Negligent apathy – the pandemic gift that keeps on giving

Close up of a wet pavement with a small segment of orange dropped on it.
Out walking a few months ago, I noticed a baby navel orange that had been dropped on the ground.

What happened to our capacity for relating?

There is something that I have been noticing for a while now, in every part of my life.

Over the last three years, our capacity to honour working arrangements, connections, friendships, and even simple responses has often become severely impaired. Of course, I include myself in this.

So how have we come to this normalisation of burnout? Behaving as if those around us are disposable, and it is simply too much effort to put ourselves in others’ shoes and understand the consequences of our actions, because we are just too zoned out.

We were already overloaded

Looking back to long before the pandemic, many of us were already at the limits of our capacity to endure stress. This might be due to a minority or global majority identity, past trauma, juggling survival (perhaps with disabilities, housing issues, chronic health issues, and/or chronic financial stress), and the sheer exhaustion of living in a society that is, increasingly, trying to kill us. Then there was and is climate change and the rise of fascism.

Even if we had ‘enough’ resources for the day or week or month, or even the year, and were in good health, the spectre of that changing was ever present.

When you’re already on the edge, small setbacks feel like big ones, and big ones feel like catastrophes. If you haven’t had time to recover from one thing, and another one happens, you are dealing with more than one layer of response, and these layers can quickly pile up. This over time is likely to reduce your capacity for empathy and your energy to receive others’ bids for attention or help, let alone your capacity to respond to them.

The impact of sudden change

We have all had different responses to the pandemic. But one thing is true, that we all had to adapt to Covid-19 very quickly. Over time, we realised our resources were shrinking : social, personal, and financial. While time seemed to stretch, and some felt persistently hopeful that we were almost out of the woods (we aren’t, still), many people found themselves with less energy. Many people stepped away from relating because it just took too much personal resource.

Remember the frenetic activity of those suddenly finding themselves at home all days? Creating mockups of famous paintings using saucepans and pet cats, learning Italian, and baking sourdough. Those whose labour keeps society propped up were neglected, while being expected to keep turning up for work, or they would lose everything.

The pandemic itself

If you have Long Covid, (or greatly fear getting it for all sorts of valid reasons) you will have been navigating that on top of the huge society wide denial by many governments that the pandemic is still happening. A very redundant form of individualism has been normalised and encouraged, as if to check whether others are okay – family wide, community wide, or country wide – is seen as laughable. An infantile notion of ‘freedom’ has been invoked, freedom from ‘lockdown’ which sounds carceral and something to be rebelled against, instead of a way to keep us all safe.

People as a whole have been encouraged since the start not to take the pandemic seriously. So many aren’t wearing masks now, or acknowledging the decreased capacities, and increased access needs, of a significant minority of people. I am sad to see this even in queer/left community. I wrote more about this here.

This is a trauma response

Before you think I am condemning all humans, it is very clear that this negligent apathy is also a trauma response. Many people have been struggling to connect the way they did before. They may have felt abandoned by close people, friends, partners, and the social system they exist in. They may have experienced multple bereavements, both due to Covid-19, waiting lists, or inadequate medical care due to a deliberately depleted NHS. They may have hated working from home, or been laid off work, or lost their business. They may have been evicted by a rogue landlord.

Life has changed, and this is the new normal, but many people still feel that we can get ‘back to normal’ with no consequence. I find this somewhat delusional – but I am well aware sometimes our delusions and denials are all we have in order to remain upright.

Traumatic dissociation is a major driver of what I am talking about in this post. Dissociation is a very valid survival response and most of us fall into it at some time or another. It may for example be masking a flight response, or a freeze, or any other response to overwhelm.

And what is hard to talk about here is that trauma can make us self-absorbed, selfish and worse. Trauma isn’t pretty. The fight response often isn’t, and the fawn safety response (tend and befriend, caretaking, or appeasing) tries to be pretty, but often can only be sustained on the surface. I’ve even noticed a hierarchy of trauma responses – basically fawn is the most acceptable, and fight the least – which deserves unpacking in another post.

How do we reframe our existence, heal, and reconnect?

I wish I had an immediate answer to this.

I admit that I have been shocked to the core by the behaviours and attitudes of people that I thought I knew. And I know I’m not alone in this. I’ve been baffled at being ignored, over and over, when attempting to maintain a collaboration. Again, I know I’m not alone. Endless one-sided initiation feels like a mug’s game, and trust seems in short supply now.

One thing this society does is divide and rule. The more we fight each other, the more we remain divided. I also know that it is not that simple, and in many cases of discrimination there definitely aren’t two equal sides.

I hear people in certain circles criticising individualism and insist on community all the way, especially in terms of transforming society from the extractive to the supportive. Which is fine, but many of us have not been trained in how to be in community, and we have no experience of how to do it at all, let alone well. And when we do try, very often abusers (emotional, financial, or sexual) find their way into positions of power. It happens over and over again.

There is a lot of work to do here, and a lot of healing and reconfiguring. And we have to start somewhere. As in therapy, sometimes all we can do to begin is make the unconscious concious, by naming what is going on and keep it from falling below the surface again.

How do we tend our grief?

Photo of tyre tracks on frosty grass.

2021 has been a hell of a year

Globally, nationally, community-wise, and personally, it has been extremely challenging. While for me this time has also been transformative, grief has also been ever-present, particularly in the last six months. So last week I was very glad to participate in a grief-tending workshop, of which more further down the page. But first, the year.

Good things

The Queer Menopause project went from strength to strength. My research was published in February, I spoke at conferences, wrote a chapter for a therapy book (publication in 2023), met some excellent and inspiring people on Instagram, and gave written evidence to UK Parliament (Ref: MEW0087). I joined up with the Global Menopause Inclusion Collective, and I will have a piece in Mona Eltahawy’s Bloody Hell! And Other Stories, Adventures in Menopause from Across the Personal and Political Spectrum. (Please support this Unbound crowdfunder if you can!)

It’s all very exciting and I’m delighted by the increasing support and attention that this project is getting. 

Another good thing: after they Found Something on a scan, I spent a month wondering if my breast cancer had come back. It turned out to be the shadow of a mole. Oh the relief.

Sad and challenging things

This was a year of losses. Three people died, all of whom I had a different kind of connection with and all of whom were, in different ways and degrees and at different times, significant presences in my life: 

• Sue (who I had known for about four years, was part of various communities I am in, and was a powerful presence in them). 

• Ruby (who I had known since the mid 90s, who I met at a bar when I was first exploring the scene, and who took me to my first Pride in 96 or 97). 

• Tobias (who I had known since 2010, whose events started up just as I was coming out of a two year physical and mental health hole since having a stroke in 2008, and via whom I met a whole new community of people who remain friends today.)

All of you, Rest In Power.

And then there was the loss of, and damage to, some significant connections due to miscommunication and conflict. This is what happens when we are carrying more trauma than we know how to deal with. ‘Community’ feels like a fragile thing at times, particularly in the shadow of a pandemic, and self care comes in many different forms. Covid times have amplified all of our experiences in this. My work as a therapist reminds me of this daily.

What I have described above is just part of what happened this year, but by the end of it I was feeling washed up and unformed, like a plastic bag on a beach.

Embracing grief

Then, a week or so ago, I was scrolling on Facebook when I saw a link to a workshop which really resonated with me and I thought, it’s time.

Embracing Grief was hosted by Tony and Sarah Pletts of Love & Loss, and Bilal Nasim. (Disclosure: I have known Tony and Sarah for a number of years. I know them as highly experienced in holding spaces of all kinds and don’t hesitate to recommend their work.)

This page explains in more detail the nature of grief-tending. It is not therapy, but a place to be witnessed and to witness others. The workshop I attended was four hours online, but they also do all day in-person ones.

