Working with distress around gender/sexuality

A version of this article first appeared in the journal of the BAPCA

Since January 2017 LGBTQ+ people have been protected from conversion therapy by members of all of the major organisations which regulate counselling in the UK (1). The harms of conversion therapy have been demonstrated, both through the lived experience of clients, and all research on the subject. A consensus has been reached that trying to change someone’s gender and/ or sexual identity is contrary to ethical practice (2).

However, this leaves a question, especially for those who have “person-centred hearts” – how do we reconcile the known harms of conversion therapy, and the prohibition on offering to change a client’s gender and/or sexual orientation, with a client who enters into therapy in distress about their gender and/or sexual orientation, and wishes to change it?

We can say with some certainty that a person-centred approach can be exceptionally beneficial for gender, sexuality and relationship diverse clients (GSRD). Coming from a place of accepting the client’s reality creates space for a client to bring what they need to a session. A person-centred approach is rooted in leaving the counsellor’s beliefs at the door, and entering into the client’s world without judgement. This can be especially empowering for GSRD clients, who experience a world laden with judgments about their most intimate thoughts, feelings, and ways of being.

As Carl Rogers himself said: “true empathy is always free of any evaluative or diagnostic quality. This comes across to the recipient with some surprise. “If I am not being judged, perhaps I am not so evil or abnormal as I have thought.”

Words like evil and abnormal have dogged the footsteps of GRSD people as they have been criminalised and pathologised. This can lead to internalised homo/bi/ace/aro/trans/phobia. A belief they are intrinsically wrong because they are LGBTQI+. As Dominic Davies discusses here (3), demonstrating the core conditions can of themselves be life changing for GRSD clients. To a client exploring their gender and/or sexuality, to be met with empathy, lack of judgement and unconditional reguard, perhaps for the first time, can be a moment of revelation. One can move from certainity about the wrongness of being LGBTQ+ into a far more nuanced landscape, led by the core belief of the therapist they they do not see you as wrong, or abnormal, or perverted. The client can begin to believe that perhaps the beliefs they have internalised are wrong. To see that the aversion others show is not universal.

From the schoolyard insult of “That’s so gay” to transphobic jokes on mainstream TV, a client can absorb messages from birth about how certain ways of being are aberrations, lesser, worthy of mockery. Whilst the idea of rehearsing in the therapy room may seem to belong to CBT, the person-centred therapeutic relationship is often a rehearsal for the world outside too. Picture a client who looks “male” but tells their counsellor that they are a woman. In a split second a myriad of possible reactions, each with huge repercussions are opened up. If the therapist responds to the client with acceptance of their gender, with empathy and unconditional regard, then the path marked “this is possible outside the therapy room” will seem a little more achievable.

What about the client who says, I am trans and I do not want to be, or I am gay, and I do not want to be? What about the client who feels bisexuality is shameful, or that their thoughts about their gender need to be “fixed”?

Part of our role as counsellors is to hold negative emotions, not to deny, nor seek to denigrate, downplay or minimise them. If someone is in a place where such a vital part of their identity as gender and/or sexuality is causing them pain, that must be acknowledged. Perhaps part of the problem here is simple narratives, often put forward to reassure cisgender (not trans) heterosexual people. There is an idea that, like a butterfly emerging from a cocoon, members of gender and sexual minorities all unfold their wings and fly with a clear and certain knowledge of their destination. In this emergence the only issue faced is acceptance of oneself, which has become framed as being either in or out of the closet. To be in the closet is seen as incongruent and inauthentic, and to “come out” (presented as a one time event of transcendence) is to be one’s authentic self.

Darnell L Moore argues that coming out is in fact a heteronormative construct (4). For some GSRD people coming out is indeed a celebratory moment, but not for all, and, in a recursion of pain, and shame, there can even be guilt at their shame of their identity. As Tangney (5) explores, shame and guilt can be anticipatory, and consequential. A client need not have acted on their desires in order to be feeling shame or guilt about the existence of these desires. Nor do they have to have a clear view of what their authentic self is to have absorbed ideas about what an authentic self is, raising within them feelings of shame, and failure.

Within a person-centered therapeutic relationship, the first step is to create a space where these negative emotions can be displayed, received by the therapist, and not judged. It may feel “right” to say “it’s ok to be gay”, or that gender is a spectrum, and – indeed – further along the road some clients may want and need to hear that. However, such affirmations contradict the client in the here and now, and may add to the feelings of guilt and shame. Just as we would not (hopefully) tell a mother who disclosed she did not love her children equally that she must change how she feels, so we should not tell a client unhappy with their gender and/or sexual identity that they should feel differently. It may feel like challenging the shame is the right thing to do, but the challenge itself may add to the feelings of guilt and shame.

Holding the negative feelings, allowing them to exist, going further, and honouring the trust which leads to their expression, allows space to explore where the negative feelings come from. There needs also to be a space to acknowledge the very real fears some clients may have. As Julia Serrano discusses detransition is often a result of transphobia (6). Each client will have their own particular reasons for struggling, but some familiar themes may emerge. Cultural and religious backgrounds which see their identity as sinful, aberrant or outwith the culture cannot be ignored. Nor can the very real existence of homophobia, biphobia and transphobia in society. In some ways a counsellor can be a permission giver, or denier, to the fears expressed by the client. By openly accepting the negative feelings we say that they have value. It is why it is especially important all therapists, regardless of orientation, be aware of the oppressions a minority client may face. This was reflected in the recent update to the BACP ethical framework (7). Some people face violence, family ostracism, hate speech and rejection by their community. They need to be allowed to express their grief, anger, and uncertainty around this.

For those of us with person-centred hearts it should not be a new step to accept where the client is coming from without interpretation or judgement. As we accept the client’s negative feelings, we must be aware though that we are not colluding with them. We should have examined reflectively how we feel about GRSD people. By collusion, I mean when a client expresses dislike of a part of themselves, it is not our place to agree that being gay, or bi, or lesbian, or trans, or any other identity is worse than belonging to the majority. Acknowledging that society may make it harder, that there may be violent reactions to a client, is not the same as saying society is right. A client may well be right in expressing a belief that life would be easier if they were cisgender and heterosexual, it does not equal cis het being better. In the same way, exploring how a client might accommodate some of their fears, by for example inviting in rather than coming out, should not be about diminishing their identity, but recognising the fears are genuine.

Stonewall Welcomes Clinical Condemnation of Trans “cures”
The Lies and Dangers of Efforts to Change Sexual Orientation or Gender Identity Human Rights Campaign
4.Coming out or Inviting in? Moore (2012)
5.Moral Emotions and Moral Behaviour Tangney (2006)
6. Detransition, desistance and Disinformation Serano (2016) rstanding-transgender-children-993b7342946e#.o2desamtm
7. Just who is educating who? Pollock (2016)


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