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.

Trans Britain – Our journey from the shadows (Book Review)

Cover of book 'Trans Britain'

Trans Britain is an important and timely book

It stands out especially at the moment when the mainstream media is unfortunately promoting harmful and inaccurate information about trans and non-binary people.

Revision of the Gender Recognition Act

One of the reasons for the explosion in media coverage of trans lives and issues in the past year or so is the revision of the Gender Recognition Act (GRA), which was originally created in 2004. If you would like to see improvements to the GRA – especially in terms of allowing people to self-define their gender without having to go through overlong and at times humiliating processes, and including the rights and recognition of non-binary people – please fill in the consultation here. (Closing date 19th October 2018.)

This excellent podcast by Meg-John and Justin provides useful pointers about the Act and the current situation for trans and non-binary people overall.

The City of London is also doing a public consultation on their Gender Identity Policy. (Closing date 14th September 2018.)

The ‘debate’ around trans identity

If you don’t know much about it, there is nothing wrong with feeling confusion when reading about gender variance/non-conformity. What you may well be responding to is a media filter, and fear-mongering headlines which have the power to lodge themselves in the mind and remain there. (And if you think you don’t know, or have never known, any trans or non-binary people personally, you very likely do.) None of this is helped when someone’s right to exist is framed as a ‘debate’.

I am somewhat suspicious of the concept of ‘debate’. What it often means is ‘a contest between a privileged person and a less privileged person to see if the less privileged person gets upset first’. (It’s a sibling to the ‘false opposition’ trope that has taken over so much media output.) Pushing someone to explain themselves over and over has less to do with information-gathering than tiring the person to the point where they have no energy to carry on, so that they will make mistakes that can be used against them.

But the good news is that there is plenty of information out there, and an increasing number of accounts of contemporary trans lives. For example, see Trans, A Memoir by Juliet Jacques, and Trans Like Me, by CN Lester.

A much-needed history

Christine Burns, the editor of Trans Britain and a contributor to it, has been a stalwart campaigner for many years and it was exciting to see the crowdfunder on Unbound build up so quickly. [Disclosure: I contributed to it.] This book is much needed – partly as a history, partly as an illuminating account of activism before the internet and after, and partly as a counterbalance to some of the transphobic material that has been going around for too long.

We are living in a time of fascist resurgence, which is creating a heightened sense of permission to attack anyone who may be considered ‘other’. But, as Meg-John points out in the podcast, so many complaints and fears about trans people have a mirror in the cisgender population. If cis people don’t have to prove they are cis, why do trans people have to prove they are trans? Just as some trans people access medical services, such as surgeries and hormones, to feel more comfortable in their gender, so do some cis people.

A book in three parts

Trans Britain comprises early history, the birth of activism, and modern day trans and non-binary life. It offers very detailed accounts, through historical stories of pioneers from previous centuries and then to living memory and the rise of the newspaper exposé, starting with a reminder that binary gender is largely a western concept.

The 1960s were a time of increased media salaciousness, but they were also a time when people started to organise on a bigger scale. However, first of all they had to find each other, and for a long time the pressure to conform by ‘passing’, and living in stealth, was an obstacle to this. Ignorance and fear and lack of legal protections meant that if a person was known to be trans they could lose their job and their home. One contributor writes heartbreakingly about their isolation in the 60s and 70s as psychiatrist after psychiatrist offered terrible help and left them struggling alone. Some spent years playing along with the whims of autocratic and idiosyncratic clinicians. Some others got lucky with the medical profession. For example, in the 1940s, one doctor helped his trans patient by using the pretext of ‘a supposed intersex condition’ as a cover for their surgery.

Christine Burns: ‘Movements often start with campaigns for what can be legislated. […] Populations en masse somehow need to be persuaded that previous ideas for what was acceptable have to be revised. It is not legal sanctions that ultimately bring about lasting changes, but shifting cultural norms.’

With profound patience and tenacity, and endless meetings and reports, activists pushed for change. The Gender Recognition Act was created in 2004, around the same time as the explosion of social media, which enabled people to communicate with each other, and share and promote ideas to a previously unimaginable extent. In 2007 came the landmark study ‘Engendered Penalties’, the largest ever study into trans marginalisation, with nearly 900 participants.