I had been swinging from dissociation to sadness to anger and back, with a strong need to feel both supported myself, but also to support others. This is where group work, at its best, can be so effective. Our three guides facilitated and held us, a group of 10 participants, all with very different stories to tell about why we were there.

They took us into it gently in stages, so by the time we got to taking turns to share, (and there was a very open invitation on how you might wish to do this, or not), I felt able both to open up about my own experiences and to listen and support others as they shared theirs.

By the end I was lying on the sofa by my Christmas tree, wrapped in a blanket.

In the days after the workshop, I felt less broken and somehow more solid. But also with the permission to lean into whatever I was feeling. The losses I experienced this year still hurt, but through this experience I felt more able to integrate them.

Thank you Tony, Sarah and Bilal for helping me anchor myself as winter comes. 

Forthcoming grief-tending workshops:

Embracing Grief – One-day In-person event Saturday 22nd January 2022.

Embracing Grief – Queer and GSRD (online) Friday 4th February 2022.

Menopause and Therapy

Expressionist painting from Hokusai's Great Wave off Kanagawa in reds, yellows and black.

World Menopause Day 2021

Truthfully I don’t know how – or even whether – to celebrate World Menopause Day. What I do know is that if you are reading this, you may be seeking some clarity about your situation, whether for you or someone close to you.

Things are gradually changing for the better. Awareness-raising is increasing and more people are shouting about menopause, particularly those who are generally excluded from the mainstream narrative, for example: people who are LGBTQIA+, Black, neurodivergent, or who experience surgical or premature menopause. 

‘Why did nobody tell me?’ 

But there is so much more to do and, while society learns to adapt to the needs of this enormous population group, a lot of people are still floundering. Particularly those without the resources to have their voices heard via the media. But whoever you are, and whatever resources you have access to, you may still be wondering why no one ever said a word to you about peri/menopause.

Perimenopause is a Thing

I mean, you probably knew that – but if you’re in your 30s you need to be knowing about it now. If you’re in your mid-late 30s to early 40s and are experiencing changes in your mood or body, or exacerbations to existing conditions you may have, this may be peri and you need to know about it. You are not ‘too young’, no matter what anyone tells you. Looking back, mine started at 39 and possibly earlier.

Menopause is a Hormonal Transition

A hormonal transition means change. A change in outlook. A change in desire. A change in what you can tolerate. It may mean a shift in how you view your sexuality and your gender. I’ve spoken about this in a talk called ‘Menopause – Agent of Queerness?’

Menopause is Compounding and Multifactorial 

Whatever is already going on for you, whether connected to your identity or to your life experience, menopause is going to interact with it. If you are already affected by past or present trauma, mental and physical ill health, disability, financial concerns, domestic abuse, lack of resources, minority or minoritised identity, menopause will exacerbate it. (Eventually, it may help things too, but there is a lot to get through first.)

And the way menopause is promoted, and treated, in society mirrors systemic bias, whether ageism, racism, ableism, misogyny, or transphobia.

Menopause doesn’t only happen to Cis Women

Trans men and non-binary people also experience menopause. (I’ve written more here about the non-binary experience of menopause.) Seeing peri/menopause information, resources, discussions, social media posts, etc, addressed only to ‘women’ can actively hinder someone’s attempt to inform themselves and get support. There are negative health outcomes to this. Actually, lots of folks dislike the gendering of everything in healthcare particularly, especially being called ‘ladies’.

Menopause doesn’t only happen to White Women

As above, I could say the same about the whiteness of much menopause information and resources. People of colour’s experiences are barely being heard about or acknowledged. It’s not good enough.

‘I need help – but what kind of help?’

 In some corners of social media there is a certain pressure to be super positive about menopause. If you are seeking cheerleading, there are plenty of practitioners and they are easy to find.

But I’m thinking you came onto a therapist’s website because you need somewhere to talk about what’s going on for you on a number of levels. To name aloud what’s happening to you inside and outside. 

There may be anger, fear and shame. You may not feel able to talk about the things that are going on in your mind and body. Your working life and relationships may be in turmoil. You may be wondering who you ever were and realising that, looking back, it all felt like a costume. Parts of you may be opening up, and other parts may be shutting down.

You may be non-binary or trans or queer and have very few places to explore how menopause intersects with your life. You may be cis and straight but feel totally alienated by the mainstream menopause narrative. 

Whatever you need to bring, I can offer you a place to talk about it.

You can contact me here.

Conference: Black Trauma in the Therapy Room

BME Voices Talk Mental Health Trauma Conference 2020

This Saturday I attended Trauma Conference 2020 – Black Trauma: When it presents in the therapy room. This excellent online event was put on by BME Voices Talk Mental Health.

The speakers were Dr Dwight Turner (psychotherapist, academic, and forthcoming author), Dr Keren Yeboah (psychologist and author of the study ‘Power and the ‘hidden self’: reimagining the therapeutic use of power in work with Black people diagnosed with psychosis’), Ebinehita Iyere (youth practitioner working with young people affected by the youth justice system), Sharon Frazer-Carroll (occupational therapist, organisational expert and founder of Time To Talk Black), and Dr Isha Mckenzie-Mavinga (psychotherapist, academic, and author).

A note on trauma

Trauma is a spectrum, not a binary. Despite the best efforts of many, society as a whole is only just beginning to comprehend the multifarious nature of trauma, what trauma means for people individually and collectively, and the different ways it can manifest. Many now accept that you don’t have to be a combat veteran, refugee, or incest survivor to be traumatised and to experience PTSD or CPTSD, and that trauma in your ancestry is likely to manifest in the present.

It’s also more understood that ‘minor’ daily incidents, known as microaggressions, can cumulatively cause a high level of distress in a person. And that ongoing fear of threat can cause as much harm as an actual incident. But some, especially those with power, may find it harder to accept that certain populations experience this more than others. The challenge comes when these same people realise that it is they themselves who are causing the harm. Without deep reflection, it is hard to own our acts and do the work.

The multiple impacts of systemic inequality

At the conference every speaker, in different ways, outlined the systemic construct of whiteness and Blackness (the racial complex that binds us) and its impact, through racism, on Black lives. We heard about trauma responses to racism and the impact on mental and physical health, including internalised racism (or our ‘internalised supremacist’), and how quickly you lose touch with your humanity when you are forced to adapt to a culture that someone else has created.

Gaslighting and double standards

We heard about the harms done by the white-constructed mental health system to Black patients with psychosis, (for example being criminalised on entering the mental health system, and having anger mislabelled as a pathology) and the constant location of issues solely within the Black community, and the minimisation of the racism that creates this.

Ancestral trauma held in the unconscious

We had an interactive discussion about whether Black trauma exists, and whether therapists should undertake specific training about it. We were reminded that in 2020 the (white) world is waking up to a reality that many have already lived with for a long time, and that white therapists need to do more self-reflection and investigation. The silence of early lockdown ’emphasised the noise in peoples’ heads’ – the ancestral trauma, bursting to speak, that is so often buried in the unconscious.

Examining racism in supervision and training

We heard about the process of unmasking racism in clinical supervision, and the reminder that Black therapists are impacted by racial trauma while also hearing about it, and yet sometimes feel unable to name racism to a white supervisor. And when a Black student is expected to educate the rest of the students in the room, and do the labour of caretaking White fragility, (and keep their own feelings in check to protect others as well as themselves within a white system), they cannot give time to their own development.

The whiteness of the therapy world

Self-care

For the last hour of the conference, the primary theme in the panel discussion was self-care. When Black therapists speak about interaction with white colleagues, the word ‘exhaustion’ quickly comes up. There will be times when Black therapists cannot be with white friends and colleagues, because of this exhaustion, rage, and hurt. White people cannot expect to be rescued from this – ‘It’s not about you’. One speaker spoke of ‘trying not to be drawn into other peoples’ awakenings.’ Another quoted: ‘Just because we are in the same storm, does not mean that we are in the same boat.’ White therapists are advised to read, especially outside therapy subjects, and process shame and guilt by finding a place where it’s okay to talk.

