Therapists, are you harming your Autistic and ADHD clients? (PART TWO)

Photo by C D-X on Unsplash

Part 2/2: Negative outcomes, what you can do to avoid them, and some further resources

You’re likely here because you’ve read my previous post, ‘Therapists, are you harming your autistic and ADHD clients? (Part One)‘ and are interested in reading more. If you’ve just stumbled on this page, I recommend you check out Part One first.

Part One received a lot of support and resonated for many people. In response one person noted that, when handled effectively, silence can also be a positive thing for the autistic or ADHD client, as it allows time for differences in processing speeds. Someone else reminded me that supervision can also be a challenging environment for the ND therapist. Along with harm in therapy and harm in training, it feels like our industry needs to examine its approach to harm in supervision.

I know there’s a lot of talk of harm here, of damage, but we need to look deeply into this before we can start to build something better for our industry, for ourselves, and for our clients.

Of course, we’re therapists so we know that everything can be flipped on its head and reframed. And lateral thinking can absolutely apply. There may be moments where some of the interventions I describe in Part One, between a sufficiently attuned therapist and their safe-enough-feeling client might, in a particular moment, be okay and helpful. But we cannot count on it.

PLEASE NOTE

• This post is not a primer about autism, ADHD or any other form of neurodivergence.

• Please note that Autism and ADHD often co-occur, so you will see people increasingly describing themselves as AuDHD.

• The list of resources at the bottom is a starting place, an invitation to deepen your knowledge and find greater understanding.

• I do not endorse every word ever written by anyone I list here, or on the websites where these posts may appear.

• A list of red flag words, expressions, names and media output that you would do well to take care around is unfortunately beyond the scope of this post. [anyone?]

So what might the outcomes of harmful therapist behaviours, (however unintentional), be for the autistic and ADHD client?

(1) In one-to-one therapy

(a) The client leaves therapy without being helped.

Actually, simply not being helped may be the least harmful outcome. Someone may end up feeling as if this ‘failure’ was all their fault, confirming their sense that they are defective, broken, and beyond help. The therapy may have replicated how they have already been treated in other contexts.

(b) The client leaves therapy, never to return.

Their trust in people may already have been low – now it will be lower. Their internalised stigma may also increase. They may feel that getting support is just not worth the effort.

(c) The client remains in therapy but evolves strategies for pleasing the therapist.

This is of course no help to the client, but again they may be playing out a scenario familiar from the rest of their life. They mask in sessions and evolve ways to please the therapist by, for example (as I described in Part One), staring at the therapist’s forehead, or tolerating discomfort in the therapy room such as non-optimal seating arrangements, or tolerate amusement or judgements from the therapist about talking too much or getting angry about injustice, or wanting to stim. Ultimately, while this therapy might produce something positive, overall it will simply reinforce the status quo.

(d) Remember that the suicide rate is higher in autistic people and people with ADHD than in the neurotypical population.

The first of the two studies I link to there also highlights the presence of undiagnosed autistic traits in those who died by suicide. I wonder, in fact, just how many undiagnosed neurodivergent people attempt suicide. Perhaps they got labelled with ‘anxiety’ or ‘depression’ without anyone looking further, because they weren’t presenting like a ‘naughty little boy’. It is for this reason, on top of many others, that therapists need improved professional competence in this area.

(2) What happens to the parents of neurodivergent children (who may well be neurodivergent themselves), when accessing therapy and support?

Although these two posts do not focus on the specific experiences of children and young people, it’s worth looking at parents’ experiences when trying to get help – for themselves and their child. The original group discussion was particularly full of frustration and anger on this subject. It deserves a whole article on its own.

(a) Back we go to attachment theory!

This seemed almost a rite of passage for a parent trying to seek help for their child from local authorities. They would be labelled ‘enmeshed’ and pathologised as having ‘attachment issues’. Social workers, teachers, and therapists, (etc), may tell parents they are ‘overprotective’ of their children, or label someone an ‘anxious mum’ who is overreacting and ‘attention seeking,’ when the reason for them appearing to be this way is that they have had to fight for their child since they day they were born. This seemed particularly the case when the child had already been bullied or ostracised at school.

(b) Parents being accused of FII (Fabricated or Induced illness) to get their child some attention. 

Given the existing scarcity of local authority resources, it is sadly unsurprising that those with the job of gatekeeping are going to try to find ways to keep people out of the system. But seriously?

(c) The mental health impacts of fighting the system.

The stress of this for the parents, and the impact on the child or children, may drive parents and whole families to burnout. This may then itself then be pathologised by gatekeepers as ‘inability to cope’. Also, as neurodivergence runs in families, these parents may be neurodivergent themselves, so they may be doubly struggling. The judgments inherent in these attitudes and the battle for basic services simply cause more stress, anger, guilt and shame for the parents which may in turn impact the child. (It is worth reading about the history of autism and the outdated idea of the ‘refrigerator mother’.)

(d) A reminder that the system is set up to be adversarial.

Just like the benefits system, the social support system seems designed to tire people out so that they either give up and go away; submit to whatever they are being told to do; or react strongly negatively which will then ‘justify’ rejection or disqualification from support or benefits, or sanctions.

(3) What about neurodivergent therapists who are being managed or trained by other therapists?

The experience of ND therapists is a whole other topic which needs a separate post. There are a lot of us around.

(a) Neurodivergent therapists may struggle in the workplace.

Their managers may assume that all ND therapists need the same workplace accommodations, and then may react badly when the therapist asks for something specific, such as no scented products or loud clocks in shared therapy rooms.

(b) Neurodivergent trainee therapists are likely to be treated differently.

Even if someone has a diagnosis, they may feel self conscious about asking for accommodations. If self-diagnosed they may have to debate this and struggle to be taken seriously. If the trainee is undiagnosed and unaware of it they may experience all sorts of unowned poor treatment from their training organisation.

Systemic factors

It is important to reflect on where patriarchy, colonialism and the medical model collude to influence healthcare systems and public understanding, causing neurodivergent people (and their children) to be seen as annoyances and anomalies.

Many gender variant people are neurodivergent, (and many GSRD identified people as a whole). If a therapist is not sufficiently aware of GSRD identities (and worse, holds prejudiced views about them), the likelihood of damage will be greater. Similarly, for example, in the case of a white therapist working with a client of colour who is also ND.

‘Oh gosh! We’re back at identities and labels again! Can’t we get beyond this, just for once???’

When people speak, you need to listen (which is kind of what therapy is about, no?). When a whole group of people speaks, who are united by a particular identity (or label), you need to listen extra hard, particularly if you are a therapist! This needs to change at root level, which means from training organisations who provide primary trainings upwards.

Therapy has traditionally been framed by patriarchal, white western thinking. I don’t necessarily say ‘throw it all in the bin’ (not all of it anyway) but it simply isn’t questioned enough from within. There is no getting away from this. It brings a top-down aspect to therapy which can engender harm (‘therapist knows best’), and a lack of consent. If you are working as a therapist, you need to keep the ultimate consent question perpetually in mind: ‘Who is this for?’

Equally, the ‘I don’t judge’ approach sounds nice on the surface, but it is clear that if a therapist doesn’t have a good handle on GSRD, (or race, or in this case autism and ADHD), as soon as they hcome across something they have no handle on, they are likely to do exactly that. Ditto ‘I just want to help people’ – your saviourism may also do harm.

