Are you a queer therapist/trainee (identities not policed by us) with an interest in the person-centred approach? 

The 'genders, sexualities and relationship diverstities (GSRD) special interest group' for tPCA are holding what we hope will be a regular zoom social on the second Friday of the month from 6.30-8. Our first meeting will be 11th March

It's a relaxed chat space for those of us who identify as queer in some way, with an interest in PCA to meet other like-minded people over a shared (virtual) beverage of choice - you of course are welcome to bring your own real beverage of choice! We're a group run on person-centred principles, but this is a very informal space with no agenda other than facilitating connection with others. Please email us on gsrd.group@the-pca.org.uk for the link or drop us a private message on facebook or DM our twitter.

 We hope to see you there!

A Queerer Way of Being: A Monthly Blog Series on Gender, Sexuality and Relationship Diversity (GSRD) and Person-centred Theory and Practice
(Rachael Peacock, GSRD Special Interest Group Link)

Welcome to the first blog post by the Person-centred Association’s (tPCA) GSRD Special Interest Group! Over the coming months, we’ll be posting a series of blogs exploring a range of GSRD related topics, focusing on person-centred theory/practice and therapy practice more generally. Each blog will be written by a different author with their own unique experience and voice, exploring GSRD therapy practice from a variety of angles. The blogs are intended to be a resource for person-centred therapists (of all identities) working with GSRD clients as well as person-centred supervisors and trainers, clients and anyone else wishing to develop their knowledge of the person-centred approach and GSRD issues more generally.

We believe that cultural competence for working with GSRD clients is a vital and ethical way of being for person-centred therapists, supervisors and trainers and that empathy can be developed by specific training on GSRD issues (Rogers, 1975). Through the blogs, we aim to raise awareness of GSRD issues within person-centred theory and practice. Irrespective of identity, self-education on GSRD issues is essential if we are to meet clients, students, supervisees in the totality of their experiencing. We hope that by engaging with the blogs, you will experience an attitudinal training that will help you develop the internal resources for a ‘queerer way of being'; a greater fluency in sensitively responding to the multifarious elements of queer experiencing.

Theory-wise, although there had been some detailed theoretical activity regarding working with LGB clients at the turn of the twenty-first century (e.g. Davies, 2000; Davies and Aykroyd, 2001), discussion on other areas of GSRD identities has been sporadic rather than consistent (e.g. Brice, 2011). Recent publications (e.g. Hope, 2019; Westmacott and Edmondstone, 2020) have been a positive development for the person-centred world in terms of generating awareness, perhaps indicating a growing consistency within this area of discourse. We aspire to add to this conversation through the blog series.

A few words about us: since our inception in November 2019, we have welcomed and continue to welcome members of all identities within tPCA expressing interest in GSRD issues in therapy and beyond. From the outset, we have used the umbrella term GSRD rather than LGBTQIA (Lesbian, Gay, Bisexual, Transgender, Queer and/or questioning, Intersex and Asexual and allies). The reasons for this are twofold: as well as ensuring our work is responsive to developments within the wider GSRD therapy field (Barker, 2019), our decision is also based on a wish to avoid an ever changing ‘alphabet soup of acronyms’ that may muddle the focus of the group.

Finally, as a group of person-centred counsellors and psychotherapists, we hold a strong interest in the social and political context of therapy encounters. We consider Schmid’s view of person-centred therapy as ‘sociotherapy’ (2015), encompassing the importance of encountering diverse social realities, as a foundation for all our discussions. Our diversity of experiences has proved to be a strength in terms of generating ideas and rich discussion in our monthly online meetings. If you are interested in joining the group and are a tPCA member, please email us at: gsrd.group@the-pca.org.uk

References

Barker, M.J. (2019) BACP Good Practice across the Counselling Professions 001 Gender, Sexual, and Relationship Diversity (GSRD). Lutterworth. BACP.

Brice, A. (2011) “If I go back, they’ll kill me…” Person-centered therapy with lesbian and gay clients. Person-Centered and Experiential Psychotherapies. 10 (4), 248–259.

Davies, D. and Neal, C. (2000) Therapeutic perspectives on working with lesbian, gay, and bisexual clients. Buckingham: Open University Press.

Davies, D. and Aykroyd, M. (2001) Sexual Orientation and Psychological Contact. In: Wyatt, G. and Sanders, P. (eds.) (2002) Rogers Therapeutic Conditions: Evolution, Theory and Practice Volume 4: Contact and perception. Ross-on-Wye: PCCS Books: 221-233.

Hope, S. (2019) Person-Centred Counselling for Trans and Gender Diverse People: A Practical Guide. London: Jessica Kingsley Publishers.

Rogers, C. (1975) Empathic: An Unappreciated Way of Being. The Counseling Psychologist 5, 2-10.

Schmid, P. (2015) qqPerson and society: towards a person-centered sociotherapy. Person-Centered and Experiential Psychotherapies 14, 217-235.

Westmacott, R. and Edmondstone, C. (2020) Working with Transgender and Gender Diverse Clients in Emotion Focused Therapy: Targeting Minority Stress. Person-Centered and Experiential Psychotherapies 4, 331-349.

LJ is a white non-binary person-centred therapist living and working in the UK with clients who we might term LGBTQ+ or GSRD

Whilst this blog may be read by anyone anywhere in the world, I write this as a white British therapist living and working in the UK, and this is where my experience and expertise lie. I recognise that not everything I speak to here will feel relevant to all.

