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.

Christmas cheer? I’d love to see less ableism.

I spotted this damaged Christmas tree ornament in TKMaxx.
There was another broken one, in the form of an owl with an unintentionally heart-shaped hole in its chest. I couldn’t bear to photograph it.

This is neither a festive post nor a beautifully crafted one. You have been warned.

If anyone feels personally judged or attacked by this post, I would encourage you to sit with it. Remember this is a systemic, collective issue and it can be changed.

1. The pandemic is still going.

The pandemic is not over. Not even close. In the UK and worldwide people are still dying every day. Over two million people in the UK (let alone the world) have Long Covid. This means symptoms that continue beyond 12 weeks, and in some cases over 2.5 years. (You can end up with Long Covid from a very mild infection, not just from a transmission in the early days pre-vaccinations. ). These symptoms may be such that a person’s capacity to go about their daily life is impaired. They may have to give up work. Do you understand what it means when a person is no longer able to earn a living in this society?

2. Perhaps you have a trust fund?

Let’s cut to the chase. I may have missed something. It may be that the majority of people in the world, the UK especially, are privately wealthy and do not care if they, or someone close to them, can’t work again. I can’t help thinking that this doesn’t add up, but hey.

3. ‘But it’s just like a cold or a bit of flu, no?‘

Superficially perhaps. It enters the body via respiratory channels, but can affect many organs, which is why you have people experiencing chronic fatigue (remember how people with ME/CFS were gaslighted for so long?), heart rate changes, breathlessness, anxiety, cognitive deficits – do I need to say more? And a person in prevous good health could experience this, not just ‘Oh did they have existing conditions oh well there you are then nothing to do with me I am healthy.’ (Vaccinations have helped enormously, but they don’t keep it away completely.)

4. The great leveller?

The pandemic taught non-disabled people what it was like for those confined to their homes or only able to travel with difficulty and extensive planning. All those who could – (what have been called middle class workers) – took their work online. Events – (and there are a potentially lot of those in a therapist’s life like mine, for example) – went online. And it was great! You lost some of the networking capacity for sure, but it made a more equal playing field. Neurodivergent people, disabled and chronically ill people, people struggling with their mental health, those on lower incomes who can’t always get childcare, etc – lots of those people could now attend trainings and meetings. And it kept everyone safer from the virus by removing travel from the equation.

5. Not all benefited from this ‘levelling up’, however.

Anyone doing labour that cannot be done on screen had to keep on going to work in person. That’s a lot of people cleaning, delivering, processing food, working on transport, working in retail, building and of course healthcare. All of them keeping our society going. Without those workers we would have no society. Instead of treating those workers with respect (eg free masks, priority vaccinations etc), our administration played games with the entire population. 

6. Please remember the lies you were fed.

As well as being regularly and deliberately confused about what was happening via the media, with ‘bubbles’, endlessly shifting ‘tiers’ and u-turns (remember Christmas 2020), we were left with an idea that Covid-19 was some kind of naughty enemy of the British Empire that could be dealt with by using infantile language about ‘moonshots’, and maybe a really embarrassing gun battle on the Thames (sounds familiar?) with people dressed as doctors hurling custard pies at people in racist-looking virus costumes.

We didn’t quite get to ‘freedom fries’ but the F word was used, as if the doughty brits were really going to stick it to a virus. And the people in charge who pushed it out were merrily attending parties and going on holiday all along, while ordinary people died in their hundreds of thousands. People were being literally suffocated to death by misinformation, a disproportionate number of them People of Colour. 

7 ‘Then why isn’t everyone masking up wherever possible?‘

We have been told it’s over when it’s not. Even though it’s winter now and wouldn’t it be great not to catch all the other seasonal viruses? Every time I go on public transport in London I am one of the very few people wearing a mask. The other week, on a very crowded delayed Overground train, I was lucky enough to get a seat and therefore have a close up view of someone’s workplace pass clipped to their belt. An actual doctor working at an actual hospital – in a soupy rush hour crowd – not wearing a mask. And yes, I hear stories of hospitals and clinics not enforcing masks and staff not wearing them. (Not all, thankfully.)