What to do next

What you need to do now is check out the people who are talking about this publicly and LISTEN TO THEM. Listen to autistic people and ADHD people and all neurodivergent people who have been in therapy and had a negative experience – or a good one.

Particularly if you are in middle age and older, go online and read what younger people are saying. A lot of people are out there putting a lot of time into explaining their lived experience in the public sphere. That is where you will find current thinking on all this.

Some older therapists maintain a lofty distance from social media and therefore from social trends. This will not help your practice. If you cannot be online much, then talk to younger people. But please don’t use your younger clients as resources!

You can also attend one of the many trainings that are available. (See below.)

‘So are you saying we should treat our neurodivergent clients like helpless little snowflakes??’

Here we come to the central issue. If therapists and their trainers mainly come from a homogenous and privileged group with little experience outside that group, they will assume their knowledge, experience, resources, and levels of resilience are the same for everyone else in society. This of course is not the case.

Remember, it is labour for a client in therapy to challenge and correct their therapist, especially when they are not sure what they are challenging them about. It’s easy for a therapist to say ‘But that’s the work, isn’t it?‘ I mean, sure, yes, in an ideal world! But there has to be trust. And if you as a therapist don’t work on your cultural competence, you are creating extra work for your minority and minoritised clients – clients who are already likely to be exhausted from navigating similar scenarios in the rest of their lives. It’s not your job to make this harder for them.

Work towards changing therapist trainings from the inside

I keep mentioning primary qualification trainings (ie Diploma, PGDip, Masters) because the way the trainers model the work will be replicated by the therapist in the therapy room.

A central issue here is the learning edge. This is the place, that is not too comfortable but also not too stressful, where we are especially open to taking in new experiences. Trainers aim to take us to this place and hold us there for just the right amount of time for us to benefit and take in the information.

But the learning edge is not a rigid boundary like a circle or square, along which everyone will have the same experience. In fact, everyone’s learning edge is different. Any individual’s learning bandwidth is going to be wider or narrower depending on many factors. One size does not fit all.

Once again, I hope this is helpful.

Resources

Below I have frankly infodumped some links. I have not read every word of everything here. If you know any good ones please tell me and I will add them – or if you think any of these are terrible.

You will notice the skew towards autism. This is due to the nature of my own existing resources. However, the more I learn, the more I find that the map of neurodivergence is a closely knit Venn diagram rather than, say, a flower. As I said above, a significant number of people with autism also have ADHD, and a fairly high number of people wth ADHD are also autistic. Hence a number of people calling themselves AuDHD. There will be much that is relevant here for many people.

Autistic and ADHD clients in therapy – experiences

• Therapy & Neurodivergence

• Autistic Adults Experiences of Counselling

• Autistic people should not have to educate their therapist

• An Autistic’s Vision for Neurodiversity-Affirming Therapy

• Neurotypical psychotherapists and autistic clients

• Autistic Therapy: 8 Things to Consider

Research and media

• ‘Autistic while black’: How autism amplifies stereotypes

• Barriers to healthcare and a ‘triple empathy problem’ may lead to adverse outcomes for autistic adults: A qualitative study

• Black adults who live with ADHD

• Counselling Clients with ADHD

• ‘Living in a world that’s not about us’: The impact of everyday life on the health and wellbeing of autistic women and gender diverse people

• ’No you’re not’ – a portrait of autistic women

• Race and ADHD

• Silver linings of ADHD: a thematic analysis of adults’ positive experiences with living with ADHD

• The lived experiences of adults with attention-deficit/hyperactivity disorder: A rapid review of qualitative evidence

CPD TRAINING ORGANISATIONS

• Free2BMe, Neurodiversity training, specialist neurodivergent support

• Vanguard Neurodiversity Training

• Aspire Autism Consultancy

• The Autistic Advocate

• Reframing Autism – Autism Essentials

• Aucademy

PEOPLE TO FOLLOW ONLINE

There is a very large number of ND influencers who are producing a lot of content, particularly on Instagramand still on Twitter (X). This is a small selection and I have undoubtedly missed out some good ones.

autistic_callum_ (Tw and IG)
neuroclastic (Tw and IG)
neurodivergentrebel (Tw and IG)
autienelle (Tw and IG)
neurodivergent_insights (Tw and IG)
neurodivergent_researcher (IG)
autisticflair (IG)

annmemmott (Tw)

DrRJChapman (Tw)

• AJ Singh / AJ Singh LinkedIn

• Black Girl Lost Keys / @blkgirllostkeys

• Leanne Maskell

• Neurodivergent Rebel

• The Thoughtspot: How being autistic is linked to ego death

BOOKS TO READ

• Edward M Hallowell & John R Ratey ADHD 2.0 New Science and Essential Strategies for Thriving with Distraction – from Childhood through Adulthood

• Eva A Mendes & Meredith R Maroney Gender Identity, Sexuality and Autism: Voices from Across the Spectrum (Foreword: Wenn Lawson)

• Anand Prahlad The Secret Life of a Black Aspie: A Memoir

• Devon Price Unmasking Autism: The Power of Embracing Our Hidden Neurodiversity (also on Instagram)

• Bianca Toeps But you don’t look autistic at all

• Pete Wharmby Untypical – How the World Isn’t Built for Autistic People and What We Should All Do About it (Also on Instagram and Linked In)

Therapists, are you harming your autistic and ADHD clients? (Part One)

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Photo by Sid Verma on Unsplash

Part 1/2: Assumptions, Interventions, and When Good Intentions Go Bad

This post comes out of an online discussion involving a number of therapists who work with neurodivergent (ND) clients, many of whom are themselves ND or are parents of ND children. There was a lot of frustration expressed. I have summarised the discussion here and added some thoughts of my own.

I sense a wave building around this topic. Personally, it’s helping me crystallise some of the thoughts I’ve been having since long before I trained as a therapist but, until recent years, I was not able to name.

Why am I interested in this?

I am late-diagnosed ND. This has been highly impactful. As a previously undiagnosed ND client in therapy, I found myself on the receiving end of some of what you read here. And before I found greater understanding, as a therapist I may have also enacted some of these things myself, or at least believed in them. 

PLEASE NOTE 

• This article cannot be exhaustive, and cannot be a full-on explainer – it could easily be a long form essay or a book – but I hope it will be a conversation starter. In part two I will link to further resources.

• The main focus of this post is on working with adults rather than children.

• The online discussion focused mainly on autism, ADHD and AuDHD, so those identities are the priority here, but the neurodivergent umbrella (which covers both developmental and acquired neurodivergence) is way more expansive. However, many of the scenarios I describe here could apply across the board.

• If I have linked to an article on a particular website, it doesn’t mean I agree with everything else on that website.

• For brevity I will often be using the acronym ND in this article, short for ‘neurodivergent’ or ‘neurodivergence’. (NT = neurotypical).

‘Wait! You can’t be talking about MY modality, surely?!’

If you are a therapist reading this you may already be feeling on the defensive, so please give yourself some time. And, actually, there is no need to descend into modality wars – because there is literally no therapeutic modality that cannot be used harmfully with a neurodivergent client! 

