Surviving as an exploratory therapist in a hostile environment
Surviving as an exploratory therapist in a hostile environment
Editorial note: The following article outlines some of the issues facing therapists in the US and UK who are trying to provide exploratory (i.e. mainstream) therapy for gender questioning young people and adults in the current very adverse and challenging professional environment. It briefly summarizes the key findings of an online survey of therapists belonging to Therapy First, an international organization committed to offering therapeutic responses to this client group, as distinct from providing only gender affirming care, which is inevitably linked to progressing clients along a highly medicalized pathway. The author, Peter Jenkins is a counsellor, supervisor, trainer and researcher in the UK. He has been a member of both the BACP Professional Conduct Committee and the UKCP Ethics Committee. He has published a number of books on legal aspects of therapy, including Professional Practice in Counselling and Psychotherapy: Ethics and the Law (Sage, 2017). He writes regularly for Critical Therapy Antidote on gender issues in therapy.
The article was recently published over at ’s Substack. James, like Peter, is a member of Thoughtful Therapists, a campaigning group in the UK. James writes for his own Substack and is a frequent commentator on gender politics on social media. It is being republished here, by agreement with James, to bring these research findings to the attention of a wider US audience and also to link them to the international online webinar being held by Therapy First and Thoughtful Therapists in June (see below for registration details).
One of the Cass Review’s strongest impacts has been in accurately describing the extremely toxic debate about gender healthcare. “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour.” However, this is an inevitable by-product of the take-over of professional therapy associations by gender ideologues. Free debate about different therapeutic responses to gender issues has been stifled. A false consensus has been imposed on our professional journals and training events. Even now, there are calls for the Cass Review to be ignored, because it has failed to come up with the answers and policies favoured by a tiny minority of ideologues.
Cass Review:
Fortunately, the Cass Review is receiving strong support from the government. Health Secretary, Veronica Atkinson MP, has pledged to “work with NHS England to root out the ideology that has caused so much unnecessary harm.” This response needs to address the muddy debate about the respective roles of conversion therapy and exploratory therapy with regard to gender concerns. Implementing Cass will prove impossible, as long as therapists are hamstrung by their professional associations’ support for the Memorandum of Understanding on Conversion Therapy (MOU). The MOU equates conversion therapy for gender identity with past, discredited attempts to change sexual orientation. It is cleverly worded in such a way as to sideline the key role of exploratory therapy. In the Tavistock Gender Identity Service (GIDS), the MOU was understood by senior staff to mean that gender affirmative approaches to therapy with children should be applied. We have all seen the end results of this misguided policy. The Tavistock GIDS was judged to be ‘inadequate’ in 2020. Just recently, it was closed down for good.
Toxic debate:
As part of this toxic debate on gender therapy, therapists committed to mainstream, exploratory approaches have been on the receiving end of malicious complaints, sacking, and cancellation of their employment contracts. Activists have trawled social media for any clients prepared to complain of having been subject to conversion therapy. Undercover filming of therapists using exploratory therapy has been used to try to amass evidence of unethical practice. According to Carol, a former member of the trans community, “if anybody got wind of a therapist who was not…100% supportive of a trans identity, you would root them out like a poison and just try to destroy their lives.”
Researching exploratory therapists:
So how do such therapists, committed to providing exploratory therapy, manage to survive in such a hostile professional environment? This was the starting point for some research we
carried out. We were keen to understand how therapists found ways of working, when under a constant barrage of criticism from employers and colleagues, and attempts to undermine their professional reputation by activists and by some hostile clients. We looked at a sample of 89 therapists who were members of Therapy First, an international organisation of practitioners. This offers exploratory therapy to clients, and works mainly in the US and UK, plus other countries across the globe.
Working in a hostile professional environment:
We found that therapists offering exploratory therapy were often practising in a hostile working environment. This constrained their ability to engage in normal professional activities. It curtailed their freedom to debate and discuss contentious issues about evidence-based practice in this heavily conflicted field. So, for example, over half of the states in the US have legal sanctions for allegedly practising conversion therapy, particularly with children under 18 years. However, conversion therapy is often defined in a catch-all manner. It can include non-affirmative therapist approaches, such as failure to share or use preferred personal pronouns, or to validate a client’s often labile sense of gender identity.
One half of therapist responses referred to experiencing a hostile environment for their practice. Interestingly, this related much more to the critical attitudes of their fellow therapists than to the activities of their professional associations. (Almost all therapy associations have policies which oppose alleged conversion therapy and support gender affirming therapy.) One third of responses referred to experience of a complaint. This was broadly interpreted to include threats of complaint by colleagues, clients or third parties. Actual formal complaints were rare. Hence one therapist reported that “A few local practitioners complained to the licensing board about my refusal to offer affirmation therapy. They claimed I am transphobic, homophobic, and racist.”
Anxiety regarding complaints:
Such allegations might lack convincing evidence. However, they could clearly make a therapist feel harassed and anxious about their ability to survive and to earn a living. We found that half of therapist responses referred to anxiety about experiencing a complaint, or another form of hostile action. It also emerged that the vast majority of respondents were working in private practice. This raised an unanswered question for us as to whether this was partly a conscious survival strategy. Private practice could possibly provide greater professional autonomy for therapists to practise in their preferred manner. This arose from the fact that many therapy agencies were so clearly ideologically captured.
Surviving under pressure:
So how did therapists survive this kind of pressure? Generally, therapists used long-established means of finding the clients who were looking for exploratory therapy. They also deflected those who were seeking only gender affirming therapy. Often, they did not view their client group as unique, or conclude that gender therapy required highly specialist training. Therapists relied on their core therapy training to provide the best working model for their own practice. As one therapist put it, “I’ve really done nothing other than practice the way I always have.”
A key finding was that almost half of therapist responses referred to their primary commitment to their therapeutic role as a key motivation to continue working under this unrelenting pressure. There was a strong sense of the therapists’ dogged refusal to give in to external pressure, however intense. As one therapist explained: “I care. People are being harmed and they don’t know it.”
Article download:
Peter Jenkins and Dwight Panozzo. “Ethical Care in Secret”: Qualitative Data from an International Survey of Exploratory Therapists Working with Gender Questioning Clients. Journal of Sex & Marital Therapy. (2024).
Article download here.
Webinar: Holding the Space for Exploratory Work in Therapy
Seminar Description:
Co-sponsored by Therapy First and Thoughtful Therapists, this webinar will highlight some of the main findings of the research paper recently published by Dwight Panozzo and Peter Jenkins on the professional practice of members of Therapy First. This looked at how therapists working with clients experiencing gender distress are able to practice successfully in today’s very challenging professional climate. The speakers will unpack the background and context to the highly contested terrain currently facing therapists at present, and provide a necessary defence for exploratory work within the main therapy modalities. It will offer an optimistic perspective for the fresh opportunities for exploratory work within therapy which are now opening up in the post-Cass Review environment.
Thursday 13 June 2024, 12.00 pm – 1.30pm EDT (New York)
Thursday 13 June 2024, 9.00 am – 10.30pm PDT (Los Angeles)
Thursday 13 June 2024, 5.00 pm – 6.30pm BST (London)
This seminar will be solely on Zoom $20.00 USD ($10.00 for Therapy First and Thoughtful Therapists members)
Bookings can be made here.
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