Spectrums not binaries

But challenges alone don’t define people, and the ‘born in the wrong body’ narratives of the past have given way to a more powerful and wide-ranging set of voices and platforms. Gender non-conforming people have had a major influence on contemporary culture, (eg Transgender Tipping Point, Time 2014). With this increasing visibility have come a number of supportive and educational organisations such as Gendered Intelligence, All About Trans, and Trans Media Watch. And for the last three years, the UK has had an annual Trans, Non-Binary and Intersex conference.  

With this visibility has come a sense of permission for many more people to examine their gender identity and expression. It’s well worth reading this study by Joel et al from 2013: Queering gender: studying gender identity in ‘normative’ individuals. Over 35 percent of the 2000+ people studied felt their gender identity was other than that which they had been assigned at birth. As the researchers say: ‘We conclude that the current view of gender identity as binary and unitary does not reflect the experience of many individuals, and call for a new conceptualisation of gender, which relates to multiplicity and fluidity in the experience of gender.’ If you’d like to read further about this, How To Understand Your Gender by Alex Iantaffi and Meg-John Barker is a good place to start. Also Resources for Non-Binary Identities.

I highly recommend Trans Britain for a number of reasons, not least for recognising the sheer graft of everyone involved as they fought to live their best lives, and to ensure that others coming after them do too.

From Stephanie Hirst, who wrote the final chapter: ‘…’Generation Z’ […] are growing up with the normality of people of all genders, sexuality and ethnic backgrounds. This new generation will see fluidity in all people, and look back in total horror at how trans people were discriminated against during the late twentieth and early twenty-first century.’

So what makes some people so angry about the existence of gender non-conforming people, and their right to self-determination being enshrined in law?

As a therapist working with gender, sexuality and relationship diverse clients, I reflect on this frequently. There seem to be a number of factors at work here.

  1. ‘Think of the children’

Much of the recent wave of anti-trans prejudice relates to the support and treatment of trans children. ‘Won’t someone think of the children’ is an often-used argument against the existence of anything that questions current sex, sexuality and gender norms. What is being said about trans people today was said about queer people 30 years ago. Remember Section 28 in 1988, that prevented the ‘promotion of homosexuality’ in schools, and that awful phrase ‘pretended family relationships’? The thinking seems to be that where there is freedom for a person to be congruent and authentic in their gender identity and expression, the world has ‘gone mad’ and the brainwashing and abuse of children must follow.

There is a lot of anger from some quarters about medical interventions for trans children, and yet often total silence from those same quarters about the non-consensual and traumatic surgeries done to Intersex children to give them the ‘correct’ gender.

Further reading on this: Detransition, Desistance, and Disinformation: A Guide for Understanding Transgender Children Debates, and the follow-up post Reframing “Transgender Desistance” Debates (both by Julia Serano), and Why ‘Rapid-Onset Gender Dysphoria’ is Bad Science (Florence Ashley). This post by Rosie Swayne is also good: Unqualified, middle-aged lesbian swerves abruptly out of her lane to talk about trans issues.

  1. A binary view of gender

People are hugely invested in a natal gender binary. Unfortunately, much trouble comes from looking at a baby’s genitals when it is born, (particularly if the child is Intersex), and deciding which of two genders it is going to be and therefore what sexuality the child is likely to have. From this at-birth assignment of labels comes everything from earning power to personal safety, to how much this person’s opinions will be taken seriously, to medical treatment, to everything else.

It takes a lot of reflective work and uprooting of ancient beliefs to realise that neither genitals not perceived biological sex have to define gender. And some people do not define as either of the binary genders at all, as neither feels congruent for them.

It’s worth reading the work of Cordelia Fine on gender: particularly Testosterone Rex and Delusions of Gender, and Julia Serano: particularly Whipping Girl and Excluded, and a whole range of clear and well argued essays under the heading Debunking anti-transgender myths and tropes.

  1. A sense of entitlement to define others

I cannot say this is just something specifically about British culture, but as that is the one I grew up in, I will use it as a baseline. When I was growing up, it was much more normalised for parents and teachers to tell a child what they are, particularly when it was something negative. ‘You are bad. You are fundamentally inadequate. You are a disgrace.’ It wasn’t about the child’s actions in that moment, but something much deeper – about their entire being. So the opposing idea, that someone might respond, ‘No, you don’t get to define me – I do,’ feels positively revolutionary.  

