Déjà vu in diversity discussions?

I was surprised to see the letter 'Freedom of expression around diversity guidelines' in the October issue of The Psychologist. In that letter Alcock et al. argue for the withdrawal of guidance for psychologists working with gender, sexual and relationship diversity (GSRD). I was surprised because I simply do not recognise the version of the document described.

Contrary to what is claimed, nowhere in the actual document do I see a rejection of useful models, not unless they refer to the statement that 'modalities which do not accept GSRD identities and practices as being entirely as valid and legitimate as other identities and practices must not be used' (p.7) – but that doesn't stop us using helpful models of practice, and on what grounds would psychologists want to use any approach that pathologises sexuality and gender?

Similarly, nowhere do I see a definition of affirmative, let alone one that suggests a rigid, static understanding of gender that is not open to evolution, updating and development in light of deepening understanding. Nor do I read a call to eschew research – neither the use of existing work nor work that would further strengthen the field. To the contrary the guidelines explain that 'psychological practice should be evidence-based and include established best practice' (p.7). It is for this reason that I have used these guidelines in my teaching for many years and students have never voiced the concerns outlined by these colleagues. To the contrary, what has happened on several occasions is trainees have fed back that these guidelines are unusually clear and useful and help them think their way through the complexities of practice. Of course, this doesn't mean that these guidelines cannot be further developed but nowhere does the document claim to be the final word. It is clearly open to ongoing development as evidenced by this being the second iteration and I was pleased that the Society noted some potentially useful areas of development already on the horizon.

These colleagues feel 'the current guidelines effectively prohibit psychologists from taking a questioning approach and applying ethical practice in these situations'. How on earth does one come to this understanding? I am perturbed as there is a 'déjà vu' quality to this argument. In years gone by, multiple discussions/arguments occurred to the effect that we should not offer lesbian and gay clients an affirmative therapy. Amongst the range of concerns (some scarily problematic) seemed to be a concern that 'affirmative' might have to mean the privileging of a static identity marker over and above an attuned understanding of lived experience. I hear echoes of that here. Yet, it seems to me that, as in the past, these concerns can be ameliorated with the recognition that 'affirmation' does not imply anything static. To affirm as valid, the experience being described, means that one has to recognise what a client tells us is valid. We should still be aware that that may become more alive and nuanced as time goes on – experience is dynamic and in flux. Affirmation does not require a premature assumption of one singular experience, not if one is truly aiming to be attuned to the client's experience. Initial understandings are always open to evolve, contrary to what seems to be floated in this letter this document supports formulation. Although I would be concerned if a psychologist was found waiting to pounce and somehow doubt an expression of sexual or gendered identity.

Contrary to the authors' claim, these guidelines do not imply that GSRD folk should be understood as not having 'multiple contributory factors to psychological distress'. In fact, the guidelines explicitly remind us that 'many of the principles and guidelines discussed below apply equally well to heterosexual, monogamous and cisgender people, as well as people with forms of diversity other than sexuality, gender or relationships' (p.4). This is an explicit suggestion that we should bring our most contextualised understanding to all clients. If it were the case that a client's experience led a clinician to have to somehow doubt the gendered or sexual identity aspect of a client's experience, this can still be assisted by these guidelines, they simply remind us that good practice requires that 'robust clinical reasoning should be presented on those occasions when an identity or practice is not supported' (p.6). How is that not best practice?

So rather than see a need to withdraw these guidelines, I would think there is a need for them to take greater prominence in psychological training and policy in order to ensure that a richer, more nuanced understanding of them is available to more psychologists, and that in turn, we as a Society would be more able to respond usefully when the time comes to update them. That is where the real value of freedom of expression would come to the fore, potentially resulting in a vital and enriching engagement rather than simply more of the 'cancel culture' that is so prevalent today.

Professor Martin Milton
Regents School of Psychotherapy and Psychology
Regents University London
[email protected]

Additional info [16 April 2021]: The BPS guidelines for psychologists working with gender, sexuality and relationship diversity are aimed at practitioners working with adults.