a queer non-binary client’s views on dichotomies in the mental health professions

personal/professional, public/private

An ideological dichotomy that exists both within the mental health sector and elsewhere is the split between personal and professional life. The BACP Ethical Framework emphasises the necessity of separating the two stating, “We will establish and maintain appropriate professional and personal boundaries in our relationships with clients”. But how is the boundary between professional and personal defined? And what does appropriate actually mean?

The professional/personal binary is similar to the notion of public and private spheres. The private sphere is the realm of personal identity and tends to be associated with intimacy, authenticity and femininity. Like professional life, the public sphere is governed by shared norms and values and tends to be associated with detachment, conformity and maleness. Feminists have long argued that the split between public and private is a myth which perpetuates gender inequality since both the public and private domains are both personal and political.

Professional life can also be both personal and political. As the BACP representative acknowledged in their email* to me, many people are let down by professional services and in my own experience this is often due to not being seen or heard on a personal level. The scale of economic cuts to services that we have seen in recent times has also reduced the capacity and resources available to many professional and public services. Of course, these are all political issues!

Within my own professional field, for example, there are often tense relationships between local councils and residents due to the ongoing reduction in provision for local heritage and library services. As a passionate heritage worker and library lover these closures and budget cuts personally offend and impact on me, but if I wish to remain in regular employment it is also necessary to think carefully before I speak out publicly.

When facing up against authority it’s often easy to feel that we only have two choices: conformity or rebellion. However, examples such as the DERAIL forum, a collective of Library & Information Services (LIS) workers in the USA, show that it is possible to work to dismantle oppressive power structures from within LIS institutions through workplace activism and by speaking openly and authentically about our personal experiences.

To me, “professionalism” is an oppressive social construct that keeps workforces subservient via the requirement for conformity, detachment and the suppression of personal identity, thoughts and feelings. In the article, You Call It Professionalism; I Call It Oppression in a Three-Piece Suit, Carmen Rios explains:

 When we’re told that we need to look or act professionally, we rarely recognize that it’s code for “appear, as much as possible, as if you’re something you’re not and never want to or could be.”

Many people find it difficult to access mainstream therapy services for the same reasons. In Falling for Therapy: Psychotherapy from a Client’s Point of View (p.21), Anna Sands describes how therapy is often a deeply intimate and personal experience for the client, whilst for the therapist it is a more formal work context:

…too much frankness can seem indiscreet or inappropriate in the context of a professional relationship. So a client’s most immediate considerations in this respect may be very different from those which occur to a psychotherapist… In many cases, [therapy] is relatively formal. At the same time, it is unusually intimate. To me, the two seemed at times to be impossibly incompatible

An emphasis on “professionalism” within the therapeutic context can be patronising and inappropriate, especially when the client has already been let down by or betrayed by other professional services. However, for me, the real danger of “professionalism” within the therapeutic relationship is that, since it requires the suppression of personal feelings in favour of conformity to shared norms and values, it can also lead to inauthenticity from the therapist.

In their blog post, Bad, Mad, and Dangerous to Know. A talk for LGBT History Month, Karen Pollock discusses the history of therapeutic attitudes to LGBTQ people and provides evidence of a long history of homophobia and transphobia within the mental health professions. For example, for 25 years after homosexuality was decriminalised in the UK it was still seen as a mental disorder by the Diagnostic and Statistical Manual of Mental Disorders.

The BACP finally condemned conversion therapy for the treatment of homosexuality as recently as 2012, but continues to deliberately exclude trans clients from this statement. In March 2017, Dominic Davies, CEO of Pink Therapy, resigned from the BACP, citing their continued failures to adequately cater for LGBT+ therapists and clients as the reason for doing so (Pink Therapy is the UK’s largest independent therapy organisation working with gender and sexual diversity clients). Within the last couple of months the BACP has also published a misleading and transphobic letter from an anti-transgender rights lobby group in it’s monthly publication Therapy Today.

Why would I want my therapists to be members of an organisation that behaves like this?!

A therapist who adheres to the BACP’s current norms and values is neither helpful to me nor welcomed by me. Transgender people, queers, and all other gender and sexually diverse clients (as well as people of colour, disabled people, working classes, women, activists and others trying to escape structures of oppression) deserve therapy that doesn’t perpetuate the same injustices they experience in everyday life.

I strongly believe that mental health is deeply political, with many mental health issues resulting from societal oppressions that impact different people in different ways. The BACP Ethical Framework for Mental Health Professionals is informed by the dominant culture which is capitalist, patriarchal and heteronormative. Why should I care about these ethics? They’re not my values.

How are gender and sexually diverse clients supposed to resolve issues in a therapeutic relationship when it’s already clear that they can not trust the BACP to be understanding of their ways of life? Where are they supposed to go for assistance? How are they supposed to know who to trust?

*see previous blog post re. email sent to me from ‘BACP Good Practice Manager’. I’m happy to send a copy of the email to anyone on request.


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