8 ‘Hold on, not everyone is able to wear a mask!’

Yes. Some people have a sensory or trauma response, or a respiratory one, which means that mask wearing is acutely stressful for them and just not possible. So all the more reason for everyone else to wear one to boost everyone’s protection and allow those who can’t to live a reasonable life.

And yes masks can be pretty grim if you’re wearing one all day. (Think about the doctors and nurses with dented bruised faces.) I see why many people would be willing to take the risk – I really do see this. And yes I can see why that doctor on the overground wasn’t wearing one, as maybe he had been wearing one all day. But even so – how can we do better?

9 ‘But not everyone can afford masks, esp N95 ones!’

Yes, I agree. imagine if the government gave out masks instead of wasting millions – billions – on mysterious deals that benefit only the very few. Masks for all sounds a lot more worth it, doesn’t it? This would never happen because it might start showing people how they have been corralled into a ‘me first’ space, even while having what they have stolen from them in broad daylight.

10. ‘So why are so many events going back to in-person only, then?’

Good question! It’s like everyone’s forgotten what ‘access’ means. It is directly ableist, with all the knowledge and resources we have now, not to make your seminar/conference event a hybrid one. [As with this entire post, someone will remind me of exceptions to this. There are always exceptions.]

Unfortunately plenty of ableism goes on even in online-only events. This especially confounds me when I see it in the therapist/practitioner world. I have online access needs myself and I admit that I have become a bit of a professional annoyance to some events organisers.

11 ‘Lighten up, will you, lefty killjoy!’

No, I won’t. But I don’t want anyone to stop going to gigs, pubs, theatres, parties and on holiday either! They are a fundamental part of life for many people. But if we all did a little bit to make these things more accessible for everyone, life would be better, no? 

PSA: Until we as a society learn to look after each other better, we will remain in thrall to toxic values that are dragging us all down. Do I really need to name these values? Toryism, neoliberalism, Thatcherism and of course another F word. Of course, many brown and black and trans and queer and working class – and of course disabled – folks have been shouting about this for literally ever.

It’s not that we shouldn’t look after ourselves too, but if we remember that our actions have consequences, and if we pull up everyone behind us, then we all benefit. I’m not sure why that’s so hard to understand. We have all been encouraged to sink into an intoxicating swamp of individualised wellness. Keep working on yourself as the problem, so that you don’t see the structural issues which of course no one person can change alone and will just make you feel worse.

Best order another scented candle. But none of that will get us out of this.

12. Lefty Queers, why aren’t you talking about this?

This is part of the reason for this post. I am feeling increasingly heartbroken when attending queer events where no one is masked (or seeing pictures/videos of them online), despite this community having a higher than average number of disabled and vulnerable people in it, and a lower than average income. This is a community that often speaks of little else but ‘community’, but here seems to be talking the talk rather than walking the walk. Are you content to collude in exclusion?

(Despite my words above, I am also cynical about some usage of ‘community’ as a carry-all badge of goodness and sincerity. It often involves ingroups and outgroups which are not always acknowledged. However, this is not the post for unpacking my thoughts on this because, trust me, we would be here all week.)

13(a) Please read this important article:

Please read this piece by queer disabled activist Leah Lakshmi Piepzna-Samarasinha: Abled-Bodied Leftists Cannot Abandon Disabled Solidarity to “Move On” From COVID. I’ve been sharing it around the place and am baffled by the relative lack of engagement. There are plenty disabled folks who have been effectively written out of in-person engagement by this ongoing ableism.

13(b) And this one:

The pandemic isn’t over, and queer people shouldn’t be acting like it is by Dev Ramsawakh. Someone told me about it earlier today.