As person-centred practitioners, we try to hold to the concept of Rogers' (1957) six necessary and sufficient conditions. A central tenet of those conditions is that of empathy; we walk ‘as if’ in the shoes of another. And as therapists we are very used to working in this way. We work very hard to be empathic with clients, no matter what the topics they bring. Some clients and/or topics feel somewhat easy to do this with. Others perhaps not so much.

It is tempting to think that because we are person-centred, that this is enough by itself for our clients. I speak as a person-centred therapist who is trans and who has been a client of different person-centred therapists. And my experience is that it is not enough. This is something that Rogers also comments on, as has been referenced in other blog posts in this series.

No matter who we are in the world, we are situated within certain discourses and certain rhetorics. We breathe in messages about what it means to have gender. What it means to ‘be’ certain genders. What sex is, what ‘gender identity’ is, and the ways in which genders and gender identities ‘should’ be portrayed. Many who are cis have not really had to question these identities, and some really have. It is not as simple as a trans/cis divide – some people who are cis (that is, identify with the sex assigned at birth) have had to ask these questions of self in the same way that most (if not all) who are trans have done. But for some of us, we have never had to consider ‘gender’. We just have one.

If we have never had to consider our relationship to gender, to question whether something is right for us, whether a gender (and gender identity) fits, and whether we want to change some or all of our lives in response to that knowledge, then it is going to be difficult for us to accurately empathise with the person in the client chair in that position.

Consider your gender (trans people, you can sit this one out if you want. Or not – as you wish). How would you explain your gender to someone if you couldn’t make reference to your genitalia? How would you convince someone you are the gender you are if you cannot reference your physiology? I’m not saying it’s impossible – trans people basically do this all the time. But if you’re cis, you probably haven’t had to. And the idea that someone might be asked to do this over and over just to hear the correct pronouns might be new to you.

That’s what we call cis privilege. It’s not inherently bad to have privilege. Most people reading will have some form of privilege – I’m white. That’s one layer of privilege I have. Privilege means that that aspect of our identity is not something we usually have to consider. I never have to worry about being white when I apply for a counselling job. A Black counsellor might well wonder whether to put their photo on to their counselling profile. Cis privilege then, is not having to think about gender, and the impacts of that on their lives, and the lives of others.

So you’re reading and thinking ‘ok, so I have cis privilege. And I know I don’t want to harm trans clients. Now what?’

• I’m inviting you to keep doing what you’ve hopefully started doing if you’ve made it this far. Examine the dominant understanding of gender in your cultural and/or community contexts, and recognise that this is only one way of understanding gender.
• Reflexively engage with your own position in relation to gender, and the relationship between this and your other intersections (race, ethnicity, class, sexuality, disability, etc)
• Become aware of your implicit biases, and the structural inequalities in your wider society, and reflect on these in training and perhaps through contemplative practice (Barker 2015).
• Engage with intersectional understandings of how queerness is situated within intersecting social identities and dynamics of privilege and oppression, and consider bringing this awareness into the room with clients.
• Be aware of the impact of gender, sexuality, and relationship normativity, stigma, and discrimination in the lives of marginalised clients, particularly the legacy of pathologising therapeutic practice.
• Be mindful of the power dynamics between client and practitioner, and the potential of reinforcing social structures of oppression (Proctor 2017)
• Engage in CPD and reading on queerness if you want to work with trans clients. If you’re trans, this includes you too.None of us are immune to those societal messages and we all have work to unpick.
• It is enough, to be person-centered, if we are truly beinga person-centered practitioner and we are congruently exploring ourselves in relation to what our clients are bringing, and recognising when we might need further information and support.

For me the bottom line is this: If I know little about the world that my client comes to me with, no matter what that world is, it is for me to go educate myself on that, to make sure that I can be my person-centred self, truly empathically in their world.

References and further reading

Barker, M.-J. (2015) ‘Depression and/or Oppression? Bisexuality and Mental Health’. Journal of Bisexuality 15 (3), 369–384

Hope, S. (2019) Person-centred counselling for trans and gender diverse people: a practical guide. Jessica Kingsley 

Proctor, G. (2017) The Dynamics of Power in Counselling and Psychotherapy: Ethics, Politics and Practice. 2nd edn. PCCS Books

Rogers, C. (1957) ‘The Necessary and Sufficieent Conditions of Therapeutic Personality Change’. Journal of Consulting Psychology [online] 21 (2), 95–103

Dear all,

Some of you may have seen the government’s recent consultation on LGBT conversion therapy and are wondering if and how to respond.

It is (what feels to me as a non-legal person) a complex bill to respond to and is a law that covers several areas in one umbrella term. Whilst the bill calls itself conversion therapy, it actually refers to several types of conversion practices, only one of which we would recognise as conversion ‘therapy’. But it does also include us as therapists within the bill, and therefore, as far as I am concerned, it is important that we have a voice in what is written in to law.

There are those who call themselves ‘gender critical’ who feel that currently the Memorandum of Understanding on conversion therapy is unclear and that therapists are currently at risk of complaints if they work under it. I would disagree. I feel that my role as a therapist is to give any client the space they need, to consider their identity. That working in a ‘gender affirming’ way (that is, to affirm the client’s expertise on themselves rather than imposing my own) is completely in line with the MoU. Those who are gender critical express concern about 'detransitioning teens'. It may well be that some teens do 'de-transition'. Most of the research about detransitioners is based on one research article that included 'gender non-conforming' people as well as those who identified as trans. Being 'non-conforming' does not make one trans, and many of us do not have to look far in our lives to see someone who is 'gender non-conforming', so that these young people do not go on to identify as trans should not be a surprise. They have not 'detransitioned'. Also, I would like to suggest that if someone wants to see if one way of living suits them, and then decides it doesn't, we should allow for that. Let's normalise freedom of expression including gendered identities.