Challenging course leaders

How do Black trainees stand up and challenge their course leaders? One speaker sent their comments to all their leaders and fellow students, and spoke out on social media, adding: ‘Get your message right and don’t endanger yourself.’ It is important to create Black spaces if there were none previously. But ‘realise you can’t do it all.’

Beyond eurocentric trainings

In the Q&A, someone asked: ‘Where are the Black and Asian modalities?’ The response came: ‘Here we are!’ The teachers, supervisors, and learnings are already here! They need to be listened to, and training organisations need their wisdom and experience in order to build equality-based and culturally competent trainings from the ground up. There are plenty of people and organisations out there who can help: Kaemotherapy, Race Reflections, Me & White Supremacy, Radical Therapist Network, Resmaa Menakem, and others can all contribute to new forms of training that prove the organisations truly value every student equally.

When I attended the inaugural BME Voices Talk Mental Health conference back in October 2018, I was surprised to see so few other white therapists there, perhaps 10% of the delegates. This was an indication of the work we have to do to make counselling and psychotherapy truly reflective of all populations, in respect of both therapists and clients. However, after the events of 2020, and the increasing profile of Black Lives Matter, I suspect this year the numbers were greater.

There is a long way to go

Every speaker had something positive to say about how we might go forward. But it was also clear that, in many ways, things have barely changed in 30 years. There are of course many individuals of all backgrounds desiring change in the mental health system and psychotherapy – but the process is slow. And, unfortunately, it is not clear that organisations are truly listening. One major piece of evidence of this is the ScopEd project, a proposed framework for a hierarchical classification of therapists, and promotion of particular member organisations. ScopEd was not mentioned at the conference (as I recall), but I feel it fits strongly with the theme.

A missed opportunity

This is not the post to go into detail about this, but I will describe it in brief. There was an opportunity for some real systemic thinking to address the huge missing pieces currently within mainstream therapy trainings, (race, racism and white supremacy being one of the most significant, but not the only one). Instead a top-down medical and analytic model is being proposed, and many counsellors may be put out of business by being deemed incapable of taking paid work. This hierarchical structure does nothing to address racism, misogyny, homophobia, biphobia, transphobia, classism or ableism, and does not seem to address systemic factors at all, even though they affect all of us every single day, therapist or client. It also doesn’t address the access issues that prevent so many people (particularly Black, and working class) from training as therapists in the first place. While I would agree that training standards do need to be addressed, it is the counsellors who are bearing the brunt of this project, rather than the training organisations who trained them.

In his book How to be an antiracist, Ibram X Kendi states, over and over again, that it is racist policies that need to change, and that only working towards anti-racist policy will have meaningful impact. Sadly it feels as if this is being played out, however unintentionally, in the counselling world. Of course, good intentions mean nothing without deep reflection on the impacts of our actions.

I am very grateful to all the conference speakers for sharing so much, and to Helen George, founder of BME Voices Talk Mental Health, and co-host Leoni Cachia. I’m looking foward to the next one already.

World Menopause Day 2019 – There’s a long way to go

It’s World Menopause Day today – 18th October 2019

If you have any interest in human welfare, and the welfare of those you love, please read.

I would love to go into detail about the results of my Queer Menopause study, (which I am about to start writing up), but in the academic world you are supposed to keep fairly quiet about everything until it’s coming out in a peer reviewed journal. At best this means likely a year’s time! And that assumes it’s going to be accepted by the journal I will be pitching it to.

So I will simply take this moment to thank everyone who participated in my study. I am very grateful to you for sharing so much on such a crucial topic.

However, it’s safe to say, from my reading online, personal experience, and conversations everywhere that menopause can have a huge impact on life. [Tip for happiness: If menopause has been easy for you, that’s great. But I’m not going to debate with you about why the system needs to change.]

The general response to menopause is a reminder that we are still living in an ageist, ableist, sexist, misogynist society.

Folks desperate for help are going to their GPs, but the response is a lottery. You may get lucky first time, or your GP may realise the limits of their knowledge and refer you on to a menopause clinic. But equally you may be dismissed, gaslighted, and lied to. You may be told ‘It’s natural, just get over it’, or fobbed off with antidepressants.

Of course, hormone treatment is not simple, and it carries health implications, but the implications of oestrogen deficiency are equally concerning. The fact that so little is truly known makes me suspect that if people took the time to look hard enough at hormone function, we would be less hung up on the gender binary, which would make a lot of us very happy, but some other folks, clearly, very upset.

PSA: hormones don’t have genders. All bodies need oestrogen and testosterone to function.

The whole thing is doubly stressful for queer/trans folks, who may end up having to do a huge amount of education work around gender and sexuality while trying to get help from the healthcare system. And the general media narrative about menopause is suffocatingly heteronormative and often incredibly infantilising. We can do better – on a number of fronts.

And if you’re in your 20s and 30s, don’t think it starts at 50 and you can forget about it for a while

Perimenopause (the phase up to when your periods stop) can start in your late 30s or earlier. My periods started to fluctuate when I was 39. Fluctuating oestrogen levels can affect mental health for years before your periods stop.

The effects of menopause can be inherited, so it’s worth finding out, if you can, how your biological mother experienced it. It’s also biopsychosocial, which means, put simply, it’s constructed within the body, the mind, and the world outside. If older women/AFAB (Assigned Female At Birth) folks were respected in society, I have no doubt the experience would not be as bad.

Things are starting to change

Workplace policies are being created, and campaigners are pushing for changes in the law. I would like being in menopause to be a protected identity. At worst it disables people to the point where they cannot work due to physical and mental ill health, and they lose relationships and careers. I think everyone should have the possibility of subsidised time off work. I would also like to see menopause pensions to cover this too.

If you run a workplace, please think about how it could be more welcoming to folks in menopause.

If you are struggling, don’t suffer in silence

Go to your GP armed with the NICE Guidelines 2015. If they won’t help you, find one who will, or ask to be referred to a menopause clinic.

I wrote this first thing this morning. As time passes I will add some links. Thank you for reading.

Pink Therapy’s Sex Work and Psychotherapy Conference – history in the making

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I have just spent an extraordinary two days at the Pink Therapy ‘Sex Works!’ conference, about the intersection of mental health and sexuality professionals.

Every year the Pink Therapy conference covers a different GSRD (Gender, Sexual and Relationship Diversity) topic. Created by Pink Therapy founder Dominic Davies, in recent years they have featured gay men, trans, bisexuality, and kink, non-monogamies and other sexualities/orientations beyond LGBTQ. 

The purpose of the Sex Works! conference was multiple: to look at sex worker mental health and how the system could better support sex workers; to look at the experience of psychotherapists/counsellors (and trainees) who are also sex workers; and to look at the various forms of somatic sexology that may include genital touch, and how a dual trained counsellor/somatic sexologist may be protected within the psychotherapy system; and the ethical issues relating to all the above.  

For clarity: somatic sexology can include sex coaching, sexological bodywork, somatic sex education, some tantric practice, and sex surrogacy.

We heard about: busting some of the myths around sex work, sexual services for people with disabilities in Australia, somatic sexology, and a large scale research study of sex worker mental health. Sex surrogacy, conscious kink, Urban Tantra and Somatic Sex Education 101. We heard about ethical frameworks from a British Association for Counselling and Psychotherapy (BACP) perspective and from a highly experienced long-term member of the UK Council for Psychotherapy (UKCP), and about the Association of Somatic and Integrative Sexologists (ASIS). Also sex coaching for sex therapists. To round off the second day, there was a panel discussion about ethics (that included a representative from the Psychotherapy and Counselling Union (PCU) and the College of Sex and Relationship Therapists (COSRT)), which was supposed to be about how to protect dual-trained therapists, but turned out rather differently. 