I’ll say again, if anyone feels personally judged or attacked by this post, I would encourage you to sit with it. Remember this is a systemic, collective issue and it can be changed.

14. OK I’m done

I’m tired from writing this. I will try to put some links in later on. I hope this post is at least a thought-starter for someone.

If you are still looking away in order to maintain an ‘us and them’ paradigm in terms of health and disability, please remember that however positive-thinking you are, however immune you feel to the issues here, you can still be taken from ‘us’ to ‘them’ in a heartbeat.

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.

My Research is now Published!

Read about the experience of LGBTQ+ menopausal clients in therapy

I am delighted to announce that my research, ‘How can therapists and other healthcare providers best support and validate their queer menopausal clients?’ is published.

You will find it in the journal Sexual and Relationships Therapy, which is published by Taylor & Francis. SRT is the in-house journal of COSRT, the UK-based therapist organisation College of Sex and Relationship Therapists.

You can read more about this research on my other blog here.

Please check out my site queermenopause.com for more information on the project as a whole, and the resources page.

I started this project two years ago. I am incredibly grateful to the friends and colleagues who helped me shape my ideas, and to the participants who gave me their time and told me so many important stories.

If you are struggling with anything to do with menopause and would like to explore more deeply what is going on for you, you can contact me here.

Queer Menopause now has its own website!

Blogging silence

First off, I’m aware that I haven’t been posting on here much during lockdown. I keep starting things, and then experiencing a sense of extreme pointlessness. Each time I decide to write about opening up relationships, or peak experiences, or sexual and non-sexual BDSM from a therapists’s perspective – (or for that matter, the urgency of queer haircuts in a time of Covid) – I remember that we have an incurable virus at large at the beginning of winter, people dying, fascism everywhere, and the earth going up in flames.

Menopause takeover?

A Martian dropping by might think this site was really all about the subject of menopause, or that menopause had somehow taken over. Perhaps, along with the murder hornets, walking sharks, and some nervously awaited geese, a further horror come true of 2020 will be the entire population being forced into menopause until a vaccine is found. This would be most interesting.

Queermenopause.com unveiled

Menopause has not taken over, but, while my research goes through the peer review system, I’ve been working on a project that I hope will be helpful in the future. The project is a new website which I am delighted to reveal: queermenopause.com.

Menopause happens to people. Trans men, non-binary people, and intersex people are excluded when menopause information is restricted only to cisgender women. The site has an LGBTQIA+ focus, but I also want to offer resources that apply to anyone whose experience of menopause is excluded from, or not sufficiently acknowleged by, the mainstream. There is a lot of work to do. First blog post here: Welcome to queermenopause.com. You can also find this project on Instagram @queermenopause.

I am also seeking to inform practitioners of all kinds about the LGBTQIA+ experience of menopause, and about menopause itself.

Queer Menopause in the media

I have been seeing my clients online all the way through lockdown, and I’ve also contributed to a couple of books. One is an interview for Still Hot!, a collection of 42 interviews about menopause experience. I’m also happy to say that Diva’s queer menopause feature from December 2019, which I took part in, is now available online: This is the end… of your period.

Moving forward…

I’m very glad to have this project off the ground, and I will be adding to it as time goes on. Please get in touch if your work is relevant to this project. I welcome suggestions of practitioners, trainers and researchers who are working in this area.

I hope to return to non-menopause blogging soon.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Things are starting to change

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

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

If you are struggling, don’t suffer in silence

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

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

Queer Menopause – New research project

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Queer Menopause flag

This year, when I’m not working with my clients, I’m doing a Masters in Counselling and Psychotherapy with the University of East London.

In brief: I’m doing my MA dissertation on queer menopause, and how therapists can best support and validate their LGBTQIA+ menopausal clients. 