Any therapeutic modality (as well as the therapy world itself) may become ossified without constant self-reflection and consideration of the shifting social context as well as increasing awareness of neuro difference. For example, out in therapy land you will find folks who believe that, for example, Unconditional Positive Regard and Attachment Theory, are immutable concepts like the sun rising again.

Also – and this is really important – a lot of therapy research has been carried out by, and with, white neurotypical people, which potentially limits their value to many. 

Much of what I’ve written below fits within the contemporary definition of gaslighting. The word has come a long way since the old movie, Gaslight. In essence, it’s about misusing power over another person by telling them that they don’t know their own mind. 

This list is long. I’ve laid it out as simply as possible.

ONE – RIGID ADHERENCE TO MODALITY

I go into further detail in the sections below, but here are some obvious ones:

(a) Being determinedly non-directive despite the client needing, and requesting, structure and clarity. 

(b) Not answering direct questions from the client without going into a whole ritual dance of ‘I wonder why you are asking that’ first is often unhelpful. [This is similarly unhelpful when a client is also GSRD (Gender, Sex and Relationship Diversity) identified and may welcome a therapist explaining or disclosing.] Psychoeducation is valid and may bolster a client’s sense of autonomy. For example, if someone is having issues at work, they may need help to understand the covert meanings of what is going on, and so start to protect themselves from power games played by colleagues. A client may feel abandoned if the therapist does not support them when they ask about something.

(c) Therapist silence can be highly detrimental. The inherent slipperiness of the blank screen technique can simply be torture to an autistic client who may be seeking rules to work by, or an ADHD client experiencing RSD (Rejection Sensitive Dysphoria).

(d) Relying on specific jargon, eg ‘splitting’, when the client shows strong emotion; or if they are talkative, being told this is ‘ego defence’ or ‘resistance’. (The irony of this rigid adherence may not be lost on an autistic client who may have previously been criticised for their ‘rigidity’.)

(e) CBT-style thinking: No one (ND or not) should be encouraged to see their thinking as defective, and be encouraged to change their behaviour as if they are the one at fault, when the issues are likely their environment and lack of accommodations.

TWO – THERAPIST ASSUMPTIONS

(a) ‘Of course it’s not autism or ADHD – it must be trauma!’

Being autistic or ADHD does not mean the person is automatically traumatised. But due to the way ND people are often treated from a young age, they are very likely to be traumatised because of this. Being either diagnosed and stigmatised, or living undiagnosed and spending life thinking they are defective or useless – that for sure is trauma.

(b) ‘Of course it’s not autism or ADHD – It must be attachment issues!’

There was particularly pronounced anger in the group about this, particularly from parents of ND children. I go into more detail on this in part two, on negative outcomes. There are many critiques of attachment theory and it is not an immutable law.

(c) ‘Isn’t this client just avoidant?’

The alleged avoidance may actually be alexithymia. Lack of ability to name feelings is one reason why an ND person may find life difficult, and be bullied and abused because they are simply unable to express what they are feeling or protest against it. Also, when you have been stigmatised because of who you are, you may well have learned to hold back as an aspect of masking, for safety.

If the client says they don’t know the answer to something, or cannot name how they are feeling, this is not an invitation for the therapist to start pushing them as if they are hiding the truth from themselves.

(d) Assuming deficits rather than differences

Using the medical model of cognitive or behavioural deficits, while not understanding, say, sensory processing differences or monotropism, is not helpful, and neither is assuming the client is broken or disordered and needs fixing. The therapist may rigidly adhere to the DSM, which assumes a deficit model. The therapist may try to get the client to change or deny their ND characteristics, and when this doesn’t work the ND client leaves feeling broken (see part two). This will not help a client work on undoing the internalised ableism they are likely experiencing.

(e) Not understanding the autistic sense of injustice and moral injury

‘I can’t understand why you’re still angry about that!’ It is infantilising and frustrating when a therapist regally waves away a client’s lingering sense of injustice. (Poorly held therapy may of course incite this feeling in the client also.) This may be compounded by the power dynamic between therapist and client, highlighted by, for example, gender, race or class differences.

(f) Assuming the client is ‘nervous’ or ‘anxious’ 

It’s important not to assume the client is nervous just because they are stimming in various ways, or they are talking a lot about special interests, which a therapist may dismiss as ‘obsessions’. Also many ND people may process what’s going on for them out loud and rapidly in a way that may seem over detailed, or a distraction, to a therapist who is not aware. If a client talks fast this may just be how they talk, rather than a sign that they are stressed and need to calm down.

(g) Infantilising the client for their ‘compliance’

A client who pays on time and turns up on time may be held to be ‘compliant’. This in autistic people may be viewed as something childlike or even negative rather than cooperative.

THREE – UNHELPFUL INTERVENTIONS

(a) ‘You’ve got to make them feel the feelings!’

Many ND clients are already feeling a lot of feelings and a therapist pushing them to feel more will not be therapeutic. Ditto the technique of goading the client into anxiety or anger in order to get them to have the feeling again in the ‘safe space’ of a transferential relationship in the therapy room. 

Also, a client may express feelings via all sorts of media, metaphor, simile, imagery, sounds, movements, creativity as a whole, and their special interests, rather than direct description. 

(b) ‘Let’s do some meditation!’

Speaking as someone who experienced the query ‘Have you tried meditation?’ many times in a therapeutic context, there are actually many people who cannot sit still and focus inwards, and for whom this may be actively detrimental. Focusing on the breath or doing body scans (see below) may be traumatic and bring up bad memories. In fact, meditation can be anything you want it to be, eg dancing or cleaning, but this is rarely pointed out. When I explained that traditional meditation methods did not work for me, there was often an implication that I just hadn’t tried hard enough, which is often directed at ND people.

Similarly with guided visualisations – someone who is aphantasic or hyperphantasic may struggle.

(c) ‘Let’s do a body scan!’ or ‘Let’s explore your bodily felt sense!‘

Many ND people struggle with interoception and may be unable to access what is apparently being asked for. Also, someone with sexual trauma (of which there is a higher than average incidence among autistic girls and women) may find themselves going into a fawn (compliant) response when asked to do things with their body, which will leave them feeling worse afterwards.

(d) ‘Why aren’t they looking me in the eye? I need to do something about this.’

The therapist may interpret a client not looking them in the eye as denial, avoidance or dishonesty. Actually, eye contact is not the universal positive this would seem to imply. In many cultures it is seen as disrespectful to look someone in the eye, particularly someone in authority. Some ND clients who struggle with eye contact will simply evolve a way of staring at a point on the therapist’s forehead and hope that it’ll do – thereby distracting them from the work.

(e) Pathologising a client being late for sessions

Again this is treated as if it must be avoidance, when it may be executive functioning or memory. Some people with ADHD really struggle with this.

(f) Pathologising a client’s special interests

Someone might have an aspect of social justice or any kind of politics as a special interest. If this makes the therapist uncomfortable this is for them to work on.

(g) Expecting homework tasks to be completed

Many clients struggle with homework for all sorts of reasons. Making non-completion (non-compliance?) a thing may add to client stress. There may also be echoes from challenging schooldays here, as well as the impact of PDA (conventionally known as Pathological Demand Avoidance, but also known as Pervasive Drive for Autonomy).