The other research that gets mentioned in relation to this is that of 'Rapid Onset Gender Dysphoria'. This piece of research was retracted by the journal that published it because it was methodologically unsound and thus valid conclusions cannot be drawn from it. If you are asking parents on a space that is traditionally seen as unsupportive of trans topics, and those parents did not know their teens were trans until their teens 'came out', this is possibly not a surprise - a conclusion we might draw instead (that wasn't referred to in the research) is that the young people (whose voices are not heard in this research) were unwilling or afraid to talk to their caregivers until some kind of transition became an internal imperative.

Whatever our opinion, the conversion therapy bill is at the moment, unclear. We have until 10 Dec to respond. Here are two links that might help – the government’s own research commissioned into conversion therapy and the Ozanne foundation, (an Evangelical Christian association) has also written a report in support of the ban.

I (LJ) have been part of creating the Pink Therapy Briefing Paper, and there is also a Stonewall briefing document, as well as an incoming MoU signatories briefing document also (to be updated as it becomes available). The stonewall briefing document talks through point by point how they suggest people respond. It is very clear documentation and I would suggest easy to follow, with the additional points made in the Pink Therapy document, some of which are mirrored in the Stonewall document and some that are not.

It is important that conversion therapy and conversion practices are banned. No-one should be convincing anyone that it is better to be any gender or sexual orientation over another. The consultation currently allows for religious exemption and ‘consent’ exemption. But on the other hand suggests that conversion therapy is egregious and should be punishable by 5 years in prison. If something is harmful enough that it needs a jail term, then there should be no religious exemption. Given that therapy is often a ‘last chance’ resort for people, there should be no ‘consent clause’ either. The number of homeless young people who are LGBT is about 25% - a significant over-representation. The likelihood that LGBT young people could be pushed in to ‘counselling’ as a condition of staying at home is high and therefore there is significant doubt on just how informed the consent is. There is no evidence that conversion therapy works, and significant evidence that it is harmful. There should be no circumstances in which it is ok to submit someone to that experience.

It is equally important that missing areas are covered, such as asexuality and intersex. Research suggests asexuals are the group of people most likely to experience conversion therapy. The bottom line is, whilst people MAY WELL be unhappy in their gender and or sexuality, this is a societal problem, and it is society that needs to change. Whilst sexuality and gender may be fluid for some people, we should not be trying to enforce change in clients because society is stigmatising of some genders and sexualities. That places both the blame and the responsibility on clients, and it is just not theirs to own.

Open to members of any gender, sexuality or relationship identity. We focus on Gender Sexual Relationship Diversity (GSRD) issues and their relationship to person-centred theory and practice. We are currently considering how GSRD issues are approached within training settings and areas for further development that ensure person-centred practitioners are well-prepared and receptive to the lived experiences of the GSRD clients they may work with.To ensure our discussions are holistic, we aim to adopt an intersectional approach to GSRD topics (i.e. that people have interconnected social identities such as ethnicity, age, class, ability etc. in addition to gender and/or sexual identity). A key consideration of the group is to find ways to build deeper awareness and dialogue regarding GSRD issues within the person-centred approach.

Please check your junk folder after making contact as emails sometimes end up there.

This month's article on queerness and therapy comes from Ronete Cohen. It is a longer article than some of our other offerings have been but incredibly interesting and we hope you enjoy it.

Ronete Cohen (she/her) is a psychotherapist who works with individuals and relationships. She is a Pink Therapy Clinical Associate and specialises in the intersections of GSRD (Gender, Sex and Relationship Diversities), race, culture, neurodiversity and disability. She has specialist training in trauma, PTSD and CPTSD, and dissociation. Her website is www.rainbowcouch.com and she's @rainbowcouch on Twitter.

 Queer Disorientation: The Loss of the East

I picked a subject close to my heart – queer migration from the east to the west. It’s the experience of many of my clients and in a much lesser way mine too. It’s the experience of the queer migrants we’re likely to see in our practices. I’m using my privilege and the voice I’ve been given to speak on their behalf. It’s really scary. It’s such a diverse group that I’m constantly picturing each and every one of them jumping up in turn and crying: But this isn’t my experience! And they’ll all be right.

“Disorientation is the loss of the east. Ask any navigator: the east is what you sail by. Lose the east and you lose your bearings, your certainties, your knowledge of what is and what may be, perhaps even your life. Where was that star you followed to the manger? That’s right. The east orients.” - Salman Rushdie – The Ground Beneath Her Feet

Queer migration is a process where both east and west are distorted. It’s one where the migrant’s identity is reshaped and then lost in translation. It’s a process of disorientation brought on by complex transformations. It’s a complex process of trauma; the traumas of the past collide with new traumas. It’s hard to find help that can contain such complexity.  

I’ve used composite stories and I’m not going to name countries. I’ve assigned random names except in one case where I’ve borrowed my grandmother’s given name, Nadra, to honour her, a Yemeni Arab-Jew and a migrant. I don’t know what her sexual orientation was – she died when I was ten – but one of her sons, my uncle, was queer.