After looking at several dissertation ideas, this one stood head and shoulders above the rest. The idea crystallised after a day in December 2018 when I had conversations with about five different friends about our experiences. I sense a lot of excitement about the topic, especially as there is very little existing research out there.

UPDATE on 5th November 2019

I’m adding this for clarity, and making a few changes below. My call for participants has now ended and I am in the process of writing up my findings. Thank you very much to everyone who took part, and everyone who took the time to write to me.

I’m going to keep this post as simple as possible because this subject has many aspects to it. This is a qualitative study using Thematic Analysis. My aim is to open some doors, shine a light, and give a voice to those who have not yet been heard. I want to create a building block that will inspire others to doing further research in this area.

Call for Participants (now ended)

‘How can therapists best support and validate their queer menopausal clients?’

As my subject is counselling and psychotherapy, my research focus is on what queer menopausal clients would like their therapists to know. (‘Therapists’ could also extend to other health practitioners.) This question may evolve over time.

I am seeking to interview LGBTQIA+ identified people who have experienced perimenopause/menopause, and for whom my question above has resonance. I have ethical clearance from UEL.

You can contact me here.

First of all, what is menopause?

Menopause happens to people with ovaries, not all of whom will be women. (I am using a very specific definition of menopause in this section, and this is the main menopause to which my study refers, but not to the exception of all other experiences. More on this further down.) Put very simply, the body slows down oestrogen production and menstruation eventually stops. When menstruation has stopped for a year, the person is said to be post-menopausal. This all sounds quite straightforward. Many people might welcome their periods stopping and, if they were having PIV sex, losing the risk of getting pregnant.

In fact, fluctuating and diminishing oestrogen levels can have many different effects on the body and mind. People (and experiences vary widely) can experience hot flushes, night sweats, insomnia, anxiety, depression, weight gain, memory loss, reduced libido, and thinning of the tissues around the vagina and urethra, leading to stress incontinence and increasingly painful penetrative sex.

Some barely notice anything at all. Others are so badly affected that their relationships fall apart and they have to stop work. Most fall somewhere along a spectrum between these two points.

Perimenopause – it starts much earlier than you think

If you’re under 40 and reading this (or even under 45), this may feel like something you don’t need to think about. But, actually, menopause can start in your late 30s. (And earlier if your ovaries were removed.) The first phase of menopause is known as perimenopause. Previously regular as clockwork periods may start to become more random. You may bleed more heavily at times. You may experience mood swings, and as hormone levels start to fluctuate, this may exacerbate existing physical and mental health issues.

No, I hadn’t heard of it either, once upon a time. Well, I kind of had, but there was no ‘official’ info so I took no notice of the changes that, now I look back, were clearly going on in my body from the age of 39 and perhaps even earlier.

LGBTQIA+ Menopause – a subject in need of a spotlight?

Where menopause is concerned, the media narrative, overwhelmingly, concerns cisgender heterosexual women – who are generally married to men, and who are experiencing loss of capacity (and desire) for penis-in-vagina sex. It is frequently framed around increased self-hatred due to the visible signs of ageing, and the idea that someone should be locked in increasingly desperate combat with their own body as their perceived attractiveness to men is reduced.

There are a number of peer-reviewed studies of lesbian experiences over the last 30 years. However, there is (that I have found so far) next to nothing out there about everyone else on the LGBTQIA+ spectrum. Bisexual women may pop up in studies, but in numbers so small that they slip through the cracks. And what if you are non-binary or trans? Or intersex? Or asexual?

Unfortunately, despite cisgender heterosexual women representing a large percentage of the menopausal population, the variation in medical advice and appropriate treatment for them is nothing short of a disgrace. Too many experience gaslighting and dismissal from doctors, despite the NICE guidelines. So the situation for anyone not cis or not heterosexual, who is concerned about their symptoms, could be much worse.