Unfortunately this drive to normalise through criticism is sometimes still mirrored in the psychotherapy world; the idea that anything that deviates from the [eg cisgender heterosexual monogamous vanilla] norm is a pathology that must be uprooted. These attitudes have not gone away, and may be echoed in the interaction when a client says ‘But it’s not like that’ and the therapist insists that they know better. At worst this becomes conversion therapy, a practice which the profession is increasingly distancing itself from.

  1. Envy of someone who is living as their authentic self

Some (many) people grow up letting themselves be what other people define them as – this path of least resistance may be the safest path at the time. But when they realise that the norms they have conformed to do not reflect their true selves, it may feel as if it is too late. This may bring out deep envy of those who appear to be demanding and getting more from life, and this envy may manifest as a desire to attack. (And of course children can be harmed by unhappy parents who are not living as their true selves.)

  1. A fixation with the purity of womanhood

There is a lot of frightened and at times Victorian-sounding rhetoric around who is allowed to self-declare as a woman. Some of it veers dangerously close to white nationalism, implying that somehow the classification ‘woman’ will be forever dirtied by allowing trans women to enter it.

  1. A deflection of something much bigger, all-encompassing, and harder to challenge: how boys and men are raised

A widely expressed anti-trans fear (specifically in relation to trans women and the revision of the Gender Recognition Act) is that cis men are suddenly going to self-define as trans and start invading toilets and assaulting women. In fact, men can and do already invade toilets and harass people – which is already illegal. And of course, a woman entering a toilet and harassing people would also be committing a crime.

From what I observe, many objections to trans women’s existence involve things that men actually do (or might do), and I see a lot of fear expressed around this. It would therefore seem beneficial to campaign about better education for boys, better sex education in schools, and dismantling patriarchal structures in general. If campaigners put their considerable resources towards this instead of attacking a small minority of human beings, they might get a lot more support.

 

Trans Britain is available from Unbound, Amazon, and Hive.

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.

 

Gender and Sexuality CPD trainings

Need some CPD?  Would you like to to update your skills and knowledge?

In 2017, as part of London Sex and Relationships Therapy, I am offering trainings on Gender and Sexuality in the therapy room, and other related subjects.

In January I will be in Cambridge and Edinburgh, facilitating:

Gender and Sexual Diversity in the Therapy Room

Drawing on the book Sexuality and gender for mental health professionals: A practical guide (Richards & Barker, 2013), this training provides a basic outline of good practice when working with issues of gender and sexuality. Attendees will be encouraged to reflect upon their own ideas and assumptions about gender and sexuality, and those implicit in their therapeutic approaches. We will consider various ways of understanding sexuality and gender, and their implications for therapy across client groups. Specifically we will focus on the issues which can be faced by those who fit into normative genders, sexualities and relationship structures, as well as for those who are positioned outside the norm.

If you would like to attend, please follow the links below for bookings:

Relate Cambridge – Saturday 14th January 2017 (10-4pm)

Information about this training and about Relate

Relationships Scotland – Saturday 28th January 2017 (10-4pm)

Information about this training and about Relationships Scotland

If you would like further training

If you are looking for training on this subject or something related, please contact me and either I or one of my colleagues will come back to you.

Am I kinky? And is this a problem?

screen-shot-2016-11-16-at-10-07-38Due to media stereotyping, unhelpful labelling with words like ‘paraphilia’ and ‘perversion’, and the assumption of mental illness or pathology – if you identify as kinky (or feel you may be) you sometimes wonder if there is something wrong with you.

You may have felt unable to share your feelings with anyone else. And you may also have avoided going to therapy, even for something entirely unrelated to your identity or lifestyle, because you fear either being treated as ‘sick’, or having to spend many hours justifying yourself.

For a start, kinky does not equal bad or weird

For some people, being drawn to BDSM (Bondage and Discipline, Domination and Submission, Sadism and Masochism) dates from their oldest waking thought or memory. Others discover it later in life. We live in a time when what you might call identity essentialism (‘If you weren’t born this way it’s fake’) is being questioned. Identities and orientations can evolve over time:

  • For example, from a young age you might have found yourself wishing to be restrained, or were aroused by certain scenes on television or in books, or took a specific dominant or submissive role during play with others. You may have put these thoughts and feelings away for years.
  • Or perhaps, as you grew up, you never felt right doing what everyone else seemed to be doing sexually, but weren’t sure how to articulate it, and just carried on doing things that didn’t really do much for you. Or stepped away from intimacy altogether. 
  • Or later in life you felt exciting changes coming on and, like Alice down the rabbit hole, you tumbled into a whole new world that you never wanted to come back from.