The conference was a potent reminder of the enormous variety of what might be called sexuality work. As well as an opportunity to speak to dual-trained practitioners, there was a lot of vital, and courageous, testimony from speakers who are both psychotherapists and sex workers.

What became rapidly clear was just how badly people who do sex work can be treated as trainees of psychotherapy – and this mirrors the experience that many sex workers have as clients trying to access counselling.

Many sex workers are not out to their therapists, because it is just not worth it, due to the judgements and pathologisation they are likely to experience. Importantly, very often the reason someone might want to go for therapy has nothing to do with their life in sex work, but they need to know they won’t have to endure projections, rescue or confused hostility.

The bottom line is that therapy clients who do sex work are often being harmed – by therapy.

What was especially disappointing was the way the therapy registration bodies represented, BACP and COSRT – (sadly we lost the official UKCP representative at the last minute) – seemed to have provided those speaking with very little relevant research and opinions for the conference, even though they were invited to participate six months ago. Contrast this with how, after the presenter of the session that preceded the final panel discussion was absent at the last minute, two psychotherapist sex workers created an excellent workshop at two minutes’ notice.

It was particularly saddening to see how the psychotherapy establishment continues to conflate sex work with abuse.

It seemed impossible to discuss the ethics of being a dual trained practitioner, or a sex worker being a psychotherapist, without the discussion leaning further and further into complaints, abuse, and the nebulous and highly politicised concept of ‘disrepute’. It was pointed out that sex work is actually legal in the UK – and yet there is a persistent lack of clarity on this in the psychotherapy world.  This is part of a bigger picture, of a generalised lack of understanding of GSRD clients and identities that is consistently displayed in mainstream psychotherapy and, as a consequence, in training organisations. I find this issue especially disturbing.

From the many personal stories I have heard, a trainee therapist with a minority identity may well be expected to educate their peers about this identity, and may also endure endless questioning, assumptions, microaggressions and invalidating ‘debate’, even from tutors. The lack of understanding of minority stress, in organisations supposedly training people in how to support others, and how it can contribute to trauma, is mind boggling.

Of course, the excuse might be that by marginalising sex workers and sexuality practitioners, they are simply mirroring public life and the media.

Sexual pleasure in all but its most regimented, prescribed forms is othered and kept in darkness in a society where attention is not paid to sexual competence, and we are educated neither in negotiation nor consent, let alone in giving attention to our true desires. Apparently there is a perfect way to be a human, and that is to be monogamous, vanilla, cisgender and heterosexual, and the further away you go from that, the more deviant and in need of fixing you are. If you sell sex and do therapeutic or educational sexual touch, you are seen as almost beyond repair.

Counselling students who do sex work may be told that there are grey areas that may cause them to fail their course. This despite that, as was pointed out repeatedly, one of the skillsets necessary to survive as a sex worker – (intuition and trusting your gut, negotiation, establishing consent and boundaries, working with the client’s needs) – goes far beyond anything taught on counselling courses.

There was a lot of anger in the room towards the end, particularly when one panel member suggested the audience give them more information. It was pointed out that marginalised groups get very tired of doing the labour of explaining. 

I and a couple of my colleagues have a list of queries that have been left hanging:

  • Can you be a sex worker while training as a psychotherapist? (Still unclear)
  • How are the registration bodies going to look out for dual-trained practitioners? (Still unclear)
  • What is the legal reason for COSRT’s two ethical issues, that a COSRT member therapist cannot refer a client to a sex surrogate because it constitutes a form of ‘pimping’ (scare quotes mine), and that a member cannot signpost a client towards doing sex surrogacy work as this apparently constitutes coercion?
  • COSRT’s journal, Sex and Relationship Therapy, is currently planning a special issue about sex work, written entirely by sex workers. (Deadline for submissions March 31st.) We are wondering why this was not mentioned at the conference?

And here are some thoughts about how we can all move forward:

  1. There needs to be a basic CPD training for therapists around competency in working with sex workers.
  2. There needs to be a directory of sex work friendly therapists, a bit like the kink and poly ones that already exist, with a badge to go on the practitioner’s website.
  3. The main counselling and psychotherapy bodies would do well to reflect on why there is increasing frustration among therapists who work with GSRD clients, and who may well be GSRD identified themselves. There is a great opportunity here for these organisations to offer better support to all these client groups. Currently, too many minority clients are being harmed by a lack of understanding of their needs, judgement and pathologisation, and unhelpful use of therapeutic techniques and theories.
  4. Led by the registration bodies, training organisations need to focus on diversity as the baseline, not an extra – and actual identity-based diversity rather than just ‘theories of diversity’ or relying on the students to provide the topics. The same goes for sex – this also needs to be a baseline subject. I have encountered many clients who are not sure whether they are allowed to mention sex at all in sessions. 
  5. Training organisations need to find ways to make trainings accessible to less well off students. Important minority voices are being lost due to this. Actually, many people do sex work because it is the only way to make a reasonable living (often on top of parenting and working around health issues) – for many people it would be the only way to make the kind of money needed to pay for counselling training.
  6. Dual-trained practitioners are crying out for a membership organisation that can respect them and cater for all their needs. When one becomes visible, I suspect many will leave their existing registration bodies.

Several participants were reminded of the American Psychiatric Association conference in 1972, when being gay was still designated a mental illness. John Fryer, a gay psychiatrist, spoke on the stand while heavily disguised in a mask. This was an act of great courage, and we saw similar courage over the last two days. 

This was a groundbreaking event that I was incredibly privileged to attend. Huge thanks to everyone who organised, presented and participated.

The next Pink Therapy conference, where I may be speaking, is ‘Contemporary Issues in BDSM and Therapy’ on 6 October 2018.

 

Bisexual life – hiding in plain sight?

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Pink Therapy conference 2016

Last Saturday I spent the day with colleagues at Pink Therapy‘s annual conference for therapists. This year’s theme was Beyond Gay and Straight. 

‘There are gay bars and straight bars, but where are the bi bars?’

Someone made this point during the plenary session. Erasure is something bi people experience on a regular basis. I’ve been told more than once that the word ‘bisexual’ is a bit of an audience killer and best left off publicity materials. This is sadly unsurprising.

Bisexuality and mental health

Dr Meg John Barker reminded us that not enough studies have been done specifically around bisexuality, but what there is – sometimes the B element has to be squeezed out of the side of a larger piece of research – is unequivocal. A bisexual person is likely have worse mental health than someone who is either gay or straight. An aside from another discussion, a good proportion of people diagnosed with Borderline Personality Disorder (who are, incidentally, mostly likely to be women) also identify as bisexual. (For more research and information, see BiUK.)

Prejudice from all sides

Bisexual people experience discrimination from both straight and gay communities. Bi people are seen as fence sitters, greedy, manipulative, unstable, sex-obsessed, and indecisive, perpetually on the way from one place to another but never getting there. Women only ‘do it’ to tease or please men. It is seen as marginally more acceptable to be a bi woman than a bi man, however – bi men are either ‘gay, straight or lying.’ A bi person must experience an exactly balanced 50/50 attraction to men and women (never mind other genders), or they are fakes and must be straight. Sometimes therapists (and partners) offer to convert them, or tell them that their issues will be resolved when they ‘pick a side’.

Charles Neal, author of The Marrying Kind, talked about the lives of gay and bi men married to women, the ‘mixed-orientation marriage,’ and the misery experienced by people stifling their identities in order to remain in a socially acceptable unit. ‘Experience before identity’ was his message – but even nowadays, if you don’t identify sufficiently with one tribe over another, you may feel left out in the cold. (See also How To Support Your Bisexual Husband, Wife, Partner)

Born this way?