Distortion through eastern eyes

“Before I came here, everything negative was so huge and overwhelming. It eclipsed everything else. It was all I could see. It was what home looked like to me. London seemed like the Promised Land. Now that I’ve had a reality check I’m able to see what I couldn’t see when I was back home.” - Samira

Migration involves leaving some of your past behind and hoping for a better future. Leaving the people and places you love and moving to a place full of strangers is scary. Migrants use distortion to make it easier. They magnify the negative in their country of origin and erase the positive. It’s self-soothing. They idealise their destination to reduce their fear of the unknown. Then, when the migrant reaches their destination, a reciprocal distortion begins.

Distortion through western eyes

Distortion happens through ignorance and applying a western context to eastern experiences. A common western distortion is to view queer migration as a move from “repression” to “liberation”. There are inequalities as well as opportunities everywhere. They are simply restructured during the process of migration. Ignorance of this is a distortion of both the east and the west.

"A white saviour is a western person going in to “fix” the problems of struggling nations or people of colour without understanding their history, needs, or the region’s current state of affairs". - Urban Dictionary

Ignorance of the east leads some to apply a western context to the east. This distortion is at the basis of white saviourism and of many microaggressions. Many queer migrants find themselves distorted in spaces where they had hoped to be safe. White saviour distortions of the east can make it possible for them to show support for oppressors of queer communities. These groups are often oppressors the migrants have personally escaped.

Migrants don’t need white saviours: they are capable of liberating themselves. The Middle East alone has dozens of LGBT organisations active in the region. They need allies rather than people who infantilise them by fighting their battles on their behalf.

Western feminist groups can overwhelmingly focus on white feminism. This distorts expressions of feminism and the lived experiences of eastern women. Queer groups ignore context and distort lived experiences of queerness that don’t match their definitions.

Eastern queer identities

Queer identities are formed in a context of location and culture. In the west, many don’t consider the privilege that shaped their queer identities and lived queer experiences. Context matters; without it, everything becomes distorted.

Eastern queer identities can’t always be translated into western ones. For instance, in many countries, identities will resist the binary and be more fluid. Queer communities can be small and therefore not segregated into their components. You’ll find queer people mixing with straight or hetero-flexible allies. Judging or trying to force labels on this fluidity is a distortion.

Nadra had a long-term girlfriend back home. Her girlfriend is married and has children. Because of the strict segregation between the sexes in their culture, when Nadra was around, her girlfriend’s husband would leave them alone. She would even stay overnight and they’d have sex. Nadra now identifies as bisexual but didn’t label her sexuality back then. Her girlfriend doesn’t label herself.

There are of course many people who do use labels we’re familiar with: LGBTQ+, kinky, poly. They tend to be a minority and often middle class and educated. Their freedom is conditional and limited.

Living in a hostile culture means existing in bubbles of acceptance and compartmentalising your queer identity. There can be total freedom within those bubbles but also a constant fear of discovery by outsiders. Queer physical appearance can make you more vulnerable to attack. In some countries, your neighbours could report you to the police if you’re careless enough to have loud sex.

Coming out is complex. In many countries, queer people aren’t free to reveal their sexual orientation or gender identity. They could be out to their friends and an even wider queer network of acquaintances. They could even be out to strangers (in queer or queer-friendly venues) but not to their family. They could be out to their immediate family but not to their extended family.

Even when family members know, social stigma prevents a more public coming out. A very small minority do come out publicly and live lives dominated by their queerness. In many countries, legal status and active persecution by the state do not play as big a part in this process as people in the west imagine.

Samir still uses his deadname with his parents. He’s had top surgery and is on testosterone. He hasn’t video called his parents in a very long time because his appearance is now undeniably masculine. He even avoids phone calls and uses text instead because his voice has deepened, but he’s running out of excuses.

It’s important to understand that the east doesn’t completely disappear as a context when you move to the west. Your behaviour can have consequences for your life here, for contact with your family, and for how safe it is to visit the east.

Dalia Alfaghal, a lesbian activist living in the United States and co-founder of Solidarity with Egypt LGBTQ+, was out on her personal Facebook page. The page was public, but she thought only her friends read it. Then one of her posts went viral and was picked up by Egyptian media. She received many death threats and hate messages.

Transformation

Identity is complex. When your environment has never changed, it’s easy to believe that identity is only influenced by internal processes. But context distorts. When migrants are subjected to distortion, it transforms their identity. It slowly changes towards the distorted image in other people’s eyes.

Identity can be viewed as a construct grouped into external identifiers, internal identifier and hidden identifiers. The external identifiers are the ones your community uses to identify you. The internal ones are the ones you use to identify yourself. And then there are hidden ones: either ones you don’t feel safe publicly identifying as, ones you find no longer apply to you, or ones that have become obsolete.

The following example illustrates how identity can transform along the lines of this construct. Back in the east, Marwa is assigned an identity according to their class, religious/sectarian and professional identifiers. At the same time, they identify primarily as an activist and a feminist. They are also bisexual and trans but can’t express this publicly. Then they migrate to the west.

The early days are about leaving behind the constraints of their community and the freedom to choose. Their external identifiers include two of the hidden ones: bisexual and trans. Activist has been “downgraded” to an internal identifier because the context has changed: the groups from back east don’t exist in the west, the causes are different. Class also changes with context: they feel the same class but are different from their class peers in the west – migration downgrades class. Writer may still be relevant in the east but not accessible to western eyes because of language barriers. Being a Christian is no longer relevant. It was more of a family and sectarian thing back home and they weren’t a practising Christian or a believer.