Secondly, it’s far more common than you think

And, even more importantly, studies (see the links at the end of the article) suggest that the kink identity correlates with a number of positive attributes.

A spectrum rather than a binary

I find it preferable to open up the definition rather than narrow it. Do you find greater release in giving or receiving extreme sensation? Do you experience something deeper when you give yourself over to another person, or take power over them? Do these experiences make you feel more fully you?

There are an almost infinite number of ways to express your kink

You do not have to join a particular community, or love leather or rubber, or spend your evenings in underground play spaces. For some it may be about handcuffs and a blindfold, for others total enclosure, for others extreme sensation. For others it could have nothing to do with physical sensations and everything to do with psychology. It could be about taking control, or giving up control, with no pain or restraint at all. 

For one person, it may be spending thousands on rubber clothing and dungeon furniture. For another, a simple phrase sent in a text message and a 24/7 household setup that others would have to guess at. It might involve going out to events, like clubs or munches, with others who share the same interests. For some people, no act, however apparently extreme, counts as kinky unless there is an exchange of power. 

It could be mild and playful, or it could be extreme and unusual, or combinations of all the above.

Does it have to be ‘all about sex’?

For some kink is inextricably linked with genital sex. Other people very clearly separate the two, and others are fluid in their approach. So however you feel, however you see yourself, there is no ‘one true way’.

Our society has a very poor record on acceptance of sexual diversity and many remain closeted just to feel safe

Perhaps you feel shame when reflecting on your fantasies or activities, and have never told anyone about them. You may also be struggling because:

  • What you like may have a more extreme taboo edge or safety element to it.
  • You may fear that you might hurt someone non-consensually.
  • You are happy for it to remain in fantasy, but want to be sure you are okay.
  • You have been paying for kink services and are wondering if this is okay.
  • You fear you are doing it too much, or thinking about it too much, and need reassurance that you are sane and not an ‘addict’.

If any of this troubles you, it may be helpful to talk to a therapist

Psychotherapy can help you look at the emotions underlying your current situation, and help you with any difficult feelings you may be experiencing.

It’s worth choosing carefully, however. There has been a tendency in traditional therapeutic schools of thought that any activity that is not 100% heterosexual, monogamous or vanilla (ie non-kinky) must stem from a pathology, or possible early-years damage. I have gone further into the problems with this viewpoint in a piece for Lancet Psychiatry: BDSM, Psychotherapy’s Grey Area.

I never discount the idea that this could for some people be the case, that a response to a past difficulty has evolved into a kink or fetish. And people do sometimes eroticise past experiences. But past experience may have meaning here or it may not. Be very wary if someone wishes to turn detective and start ‘uprooting’ your kink or trying to convert you.

You are not sick – you may just need to be heard. Rest assured you are not alone.

Where to find a kink friendly therapist

Further reading and research

On the subject of orientation and identity, there is an interesting discussion around this post by Clarisse Thorn: BDSM As A Sexual Orientation, and Complications of the Orientation Model

These two studies may also be of interest:

Sex work and the transactional nature of human relationships

Sonnenschirm_rot_redNew essay in Lancet Psychiatry

My latest piece is called Sex work – society’s transactional blind spot.

In the article I explore the transactional nature of human relationships and how we are encouraged to bargain with others, from a very young age, for social and emotional survival. I have focused on sex work because it is a significant cultural issue that polarises opinion and inspires much clichéd and harmful representation in art and media.

Sex workers also report poor experiences in therapy and within the mental health system as a whole.

The opinions and experience of those who actually do it are often ignored or marginalised

Even if you cannot imagine doing sex work yourself, or think you don’t know anyone who does it, it’s worth reflecting on it as an issue of labour rights, self-determination and consent.

Political support for change

Just after the piece was published, the UK Home Affairs Select Committee declared in a report that there was a very strong case for decriminalisation. Amnesty International reached a similar conclusion in 2015 which has now become policy. This move has also been supported by the Lancet.

If you are affected by any of the issues here and would like to explore them further in therapy, please get in touch.

[The image above is by Usien and can be found at commons.wikimedia.org]

Infidelity – deception is even more exciting than sex

beach 3Cheating – why do people do it?

Actually, perhaps the word ‘cheating’ sounds a little bit old fashioned, so let me put it another way: Why do people go behind the back of a negotiated relationship? Even if the relationship involves multiple partners and freedom to explore sexually?