Current activism tends to promote sexual and gender identities as self-defined, but it wasn’t so long ago that you had to be ‘born this way’ in certain queer scenes, (and adopt one of a specific set of appearances) or you were seen as a ‘tourist’. You were ‘bi-try’ (for bi or bi-curious women entering lesbian environments) or a ‘stray’ (for bi or bi-curious men entering gay ones). And, on arriving at an event, there was that look from the door person that said ‘Your hair goes past your shoulders – are you here to write an article about us?’

Binary versus fluidity

These attitudes remind us how the desire for a binary universe is so pervasive. If you are not one thing you must be another, because of course there are only two things to be. The idea that a person’s desires may shift and evolve over time seems entirely absent. To be fair, if you have fought for years for your singular identity, you may well feel threatened by any kind of flexibility around this, but this feels increasingly out of step with younger people, for whom fluidity of identity feels as if it’s becoming the norm.

It all sounds very like the dismissive way some old-school kinksters speak of switches, ie people who are comfortable occupying both sub/bottom and dom/top roles, or have a different role depending on the gender of their play partner. And, for that matter, people who cannot accept non-binary gender identities. There is, perhaps unsurprisingly, a high proportion of bisexuality in trans communities. DK Green spoke in detail about both topics. Validation from partners is essential: ‘Does your partner see you as you see yourself?’ (Trans Media Watch has a good resources page.)

Caution around labels

A therapist simply being affirmative may in fact be damaging when a client holds multiple identities, and this can apply particularly if they are intersex. And in a flurry of anti-religionism (for sure understandable given the damage that religion has done to people with minority identities), you may trample over the fact that a queer person is religious and gains comfort from it.

Multiple intersections – multiplied difficulties

Ronete Cohen spoke about the intersection of bisexuality and race, where a bisexual person of colour can be marginalised and objectified in a number of communities simultaneously. Microaggressions are multiplied, and there is far less social support and consequently worse mental health outcomes. She gave the example of a bi person of colour asking for help dealing with stress, and being told to go to yoga. There are a number of reasons why this was inappropriate – western yoga is generally white, middle class, often expensive, promotes a particular body type, and contains potential inherent cultural appropriation.

Elsewhere during the day, someone gave another example of a therapist trying, unsuccessfully, to take mindfulness into communities of colour, having not thought through the missionary implications of this. A therapist may have training around gender, sexual and relationship diversities, but they may not have any cultural competence training around race. (See Bis of Colour for more information and support.)

Queering relationships

From the other sessions I attended:

Niki D talked about biphobia in relationships, and the difficulties of being a bisexual person in a relationship with someone who is monosexual.

Meg John Barker, using their excellent zine ‘What Does A Queer Relationship Look Like?‘ talked about queer relationships, and the fact that a high proportion of bisexuals are also non-monogamous. (The ‘Normativity Castle’ is especially pertinent here.)

Amanda Middleton presented on queer identities and offered a breakdown of Queer Theory. She outlined the slippery and paradoxical implications of queer – (for example, if a queer person experiences microaggressions, it can mean they are doing queerness well) – and the fact that identity will inevitably change over space and time.

It’s an exciting time for Gender, Sexual and Relationship Diversities therapy

Thanks to Dominic Davies and the Pink Therapy team once more for a great day and an excellent learning and networking opportunity. There’s a lot of work to do – especially around training – but this community is growing.

For videos of the main talks, go here.

Contact

If any of the issues in this post are affecting you and you would like to talk further to someone, you can contact me here.

Alcoholism – do women have a special relationship with wine?

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Women and drinking – interview for the Irish Independent

Here’s the full version of an interview I did with the Irish Independent earlier this year about women’s relationship with wine, and whether it has unique characteristics.

Do you think that women’s relationship with wine is partly fuelled by sexism/misogyny in that it’s the ‘acceptable’ face of drinking, because society doesn’t like to see women as hard drinkers or drunk, whereas wine gives the patina of respectability? (Even if you’re drinking three bottles a day.)

It’s always difficult to tease things like this out, because most attempts to single out and pathologise women’s behaviour come from sexism/misogyny! In fact, many women I know drink a lot of beer and cocktails too. However, in pubs in the past there was a tradition of ‘wine for the ladies, beer for the men’ and I think those gendered stereotypes may have stuck around in certain parts of the media.

You used the great phrase ‘White Wine Witches’ in your book Cleaning Up. Can you elaborate a bit more on this and why you think that white wine can drive some women ‘crazy’?

I remember parties, particularly media/corporate ones, where white wine was the main alcoholic drink on offer, and after not very long there was an unusual level of hysteria in the air. Some people I knew would end up in tears relatively early in the evening. However, those events can create tensions in themselves, particularly for those who are nervous around networking – and the drinks were usually free and sometimes never ran out.

There are many theories about this, which may have more or less value. To generalise: It is said that some wines, including Chardonnay, contain more chemicals like sulphites than red wine, and some women seem to react badly to them. It may possibly be something to do with the sugar content, which may also cause some kind of energy spike, which could be especially potent when teamed with alcohol. (Although I should point out that other drinks, such as cider or liqueurs, have far more sugar in them than wine.) Other factors may be that wines have on average become stronger over the years. Also, after work people do tend to knock the drinks back very quickly, and I can well remember doing that. In general, since the recession, the general level of stress in large parts of the population has gone up, so this may well be influencing drinking habits.

Women are drinking more and there’s increasing evidence of a younger demographic being diagnosed with problems like cirrhosis. Do you think this is being dealt with sufficiently by governments – or even being acknowledged by society?

I don’t think governments and society are doing enough about this at all, whether about younger women drinking or anyone else. It’s heartbreaking to see hospital time being taken up by the results of over-drinking, whether in A&E or long-term wards. A huge number of accidents and illnesses are caused by alcohol, and yet governments spend millions on the entirely pointless and unwinnable ‘war on drugs’. Of course, to truly tackle this, quality of life would have to be examined from the ground up, and this might uncover too many things that are unacceptable to those in charge. Life is stressful; for women and minorities even more so. Tackling sexism and bigotry from the ground up would cause major societal change, but the media continues to feed the stereotypes.

In the last hundred years, huge numbers of women have come into the workplace, but the workplace has not fully evolved to accommodate them. Women still battle daily sexism, the glass ceiling, competitive presenteeism, and issues around maternity leave. This can make the workplace incredibly challenging.

It’s also useful to reflect on why there is this gendered examination of peoples’ drinking habits in the first place. A drunk woman is a woman who is potentially less easy to control, which is why there is so much flapping about it. (I’m aware that pregnancy is an obviously complex gendered health issue where alcohol is concerned.) However, while I am a bit suspicious of medical statements that have an element of social control to them, it is also true to say that physiologically, women are seen to be generally more susceptible to the effects of alcohol than men, however unfair this is.

Also, UK society is obsessed with drinking. In society at large, people tend to have a blind spot around alcohol, saying things like ‘I’ve got a right to enjoy myself, haven’t I?’ which on the face of it is quite hard to argue with. But it’s worth unpacking why enjoyment so often tips over into loss of control and thereby loss of responsibility. To resist the pressures of the group and stop drinking is very hard – whether ‘getting your round in’ or just being one of the gang. Stopping drinking can change your life irrevocably. If the drinking culture in your life also focuses round your workplace (or your partner drinks a lot) then giving up is doubly difficult.

It’s a pretty broad question but why do you think women drink and are drinking more increasingly?

If this is the case there are a number of factors. (see my responses above and below). Put simply, women drink because drinking is enjoyable and because they are human.

There’s a part in Caroline Knapp’s book Drinking: A Love Story where she comes to the realisation that maybe it’s not that she was drinking because she was unhappy, but that drink was making her unhappy. What do you think of this – are women who drink excessively inherently unhappy or can it just be a habit that they fall into which then creates its own problems?

