Freedom of expression around diversity guidelines

Following the response to J.K. Rowling's essay 'Reasons for Speaking Out on Sex and Gender Issues' and the 18 June Newsnight report of safeguarding concerns at the NHS Gender Identity Development Service, we call for an immediate review of the recent BPS Guidelines for Psychologists Working with Gender, Sexuality and Relationship Diversity (BPS, 2019).

These guidelines state that a 'gender-affirmative' stance should be the default position adopted by psychologists. We are concerned that the instruction to 'integrat[e] an affirmative stance into their model of practice' restricts the use of many core models (systemic, trauma-informed, developmental) in formulating the factors resulting in the clients' presentation. This places limitations on researchers and practitioners exploring the wider context of 'gender' and seeking to establish 'best-evidence' for the support of individuals with gender dysphoria.

For those unfamiliar with the guidance or discussion in this field, 'gender affirming' practice calls for psychologists to work on the basis that an individual's belief in self-ascribed gender is 'valid and legitimate'. We hope all psychologists value and respect the varied understandings that people hold of the world around them and of their personal experience. We suggest it is possible to value and respect a client's experience, without taking a position of affirmation. Indeed we often do this within our work with various client groups. The BPS guidance stipulates that practitioners validate a belief in gender (both in general and in particular to the individual's sense of self) without considering the evidence base in relation to the practice of belief validation.

Individuals who are questioning their identity with respect to their sex and gender clearly report significant levels of psychological distress. The long-term implications for this population resulting from the provision or denial of access to treatment are substantial. We recognise that appropriate, evidence-based guidelines are imperative to support the skilled psychological practice which our profession seeks to uphold. However, such guidelines can only be effective when these are the result of comprehensive research, conducted in an environment that supports free and independent enquiry.

In particular, we think it is imperative that psychologists are not prevented from using our core professional skill of formulation, exploring the origins and nature of distress rather than ascribing to one pre-determined 'diagnosis' or explanation. With other presentations we are in agreement that there are multiple contributory factors to psychological distress. It is only from this exploration that we can develop individualised formulations to guide our attempts to alleviate that distress. We think the current guidelines effectively prohibit psychologists from taking a questioning approach and applying ethical practice in these situations. The absence of a robust evidence base supporting psychological and medical intervention is a concern in this rapidly growing population, leaving significant gaps in our understanding of many relevant issues. The disproportionate increase in presentations of females to services, the phenomenon of so-called Rapid-Onset Gender Dysphoria, the voices of individuals who have desisted or detransitioned, and the experiences of those for whom existing treatments have been of value must all be addressed in the search for quality research informing best-evidence practice. Such research can only be conducted in an environment that is open to discussion in a respectful and professionally inquisitive manner.

We would like to see the current guidance withdrawn and the topic reviewed afresh in accordance with the rules of proper intellectual inquiry: the weighing up of evidence; the ethical considerations of psychological practice; and the avoidance at all times of ad hominem forms of argument. Some of the signatories below, with others, have submitted a formal request for the withdrawal of the guidance to the Society. We hope that readers will support our expectation that the freedom of expression of all psychologists will be defended, unambiguously and at all times, in relation to both research and practice.

Dr Katie Alcock (Senior Lecturer in Psychology)

Rachel Corry (Occupational Psychologist)

Ms Nina Gadsdon (Psychology Masters Student)

Dr Louise Fernandes (Clinical Psychologist)

Ms Pat Harvey (Guinan) (Former Chair of the Division of Clinical Psychology)

Dr Peter Harvey (Former Chair of the Division of Clinical Psychology)

Mr Ian Hancock (Retired Consultant Clinical Psychologist, Director of Psychological Services, NHS Dumfries and Galloway).

Dr John Higgon (Consultant Clinical Neuropsychologist)

Dr Anna Hutchinson (Clinical Psychologist)

Dr Gill I'Anson (Consultant Clinical Psychologist)

Mr Eric Karas (Retired Consultant Clinical Psychologist)

Dr Jeanie McIntee (Consultant Clinical & Forensic Psychologist & Psychotherapist)

Dr David Pilgrim (Former Chair of the History and Philosophy Section) 

Julia Richards (Educational Psychologist)

Cas Schneider (Consultant Chartered Clinical Psychologist)

Karen Scott (Retired Educational Psychologist)

Dr Sarah Verity (Chartered Clinical Psychologist) 

Dr Robert Watts (Clinical Psychologist) 

Anne Woodhouse (Clinical Psychologist)

Colleagues who felt they needed to remain anonymous:

Consultant Clinical Psychologist NE England

Clinical Psychologist NE England

Consultant Forensic Psychologist S England

Clinical Psychologist NW England

Society response: We acknowledge that the BPS is a broad church, and there will always be differing views among our members on some issues. We are confident that our guidelines are based on the best current evidence and research in this important area, having been developed by experts working in the field. Clearly we share your concern about the safeguarding of children and young people, but our guidance is specifically for the care and treatment of adults, not children.

The draft guidance was sent out for Society-wide consultation on 19 March 2019. It was also sent to the Royal College of Psychiatrists, APA, BACP, BABCP, UKCP, Stonewall, LGBT foundation and COSRT for comment. At the close of the consultation on 12 April 2019 34 responses had been received. Just one of these responses mentions the issue of dissenting voices that is raised in your letter. This respondent also stated that the document was 'well intentioned and positive'.

All our guidance is periodically reviewed. This particular guidance is the second version, having been revised in 2019. If there is a change in practice or evidence, then the need to revise the guidance would be established. In this instance, we will review the guidance if there are implications for the care and treatment of adults following the outcomes of:

• the judicial review regarding the use of hormone blockers in child services on grounds of capacity to consent
• NHS's Independent review of puberty suppressants and cross sex hormones
• NICE review of the latest clinical evidence.

As a Society we are committed to our members having a view and welcome different perspectives. As such any revised guidance will be sent out for Society-wide consultation and we would welcome your input into the revised consultation process.

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