(h) Suggesting the ND client has a personality disorder or other pathology

While this takes us closer to psychiatry, it’s still worth remembering that ‘personality disorder’ as an idea is often used harmfully, and the diagnosis of BPD/EUPD is often used stigmatisingly against young women, queer and trans clients, People of Colour and ND clients when, ironically, it is often trauma that is manifesting. Similar applies when suspecting the ND client is a ‘narcissist’.

FOUR – WHEN GOOD INTENTIONS GO BAD 

(a) Not raising the possibility that a client may be neurodivergent

Generally clients are open to hearing this. Yes, it has to be done with care as most therapists are not qualified to diagnose – but it can absolutely be explored. But withholding this possibility may cause harm to the client in the long run. 

(b) Not wanting to label the client

Following on from the above, some therapists cling to the idea of ‘Why do we need labels?’ [See also: working with GSRD clients] and it generally comes from a place of privilege (or structural social advantage). This may cause them not to suggest a client may have ND traits. Actually, labels help people find their peers and make adjustments to their lives where they can, and feel as if they aren’t going mad. This can also help prevent burnout from trying to survive in a neurotypical world and keeping up with neurotypical peers.

(c) Normalising the client as a therapeutic goal

A therapist’s goals may be to make the client fit better into society. This may come from a place of good intention, by wanting to rescue the client from their struggles. However, this is likely to result in the client masking even further, on top of what they are already doing. Therapists need to understand ND masking rather than pathologise it. 

(d) Assuming that the client always has the answer

This may appear to contradict some of what I am saying, but sometimes the client does not have the answer because they may not be aware they are autistic or ADHD and so may not have the answer that needs to be voiced. Open-ended questions may not always be helpful here.

(e) Assuming that all ND stereotypes apply to all ND people

Such as: Autistics have no empathy and are good with numbers; ADHD people are lazy and lose their keys all the time and can’t sit still. Assuming all ND people are the same does not help. For example, autistic people are often hyper-empathic and this contributes to many challenges of burnout and sensory processing. 

(f) Therapist has previous knowledge about autism but their knowledge is outdated

This is why many autistic and ADHD people refuse to engage with trainings, seminars or research where those teaching or writing are not autistic, ADHD or otherwise ND themselves. Also, some organisations/individuals are still promoting ABA (Applied Behaviour Analysis) therapy which is held in very low regard in the autism community.

(g) Lack of understanding of the Neurodiversity Paradigm

This may manifest as dismissing neurodivergence as a ‘young people with green hair on the internet thing’. [See also therapist’s attitude to gender variance; and there is a high correlation between gender variance and neurodivergence.] The therapist may infantilise a client who wants to explore themselves, or try to debate them either about the diagnosis they have received, or their self-diagnosis. Another issue is not understanding why a person might choose to self diagnose, or why they may have no option otherwise.

(h) Issues in the therapy room or when working online

A practitioner may think they have made their therapy room more inviting, but this is not necessarily the case. Bright fluorescent lights, ticking clocks, scented air fresheners, flickering lights or candles, insisting that the client remains sitting still in their seat and that the seat is directly facing the client, may all cause stress. Online, insisting the client is not lying in bed. [I’m also aware of challenges to this – that sometimes changing position can be helpful.] Insisting that the client leave their camera on.

CONCLUSION TO PART ONE

I can hear many theoretical objections to the above already! But remember this is real examples from real people we are talking about. Other ND folks may have had better experiences than the above, and there is no perfect therapy.

In part two [coming soon] I am looking at negative outcomes, suggestions of what you can do next, and a list of resources.

Online event organisers! Here are some ways to make your events more accessible.

Photo of an open laptop with a zoom call in progress, and a cup of tea.
A laptop, a Zoom call, and a cup of tea. Photo by Chris Montgomery on Unsplash

Here are some things to think about when organising a Zoom event, whether seminar, training or conference. It’s not an exhaustive list, but I hope it serves as a thought starter.

Everyone who runs online events will have a different idea of how to do things – and every participant in an online meeting is an individual human with a slightly differing set of needs and a slightly different range of things that bother them and things that don’t.

Some of these things may feel trivial to some readers. But for many people they are essential.

ANNOUNCING YOUR EVENT

(1) Be clear about the nature of the event. Decide how much input you are expecting from participants, and be explicit about this.

This is especially if you will be inviting people to do role plays or other forms of experiential interaction. If you are planning a small group of less than 10 participants, and definitely if less than five, please be clear. Unless it is literally just you talking, small groups can turn into something much more intimate, where the participants are much more on show. They need to be able to make a choice on this before signing up.

Remember, this is a consent issue. Someone who is expecting to sit quietly making notes may not wish to bring their whole self to an unanticipated sharing session. And please state in advance if you will be requesting that people give long personal introductions at the start.

(2) Will a recording be made, and made available?

It’s really important to be clear on this.

(3) Be clear about attendance on the day versus purchasing a recording.

Be extra clear about this. I had to unexpectedly leave a training early one day but was still expected to pay for the recording if I wished to watch the rest of it. This isn’t okay.

(4) Stating a day of the week (as well as the date) is super helpful.

This may seem like a tiny thing, and responsibility for this likely lies with the booking system, but it’s helpful where possible.

(5) Be clear when announcing your event that you want to make it as accessible as possible.

If you do not specifically state that your event is accessible, people are likely to assume it isn’t. Invite people to contact you if they need something that you aren’t already offering.

(6) Be EXTRA CLEAR from the start on your advertising which platform you will be using, whether Zoom, Teams or anything else.

It’s very annoying to realise that the seminar you are about to join in literally 5 minutes is on a platform you never use. Sure, there may be a link, but see point (10) below. There may be reasons clicking on a link won’t work for some people, plus there is figuring out the privacy aspects of a new platform, such as blurring backgrounds and turning off the camera.

(6) CAMERAS!

This is the big one. Please state in advance whether and/or when you will expect people to have cameras on. I fully understand that in cases of confidentiality/security/safeguarding, it may be necessary for all cameras to be on in a Zoom meeting. In a training seminar or conference, however, not so much.

I sometimes get the impression (especially in the therapy world) that some online event organisers think it’s ‘not very nice’ for participants to attend without their cameras on. Attitudes can feel quite authoritarian and infantilising.

However, there are many reasons for someone to not want to have their camera on and be viewed by others, and they should not be pressured otherwise. For example:

  • If someone is neurodivergent they may struggle with the sensory overload from knowing they are on show, or the pressure to be sitting still while on view.
  • Lots of people cannot sit still in one place for a long time due to differences in learning style, focusing capacities, physical pain, or disability.
  • For mobility, pain, fatigue reasons, they may be lying down or in bed.
  • There may be others unavoidably passing through the room they are in who they don’t want to be seen, such as children.
  • They may be driving a car while listening, or doing a household task they had no other time for, and don’t want to distract others.

(7) Breakout rooms

State in advance whether these will be happening at your event. Again, as with cameras, it’s best that participation in breakouts is voluntary rather than mandatory. You could offer the option of participants reflecting solo or taking a break. Not everyone feels at their best in that context.

And remind participants about the option to put NBR (No Breakout Room) in the chat to make the tech support people aware that they do not wish to participate.

(8) If you are going to be asking your participants to use particular group participation tools, such as polling tools etc, please warn them in your pre-meeting emails.

