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

Boundaries and ethics

In light of the publication of a misleading and transphobic letter from the anti transgender rights lobby group Transgender Trend in the professional journal of the British Association of Counselling and Psychotherapy (BACP) ‘Therapy Today’ this January, I contacted the BACP to ask them about their views on the appropriate treatment of trans clients. Unfortunately I got a very, non-committal and dismissive response which directed me to the new 2018 BACP Ethical Framework.

The BACP and other regulating bodies for therapists and counsellors consistently fail gender, relationship and sexually diverse (GRSD) clients because they don’t understand us, and they are apparently uninterested in learning or examining their own unhelpful behaviours. As I had already explained in my emails to the BACP, part of my issue is with the Ethical Framework itself. I appreciate that the existence of abuse and malpractice within the counselling professions creates the desire for ethical codes or contracts to limit risk and liability, because rules and boundaries can help to create clarity in complex and confusing situations.

However, it seems completely illogical to me to have one universal ethical code that should apply to ALL therapeutic contexts. Ethics are completely subjective. Therapy is also such an intimate, personal and subjective experience. The appropriateness of any particular rule or boundary will vary according to the context and individuals concerned. There is never going to be an Ethical Framework that satisfies every person or every situation.

Meg-John Barker explains in the new edition of their iconic book Rewriting the Rules:

We don’t necessarily need new rules, but we do need to think carefully about the rules we’ve received and whether they work for us. There’s a strong idea out there that there is one “right’” or “normal” way of doing relationships that everyone should aim for by following certain relationship rules. Actually there is no “one size fits all” way of doing relationships, and it’s important for all of us to find the way that works best for us.

In March, Pink Therapy (the UK’s largest independent therapy organisation working with LGBTQ, gender and sexual diversity clients) held a ‘Sex Works’ conference looking at the intersection of mental health and sexuality professions. After the event, several attendees wrote about their disappointment regarding the lack of understanding around sex work within mainstream psychotherapy, and the counselling and therapy regulatory bodies. For example, Tania Glyde (a member of The London GSRD Practice) wrote in her blog after the event:

It was particularly saddening to see how the psychotherapy establishment continues to conflate sex work with abuse. It seemed impossible to discuss the ethics of being a dual trained practitioner, or a sex worker being a psychotherapist, without the discussion leaning further and further into complaints, abuse, and the nebulous and highly politicised concept of ‘disrepute’. It was pointed out that sex work is actually legal in the UK – and yet there is a persistent lack of clarity on this in the psychotherapy world.  This is part of a bigger picture, of a generalised lack of understanding of GSRD clients and identities that is consistently displayed in mainstream psychotherapy.

Starlight Therapy also wrote about the event:

My anger is felt towards the counselling regulatory bodies whose frameworks demonise people who are dual trained in both sex work and therapy. They come from a place where the assumption is that people will be engaging with a single client in both roles simultaneously, this is just not the case. These beliefs coming from cases which have nothing to do with sex workers and everything to do with therapists abusing their power. I was saddened at the lack of awareness of their own privilege the representatives from both the BACP and CORST showed (the UKCP rep did not attend- for reasons which in my opinion conveyed a lack of respect and a dismissive stance on the importance of the discussions that need to be had).

The current Ethical Framework is written from the cultural perspective of a predominantly (if not exclusively) white, monogamous, heterosexual, cisgender and middle-class standpoint, and as such it prioritises behaviours that are considered to be ‘normative’ from that specific cultural experience. As a result the Framework leaves out others (both clients and practitioners) who do not fit that cultural experience, causing them to feel unseen, unheard and unprotected.

In the book When Boundaries Betray Us (p.186) Carter Heyward argues that rigid rules and boundaries, such as the ones in the BACP Ethical Framework, also reinforce the structures that ensures patriarchal power remains in its place:

those most involved in efforts to curb sexual abuse by therapists and clergy often tend to absolutize boundaries as walls that discourage intimacy of any sort between professionals and those with whom we work. This absolutizing of boundaries serves to reinforce the abusive logic upon which the healing professions have been structured in the first place – that is, to hold patriarchal power in place… it is, after all, only in relation between and among ourselves – students and teachers, clients and therapists, sisters and brothers – that we can find our truths about intimacy, safety, risk, or boundaries.

What is the opposite of being boundaried? In ‘Boundaries and boundlessness’ in Therapy Today, (Vol: 21, Issue 8, October 2010) Nick Totton explains:

One answer is ‘unboundaried’; another is ‘boundless’. Undefensive practice, I suggest, draws on a sense of boundlessness – abundance, space, attention and care… Yes, a practitioner who cannot offer her clients boundaries is dangerous. But a practitioner who cannot offer her clients boundlessness is useless.

Fundamentally, I believe that an externally imposed rule or contract can never be an adequate substitute for informed and enthusiastic negotiated consent. We simply can’t assume we know what people want without listening to and learning from them. I also believe that honest, transparent communication is the basis for all mutual trust.

I want therapy that not only acknowledges that gender, relationship and sexually diverse people exist (and might have some specific needs), I also wish for therapy that wholeheartedly embraces intersectionality and queer theory and seeks to disrupt and dismantle oppressive structures. I want agency in the therapeutic process, shared decision making, and the possibility of creating our own code of ethics together.

The skills that would be necessary for this: communication, establishing boundaries, negotiating consent and understanding power dynamics are also the very skill sets that sex workers and GSRD therapists working with queer, non-monogamous and kinky people, use and discuss in their everyday work, so who better to lead to the way?

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