Today is the 10th anniversary of my first private practice client coming through my door. I’m going to mark the day here.

Becoming a therapist was a fiery process for me. Some challenging things happened during my core training that impacted me a lot as I moved into life as a therapist. Like many traumatic experiences, while I wish these things had not happened, they gave me greater understanding of the system therapists operate in. This politicisation was very useful to me as I developed as a practitioner. Throughout that period I was experiencing similarly intense shifts elsewhere in my life.

A lot has happened in 10 years, to me and to the industry, and in the lives of my clients and colleagues. This is a blog so I’ll keep it concise! I cannot cover everything here. You can assume I could write a whole standalone piece on everything I mention below.

THE GOOD

Retraining as a therapist in midlife

If this is you, your energy levels and capacities are changing and your life choices are shifting. (See also, of course, menopause.) Your experience when training, and coming into the work, will depend on your existing life experience and resources. At midlife you have been around the block, and while your life experiences will not automatically make you a good therapist, they will be useful. 

If you are already well-resourced financially your training experience will be very different to those who aren’t. I don’t recommend juggling the final years of your training on an unpredictable self-employed income with no savings and no credit! But I did it and I’m grateful to past me for hanging in there. 

The evolution of Gender, Sex and Relationship Diversity (GSRD) therapy

I was extremely lucky, in 2013, to find the Pink Therapy community (practitioner directory here). I cannot overstate the importance of this to me as a therapist. 

Bringing LGBTQIA+ people together with people who are consensually non-monogamous and/or kinky, and/or who do sex work, makes for a larger, louder group and a wider range of experience. Particularly as many of those identities and lifestyles cross over.

When I started, GSRD was GSD (without the R), and then someone suggested that relationship diversity ought to come in, to reflect all forms of CNM (Consensual Non-Monogamy). ‘Sexual’ later became ‘Sex’, to include the experience of Intersex people. It’s been amazing to see more and younger therapists come in, and to see more and more GSRD trainings being offered. 

In terms of sex and gender specifically it’s been good to see a greater understanding and acceptance of fluidity (as opposed to essentialism or ‘born this way’) as time has passed, and an expansion of the idea of ‘queer’. 

Sexology

In parallel with GSRD, sexology as a discipline has grown in stature and become normalised. The UK has the Contemporary Institute of Clinical Sexology. There has been an explosion of sex educators on social media. When I was doing sex media in the 2000s there were sniggers – ‘LOL what do you really want to be doing?’ – as if no one could ever take sex seriously as a topic, despite its universality. I am very happy to see that attitudes have shifted a lot. People are doing research around porn, and sharing information (eg Facts of Porn), and favouring ideas of compulsive sexual behaviour over outdated concepts of sex addiction. 

Sex work

Sex work is being discussed increasingly as an issue of labour rights and of decriminalisation rather than something that brings the world in general (and the therapy industry in particular) into ‘disrepute’.

Consent

Consent has been talked about more and more and I am grateful to those at the forefront of this. I have been on a huge journey around consent, in both my personal and working lives. Many people now offer training and information around what consent can look like, and what to avoid (eg The Art of Consent‘s downloadable guides; the Consent Collective; and the Wheel of Consent).

It takes a while to absorb the fact that just because you want something doesn’t mean the other person wants it too. We do well to ask ourselves ‘Who is this for?’ before any interaction, whether instigated by you or the other person. My greater understanding has come out of my time in kink and somatic sexology. But my heart breaks for much younger me – and thousands, millions, of others.

When touch is involved, consent is essential. But consent is essential whether touch is involved or not. It’s caused me to think more and more about what consent means in the therapy room.

Trauma

Our understanding has increased and this is important. It is about the individual as much as about what happened to them. Over the years I have expanded my understanding of trauma and CPTSD – I did not realise for a long time that I was experiencing it from a young age. For sure, I knew enough about it and that others experienced it. But me? No, surely not. Many people experience chronic relational trauma from childhood and its impact is incalculable.

The rise of Counsellor Power

Counsellors have been talking back to the industry for a while now, and this movement has grown and grown. (See Counsellors Together UK) There has been increasing fightback around exploitation and being expected to work for free, and against recent changes to the industry that resemble Brexit both in their unfitness for purpose, poor evidence base, and the non-consensual way they are being implemented (see below).

Thankfully therapists nowadays have a union, the Psychotherapy and Counselling Union (PCU), which also supports trainees. Founded in 2016, the PCU did not exist when I really needed them. I wonder how different my experience would have been if I had had them by my side.

THE BAD

OK, so there are a few qualifiers to what I’ve said above.

Despite GSRD now being officially a therapeutic modality, GSRD therapists are still a relatively small community. Overall, the therapy industry as a whole remains highly conservative. Also very white and middle class. I get a strong sense of a group of people holding on very tightly to something and refusing to let go.

In the case of sexology we are still not talking deeply enough about what sex means and who gets to say what it is and who has the power to create this narrative.

Also, there are still therapists who want their sex worker clients to stop doing sex work before the therapy can start. Sex workers still have to think very hard before disclosing to their therapists.

The trauma therapy industry has proliferated and trauma therapists who don’t understand trauma has become a disturbing theme. There are still, apparently, therapists who tell clients that the work cannot start until the client stops dissociating. One high profile trauma training site used to put the names of people who had purchased their products along with their home cities literally on the front of their website. A while back I pulled out of a trauma training just before it started because one of the admins (a therapist) shared all the participants’ home addresses and phone numbers with each other, without warning or obtaining consent. 