And if these tools are new to you too, please practice with them before using them in a session.

(9) Be clear on the level of confidentiality required, so that people can make arrangements in advance about where to be during the meeting.

In other words, will a shared working space be okay, or do they need a private room?

ON THE DAY OF YOUR EVENT

(10) In your pre-event emails, please provide the zoom number and password, and not just a link!

Everyone has different tech set ups at home, and there may be a number of reasons why clicking on a link is not going to work for some people. This may cause last minute stress while they try to contact you or shift the tech they are using, causing them to miss some of the meeting.

(11) Make sure the on-the-day emergency contact details are genuine ones that will reach you, the organiser, in real time.

If there’s an issue getting into the call, eg if the link isn’t working or anything else, please make sure that the contact email is a live one that will be seen by you.

(12) Accessibility in the meeting

  • Please mute everyone as the meeting is starting and while any speaker is speaking. I know it can get chatty at the start when the host knows some of the participants, but it can leave a messy audio trail if you’re not on the case with this.
  • Remind participants that if they are going to move around, to turn their cameras off so others don’t get motion sickness. This particularly applies when someone’s computer has the face following option switched on.
  • Decide how you will all use the chat box and stick to it. Some meetings have a parallel conference going on in the chat which can be interesting, but is hellish for people who cannot focus on two things at once.
  • Ask for permission before recording a meeting. The Zoom system has this built in. Others may not.
  • Be very clear whether there will be closed captions, or interpreters of any kind.
  • It’s best to enable captions, to allow a level playing field. Zoom instructions here:
    • Sign in to the Zoom web portal as an admin with the privilege to edit account settings.
    • In the navigation menu, click Account Management then Account Settings.
    • Click the Meeting tab.
    • Under In Meeting (Advanced), click the Automated captions toggle to enable or disable it.
    • If a verification dialog appears, click Enable or Disable to verify the change.
  • Be clear on whether custom backgrounds or blurring are allowed. They can create a strobing effect which is at best distracting and at worst may cause seizures in some people. (Sometimes a good old folding screen may be best.)
  • Offer regular comfort breaks. People don’t want to miss things when running to the loo or putting the kettle on.
  • Invite people to have pronouns in their screen name.
  • Use content warnings. It is considerate to offer participants the choice of whether to stay or not during particular parts of the meeting.
  • Slides: be clear from the start whether they will be available. Ask speakers to consider making them available in advance so that participants can read along with them in their own way.

AFTERCARE OF PARTICIPANTS

If there have been difficult topics with challenging content, make yourself or someone else available for a while after the meeting ends. It’s not good to leave people alone on their sofas in a state of shock. Ditto if something difficult has happened in the meeting and people need to process it.

Fully understanding accessibility is a work in progress and we can all miss things. It’s about making sure your event is open to as many people who will benefit from it as you can.

I hope this has been useful. This is not an exhaustive list and there will be many things that I have missed – if you have the time and capacity, please let me know.

If you could choose to live without a physical body, would you?

When I ask people this question, whether my clients or my friends, the answer is nearly always yes.

To clarify, this post is not specifically about:

  • Spirituality, the spirit or the soul (although it could be, depending on your beliefs); 
  • Cryonics, or the fantasy of having your brain frozen and stored until technology has developed to the point where you can be reanimated (although it could be, depending on your beliefs); 
  • Physical disability (although it could be, depending on your situation and experience).

I am speaking about the sense of freedom you could have if your physical body wasn’t confining you emotionally, mentally, relationally, spiritually and politically.

Anyone may feel this – no matter how outwardly successful they may be, or how comfortably and conventionally their body functions.

If you are, for example, read as a woman or femme or female or feminine, (no matter what gender you were assigned at birth), you will know that you cannot move through the world without your physical body being scrutinised.

You will be informed constantly that your body (and therefore you) is either too much or not enough, sometimes simultaneously, and the goalposts move faster than you can adapt to their constant repositioning. You are relentlessly beholden to the opinions and assumptions of others. (Or perhaps you are read as not feminine enough. )

You are constantly aware of being on show, and of the consequent risk of mockery or violence, so your energy is drained and your nervous system taxed by being on constant alert.

It’s hard to challenge patriarchy (or any other embedded societal structure) when it has your face gripped in its hands and is unblinkingly staring you out.

Imagine this not happening to you.

Imagine no more comments about your weight or your face or your presumed sexual capacity. Imagine that you could go where you wanted without fear.

Actually, people of all genders have replied to this question with a yes.

And this is not just about gender. Much of society believes that others owe them their bodies – whether in terms of race, class, or disability. What if we, as individuals, could choose not to have these bodies? We could be free of so many demands. 

What if we could exist without a body, and in our chosen invisible shapes and dimensions?

What if you could shapeshift your bodyless self, and be infinitesimally small in one moment, all-encompassingly huge in another.

And what if it was up to you whether you experience sensation at all? If you struggle with the demands of sensory processing, what would it be like to be able to choose what, and how much, you experienced? What if we could choose where our imagined external boundary is – if we even wished for one at all?

As a late diagnosed neurodivergent person, I now have greater understanding of my own relationship with touch and movement, and why it was never as straightforward as it seemed to be for others. Interoception and proprioception are hard work at times – what if we didn’t have to navigate them?

In contrast to much social media output, to feel less can be a luxury.

Imagine you could feel just enough to get by and more easily navigate a world that constantly threatens to engulf us with its own needs and desires?

I spent a number of years in somatic and sexual experiential spaces where (consensual) touch was central, and participants were encouraged to be fully present. When we experimented with up-regulating and down-regulating breaths, it occurred to me that some people are already feeling more than is comfortable for them, and not all of the processes we entered into were helpful. Some of us, because of our previous experiences or simply because of who we are, already feel too present. The only way to tolerate this is through self-removal, or dissociation.

Remove the physical body and there could be so much more, so much more to do and be. And what could sex be?

I’m aware of the multitude of beliefs and philosophies that hang off this thought experiment, and how we could go down any number of roads when talking about it. (And I’m aware that my utopia becomes a little fuzzy, because who would choose to lose their corporeality and who would keep it? And what power structures might ensue?)

I’m aware that technology can partially take us there. As can meditation. As can drugs. Partially.

So let’s come back to the beginning. If you could live without a physical body, would you?

Looking back on 10 years as a GSRD therapist

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

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

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

THE GOOD

Retraining as a therapist in midlife

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

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

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

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

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

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

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

Sexology

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

Sex work

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

Consent

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

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

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

Trauma

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

The rise of Counsellor Power

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

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

THE BAD

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

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

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

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

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

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

The attack on Trans rights

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

Therapeutic harms

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

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

Racism and white supremacy

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

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

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

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

BEING A THERAPIST IN A PANDEMIC

This gets its own special section. 

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

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

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

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

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

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

NEURODIVERGENCE

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

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

THE EXCELLENT

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

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

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

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

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

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

Menopause and Therapy

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

World Menopause Day 2021

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

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

‘Why did nobody tell me?’ 

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

Perimenopause is a Thing

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

Menopause is a Hormonal Transition

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

Menopause is Compounding and Multifactorial 

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

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

Menopause doesn’t only happen to Cis Women

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

Menopause doesn’t only happen to White Women

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

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

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

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

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

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

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

You can contact me here.

