humanistic therapists seemingly more comfortable with an affirmative stance than more psychoanalytically aligned therapists, who expressed concern that the essence of their work – exploration – is inhibited by the MoU: ‘[I have] fear of serious repercussions or even litigation should I somehow inadvertently be seen to be “converting” a client by simply exploring their underlying issues,’ said one respondent. There was confusion about the wording of the MoU and the differences between affirmation, exploration and conversion, resulting in conclusions, in some, that could be seen as anti-trans, such as: ‘The focus of my psychoanalytic work would not be conversion but acceptance of biological reality. In my view that is not conversion.’ Others were able to find a workable balance between affirmation and exploration: ‘Therapeutic communities give primacy to giving a sense of belonging, that is to accept differences without pathologising. Group analysis seems to accept trans identity as developments in the social matrix with meaning both for the individual and the group they belong to.’ While we are yet to appreciate the full effect of the pandemic on our lives, we recognise that it has prompted changes to how some of us work, thus creating a new normal – including a sustained increase in those delivering and accessing therapy online. You mention you approached and structured the book “collaboratively” and that the text is not academic but more a “collection of conversations.” How did you go about choosing the contributors to create this effect?

O’Donnell, M., & Taylor, B. (2014). Working therapeutically with LGBTI clients: A practice wisdom resource. National LGBTI Health Alliance. https://lgbtihealth.org.au/resources/working-therapeutically-with-lgbti-clients/It’s a book that is receiving accolades far and wide, from mental health professionals to academics and LGBTQ activists: Queering Psychotherapy, out now, is a diverse collection of essays that we have needed for some time. While LGBTQ+ people are more likely to suffer from a range of mental health issues than their cisgender, straight counterparts, we have less access to services or therapists who understand our issues. Some of the psychoanalytic community expressed confidence in working from an affirmative and exploratory stance, with the data suggesting that those who are anti trans and at risk of enacting conversion therapy are outliers. But many were simply confused – frightened, even – about how they can work with this population safely and effectively within their modality. My guess is a number will simply avoid working with trans people.

Queering Psychotherapy invites us to think deeply about intricate subjects in nuanced ways. [...] This book gifts us by showcasing how healing the work of a certified sexological bodyworker can be, how it is easy to unduly pathologise sex workers, intersex people’s lives from their own voice, how to live and work within the queer community, and a phenomenal new take on supervision reframed as ‘supra-vision’. Many of those topics are not written about enough, and certainly not in the depth that this book offers. It is a highly recommended read for psychotherapists at all levels.' As a gay man growing up in Yorkshire in the 1980s and 1990s, I understand what it is like to feel ‘less than’, an outsider within a heteronormative culture. Name-calling, bullying and the threat of physical violence, fear of (and actual) disownment and being seen as perverted or pathological were the norm. Previous generations suffered even more, but thankfully gay people have increasingly enjoyed more acceptance. Trans people – and particularly trans people of colour – are one of the most marginalised groups of today, thrust into the spotlight of debate by those unsure how to feel about this increasingly visible group that threatens their notions of binary and constant genders and comfortable norms. Chandler, D., & Munday, R. (2011). A dictionary of media and communication (1st ed.). Oxford University Press. https://doi.org/10.1093/acref/9780199568758.001.0001. As a profession, we can’t ignore our knowledge gap on trans identities. It is clear that current trainings are inadequate in preparing therapists to work with gender diversity and that many therapists feel ill-equipped to do so. Training courses need to move beyond outdated difference and diversity modules towards an emphasis on intersectionality. It’s also important that trans people are visible in our profession, particularly on therapy trainings. In the pursuit of ethical, equitable, and culturally responsive provision of care, clinicians can familiarize themselves with and adhere to established professional guidelines for psychiatric practice with gender and sexual minorities (e.g., APA, 2012, 2015). Clinicians should also seek ongoing professional development. Queer-specific cultural humility training is regularly available through trusted organizations (e.g., the National Coalition of Anti-Violence Programs; World Professional Association for Transgender Health; GLMA: Health Professionals Advancing LGBTQ Equality). Valuable resources on the intersection between queer-lived experiences and the use of psychedelics for healing can also be found through Chacruna Institute’s Queering Psychedelics chronicles.