There are many, many intersecting factors to this. Even without depression or anxiety, some kind of existing existential discomfort may cause a person to turn to alcohol, because of the way it makes socialising so much easier, and you feel so much freer. (Of course that person may also just really enjoy drinking!) It may take many years to realise that the longer and the more you drink, you are missing out on developing and experiencing certain sides of yourself.

However, regular heavy drinking in itself does bring all kinds of problems, mental, sexual and physical. The effect on your relationships and work also can’t be underestimated. Going to work every day with a hangover is no joke – and hair of the dog (another drink) is the simplest way to remedy that. Someone may have learned to drink in their family home, so a certain way of drinking may have become normalised for them.

There is also a chicken and egg situation here, in which women who like drinking may find themselves drinking more when they are already stressed (or perhaps premenstrual), so the effect may be compounded.

It’s easy to pathologise ‘women who drink’, but I am sometimes surprised that more people don’t drink regularly, particularly given the lamentable state of public mental health services.

There seems to be an increasing emphasis on how fattening alcohol is or how it can ruins your looks as a deterrent to stop drinking. Do you think this is helpful or is it avoiding getting to the route of the problem, whatever that might be?

If someone really wants to drink, none of those suggestions will have any effect at all. See also smoking, and the terrible anti-drug adverts we’ve seen over the years.

Plus, appealing to ‘women’s vanity’ is also sexist and I’m not surprised many women reject this, as this sort of deterrent would not be suggested to men.

In Ireland and possibly Britain, people tend to be at crisis point before seeking professional help when it comes to drinking. But if you’re maybe just concerned about it, would like to drink less or explore why you are drinking so much, but don’t think you’re addicted, is therapy useful here?

I think if someone is wondering why they are drinking more and more, and perhaps negative things are starting to happen to them, then going for therapy could be very useful. It may enable them to uncover aspects of their past, and their personalities, which may throw light on why they are turning more and more to intoxication. Therapy might also help someone look at their family history and figure out if there are issues with drinking or mental illness that they have not looked at in detail before.

Note: if you’re concerned about your drinking and would like to cut down, and don’t feel that AA is for you, you could try Club Soda, the London-based support network that hosts all sorts of community events and online discussions for people concerned about their alcohol intake.

Further reading:

 

Alternative sexualities conference – keynote videos

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Pink Therapy conference 2015

Here are the keynote videos from Pink Therapy’s Beyond The Rainbow Conference in March.  The conference was a great success and was very well attended, showing the great interest in – and need for – more teaching about sexual identities that are beyond the mainstream.

If you’re a therapist yourself, you may wish to use these videos for CPD.

(1) Non-monogamies

Author, psychologist and activist Dr Meg John Barker outlines the extensive range of relationship styles and structures beyond monogamy. (Video 26.16.)

(2) The kink paradox

Counsellor/psychotherapist DK Green unpacks the issues for practitioners when working with a client who has both a history of traumatic abuse and an interest in BDSM. (Video 26.35.)

(3) Living and working in the kink communities: professional boundaries and ethics

Pink Therapy founder Dominic Davies examines dual relationships when working in small communities, and how to maintain ethical boundaries. (Video 24.25.) (Needs login due to adult content.)

(4) Asexualities – doing without?

Counsellor, supervisor and trainer Olivier Cormier-Otano talks about his survey of asexuals, their diversity of experience, and their pathologisation in a culture that expects people to be sexual in very specific ways. (Video 20.21.)

(5) The place of kink in psychotherapy and counselling training

Psychotherapist Henry Strick van Linschoten discusses the reasons why kink should be included in psychotherapy and counselling training. (Video 29.44.)

(6) Further sexualities

Psychologist and senior research fellow Christina Richards describes sexualities considered to be less common than others – such as adult babies, furries and puppy play – and considers how clinicians can best support clients who are looking for help. (Video 36.42.) (Needs login due to adult content.)

You can find out more about the conference and other seminars here.

Nine things not to say to someone with a phobia

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This post isn’t ‘Phobias 101.’ It’s about the kinds of well-intentioned (or less so) enquiries that phobia sufferers are sometimes subject to. If you would like to know more, you can find detailed information here and here.

Phobias are very common and often misunderstood

Once upon a time the level of fear evoked by a phobia may have been useful, because it encouraged us to avoid genuinely dangerous things like poisonous snakes. In modern life, some phobias have a certain logic to them, despite statistical reassurance – for example, if you are in sitting in a jet-powered metal box 30,000 feet up in the sky.

They can also be distressing and debilitating

A phobic attack is really unpleasant. The body goes straight into a very primal state of fight or flight.  If you don’t manage to get away from the situation or object fast enough, it can take several hours to calm down.

Sometimes people plan their lives around their phobia, in case they are triggered. Thoughtlessly placed glass lifts and open footbridges can be really unhelpful to those with vertigo or agoraphobia, so routes have to be planned meticulously. Someone who is claustrophobic needs to gamble on whether the rush hour tube train will get stuck in a tunnel and whether it would be easier to spend two hours getting home on the bus. Some people never use underground trains at all and experience long convoluted journeys if they want to go anywhere. Arachnophobes may end up choosing to live higher off the ground so it is less likely that spiders will come in from outside.

They are also hard to explain

Perhaps due to the seemingly mysterious nature of phobias and the extreme responses they evoke in the sufferer, non-phobics (even with the best intentions) often make statements and ask questions that are at best unhelpful and at worst potentially damaging. Given parts of our culture’s obsession with the rational and explainable, the phobic person may be called upon to give an account of their apparent irrationality solely for others’ benefit.

Here is a list of things it’s best not to say to someone with a phobia:

(1) ‘Ha ha, really?! That’s too weird!’

The phobic person is likely to have taken a lot of time wondering about their phobia. Mocking or questioning them is not going to help.

(2) ‘Lol! There’s one right behind you!’

For some people, just seeing a picture of the feared object can cause a reaction. (The internet makes this a lot more challenging.) At worst at comment like this could cause someone to have a panic attack.

(3) ‘That three-year-old over there isn’t scared.’

It’s hard to know where to begin to unpack this. Just don’t go there.

(4) ‘That spider/dog/snake is more scared of you than you are of it.’

As well as being mostly untrue, this brings a jarring personalisation into the encounter, as if there was some sort of mutual exchange going on.

(5) ‘But I saw you do X the other day.’

So – well spotted – you saw them going down into the tube. Perhaps it was 11am and they had spent hours weighing up the mental risks of getting on the train against the importance of their appointment, and calculated that the tube would not be excessively crowded at this time. They may spend their entire journey praying nothing bad happens.

(6) ‘Have you tried CBT/hypnosis/flooding therapy?’

They may have tried all sorts of things. At the same time, it’s also likely that shame around their situation has prevented them from doing so. It’s also best not to keep offering to do therapy on them yourself, however kindly meant, even if you are a trained practitioner.

(7) ‘One day I decided to conquer my fear of cats/mushrooms/lifts. If I did, then so can you. You can choose to change your feelings.’

I have written elsewhere about the idea that you can ‘choose how you feel’.

(8) ‘Can’t you just pull yourself together?’

This one applies to mental health conditions across the spectrum. Please don’t say this to anyone, ever. It’s profoundly invalidating.

(9) ‘I read somewhere that people who live in war zones don’t suffer from phobias, and it’s just people with easy lives in the West who get them.’

Ah, how westerners love to tell each other how easy their lives are. A person who makes such a statement is generally hiding a vulnerability of their own.

 

Actually, this could be a bingo card. If you know of any others like these, please send them over.

Can you really choose how you feel?

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Sunrise North London‘It’s Tuesday. I call it ‘Choose-Day’ – because I can CHOOSE how I feel today!’