Conference: Black Trauma in the Therapy Room

BME Voices Talk Mental Health Trauma Conference 2020

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

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

A note on trauma

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

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

The multiple impacts of systemic inequality

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

Gaslighting and double standards

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

Ancestral trauma held in the unconscious

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

Examining racism in supervision and training

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

The whiteness of the therapy world

Self-care

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

Challenging course leaders

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

Beyond eurocentric trainings

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

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

There is a long way to go

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

A missed opportunity

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

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

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

Doing Therapy Online – Advantages and Challenges

Illustration of a flu virus

Taking my private practice online

The world is experiencing a pandemic of Coronavirus, or Covid-19 flu. Due to the way it’s transmitted, people are being advised to severely limit in-person contact with others, and to take great care around hygiene. As everywhere, the situation in London is very much ongoing – and changing rapidly.

This post is to announce that, due to the current situation with Coronavirus, I am now seeing my clients entirely online. This will remain in place until things change again. This means I will be working either by video/audio link using Zoom (or another similar service as backup), or by phone. My colleagues are doing the same, or working towards it. 

The benefits of online therapy

I would like to say more about this as not everyone feels comfortable with the idea of working with a counsellor or psychotherapist remotely. I have been working online and by phone for a number of years, and I would like to reassure anyone who is looking for therapy at the moment but has never done it online before. 

There are significant advantages to working online:

  • We do not need to be in the same location to work together. Online access has created a revolution in therapeutic communication and relationships.
  • We have greater choice of working times, as I am not tied to the in-person hours I have at my office.
  • It provides access if you are unable to leave your home for any reason, or if you find in-person work very difficult.
  • Very importantly, we can continue to work during unusual periods like this when meeting in person is not possible.

There are also challenges:

  • Finding a private space to have therapy. This is important to reflect on, if your home or workplace are not right for this.
  • Feeling comfortable using a medium that you may not have used before, or which you have previously mainly used for social or sexual contact.
  • The reliability and safety of the technology.

If you’ve never had counselling online before, I have tried to answer some of the queries you may have:

Doesn’t it feel weird doing therapy while looking at each other on a screen?
I think we all felt weird the first time we did any kind of video call, even with someone we know well in real life. The first time you have a session on video as a client, it’s okay to take some time to feel into it, make sure you are sitting in a comfortable position and, if you need to, feed back to your therapist about what’s going on for you. 

I’m worried it might feel distancing.
It may do at first, and it’s important to honour whatever you’re feeling at the time. However, humans are highly adaptive, and it’s likely that, it will gradually start to normalise.

Don’t you lose something by not being in the same room?
You lose some body language for sure. But your senses recalibrate.

Isn’t it strange to do therapy by phone?
My experience is that you can do very effective therapy by phone. With only hearing to guide us, our senses recalibrate further and our focus increases.

Do I have to install anything on my computer/phone?
You may well need to download an app and/or sign into a website. I am happy to guide you through this.

What if something goes wrong and the tech doesn’t work on the day?
This happens occasionally. Wi-fi can go down. Services may be busier as more people take their lives online. However, I have several apps on my laptop as backup, andwe can use our phones. Depending on the access issues, we can look at each other on video while speaking on the phone, or even typing on messenger. (For the latter, a discussion on confidentiality is necessary.) If everything goes down completely, we can reschedule.

What about confidentiality?
In terms of what we say to each other, my approach to confidentiality is the same as when we are working in a room together. As for protection when working online, as soon as electronic media are being used for communication, there is a slightly greater risk. This is unavoidable. It’s about balancing the possible risks with your needs at the time. Some VOIP apps are seen to be more secure than others, and it is my responsibility as the therapist to check up on this. 

When reflecting on whether I and a new client are a good fit, I take a number of things into account – and working online is not going to be the right thing for everyone. I’m also aware that for some people, the act of leaving your home, travelling to your therapist’s consulting room, and coming back again, is part of the process, and it feels odd not to have this.

While these tools – computers, phones, and the internet – are not perfect (because humans made them) they are enormously useful, especially at times like this when there are very few other options.

While we all try to adapt to this rapidly changing situation, therapy may not be uppermost on your mind. However, if you would like to start therapy and are interested in working with me online, on video or by phone, please get in touch.

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.

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.

Trying to fix your relationship ? Change does not have to equal loss

Flames

As a therapist working with couples, one of the most persistent issues I see is fear of change.

However challenging things have become for both partners, and however untenable the relationship in its current form, people have an incredibly strong urge to cling to what they know, because the alternative terrifies them.

The will to hold on sometimes feels even stronger than the will to actually fix the relationship and make both partners happy.

I’m repeatedly astounded by people’s drive to remain connected in the way they always have, as if any form of adaptation will destroy everything that came before and erase all the happy memories.

People will stay together even when there is ongoing anxiety, constant sparking off each other, endless transferences and overreactions, and frequently calling the other out over tones of voice, events from the past and other points of conflict, and when sex has been adversely affected or become non-existent.

In other words, constant stress. And yet when I suggest a gentle reframe, and paint a picture of what the relationship might look like if they pushed the structure around a bit, there is panic. Because for so many of us, change automatically equals loss. Even just the thought of adapting to new conditions can put someone into a grief process.

Pre-mourning

You could call this sadness ‘pre-mourning.’ And I well know myself that it’s very hard to accept that change might actually make things better – enabling both parties to preserve the connection and eventually re-create happiness.

Fear of failure

It’s the same mindset that calls the ending of a relationship a ‘failure’. By this standard, all relationships that end have by definition automatically failed. (I wonder what kind of ending would not count as a failure – both partners actually dying?)

I have written before about the cultural primacy of a very particular kind of coupling, and the idea that to be a fully actualised person you must have been publicly chosen by another, and this must be seen to be the case in your family and community. To tell others that your coupling is in fact not working the way the world expects it to is a source of shame. You feel that you will be pitied or laughed at, and are left wondering if people said ‘How long do you give this one then?’ when you first got together.

There are more options than you think

The normative view of relationships that they are both binary and linear. If they are not one thing they must be another, and that they must follow a certain direction and ascent or they are not valid, or just weird. If you are in a heterosexual monogamous relationship, for example, you will find little public support for alternative ways of being together, except what creates lurid headlines: ‘We tried swinging and have never looked back!’

In fact, there are many ways that a relationship can be reframed or rebuilt, but these options are rarely spoken about as viable options. Like so much in society, if you aren’t doing it in a very specific way, there is something wrong, something lesser, about your choices. Needless to say, this is rubbish, but can be very hard to get past without support, whether therapeutic or from your community.

Some ways to reframe a relationship that is struggling

In the early days of relationship conflict, you may well have worked on behaviour and communication skills. Here I am talking about further down the line.

(1) Decide to live apart, if you cohabit. (Needless to say, the more financially you are tied together, the more this will affect your decision-making. But the decision to live together in the first place should not be undertaken lightly, and ideally never for purely financial reasons. If you have children, the issues are multiplied.)

(2) See each other less often but perhaps for longer each time, or varying contact.

(3) See each other less often full stop.

(4) Figure out the sex, if it was part of your relationship previously. (If it’s gone, can it be rekindled? Do you want/need it to be? You need to be realistic about the consequences when you both assert your needs around it.)