The transformation is completed after quite some time has passed. Now western eyes view them as an Arab, which is ironically seen as synonymous with being a Muslim. A major part of their identity has been transformed and distorted. They’ve gained a new identity: migrant. They still identity as bisexual, trans and feminist. They have even found their way back into activism, very often in groups where mostly migrants fight causes in the east or those of migrants in the west (and where there are fewer or no white saviours). There has been a loss of another major identifier, that of writer. The loss of language leads to a loss of meaning. They are no longer able to make sense in the same way they did before or come across as articulate. It’s as if their intelligence and power of expression have vanished.

Disorientation

The migrant’s identity transformations can gradually transform the relationships with those left behind. In the west, they’re freer to express themselves in a way that was dangerous in the east. This can lead to disapproval or even rejection by families. The west distorts: subtle transformations can be almost imperceptible here. They feel safe. But the east distorts too: every nuance is magnified. It’s hard to hide on a Zoom call.

There is further disorientation. Engaging in activism here could endanger families and friends back home. Being forced to keep so much secret from them means they don’t know who you really are and can’t celebrate your achievements.

Waleed is an accomplished and highly respected expert specialising in eastern queer human rights. They’re not out to their family about their gender and sexuality or their work. Their many public appearances are done without them being named and with no cameras. This is done to protect them and their family who are still in the east. Their family views them as a failure because they’ve only spoken in very vague terms about their work; and also because they aren’t married and don’t have kids.

Waking up from the distortion of the west is another disorientation. The migrant is confronted with the reality of the west. The hoped-for homecoming and sense of belonging are shattered. The migrant is once again an outsider, distorted by western eyes. They are defined by their otherness.

Migrants who can visit home face another disorientation. They return transformed in a way their friends and families sometimes can’t relate to. They feel like strangers in their own home: out of touch, in a place that has transformed during their absence just like they have. They’re strangers, alienated. They’ve lost the east.

Trauma

Queer migrant trauma is complex. There are traumas related to the past that we expect to find in people who’ve left their homeland for a reason. But they are wrapped up in the trauma of disorientation which is ongoing: there’s the trauma of racism and micro-aggressions and that of the gaslighting around them, the trauma of othering, alienation, isolation, transformation, disorientation.

Sarah Hegazi, an Egyptian lesbian, committed an act of extreme bravery: she waved a pride flag at a Mashrou’ Leila concert in Cairo in 2017. Mashrou’ Leila is a Lebanese band whose singer is openly gay. Sarah was imprisoned and tortured. She was later granted asylum in Canada. Deeply traumatised, she felt alienated and isolated in exile but couldn’t return to Egypt for fear of being arrested. She took her own life in 2020, aged 30.

There’s also the trauma of witnessing and experiencing traumas still happening back home. Experiencing trauma from afar can be more devastating than when you’re there because of isolation, because of not being in the same space with people experiencing the same trauma together. In countries where trauma is not unusual, it becomes part of the culture. This shared context is holding. There’s collective trauma, collective defences (healthy or not), collective grief and collective healing. Disorientation means being excluded from that.

There’s the trauma of having suffered queerphobia. It doesn’t go away just because the real danger has been left behind. The hypervigilance remains but its source isn’t always immediately obvious. The experience of safety in the west can be overwhelming and scary. It can make hypervigilance go into overdrive because there are so many things that register as dangers.

There’s the trauma of internalised queerphobia. It can be deeply hidden under layers of a confident and outgoing queer identity; it still leads to shame, fear and guilt.

The trauma we as therapists find hardest to talk about is trauma caused by therapists. Therapists who make assumptions about your context or about you based on their own distortions of the east. Therapists who encourage you to come out because they can’t see the context in which coming out is the wrong choice. Therapists who gaslight you when you try to talk about microaggressions, who try and help you change the way you frame things instead of validating and addressing racial trauma.

“When I was experiencing an acute mental health crisis due to the trauma I suffered back home, I was referred to an Asian women’s domestic violence support organisation. I’m queer and single and had never experienced domestic violence. No one could hear or see me.”

Neelam

Queer disorientation in therapy

How do we meet our migrant clients’ complex needs in therapy? We must challenge our misconceptions so that we truly see them. If we’re not migrants, we need to check our privilege. We need to be curious about the experience of disorientation. We need to challenge our own distortions. We need to explore our clients’ queer migrant trauma.

We must take care not to force our own context on them. We should respect their boundaries even if we consider them harmful. We need to ask ourselves why we see them as harmful. Are we making assumptions? Are we using our own privileged position to judge them? Are we distorting the context? We must remember that coming out isn’t the holy grail. We need to believe our clients and take great care not to gaslight them.

We should take great care not to be white saviours trying to help the queer migrant move from repression to liberation. We’re all repressed and liberated in our own ways. If we meet our client where they are and hear them and see them without distortion, we can help them reduce their sense of disorientation.

Claire Maskery is a Person-Centred and experiential psychotherapist who works part-time for the NHS and in private practice, specialising in developmental trauma http://www.clairemaskerytherapy.co.uk

She writes:

This post is about sharing some of my experiences of working with clients who identify as regressive adult babies. I’ve been a practicing psychotherapist for about six years, but I’ve worked with adult babies for longer. I accidentally fell into working with this client group and never left, to the point where this represents a significant part of my career. In working with adult babies, I came to recognise certain consistent traits clients described. However, when researching, so that I could be more informed to better work with this group, overwhelmingly the literature did not reflect the experiences as described to me.