Never mind that’s it’s actually Friday. I see this kind of attitude lurking around online just a bit more than I’m comfortable with and, given that we are now entering a very challenging time of year for mental health and emotions generally, I thought I’d look a bit harder at it.

I can only speak from my own experience, but I think this is the worst ‘inspirational saying’ I have ever seen. If you know a more florid example of the genre, please send it over. I ought to have a Christmas competition, but you’d have to try very hard to beat that one. I suspect it’ll be me getting the Quality Street, but I remain open.

I am, for the moment, being lighthearted. And I should emphasise that I’m not knocking every just-for-today expression that’s ever been. In crisis, sometimes they’re all you have to cling to.

But – you can choose how you feel? Really? Others clearly subscribe to this view, as evidenced by articles with names like ‘10 Habits of Highly Unhappy People.’ There are quite a few of them around and they’re not difficult to find.

Great! You might think. We all fall into negative thinking and need a bit of a push out of it, don’t we? And actually, these articles often contain reasonable advice and appear on the surface to be well-intentioned. In a nutshell: don’t criticise or gossip, stop comparing yourself with others, don’t ruminate on the past, stop worrying about the future, stop feeling afraid, let go of your anger, look after your body, learn to trust people, stop focusing on the negatives, stop blaming others, express gratitude more, relax, and just be happy.

I can’t argue with any of this. In many ways, these lists are factually, existentially, correct.

But, as someone working in mental health, I experience increasing concern as I read through them.

They imply, or state directly, that feelings about your life and your place in the world are entirely your own choice. In different ways they flag the person’s apparent inner negativity as a reason for their problems, and how they may even be enjoying their misery.

Worst of all, not a single one that I’ve seen contains references to difficulties external to the individual: anything from abuse as a child, to poverty, to physical or mental illness, to violence, to relationship breakdown, to having no work, to experiencing discrimination because of your race, ethnicity, sexuality, gender, body type or anything else, and to experiencing a downturn in circumstances because of the recession we have all been experiencing for the last five years. Not a whisper.

I’ve seen too many depressed and anxious people fighting feelings like these, whatever their circumstances. I have, once upon a time, been there myself.

And the trouble with telling someone that they have chosen their feelings, is that if you bothered to look deeper into the individual person, you might actually see the pain and trauma they have suffered. I would then challenge you to tell them they had chosen their sacking, eviction, cancer or rape, because deep down, they wanted it.

Am I being a bit melodramatic here? Human motivations are complex. Sometimes we use problems as a form of defence when life gets too hard. We retreat into illness, or hide in the past, or paralyse ourselves with fear. There will be an old script at work in here, but it is way more complex than mere choice. You cannot moralise or shame negative feelings away.

So what do we have choice over? We can choose how we outwardly react. Perhaps not in the moment, but after some reflection. We can decide what we are going to work on to make a situation different. We can be mindful of our words and actions and their impact on others. We can see if there is any possibility of acceptance of any of our difficulties, just to remove the charge from them. (All that I have just said assumes our mental health is strong enough to do this.)

There is lots we can do, but choosing our feelings, I think, is not one of them.

Low-cost counselling and psychotherapy services in London

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London skylineSeeing a therapist in private practice isn’t financially accessible to everyone.

Here’s a list of reduced-fee talking therapy services in the London area. I hope you find it useful.

PLEASE READ THIS FIRST:

• This list is not definitive or exhaustive – it is a work in progress, and I will be adding to it as time goes on. [Most recent changes 17/12/17]

• Being listed here doesn’t necessarily mean I know the service and/or can personally endorse it. It may have been recommended to me, or I may have heard of it a number of times. I am going on what is stated on the organisations’ websites so cannot personally guarantee the content.

• There will be a number of different fee scales and a variety of numbers of sessions offered, from a few to open-ended. The trend is generally towards time-limited work of up to 12 sessions, but some places offer longer. And there will also be a variety of therapy offered. Don’t be embarrassed to ask questions.

• The counsellor you see at some of these services may be in the later stages of their training. Please don’t let this put you off. In order to practise, their trainers, if they are from a reputable college, will have spent time reflecting on whether they are ready or not. Psychotherapy students generally work very hard and have to give very detailed accounts of themselves on a regular basis.

• Some therapists in private practice do offer reduced fee places. Pink Therapy, The Counselling Directory, and the BACP’s It’s Good To Talk are all good places to start looking.

GENERAL – Clients accepted from all round London

Awareness Centre (Clapham SW4)

The Blues Project at the Bowlby Centre (Highbury N5 – waiting list currently closed at 11/17, but they say they may have spaces again in 2018 – also worth contacting the main therapy team as there may be some therapists there offering lower cost)

British Psychotherapy Foundation (Scroll down for their list of reduced fee schemes. Longer-term work.)

Centre for Better Health (Hackney E9)

Centre for Counselling and Psychotherapy Education (CCPE) (Training organisation in Maida Vale W2. Also runs The Caravan drop-in counselling service at St James’s Church, Piccadilly W1)

Community Counselling (East Ham E6)

Free Psychotherapy Network (Collective of therapists offering free and low-cost therapy, mostly in the London area but also elsewhere)

IAPT (Improving Access to Psychological Therapies) (A long list of London-wide local counselling services, many of which take self-referrals. Otherwise through your GP.)

Metanoia Institute (Training organisation in Ealing W5)

Mind in Camden – Phoenix Wellbeing Service (Mental health charity in Camden Nw1)

Mind in Haringey (Mental health charity in Haringey N4)

Minster Centre (Training organisation in Queens Park NW6)

Psychosynthesis Trust (Training organisation near London Bridge SE)

Spiral (Holloway N7)

WPF (London Bridge SE1)(Fees not really low, but they have a range of types of therapy.)

BOROUGH SPECIFIC

Help Counselling (Kensington & Chelsea W11 – mainly for residents of K&C but not entirely)

Kentish Town Bereavement Service (Kentish Town NW5 – for residents of Camden, Islington, Westminster and the City of London only)

Mind in Islington (Several sites – short term therapy for Islington residents only. Longer-term work also available.)

Mind in Tower Hamlets and Newham (Tower Hamlets E3 – for residents of Tower Hamlets and Newham only)

Time to Talk (Hammersmith & Fulham; part of Mind – likely for Hammersmith & Fulham residents only)

West London Centre for Counselling (Hammersmith W6 – for residents of Hammersmith and Fulham only)

Wimbledon Guild (Wimbledon SW19 – for residents of Merton only)

BME/INTERCULTURAL

BAATN (Black, African and Asian Therapy Network) (Extensive list of free counselling services for BME clients – UK-wide with a good number in London)

Nafsiyat (Finsbury Park N4 – for residents of Islington, Enfield, Camden and Haringey only)

Waterloo Community Counselling (Waterloo SE1 – for residents of Lambeth and Southwark, and London-wide)

CANCER SUPPORT

Maggie’s (Hammersmith W6 – clients from all round London. Also other centres UK-wide.)

Dimbleby Cancer Care (Based at Guy’s and St Thomas’s Hospitals SE1 – patients from South East London and West Kent.)