And why do people do this even when the secret sex isn’t that good – and even when there may be no sex going on at all?

As a relationship therapist, I reflect often about what makes people seek something beyond the current boundary of their romantic partnership(s).

A popular subject for study

There are many theories about nonconsensual non-monogamy. This 2010 paper, Infidelity – When, Where Why? is a thorough roundup of a number of studies on the subject, covering everything from improving the gene pool; poaching a ‘better’ partner; unhappiness in the current pairing, whether due to insufficient sex, care or support; attachment style; boredom; dissatisfaction; and entitlement. There are also a large number of self-help books that attempt to address the issue.

This piece covers one aspect that has been on my mind for a while.

I suspect that, for many people, the urge to secrecy is even stronger than the sexual drive

This may not sound very logical on the surface. We are all supposed to be obsessed with sex, worrying about it all the time, chewing over about who is ‘getting’ more than we are. We spend loads of money on our appearances and fall easily into what I call ‘sex toy capitalism’, the endlessly evolving supply of slightly variant and increasingly expensive tools, of somewhat varying efficacy, which are sold as ways to enhance sexual pleasure. (This mirrors the encyclopaedic numbers of barely distinguishable (or pointlessly athletic) positions used to fluff out magazine articles, eg ‘The Wheelbarrow.’)

Sex is supposed to be the most important thing ever. Only money has more significance in terms of taking our attention and symbolising our social success to others.

So who would care about secrecy?

Ok, think about all the times you have been lied to. Well, there will have been so many of them that you won’t be able to. And then think about all the times you have lied to someone else. Much of the time people claim to hate the idea of lying, (and children are frequently warned against it) but when someone comes along and states the truth to you very brutally, you may well wish the untruths had continued.

So most of us have a shifting wall of defence available to us at the drop of a hat, when social needs arise. How many times have you told a person you were fine when you were not? Secrecy, of which this relatively innocuous exchange is an aspect, protects us from others and protects others from our real selves.

The excitement of a double life

It is very easy to fall into ways of living that do not feel fulfilling or exciting. We can easily forget the importance of excitement and fulfilment when we only have one life to live and we have been told over and over that we must live it in a certain way – through getting a job and a mortgage, and being married to one person, and having children. We may have had very good reasons for doing these things, and they can be very fulfilling in themselves. But perhaps we gradually stop testing ourselves, stretching our capabilities, until we have no idea what we are capable of. In that light, secret sex is a very quick way to reassert a lost, and intoxicating, sense of risk. And our suddenly dull-seeming partner, still stuck in their pyjamas, is unaware of our adventures, and momentarily we become more alive.

Secrecy is power

Secrecy is also control. Doing a thing that another person doesn’t know you’re doing gives you space. It gives you a chance at another identity, even for a few brief hours. It gives you space where you are less known and fewer assumptions can be made about you.

Secrecy is a form of individuation

If we are in any way unsure about who we are, no amount of sex will give us a solid sense of ourselves as individuals. If we find the presence of others encroaching despite our urge to bond with another; if being very close to another person risks us being truly known by them, we may seek to find outlets where we feel we can breathe, away from the main figure in our lives. Lies are like oxygen when the space you occupy with another person is overwhelming.

Response to a parent?

I could take this further and say it is an intrusive parent that we escape from when we do something secretively behind a partner’s back. An intimate partner can become an all-seeing eye – our instinctive response is to rebel.

Secrecy – not all bad

A person may have good reasons to have secret sex – perhaps they are caring for a partner who is incapacitated. They are not going to abandon them, but would like a sexual outlet.

I float this idea as a way of interpreting something I see very often. It is, of course, open to discussion. If anything in this post is relevant to what’s going on in your life and you would like to explore it, please contact me.

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.

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)

Bipolar disorder, race and mental health services, ableism and sex, and more…

Blue keyboard‘That orgasm problem’, zoophilia, sex positivity, the meaning of public relationship announcements…

Interesting things online, because they’re recent or because I think they deserve another outing.

PLEASE NOTE: As always, me linking to something doesn’t mean I endorse every word of it, or everything in the publication it came from. There may be obvious content warnings and some may be a bit unsafe for work.

MENTAL HEALTH

I’m a therapist and keep this poster in my waiting room, apparently it’s saved a few lives (9gag)
I’ve put this one up before elsewhere, but it’s so powerful I’m going to link to it again.