Unless one is immersed in the ABDL community, information about this group comes from two main sources; academic journals and from Main Stream Media (MSM). What appears to be common for both sources are a lack of consistency, general misinformation and misrepresentation. TV and MSM proffer salacious views of adult babies (Attack of the Adult Babies (2017) - IMDb, n.d). Representations of adult babies which focus on sexual practice are confirmed in academia, perpetuating a view of non-sexual adult baby practice as a paraphilia (Banbury et al., 2017). Clearly, this is inaccurate, non-sexual behaviour being impossible to be categorised as a paraphilia. However, when society looks to academia on how to regard adult babies and finds such literature, it reinforces a view that all adult babies engage in sexual practice. This has profound implications for the lived experience of adult babies. It was for this reason that I undertook a part-time PhD researching adult babies, of which I am now, if all goes well, in my fourth and final year.

Though this piece references diaper lovers, this is not the focus of this blog and it may be that you decide further research is required to support your work with that specific client group. This post is written with therapists and supervisors in mind, those who are established in practice but may not yet have a clear understanding of working with clients who identify as adult babies. As such, this post assumes a certain level of knowledge regarding issues around clinical practice, such as when client and therapist do not appear to be a good fit to work together, when issues re client work and the therapist’s process should be taken to supervision, when supervisors need to expand their knowledge-base, and other such ethical considerations.

Adult babies may self-identify as Littles (Lewis, 2011) and I will use the term Little interchangeably with the term adult baby in this post. The reason some people to prefer the term Little, is that the term adult baby can be seen as not fitting with experience. For instance, some people have a Little side, but it’s a self who is a child, not an infant, and as such the term ‘baby’ does not accord with their experience. Also, some people feel the term AB has become synonymous with salacious MSM output, which does not necessarily promote a representative view of their experience (Diagonal View, 2012).

Here's a little background about this client group, dry but necessary; ABs are part of a community known as the Adult Baby/Diaper Lover (ABDL) community (Zamboni, 2018). These groups, adult babies and diaper lovers, may superficially appear the same, exhibiting similar behaviours such as wearing diapers (or nappies as they are known in the UK), however, the motivations behind the actions come from very different places. As such, I offer it is incumbent upon therapists, and their supervisors, to have an appreciation of the different drives being enacted, the rationale being each client group necessitates a different clinical formulation. Rather unhelpfully, it is also a consideration that as yet there is no universal definition of ABDL (Oronowicz-Jaśkowiak, 2016). It is interesting that although Oronowicz-Jaśkowiak wrote that some seven years ago, it still holds true. This demonstrates how little research there is in this field of study.

Here are a few key points which may be of help, from my experience of working with the ABDL community:

1. There are multiple subgroups residing within the ABDL community.

2. It is a consideration that people may have more than one adult baby self, potentially of different ages and genders.

3. Diaper lovers are adults who retain an understanding they are adults engaged in behavior which is pleasurable. Their practice may, or may not, involve a sexual component (Zamboni, 2017). Diaper lovers are adults who never conceive of themselves as either playing the role of a juvenile, nor do they encounter a regressed self. Their practice may hold its origins in seeking a soothing pastime which aids relaxation. Some diaper lovers engage in sexual behaviours and this may, in certain instances, be connected to their sexual identity. Further, their practice may be a solitary activity, or one engaged in with others. Diaper Lovers retain an understanding they are adults engaged with behaviours which they find pleasurable, predominantly diaper-wearing. They tend not to play with children’s toys, finding them unstimulating.

4. There are a group of adult babies who may better fit the description of age-players. They retain a clear understanding they are adults pretending to be juveniles. It is a consideration that they may not just pretend to be babies but children, and therefore the term ‘baby’ may not fit with their experience. For this ABDL subgroup these behaviours are an enjoyable pursuit which may, or may not, have a sexual element in their practice. Their practice may be a solitary activity, or something undertaken with friends or a partner. It may be that their friends or partner is a care-giver, a sexual partner, or a fellow adult baby or age-player.

5. There is a further subgroup within the AB community; regressive adult babies. This is a group whose experience is different to that of the groups described above. This group do not play a role, but regress to a pre-verbal or child-like state. Such a regressive process is similar to clients who encounter a non-verbal self within the therapeutic environment (Erskine et al., 2014, p.68-69). This subgroup finds behaviours such a pacifiers, bottles and baby toys both soothing and engaging. This level of engagement with infantile toys is indicative of a regressed state, rather than an adult playing a role, such activities insufficiently engaging to maintain the attention of an adult for prolonged periods of time (Oronowicz-Jaśkowiak, 2017, p.27). This ABDL subgroup’s behaviour does not have a sexual element, though they may have experienced pressure to be sexual. Some Littles, due to developmental trauma (Van Der Kolk, 2014), may be vulnerable to sexual predation precisely because of their Little practice. Their juvenile behaviour is often a solitary activity, this may be because they cannot find a caregiver or because they are too ashamed of this aspect of self. However, it may be their regressive practice is undertaken with friends or a partner who acts as a care-giver, or a fellow adult baby or age-player. Regressive adult babies may present in therapy as survivors of adverse developmental experiences (Felitti et al., 1998), and as such the clinical formulation ought to be based around trauma-informed care. Such an approach necessitates embarking on the three-phase trauma approach of Lewis Herman (1992). Any client entering therapy will have unique reasons for doing so, however, in my experience regressive adult babies often present requiring psychotherapeutic work around guilt, fear and shame. Evidently, this is in stark contrast to the formulations required when working with other ABDL subgroups, as outlined above.

One more important point; many adult babies live in fear of being ‘outed.’ The greatest fear an adult baby can imagine is to be mistaken for a paedophile. I’ve heard this fear expressed so many times – and it is not hyperbole. I have supported a client who has had to move home and job, and has lost a family member because of being reported to the Police for being a non-sexual adult baby. One well-known example of the cost of such misrepresentation was when a UK paediatrician was thought to be a paedophile, and her house was vandalised and she had to move out (Allison, 2000). Many adult babies live with this fear every day.