And people are still being labelled ‘borderline’ when they are actually traumatised or neurodivergent, and this label is still being dumped onto young women, queer and trans people, causing further stigma. I’ve actually seen high profile therapists on Twitter use ‘borderline’ as a way to put someone down during an argument. (Therapists on the internet is a rich and concerning topic which I will spare you today.)

The attack on Trans rights

Trans rights have been increasingly under attack across the UK over the last 10 years and more. This ongoing attack has found its way into the therapy industry, partly in the form of conversion therapy. The fact that this is happening represents a failure of human rights awareness and of feminism, a lack of understanding of patriarchy, and a lack of respect for humanity. To see this manifesting among therapists is disturbing and highly distressing.

Therapeutic harms

Harm in therapy is being discussed more and more (and I myself have absolutely been harmed in therapy) as well as harm in training (ditto). It’s important to remember that one mirrors the other. I have heard terrible stories of trans trainees being bullied, debated with by facilitators, and expected to educate other students; endless racism and classism; lack of regard for, and understanding of, systemic and intersectional issues; and breaches of confidentiality.

If it’s happening in training it’s happening in the therapy room.

Racism and white supremacy

Where racism and white supremacy are concerned, not enough change is happening. I don’t see enough will to make this profession accessible to those who are minority or global majority identified. There are a number of practitioners offering books and courses that provide opportunities for self (and organisational) reflection. For example: Race Reflections (Guilaine Kinouani); Me & White Supremacy (Layla F Saad); Working Within Diversity (Myira Khan); Dwight Turner (Training and books); Somatic Abolitionism (Resmaa Menakem). There are many others paving the way for improved education – their work needs to be built into counselling from the start.

Large scale shifts in the industry, in the form of the SCopEd project, do not seem to be addressing any of this at all (basic outline here ; many critiques here) and in fact seem to have the intent of entrenching old ideas further. Any idea that context and identity matter, and affect a person’s experience, seems still difficult to grasp. It represents a systemic failing, which is interesting because Systemic Therapy as a modality seems to have be ignored throughout.

There is still too much medical model, top down, old school thinking lurking behind a humanistic mask. Many would also say that western notions of therapy are harmful and we need less individualistic models. For more on this check out the Radical Therapists Network, founded by Sage Stephanou; and Dr Jennifer Mullan whose book Decolonising Therapy is coming out on 7th November.

On a meta level the psychotherapy and counselling world industry exists in a place of non-consent and we need to be naming it.

BEING A THERAPIST IN A PANDEMIC

This gets its own special section. 

As my supervisor put it, therapists have been helping our clients process their responses to Covid, while processing our own responses to it – in real time. 

And we have all been simultaneously processing rising fascism and climate catastrophe.

A huge amount has happened in my life since spring 2020, in the form of positive change, huge personal revelation, and profound loss. And a huge amount has happened in the lives of my clients.

In the therapy world, the endemic technophobia (yes, another failure of education) showed itself through the mass panic when taking our practices online became a reality. I was grateful that I had been seeing some of my clients online for a number of years before lockdown started. (I now work entirely online.)

The pandemic also revealed terrible ableism, which persists. There seems to have been a collective denial, and a deliberate ‘forgetting’, of the ongoing experiences of those with Long Covid, even among ‘nice queer lefty’ circles. This has happened across society. Collectively, society had a chance to change the way we relate to each other (eg wearing masks to protect everyone, for a start) but, for multiple reasons, this hasn’t happened.

Closer to home, (the therapy world mirrors outside society, as you might expect), anecdotally some core trainings seem to have avoided dealing with Covid and protecting all their students over this period. Anyone with disabilities or health vulnerabilities (or the potential for them) may be forced into shadow. Speak out and you risk being isolated further. I would love to hear about organisations (and I’m sure they do exist) that are acknowledging the realities of differing health and disability needs of their students.

NEURODIVERGENCE

This also gets its own section. This is the biggest shift for me. For many years my thoughts on mental health and psychotherapy, as well as my experiences in therapy, have coalesced in a way that I could not articulate. As time has passed, I’ve come to understand how some of the conventional therapy narrative may be actually harmful to neurodivergent people. (I am including trauma and chronic anxiety/depression on top of Autism, ADHD, OCD etc.) It can feel like gaslighting and does not take into account how ND people experience the world. It actually starts to feel like a kind of conversion therapy.

In the last few years, as I have explored and confirmed my own neurodivergence, I have started to understand these concerns. During these explorations I’ve been consistently amazed by the sheer numbers of neurodivergent people working to shift attitudes and make life better for what is turning out to be quite a lot of us.

THE EXCELLENT

With everything I’ve named above, what keeps me in this profession?

Being part of something bigger. Receiving knowledge gained from others’ experiences, and offering it too where I can. I hope I have contributed to this profession in some way. (You can find some of my work here.) Working in private practice can be isolating, so having a community around you is invaluable and important for wellbeing.

My supervisor(s). I have been with my current supervisor for eight years and I’m endlessly grateful for her wisdom and experience. My previous supervisors also brought good learning into my life.

My colleagues. I’ve met some amazing colleagues who have become close friends. The GSRD community as a whole has been an absolute fount of wisdom. There are people out there doing important work who I am proud to know and learn from.

My clients. I could not have got here without the courage and the trust of all the people who have come to work with me over the years. It’s a great feeling having helped someone find a clearer path through life. 

What a journey it’s been. And continues to be.