For example, someone AFAB (assigned female at birth) and non-binary may have a struggle when trying to access medical help as perimenopause starts to kick in. There are multiple pressures: (a) explaining menopause symptoms in the first place and being taken seriously (and this assumes the person realises what is happening in their body), (b) having to explain non-normative gender, and (c) if a person has existing mental or physical health problems, they may be exacerbated by fluctuating hormones. There may be a lot of confusion that adds to the person’s distress.

The point is, we just don’t know. Mystifyingly, the academic journals devoted to menopause that I have seen so far (I stress so far) barely mention LGBTQIA+ experiences. And the journals devoted to older LGBT adults barely mention menopause. The therapy journals barely mention menopause either – whether in terms of clients or therapists.

If you are reading this and thinking, ‘Hold on, what about X study/project?’ I will be very glad to hear from you.

Ignorance about our own bodies

One of my concerns is that so few people know what the early stages of menopause look like – (and this is across the whole ovary-owning population) – that many may miss out on a chance to understand their bodies better, and perhaps avert a future health issue. It may be that a person isn’t having problems, but would benefit from knowing what their body is doing.

Not all bad

It’s really important to say that menopause is not necessarily terrible – for some it is a very welcome rite of passage. Culturally, it is seen more negatively among white people in the west than in many other cultures. (There are also differences in experience and responses between classes and races.) But we are not given the choice in knowing about it. Systemic (and internalised) ageism causes society to relegate this subject to ‘silly old women’ and at times to make fun of it. This is not helping anyone, other than those who profit from insecurity.

Hormones

I am wondering how the hormonal changes at menopause may interact with the hormones someone is already taking for gender affirmation/transition. At what point does the latter fully counteract the former? My sense is that this has not been studied much. I am also wondering about menopause, (or the idea of it), causing dysphoria for some transmasculine people – and not everyone wants to, or is able to, take hormones.

Queering gender – and sex?

If someone is living as a cis woman and then menopause comes along and removes her capacity to bear children and receive a penis in her vagina, is she still a woman? If the normative ‘rule’ is that the ‘only true sex’ involves a penis in a vagina, what does that mean for sex post-menopause, where this may cease to be viable? This embodied chronological ritual encourages a default queering of sex.

Other kinds of menopause

As above, my main focus is on the menopause that happens to people born with ovaries. However, it doesn’t feel right to talk about queer menopause and leave out people assigned male at birth (AMAB) who are taking hormones. Exogenous hormones can have a wide range of impacts on the body.

Who am I?

I’ve been in private practice in London for six years. I’m bisexual, and post-menopausal. You can find more about me and my work here.

Contact me

If you would like to find out more about this study, or if you have some information or knowledge you would like to share, I would love to hear from you. You can contact me here.

Chosen Family – 10 pitfalls to be aware of when creating one of your own

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Autumn leaves arranged on a windowsill

An increasing number of people refer to their  ‘Chosen Family’. These are the close people we’ve gathered around us who we are not related to by blood or by law.

While anyone might create such a group while having a perfectly OK relationship with their Family of Origin, Chosen Family is often about putting distance between yourself and your Family of Origin as the only way to stay sane or safe. For this reason, it is often used in a queer context. 

Whether you are escaping violence, prejudice, sexual abuse, bullying or neglect, you may put a lot of time and energy into gathering specific people around you.

Essentially, Chosen Family is a group of people who you believe will treat you as an equal, who you might rely on in a crisis, and who you hope will stay close to you, even when one of you has a major life change.

This applies on a societal level as well as a personal one – if you are queer, gender variant, kinky, consensually non-monogamous or a sex worker, for example, mainstream society likely sees your relationships – and your life – as less valid than those enjoyed by the majority. So it makes sense to band together and create something that works for you.

Created over years

I’m aware that my talking about ‘creating a family’ might imply that this is something done quite rapidly, like picking sports teams at school. ‘I’ll take this one and that one… oh and they look nice, but not that one…’ To be clear, we make these choices over years, during which time the desire to bond and create connection with others may override the quieter messages we may be getting that something is, despite our best hopes and intentions, not quite working.