(5) Have some time apart with a timescale on it. (This one scares people a lot as there is a lot of conventional wisdom that says ‘break=ending’. Sometimes it does – but you can only find out by trying.)

(6) Open up the relationship up to other people. (This one scares people even more, often with good reason, and it should not be undertaken without a lot of negotiation and research. There has to be mutual consent.)

Love – or helpless attachment?

The tie that binds here is a thread of what is called love, but may be more akin to helpless attachment. I cannot say for sure what is love or what is not, but if the pain and fear are outweighing the good times, you may be closer to the other.

What if it’s really broken?

It hurts when it’s broken. So the feeling of acceptance is often welcome. I am divided over whether true acceptance can really be worked on, or whether you can only invite it in, to appear when you are ready.

If you’re experiencing difficulties in a relationship and would like to explore things with a therapist, you can contact me here.

Are you stuck on the Sex Escalator?

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tg-1-27Today I’m talking about the repetitive sexual conveyer belt that we can find ourselves on if we pay too much attention to cultural influences and not enough to our own needs.

I’m calling it the Sex Escalator because you can sit on it and it will take you somewhere that feels vaguely elevated over and over again – and you need not think about it, ever.

Remember the ‘Relationship Escalator’?

You may well have heard of the ‘relationship escalator’, an idea that originated in non-monogamy research circles and promoted in excellent article about polyamory that I have linked to before. It’s about how relationships are culturally encouraged to follow a tried and tested formula – essentially meeting, dating, becoming a (preferably heterosexual) couple, becoming exclusive and monogamous, moving in together, getting married, buying property and having children.

This model suits many people for many reasons – but it also has a purpose, namely to uphold social cohesion and provide a foundation for a very specific way of having a family. It does not deserve to be rejected outright, but it does deserve examination because many people fall into it before realising it is not what they want or need at all. And this is when relationships can become damaging.

As with relationships, so with sex

Discussing this with friends and colleagues (and working in communities where we talk about these issues a lot), even highly creative sexual adventurers will admit to having sat on the escalator at some point in life. The process goes something like this:

  1. Kissing
  2. Manual stimulation
  3. Oral sex 
  4. Penetration (preferably PIV)
  5. Peak genital orgasm
  6. The End (someone falls asleep)

People base entire marriages around this paradigm. Any deviations from this become treats, exceptions or outliers, or simply never thought of.

And of course, parts of this sequence may be missing altogether because they were never there in the first place.

This is not to judge anyone or criticise this as a way of having a good time together. Over time you may have discovered the most efficient way to orgasm with one person – and after all it’s pleasure and connection you’re after. You may be frequently tired and you may be busy and you may have family to take care of.

The problems start when you’re increasingly unhappy – but you’re not doing anything about it.

Communication as taboo

The problems start when communication ends. For many people, unaccustomed to stating even the simplest needs, useful communication will stop as soon as mutual liking is discovered. For many people this may even come as a relief. In the UK we have a popular trope of two people getting drunk together on a date, waking up in a relationship, and then being delighted that it need never be mentioned again, perhaps for several years.

As with emotions, so with sex.

A package deal of conditioned behaviours and expectations

On the Sex Escalator:

  • Anything else doesn’t really count as sex, or is weird.
  • It’s vital to have a goal, and that goal is ‘full sex’ because the rest is just ‘foreplay’.
  • If you miss out the genital penetration, the sex is incomplete and has failed.
  • If the escalator doesn’t arouse you that much, you should keep quiet about it so as not to create disruption.
  • If the escalator doesn’t arouse you that much, you may need to seek outside help, because the problem is your fault.
  • If the escalator doesn’t arouse your partner that much, you should tell them to seek help, because the problem is their fault.
  • Obviously the penis owner will have an orgasm, because they definitely enjoy penetration. (Go here for a longer discussion on why a number of people actually aren’t into penis-in-vagina sex. Go here for a rather more brutal takedown of this sexual trope from a feminist perspective.)
  • The vagina owner really ought to have an orgasm because otherwise they must be dysfunctional and the penis owner won’t like them any more due to their imperfect functioning. 
  • You dare not discuss any of this with your partner in case they are offended or think you are about to criticise them.
  • Deviating from this pattern in any way is terribly adventurous and needs masses of preparation and expense.

I would like to think that the generations that have grown up with the internet will have found a better way, but looking at what young people seem to be learning, I am not so sure. And although this feels like a strictly heterosexual/cis model, any pairing of genders and sexualities could technically enact this. 

I also have a suspicion that this conveniently boxed scenario keeps people more heterosexually confined than they would ideally wish to be.

If the Sex Escalator isn’t working for you

If you keep on ending up having sex like this, and you’re not enjoying it, or you feel that there’s something missing – ask yourself some questions. If you have a partner, ask each other some questions.

  • Am I or my partner truly consenting to any of this?
  • Have we actually ever discussed it?
  • Do either of us really want it?

And if you’ve said to yourself and/or each other: ‘Well, this is okay enough, and if we don’t do these things it doesn’t feel like we’ve actually had sex – ‘

STOP!

If you want something different, here are some things to remind yourself about:

  • Sex does not need either a goal or a destination.

  • Genital sensation does not need to have primacy.

  • Specific activities do not have to have primacy over others.

  • There are no rules about which parts of the body should be included or left out.

  • Orgasms are nice but they are not obligatory.

  • Communicating your needs is vital. 

  • Focusing on breathing can add a whole layer of experience.

  • There is a whole world of sensation waiting for you in many areas of your body that you may not have considered.

  • Have you talked about your fantasies? Have you even thought about them?

What if you went right back to the start and asked yourself – or asked each other – what do I/we really want?

Am I overstating this? Judging by the responses I encounter when someone (or two people in a relationship) realises there is another world of sexual connection out there I am, if anything, understating it.

In a future post I’ll go into more detail about ways to expand your sexual experience.

If you’re concerned about anything I’ve raised in this post and would like to explore this aspect of your life in more detail, you can contact me here.

Bisexual life – hiding in plain sight?

2000px-Bi_flag.svg

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.

Am I A Sex Addict?

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Silhouette of person watching stripper in club

Sex Addiction – what it isn’t

A lot of people worry about whether they are sex addicts or not, and you may be reading this because the headline rang a bell for you. You may be doing things, looking at things – or even just thinking things – that you feel you cannot share with anyone else because you’re not sure of their reaction. Such is our society’s shame-based confusion around sexual behaviour that many people fear that they may be somehow abnormal. One of the quickest ways to contain your sense of perceived abnormality is by calling yourself an addict.

The Addiction Industry

‘Sex And Love Addiction’ has become a global concept. The media loves it because it feels on-trend, has an air of danger, and pushes buttons deep in us all. And the idea of attending 12-step meetings as the only way to fix ourselves has become a powerful meme. To be ‘needy’ is to be stigmatised out there in the world, the story goes – but in the safety of a meeting you will find a community where you can express your true self. There is nothing wrong with reaching out to a group of people that share a common issue. But by accepting a label you are also paying a price, and in saying ‘it’s not me, it’s my illness’ there is always a risk of remaining in a state of helplessness that is increasingly hard to come back from.