Juno Roche, author of Trans Power and Queer Sex describes the book as “Invaluable.”“If you’re queer or trans and working with a heteronormative therapist, the room itself can feel airless…an airless room fraught with misunderstandings.” Passionate, thoughtful and opens a much-needed discussion with the mainstream therapeutic community who often do not understand the needs and lives of LGBTQI+ clients.' Spurlin, W. J. (2018). Queer theory and biomedical practice: The biomedicalization of sexuality/the cultural politics of biomedicine. Journal of Medical Humanities, 40(1), 7–20. https://doi.org/10.1007/s10912-018-9526-0. As I write the welcome to this annual review, I’ve reflected on another year of change, growth and how we continue to adapt to an evolving external landscape. Sometimes this means not finding a place there, but it usually means re-configuring relationships. It can also lead to queering the meaning of ‘Mum’, ‘Dad’, and ‘siblings’ as part of this re-configuration. The same applies to the family we create for ourselves as adults whether we choose to have one, several, or no partner(s).

Language is an effective tool for building trust between the clinician and patient. As clinicians align themselves with queer clients’ lived experiences, they may become more comfortable with the terminology queer individuals use to self-identify. This helps them avoid the conflation of distinct concepts (e.g., sex/gender), and precipitates fewer instances of inadvertently making clients feel unseen or misunderstood. It is important that clinicians working with queer individuals listen attentively to the language they use when describing their own sexual and gender identity and mirror it carefully. This language is constantly changing on both social and individual levels. Clinicians should stay up-to-date on evolving terminology and accommodate clients if their self-identifiers change. One example of queering is the notion of family, and that sometimes LGBTQIA+ people have to re-structure their place within their families of origin dependent on how supported and enabled they are in terms of their sexual orientation, gender identity, and expressions of these. Bain, C. L., Grzanka, P. R., & Crowe, B. J. (2016). Toward a queer music therapy: The implications of queer theory for radically inclusive music therapy. The Arts in Psychotherapy, 50, 22–33. https://doi.org/10.1016/j.aip.2016.03.004. Many therapists admitted to feeling out of their depth and, due to the political climate, were nervous of missteps or getting things wrong: ‘I know my heart would be to support them in any way I could, but I can be clunky with words. I just don’t want to accidentally do harm.’ Shame at being ill-equipped was a big factor in many responses, along with a desire to rectify this: ‘A bit nervous, shows up my ignorance, I feel I can’t keep up with all the new thinking on this. It made me feel like an incompetent professional.’

Highlights

Talking with other queer, trans and POC therapists over time it came to me that using my passions — writing, journalism and therapy — I could co-create a book with a range of diverse therapists to infuse our field with the wisdom and insights from those of us who have lived experiences of being othered in multiple ways. This collection of voices is so rich and so necessary if we are to understand not only our clients’ worlds more deeply, but our own, too. J. Chance Czyzselska | Photo: Lezli + Rose Added to this is the idea that LGBTQIA+ narratives are often centred around some sort of trauma which, although these should be given attention if present, risks being the defining factor of what it means to be LGBTQIA+. I appreciate there is a risk of this happening in the mental health system, which has long contributed to reinforcing the aforementioned damaging narratives. This is another example of being queer in a binary system, which is a difficult place to be. Ching, T. H. W. (2020). Intersectional insights from an MDMA-assisted psychotherapy trainingtrial: An open letter to racial/ethnic and sexual/gender minorities. Journal of Psychedelic Studies, 4(1), 61–68. https://doi.org/10.1556/2054.2019.017 The contributors to Queering Psychotherapy present key insights and practical advice in a dynamic conversational format, providing intimate access to therapists' personal and professional knowledge and reflections. This book is an invaluable training in itself. Queer Forty caught up with UK-based nonbinary therapist, author, and editor Czyzselska to find out more about their book.