Added to this is the fact that we may replicate behaviours that were modelled to us from a very young age. Remember, your family is the first group you know. That is where you first learned to navigate other people and

We may, in our eagerness to create the perfect safe zone, forget that it takes two people to form a friendship, and more than two to form a group. We may forget that consent and boundaries here need to be negotiated, as much as in any sexual scenario, and assume agreements that have not in fact been made.

Below is a range of issues you may come across when navigating chosen family:

(1) Letting shiny new people in much too quickly

As a young person you may have been told you had to ‘take what you’re given and be grateful’. So it can feel very exciting, even intoxicating, to realise that you have choices – particularly if this realisation has come to you later in life. 

At the same time, it can also feel quite isolating and frightening to reflect on your own situation when ‘everyone’ around you appears to have so much support from blood relatives, partners and an array of incredible people they seem to have known for years. (Social media really doesn’t help here.) 

So when you meet a new person and things seem to click, the temptation can be to grab them and not let go. ‘This person is fun and we have lots in common and we’ve talked so much already – this must mean we’re destined to be really close!’ And there may be a sense of relief that counteracts the feelings of isolation, and you may stop monitoring the situation because at last you’re home safe.

But having some things in common does not mean everything will match up. NRE  (New Relationship Energy) is a phrase usually used to describe the intense feelings at the start of a romantic relationship, but it also serves to describe feelings at the start of any new association. It’s okay to enjoy this feeling – but it’s also good to wait until it dies down and re-evaluate whether this exciting new friend is right for you as a long-term close person. And it’s worth reflecting before jumping in and sharing your deepest darkest self.

(2) Ignoring warning signs

I have long found it to be the case that when you look back after any kind of breakup or rupture, you realise you actually saw the seeds of it very early on. It was likely a tiny thing the person said or did, which you ignored because it seemed too minor to be worth mentioning. And who wants to look mean-spirited or critical with the shiny new person?

It’s those little moments when the Lovely New (or not so new) Friend suddenly looks at you and says something that is – apparently – totally out of character. Or sends a message that makes you inwardly go ‘WTF?!’ Something a little bit tactless, jarring or controlling that is out of your comfort zone but you don’t have a rudder to navigate it – and you don’t want to scare them away by questioning them on it. It’s that that feeling where your stomach drops into your shoes and you can’t quite believe what you just heard – so you discount it. Such is the fear of abandonment. 

Don’t ignore these little messages. They are tiny tells and they are important. For an exploration of the more extreme aspects of this, read Gavin de Becker’s excellent The Gift Of Fear.

(3) Getting sucked into other people’s stuff

When other people are friendly to you and invite you into their group, you may quickly lose a sense of yourself, particularly if you were excluded or othered as a child. If you aren’t used to it, it can feel amazing to be included in a ready made group whose members appear to be welcoming you and inviting you to things. It’s intoxicating when you are the Shiny New Person. Be aware of your feelings around this. You may feel excess gratitude for this inclusion that may eclipse other more realistic – and accurate – feelings.

Reflect on who is really in control in this new group – the person/couple at the centre may not have your best interests at heart once the fun dies down. Are you there to prop up their glory? Are they really trying to recruit you to go to their workshops or parties (monetised or not)? Or for sex? Are there lifestyle issues, like drugs or alcohol, where you are not on the same page? Are you being increasingly weighed down by a lot of gossip and expected to take sides?

You might want to ask yourself why you want to come in at the edges of someone else’s group rather than starting with yourself and people you yourself have chosen.

(4) Trying so hard to be acceptable that you hide the real you

If your Family of Origin message was that you are unacceptable in some way, you may attempt to hide aspects of yourself from new people, in case they find you similarly unacceptable. The trouble is, the Real You is going to leak out somewhere. If you sense that your outrageous true self is disapproved of in your chosen group, wonder about it. What exactly is it that you are needing to conceal from your chosen people? Are you actually avoiding the fact that, while they may be lovely, they may just not quite be the right people for you?  

