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

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.

 

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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?

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

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 TherapyThe 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’?

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.