HIV SUPPORT

Living Well (North Kensington W10 – clients from all round London)

River House (Hammersmith W6 – clients from Hammersmith & Fulham, Ealing, and Kensington & Chelsea only)

Terrence Higgins Trust (Online counselling; Also London and UK-wide in person services)

Metro (HIV prevention and support services in English, Spanish, Romanian, Polish and Portuguese – centres in Greenwich, Vauxhall, Gillingham and Essex)

LGBT

Spectrum Trans Counselling Service (Ladbroke Grove W10 –  free service for people who identify as trans, non-binary or are questioning their gender identity)

ELOP (Walthamstow E17 – clients from all round London)

Metro (Greenwich SE10, Vauxhall SE11, Rochester Kent ME1 – clients from all round London)

London Friend (Kings Cross N1 – clients from all round London)

Albany Trust (Balham SW17 – LGBT+ and anyone with sexual issues/difficulties)

OLDER PEOPLE

Age UK Camden (Camden WC1 – for those registered with a GP in Camden)

WOMEN

Women and health (Camden NW1 – residents of Camden only)

DRUGS & ALCOHOL

REST at Mind in Camden (Camden NW1 – support for people experiencing difficulties due to benzodiazepine dependency)

CBT ‘a scam’, the joy of polyamory, parental estrangement, terrible sex ed…

keyboard close-up‘Are you a pervert?’, invisible disability, trans* history and politics, sex work and the modern slavery bill…

A regular roundup of links to things I’ve found interesting, either because they’re very recent, or because I think they deserve another outing.

Please note: me linking to something doesn’t mean I endorse every word in the the article or anything else carried on that particular website. Some of these articles carry an obvious content warning, and some, depending on their subject matter, may be very slightly unsafe for work.

 

MENTAL HEALTH

The Debt – When terrible, abusive parents come crawling back, what do their grown children owe them? (Slate)
Long, excellent article about people debating whether to resume contact with the parents who harmed them.

‘Loved ones and friends—sometimes even therapists—who urge reconnecting with a parent often speak as if forgiveness will be a psychic aloe vera, a balm that will heal the wounds of the past. They warn of the guilt that will dog the victim if the perpetrator dies estranged. What these people fail to take into account is the potential psychological cost of reconnecting, of dredging up painful memories and reviving destructive patterns.’

Lauren Laverne – It’s Time to Make Emotional Abuse a Crime (Guardian)
I think it’s important to keep saying this, whether individuals or charities. But I’m curious about the way language is used when applied to children. Children are ‘bullied’ at school, but this word is often not used when this occurs in families at home. Similarly, the word ‘abuse’ is rarely used in a school context. Sometimes is not quite joining up for me here.

‘What I remember most about emotional abuse is that it’s like being put in a box. […] So you try to make yourself fit. You curl up, become smaller, quieter, remove the excessive, offensive parts of your personality – you begin to notice lots of these. You eliminate people and interests, change your behaviour. But still the box gets smaller. You think it’s your fault. The terrible, unforgivable too-muchness of you is to blame. You don’t realise that the box is shrinking, or who is making it smaller. You don’t yet understand that you will never, ever be tiny enough to fit…’

Am I obligated to disclose my invisible disability? (xojane)
Invisible illness/disability comes up a lot in conversation, particularly around mental health as well as physical.

‘Frequently, when people who know about my accident ask me if it hurts still, I deflect or spew platitudes and just say, “Oh, you know.” I don’t say that physical discomfort has been a near constant companion.’

Oliver James declared Cognitive Behavioural Therapy to be a ‘scam and a waste of money.’ (Daily Mail)
This started a long discussion online, with most having the view that CBT is very useful for specific things, but less effective where there are deeper problems that need longer work and a fuller therapeutic relationship. There’s a general sense of too much money being funnelled for far too long into this very specific way of working. One size doesn’t fit all. I’m curious that this story has not been carried anywhere else. I’ve put it here as a discussion point, and I’m interested as to whether there will be more on this.

 

RELATIONSHIPS / GENDER AND SEXUAL DIVERSITY

The Joy of Polyamory (Archer)
Long and fulsome article by Anne Hunter. One of the big contrasts I notice between monogamy and polyamory is the issue of terminology. It feels to me as if many people in monogamous situations that are not working for them are caught in structures that they would change if only there were a name for what they are looking for.

‘Many of my relationships don’t have a simple label available to them. For example, I have some beloved intimates with whom I will jump into bed, naked, and talk about absolutely anything. The relationship is way past what most people think of as a friend – there’s no sex, so it’s not a lover; we don’t make life decisions together, so it’s not a partner. There is no term that accurately describes our connection.’ 

‘Are you a pervert?’  (Vice)
This is actually a serious and quite important piece by Martin Robbins outlining the double standards around what are still, in some quarters, known as ‘paraphilias.’

‘The thing is, pretty much every type of sexual desire can cause distress or harm to others, regardless of the kinkiness involved. Why fixate on kink? How can you even determine what is normal or paraphilic in the first place? […] Are the people who are trying to express their sexuality really mentally ill, or is the real sickness in the repressed culture that’s so terrified of them?’

The ‘dispute’ between radical feminism and trans people (New Statesman)
Long and important piece by Juliet Jacques in the New Statesman. It’s also an excellent history, both public and personal.

‘In a world where left-wing politics have often derided LGBT identities as ‘bourgeois’ and then accused us of splitting the movement, it infuriates me that I’ve had to take a break from writing a piece on the Tories’ ‘liberation’ of the NHS to write 8,500 words to debunk a sexological concept that was shown to be untenable before the start of the First World War.’

Yesterday (Nov 20) was also International Transgender Day of Remembrance.

Listen to sex workers – we can explain what decriminalisation would mean (Guardian)
After intense campaigning, an amendment to the modern slavery bill was dropped, which would have brought in the Swedish model of criminalising clients.

‘Mactaggart’s justification for attacking “demand” (clients) is that “prostitution is an extreme form of exploitation”. But exploitation is rife in many industries, including the agricultural, domestic and service industries, particularly at a time of increasing poverty, decreasing wages and insecure employment, and no one suggests that domestic work or fruit-picking should be banned.’ 

Sex education in schools: it’s just bananas (Guardian)
Eye popping Guardian piece about the state of Sex Ed in schools. I’m putting this here because this lamentable situation affects us all, whoever we are. The way we are introduced to sex can reverberate throughout our whole lives.

What’s ‘normal’?

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Beach seen through windowI wrote an article in The Lancet Psychiatry, on ‘Wanting To Be Normal’. I chose a subject very close to my heart. It seems to have rung quite a lot of bells with people. See what you think.

I have heard this desire expressed a large number of times, inside and outside my work. As a client in therapy I have also said it myself. The sense of being different from others has a multitude of meanings which are not always obvious.

Language
As a therapist and author, I always try to think before using the word ‘normal’ in any context. ‘Ordinary’ is often better. ‘Regular’ or ‘average’ might do, with care. ‘Unusual’ is usually better than ‘abnormal’. Any suggestion of ‘abnormality’ at worst equates to being diseased, a freak, other, or fodder for essentialists who ‘always knew’ there was something wrong with us, whether or not they can immediately locate a visible minority to park us in. This kind of othering can start in our homes as children. It can move through teenage years and into adulthood. It can seem as if these feelings will never go away.

‘Normality’ in love and at work
There are many unexpected ways the drive to ‘normality’ can emerge in adult life. This piece, ‘Don’t Do What You Love’ is a good example of how it’s very easy to persuade yourself to do the same thing over and over at work, even if it’s not working out for you, because at some point surely you’ll be accepted and everything will be fine. In relationships, despite the sheer volume of material on the internet, it is possible to feel incredibly isolated if we can’t immediately find someone who understands us. Dr Meg John Barker, author of Rewriting the Rules, has written at length about how to stop trying to be normal in sex and relationships, without giving yourself a hard time about it.

Appearing to be ‘normal’ carries a number of privileges. Here’s a satirical view of the kink of ‘normaling’, the sexual cousin of ‘normcore‘.

Depression
I think ‘wanting to be normal’ is a primary cause of depression, as well as a symptom of it. The picture below, that I took in Cornwall a few years ago, sums up what I’m talking about. The ‘normal people’ are over there outside, having fun in the light, with nature, being ‘natural’. The person who considers themselves ‘abnormal’ sits in the dark, held back by a very specific view of what normal appears to be. I debated whether to put this here because the heavy blackness makes this image quite hard to look at. For me, though, it sums up what I am trying to say, and what I have heard from others.