So, what do you do if a client tells you they’re a regressive Little. Just be you. Be the same therapist you always are, after all they’ve chosen you for a reason. Show them you are a safe person to discuss this aspect of self with. Welcome their Little side, offer warmth and empathy and a formulation based on what they tell you – as opposed to what MSM portrays. And finally, a warm smile goes an awful long way.

References

Allison, R. (2000, August 29). Doctor Driven out of Home by Vigilantes. The Guardian; The Guardian. 

Attack of the Adult Babies (2017) - IMDb. (n.d.). M.imdb.com. 

Banbury, S., Lusher, J., Lewis, C. A., & Turner, J. (2017). The Use of Cognitive Behavioural Therapy on Two Case Reports of Paraphilic Infantilism, Substance Misuse and Childhood Abuse. MOJ Addiction Medicine & Therapy, 3(2). 

Diagonal View. (2012). 15 Stone Babies [YouTube Video].

Erskine, R., Moursund, J., & Trautmann, R. (2014). Beyond Empathy: A Therapy of Contact-in-Relationships. Routledge.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14(4), 245–258. 

Lewis, A. (2011). Ageplay: An Adults only Game. Counselling Australia, (11), 1–9.

Lewis Herman, J. (1992). Trauma and Recovery. Pandora.

Madero, G. (2020). An exploration of the motivation and significance of roleplay within an adult baby diaper lover community [Dissertation].

Oronowicz-Jaśkowiak, W. (2017). Complex Motivational Factors for Paraphilic Infantilism-Related Behaviors [sic] by the Example of Analysis of an Internet Forum. Przegl.Seks, 4, 23–29.

Oronowicz-Jaśkowiak, W. (2016). AB/DL group. Close relationships and sexuality. Sexological Review, 3(47), 11–18. 

Van Der Kolk, B. (2014). The body keeps the score: mind, brain and body in the transformation of trauma. Penguin Books.

Zamboni, B. D. (2017). Characteristics of Subgroups in the Adult Baby/Diaper Lover Community. The Journal of Sexual Medicine, 14(11), 1421–1429. 

  Zamboni, B. D. (2018). Experiences of distress by participants in the Adult Baby/Diaper Lover community. Sexual and Relationship Therapy, 33(4), 470–486. 

By Sam Hope

Sam Hope is a non-binary, BACP accredited therapist and author of Person-Centred Counselling for Trans and Gender Diverse People, available now. Their website issam-hope.co.uk

The UK government just announced there will be a public consultation regarding the banning of conversion therapy – therapy to change someone’s gender identity or sexual orientation. Sadly, this has already initiated an outpouring of misinformation, often centred on the idea that the ban would prohibit counsellors working with clients around “identity confusion”.

Particularly focused on trans rather than gay or bi identities, the outcry implies that the approach LGBT+ organisations support – affirmative therapy – forecloses on a client’s opportunity to genuinely explore who they are. This could not be further from the truth.

In my book, I talk a lot about working in a trans affirmative way. This is a tough thing to ask of therapists when the country is in the grip of a moral panic about “social contagion”, undue influence, and the fear that a person might be “encouraged” into a trans identity, as if you can “make” someone trans by giving them information or access to healthcare.

The truth is, you cannot make someone trans or not trans. The evidence suggests that some people just are trans, where trans is a plural, diverse, and multi-determined experience of incongruence with one’s sexed body or assigned gender. No two trans people are alike, and words and definitions remain imperfect to tell the story of this broad community.

Does “trans affirmative” mean telling people it’s better to be trans than gay, or telling people they are trans even if that’s not how they see themselves? Of course not. Being trans affirmative is no use if I am not also equally lesbian and gay-affirmative (and bi and aceaffirmative, etc.). I must hold in equal value binary and non-binary identities, the desire to transition or not to, to change one’s body or keep it the same. Being affirmative means “your self-experience is valid: I hold that you understand yourself best”. It accepts the diversity, plurality and complexity of our relationships with our sexed bodies, assigned genders, and sexualities.

I should not seek to place my own language and labels on the client’s experience. Underlying our inadequate words there is an enormous diversity of ways in which people experience and relate to assigned gender, gender roles, sexed bodies, sexuality and an internal sense of a gendered self.

What is my role as a therapist? Well, to listen and be affirming (prizing, empathic, non-judgemental) of experiences that are divergent from societal norms, without making assumptions. To not make assumptions, I need to do a lot of work on exploring my own unconscious biases. If I do not realise my brain has already been trained to effortlessly think about sexual orientation, sexed bodies and social gender in particular ways, then how will I notice the assumptions, and ultimately judgements, I am making? How can I show true empathy if I am hearing a client’s story through filters I am barely aware of?

If we stop thinking about labels to box people into and think of words as ways to tell a story, I think that can help. Affirmative therapy is not about the therapist “diagnosing” and labelling the client, or confirming the client’s self-experience in an “expert” way, as if it us who is to decide whether the client is correct or not in their experience.

We tune into the client’s story, get to grips with their own ways of making meaning of their world, trust they are not confused, deluded or in error. We prize all diverse identities and signal our valuing of lesbian, gay, bi, trans, ace people equally so that we are not subtly setting up hierarchies where, for example, trans is okay but gay and not trans is better, or a trans man or woman is better than a non-binary person, or identity must be fixed rather than fluid.

