This March I attended, and presented at the annual Pink Therapy Conference,  an international event, with attendees from as far away as Australia. Usually if I either present, or attend a conference I write up my thoughts very quickly, however this time it has been necessary to let my ideas remain free, as if pinning them to the page too quickly would mean reducing them in some way, or perhaps presenting as finished something which is not yet fully developed in my thinking. As a therapist I’m always conscious of who I’m talking to, and the need to use appropriate language. At the same time I think it matters that I exist not just in the moment of therapeutic contact, but also someone who cares deeply about making sure that the framework that supports my practice is ethical, rational and supportive. This has been much on my mind as I reflect on the conference.

I can highly recommend these two pieces on the conference, by Tania Glyde and Teresa Brooks, fellow professionals who not only describe the events of  groundbreaking two days, but also highlight some of the changes which have to happen.

In many ways the conversations, and the thinking since has revolved around the question of ethics. This can I think be subdivided into four main areas.

1. Referrals and Ethical Touch We learnt a lot about therapists who use touch, and other aligned professions such as sex coaches. The fundamental question of whether it would be ethical to refer to a sexological body worker, sex surrogate, or other professional using touch is I believe relatively easy to answer. Just like any referral is it in the best interest of the person coming to therapy? If so can we be sure that the person referred to is themselves ethical. Here I have to thank Kian de la Cour for detailing the ethical standards of the ASIS. The panel discussion on the second day made clear however that some regulatory bodies are unwilling to accept such referrals are ethical. This feels particularly odd when therapists who espouse anti trans prejudice are deemed to be OK, but those who would refer to another trained professional for body work are not. In the heated debate about disrepute the point was made that sometimes to be disreputable is to be moral. When the status quo upholds harmful opinions, it does seem that our definition of disreputable is based on not rocking the boat rather than harm. This goes against the very history of the profession, where we began from a place of asking awkward questions of society in relation to a number of issues.
2. What makes someone unethical. Secondly, there is the ethical question of those with dual roles. There seemed to be a genuine fear that people would turn up in an office, unsure if they were there for talk therapy, a sex work booking, or some form of therapeutic touch. Furthermore it became apparent that due to the stigma and taboos around sex that it was assumed those who had other jobs would be unable to stop themselves abusing clients. The idea of anyone who is not cis het and monogamous being a sexual predator is of course a common myth. When it comes to sex workers there is a tautological duality where they are both agency-less victims, and sexual predators at the same time. Ethically all of us need to look far more deeply into both our attitudes towards sex, and the marginalized in our society. I wrote a letter of complaint when Therapy Today presented the idea of unaware and unreflective emotional responses to porn as acceptable. I think our current blinkered attitudes harm all those who come to us. It may be most visible in our treatment of gender, sexual and relationship diversity but it is a universal problem particularly within counselling. It seems  we have thrown the very idea of having grown up conversations about sex out with the Freudian bathwater. Counselling in particular needs to reawaken its understanding of the sexual, in the widest sense of the world, rather than upholding the mores of wider society at all costs.
3. Who is our ethical framework for? Now I know regulatory bodies will say it is for the protection of the clients, the people coming to therapy in a state of vulnerability. As the panel discussion made clear though, the rules have been written for those who abuse, largely white, cis het men who have exploited their power and privilege. We were told over and over that we could not refer to body workers, that therapists who were sex workers posed a risk (and the shocking comparison of sex workers and pedophiles still makes me shake with anger) because of the actions of those who abuse. The hierarchy of who matters, and who does not, was made clear. Touching must be seen as outside the pale not because of the unethical practices of those in the room, but because of the abuse by those not in the room. As was said on the day, the marginalized are expected to carry the burden of the behavior of those with power. It reminds me of the huge resistance to allowing therapists to disclose they are GRSD, led by those who are are not GRSD. Both therapists and those accessing therapy were denied authenticity and a better therapeutic experience (and outcomes) because the most privileged in our society had not processed their discomfort with those who have less privilege. Indeed some research has shown that those in therapy are far less concerned by disclosures of gender/sexuality that the great and good of the profession would have us believe. Which brings me to my final point.
4. Who is missing from this conversation? There was a lot of talk at the conference about what is best for clients, but of course there were no clients in the room, or at least not in the “us and them” conception of the term. I am a person in therapy, I am also a therapist, this duality is as close as we usually get to actively inviting clients into the room. What do those seeking therapy think about this? Would they like us to be able to refer to other aligned professionals? On the other hand, if the prejudices of cients, against groups like sex workers, are unfounded, do the regulatory bodies have a duty not to side with them, but to challenge the prejudice? There seems a paternalistic “we know best” at the moment, and I feel this conversation must be widened out to include those accessing, as well as those providing therapy.

It is clear that I am not the only person who left the conference thinking, more must be done to answer these questions. I am currently, with others, in discussion about how to improve training, as well as building links and community with those who so far have been excluded from  mainstream therapy. This piece is very much a first thoughts, and this is a topic I shall be returning too.

There is an interesting perspective on the conference from the Psychotherapists and Counselling Union here.

Meredith Reynolds has very generously made the slides of her talk Somatic Sex Education available here.