”A cry for help’ makes it sound like I’m supposed to take pity on you. But you don’t need my pity. This isn’t pathetic. This is the will to survive.’

Black and dangerous? Patient experiences of mental health services in London (Lacuna)

Long and very thorough investigation of the inequalities in mental health care in the UK, focusing on the black community, with a number of personal stories.

‘There are few mentions of race in the current government’s mental health strategy documents. Instead it has been submerged under the general heading ‘equalities’. Within the black community, there are wide variations of experience and concern including high rates of self-harm among Asian women and high occurrences of African Caribbean men sectioned by the police. Lumping all such variances together under the general heading ‘equalities’ increases the risk of mental health providers ignoring them. It is much cheaper to focus on meeting a general equalities duty, than commission work to investigate and improve services for specific groups. People are marginalised in different ways and each group, whether gender, class or race, needs tailored support.’

10 things you should never say to someone with bipolar disorder (Guardian)
Important list of unwelcome queries. I think every mental illness needs a list like this, and many of the questions could apply to other conditions. Actually, and physical illnesses too. And disabilities. And addictions. And being pregnant. And – it’s worth reflecting on why people feel a need to ask such personal questions of someone they have just met, about aspects of them that they have little or no control over.

‘Oh yeah, I’m a bit like that
I’ve had plenty of people say this to me after finding out that I have bipolar disorder. It’s meant kindly, as a means of finding common ground. Except often it comes across like Russia battering a flag into a bit of the Arctic she doesn’t own.’

RELATIONSHIPS / GENDER AND SEXUAL DIVERSITIES

Women and that ‘orgasm’ problem (Cyndi Darnell)

Great post by Cyndi Darnell that I put on my Facebook page, but I’ll link to it here because it makes such an important point. One day, we will find ways to have a less goal-driven approach to sex.

‘One thing I do know for sure is that when I ask women who don’t have orgasms why they want to, they very, very rarely if ever say it’s because they want pleasure. This may come as a surprise to many of you. Remember, I am in the very privileged position of hearing people’s deepest, most intimate erotic secrets day in and day out. For many women, genuine pleasure is rarely even on their radar. More than anything, their reasons are because they want to feel normal or because they feel they are missing out, or because everyone else is having them (apparently), or their partner expects it of them – all of which are answers motivated by fear and shame rather than pleasure.’

And here we are again, back at my post from the other day, about wanting to be normal.

Don’t be a sex-positive jerk (this ain’t livin)

Expecting everyone to be sexual and all in the same way can be very excluding and unhelpful. Coercive positivity is a theme I will be returning to more than once in this blog.

‘The brand of sex-positivity that continues to insist that sex is a unilateral good (except, of course, for rape), is not viewing the nuance and complexity of human sexuality, something rather surprising considering it comes from a movement that claims to be concerned with the rich array of, well, human sexuality.’ 

Getting laid isn’t the answer to ableism (Everyday Feminism)

Long first-person piece unpacking the infantilisation and presumed asexuality of disabled people.

‘Even sympathetic friends have repeatedly made it clear that how far I go in any relationship depends on the compassion and open-mindedness of the other person, as if my sexuality is grotesque to the point where only bleeding heart saints would dare tolerate it – and I would be forever indebted to them for doing so.’

What it’s like to date a horse (nymag)

Challenging and thought-provoking interview with a self-confessed zoophile about his life-long sexual relationships with horses. Many issues come up here, about consent, and about ownership. Many people actually think about human/human relationships the same way.

‘Did you date at all?
I did ask a girl to the prom. Now that I look back, I feel so sorry for her. We sat at the table and didn’t dance. I don’t even think we hugged. As much as I later experimented with people, I was always sure I wanted horses. It was never a case of “I’m just giving this a try to see if I would prefer humans.” ‘

Can You Tell That I’m in a Relationship? Attachment and Relationship Visibility on Facebook (Sage Journals)
Academic study looking at the way we portray our relationships online. One outcome is that the more insecure a person feels about their relationship, depending on their attachment style, the more likely they are to advertise the relationship publicly. Anecdotally, I can’t help noticing how quickly some people announce new relationships online, only to have them founder within weeks. In the old days, it used to be called ‘The Curse of Hello.‘ (Scroll down for the explanation, about the apparent jinx on celebrity couples appearing in Hello magazine. (Irish Independent))

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.