The prevalent arguments against affirmative therapy display a common variety of transphobia. The foundation of transphobia is often a belief that many or all trans people’s understanding of themselves is wrong, deluded or confused. Transphobic discourse wildly exaggerates the number of people who regret transition. In reality, regrets are incredibly rare, and children don’t “grow out of being trans” as many claim. Nor is the known fact that autistic people are more likely to be trans a sign that transness is merely a symptom of autism that can be mislabelled “gender confusion”.

If we buy into this transphobic climate where trans identities in particular are to be questioned and doubted, then we are unable to offer any client exploring their gender true non-judgement and a space where they are fully regarded as the expert on their own life and valued no matter what identity may emerge.

To value trans and gender diverse clients, supporting a ban on harmful conversion therapy and endorsing affirmative therapy is a minimum requirement.

Working with queer clients: Three Top Tips

Meg-John Barker

1. Reflect on your own relationship with queerness

Before working with marginalised clients of any kind it’s vital to reflect deeply on our own relationship with the systems of oppression which impact them. With queer clients this particularly means heteronormativity and related gender and relationship norms.

Deep reflection is about more than educating ourselves about these areas academically, or immersing ourselves in relevant popular and social media so that we’re familiar with diverse experiences and current issues. While those things are important, what’s needed is a more embodied, emotional exploration of our own experience with sex, gender, and relationships, including how cultural norms and oppressive systems have impacted - and still impact - us.

Expanding our understanding of queerness is important for this exploration. In what ways have we followed the normative scripts regarding sex, gender, and relationships? In what ways have we resisted these, or found them unavailable to us because of some other aspect of our body, identity, background, or life experience? In what ways do we feel queer, or not queer, or queered by life? When we reflect on our own experience, what are our feelings - such as fear, joy, shame, belonging, loss, alienation, peace, envy, anger, and more - around queerness?

2. Know your limits

Such reflection can help us to greater honesty about which themes and clients we feel able to work with currently, and which present an edge for us. All therapists are going to have some areas within their zone of competence, and some which are on - or over - the edge for them right now.

Again this is not just about lack of knowledge, as - for example - with a client considering medical transition who needs a therapist with expertise and experience around these services. At least as important is knowing our psychological edges. For example, if we have assumptions about monogamy being the best way to conduct relationships, then it would be an edge to work with a couple where one is behaving monogamously and the other non-monogamously. We would likely align with the monogamous client, and we’d be unlikely to think to explore forms of consensual non-monogamy with the couple.

This goes beyond conscious knowledge of our biase. Our deep reflections on our relationship with queerness may reveal, for example, that we have a big fear of ‘getting it wrong’ with non-binary clients, which brings up a sense of being out of touch, and risks collapsing us in shame if we make a mistake. Or we may struggle to allow that a client could be happily asexual, perhaps because of ways in which we have treated ourselves non-consensually around sex, believing it to be essential.

Igi Moon’s research demonstrates that these kinds of feelings easily leak out into the therapy room. Clients are likely to pick up on them when what they desperately need is somebody to mirror and affirm them in a world which generally does not. It’s absolutely fine to refer clients on to people with experience and expertise in such areas until you feel in a place of comfortable competence around them yourself.

3. Don’t assume queer clients’ issues will relate to their queerness, don’t assume straight/cis clients’ issues won’t

While some queer clients will approach a therapist specifically wanting to explore their sexuality, gender, or relationship style, many more will likely be grappling with unrelated issues such as bereavement, depression, or retirement. Indeed queer people are pretty likely to already have engaged in deep reflection around sex, gender, and relationships.

Our professions have a long and deeply problematic history of pathologising queerness and assuming that mental health struggles will relate to a queer person’s sexuality or gender. It’s vital not to reproduce this, for example, by interrogating a queer client’s gender, sex life, or relationship style more than you would a cis or straight client’s, or by assuming that these things will be relevant to their presenting issue.

While queer people do generally have poorer mental health than cis and straight people, this is due to the traumatic experiences that queer people are more likely to have experienced (e.g. family rejection, workplace discrimation, hate crime). It’s also due to the ongoing stress of living in the world knowing that you are considered somehow less normal and valid than others, to the extent that you may well not even be seen as you are unless you explicitly come out with all the risks that entails. Ensuring that you locate client suffering in the unjust culture, rather than individualising it, is a vital part of queer affirmative practice.

At the same time, many people who don’t present as queer will experience some degree of queerness in their lives, which may well be part of their struggle in such a queerphobic world. Statistics suggest that over a third of our clients will experience themselves as to some extent ‘the other gender, both genders, or neither gender’, an even greater proportion will be attracted to more than one gender, and an even greater proportion will be to some extent non-monogamous and/or kinky. Far more than this will - at some point - find themselves falling off the heteronormative standard for a ‘successful life’ (lifelong coupledom, kids, career, property ladder, etc.)

Finally, those who don’t experience themselves in any way queer may well have mental health struggles that are related to sex, gender, and relationship style. We might consider the statistics on suicide among straight cis men, or body image problems among straight cis women, for example, or the majority of straight cis people who report sexual ‘dysfunctions’ and/or relationship dissatisfaction. Exploring gender, sex, and relationships, and affirming queerer options as valid as normative ones, can be particularly helpful for normative clients.

Meg-John Barker is the author of the BACP resource on working across Gender, Sex, and Relationship Diversityas well as a number of popular self-help books and graphic guides on these topics. Website: rewriting-the-rules.com. Twitter: @megjohnbarker.