The Addict as Anti-Hero

It is also tempting to identify with the addict as a kind of maverick or renaissance person. There is a strong subconscious (and cultural) narrative in which the addicted person (whether to drugs or anything else) is a prodigal child who is too creative for this earth, fundamentally different from others, and even a shaman. This kind of identification is an effective way of feeling in control of needs that may be making you feel guilty, whether they are in fact doing harm in your life or not.

20 Things that are not Sex Addiction

Such is the push-pull between obsession and denial that almost any behaviour connected to sex whatsoever can be enlisted in support of the sex addiction model. I’ve seen a concerning number of activities and behaviours named as possible symptoms all over the internet and in other media. Here is a roundup:

(1) Thinking about sex a lot

(2) Having sexual fantasies

(3) Having a lot of partner sex

Societal codes dictate all sorts of highly unrealistic attitudes about numbers of previous partners. Numbers do not make you an addict.

(4) Having group sex

Ditto.

(5) Frequent masturbation

How frequent is frequent? This would be my first question.

(6) Being a particular gender and liking sex a lot

A woman is expected to have very few sex partners before her character is called into question and she may be labelled a ‘nymphomaniac.’ She is liable to be labelled an addict by others before a man is, or encouraged to label herself as one. A man may be more likely to self-diagnose as an addict as this self-label may help with fears of helplessness which are seen as insufficiently masculine.

(7) Infidelity

You entered into a relationship without first reflecting on your or your partner’s needs, and you find you cannot stay within the agreed terms of it (if there even were any). It does not make you an addict. The social primacy of the closed couple may simply not be for you.

(8) Being LGBTQ+

Othering of people who are not heterosexual or cisgender often involves a critique of presumed sexual behaviours. This particularly applies to bisexual people, for being ‘greedy’. Trans people are sometimes accused of something similar.

(9) Being polyamorous or in an open relationship

Non-monogamists are sometimes thought to be sex addicts because there must be only one reason for having more than one partner, and that is to have more sex.

(10) Having a fetish

Having an erotic focus on a particular object, form of dress, or experience is fairly common and does not make you a sex addict.

(11) Cross-dressing

Wearing clothes commonly associated with a gender other than the one you were assigned at birth does not make you a sex addict.

(12) Being into kink/BDSM

Negotiating boundaries and consent before having intimate contact is not addiction, and neither is giving or receiving extreme sensation or enjoying power exchange. People into kink may be labelled addicts because they actually talk about the sex and intimate contact they are about to have before doing it. One of the rules of normative sex is that you do not talk about it, thereby denying all responsibility for your feelings about it.

(13) Using porn

Porn use can become problematic, but one of the main reasons is our abysmal record on sex and relationships education for children and young people. It is shame based rather than pleasure based. Hand in hand with this is the denial that puts the porn industry in the shadows. There is nothing wrong with wanting to watch people having sex. At best, porn can also be educational and an aid to solo or partner sex.

Plus, don’t forget how many people skip work and partner/family time to watch or listen to sport. No one calls them a ‘sport addict’ and packs them off to a meeting (although I suspect there will be a clinic for it somewhere).

(14) Voyeurism

Enjoyment of looking at people being sexual is not sex addiction.

(15) Exhibitionism

Enjoyment of being looked at while being sexual is not sex addiction.

(16) Visiting sex shops and websites

Where else do you obtain sex toys and other sex-related material?

(17) Visiting (or working in) lapdance/strip clubs

Being involved in, or enjoying, sex-based entertainment does not make you an addict.

(18) Attending (or running) swinging/kink/fetish parties

Hosting, or attending, sex or kink-focused gatherings does not make you an addict.

(19) Paying for sex or kink

Paying for sex does not make you an addict.

(20) Receiving money for sex or kink

And neither does receiving money for it.

Lest I labour the point even further, none of these things in themselves are indicators that someone has a problem that needs fixing.

‘But my sexual behaviour is causing me a lot of problems, so I must be an addict. Are you saying my feelings are wrong?’

Your feelings are not wrong. As a therapist I would be failing at my job if I did not acknowledge someone’s own account of their situation. There is an increasing movement towards self-definition, of sexuality and of gender – so why not this too? My issue here is that sexual behaviour is too individualised to be labelled an addiction. In this model, we are very few steps from labelling some sexual behaviours an illness and even a pathology. Overall, too often (as my list above illustrates) this is no more than ill-founded moral judgement. In fact, sexual self-expression can go to all sorts of extremes and still be completely healthy and non-damaging.

When someone does feel out of control, it’s important to look at the reasons that may be underlying this rather than stick a label on them.

If you have stopped taking responsibility for yourself, and are harming others, this may be a warning sign, along with:

  • Regularly missing work or appointments
  • Neglecting those closest to you
  • Behaving non-consensually
  • Draining your or someone else’s finances
  • Putting your or someone else’s health in danger

However, the problem is as much to do with any other aspect of you as it is about sex. It may be to do with numerous other aspects of your life, or past events that you have not fully integrated. [Of course there is a red flag in here – it does not automatically follow that a person who has a lot of sex, or participates in non-normative practices, has been abused.]

If we compulsively return to a behaviour that is not serving us (whether sexual or not), it may be because nothing else in our lives is satisfying us or making us feel held.

Repeatedly doing something that takes pain away, even when the positive feelings are very short lived, may well be a sign of underlying unease. Examining harmful patterns with deep roots that we feel helpless to change is one of the main reasons people come for therapy. It does not make anyone an addict – or otherwise we are all emotion addicts.

Am I saying sex addiction can’t exist at all, ever? No, but I find that the term is being misused to the point where it is unhelpful.

Self-Help

Seeing a therapist can help you gain some clarity about what’s going on for you. You may, for example, have grown up with the message that you were ‘too much’ as a child. That you took up too much of everyone’s space and time, and that everything you do is wrong. It may also have left you with the sense that you are doing ‘too much’ of something – therapy may help clarify whose version of ‘too much’ that is.

Also, there is nothing wrong with questioning an aspect of your sexual life, identity or practice, that is starting to feel intrusive or ‘not you’ any more, and taking it to therapy. Please bear in mind, however, that conversion therapies are increasingly outlawed and no reputable therapist will suggest them.

  • To find out how I work, and what areas I specialise in, go here.
  • You can find more of my published writing, in the Lancet and elsewhere, here.

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)

Welcome to London Central Counselling

Welcome to my new counselling and psychotherapy blog.

If you’ve suddenly found yourself on this page and are wondering what it’s all about, I’m Tania Glyde, author turned counsellor/psychotherapist in private practice in Central London.

There are so many interesting things going on in the world and it all moves so fast. I’m going to share articles I’ve written, thoughts on therapy, and other material that might be useful or interesting. I’ll also be putting up links relating to mental health and gender/sexual diversity. I’ll be focusing partly on articles that have come out in the last week, and partly on older stuff that I think deserves another outing because I found it so helpful. (Needless to say, me linking to something doesn’t mean I endorse or agree with every word of it, but I and my colleagues might have found it a fruitful talking point.)

If you’re brand new to therapy, here’s my guide to having counselling and what to expect. If you’d like to read more, Sense About Sex has a detailed section about getting help. I’ll also be addressing some issues that come up a lot, and making suggestions about how to make the festive season go as well as it can, whether you’re participating or trying to avoid it.

Thanks for reading.