(5) Doing the opposite of whatever people did at home

Remember – your Family of Origin is the first group you know. This may be hard to hear, but it will inevitably influence how you respond to your role in the groups you create or join as you go through life. 

This feels unfair, but until we have sufficiently understood our own dynamics and patterns, we may continue to replicate the harmful structures we are trying to get away from. Simply doing the opposite of whatever a parent did is reactive and may cause harm. If, for example, you vow never to shout at anyone the way you were shouted at, you may go too far the other way and become a quiet doormat who never gets their needs met.

(6) Sacrificing yourself for the sake of the friendship or group

Something’s not working but you’re not going to say anything in case the whole thing falls apart. It’s cold when the fire goes out and you know how that feels. It’s horrible and you’ll do anything not to feel that again. Similarly, when you feel that if you don’t do it, it won’t get done – such as organising meetups, for example. If you couldn’t rely on your childhood family for the reinforcement and validation you needed, you may understandably find yourself seeking this in others, and this is where problems can arise.

One good way to check the temperature of things is to stop initiating. If you are always the one who suggests meeting up, just stop doing it and see how long it takes for others to realise. It can provide a harsh but fruitful lesson. It doesn’t mean the friendship is over – but it means you likely need to state your needs and decide how much more to invest in this person or group. 

(7) Your priorities clashing with the priorities of others

This is where you need to decide how aligned you need to be with your chosen family. About having or not having kids. And about politics. Being of a different political persuasion can be exhausting, no matter how much you feel you can put these things to the side. Endlessly explaining things, or being hooked into debate, is not sustainable.

You may find that some people prioritise romantic partners over friendships, putting you further down a hierarchy than you realised you were. (You may not have realised you were in one.) You may also be sad when you have a child and so few of your Chosen Family are still around a year later. 

(8) Feeling as if you matter less than others

This is hard because there may be so many echoes from childhood here – some of them are your mind playing tricks on you, and some are real. 

Example: when your Friend X mentions their other Friend Y a lot, who perhaps lives abroad and you have never met, and keeps on going on about how amazing this person is. Months or years pass, and you are finally introduced to Friend Y.  You greet them with enthusiasm – ‘I’ve heard so much about you!’ – and they look a bit embarrassed and say ‘Oh, um, what did you say your name was? Oh, I don’t think they’ve ever mentioned you.’ This hurts, but is worth knowing.

And sometimes people really love you but cannot prioritise you for a huge and complex number of reasons.

(9)  Guilting yourself into not acting on your feelings

You may have found yourself staying in friendships that are not working any more out of fear. One sure way of telling this is if you find yourself wondering what on earth your life would be like if this person wasn’t in it. If it seems unimaginable, it’s worth wondering why you have come to rely on this person (or group) for so much, even when they are making you unhappy.

You may have been told as a child that you were not allowed to have feelings, or you were ‘mean’ or even ‘selfish’ when you said you didn’t like someone or didn’t want to do something. Perhaps you were told you were inherently defective or just ‘bad’. As a result, you may have found yourself letting others take advantage of you because you just don’t think you have the right to refuse, and you must continually atone for your ‘badness’ by letting people push you around. Needless to say, you are doing all the work here, and this is not healthy.

If it’s not working – it’s not working.

You cannot make something work if it isn’t. You can try, but at some point you will need to find a way to go your separate ways. The relief you feel when this association is broken will be tremendous and tangible.

(10) Not being able to discuss the difficulties in a friendship – or end it

So much public advice is about romantic relationships: getting together and breaking up. We are not encouraged to have much emotional literacy about that, and with friendships even less. Are you able to sit one of your Chosen Family down and explain how things are not working out between you? Do you fear their anger? (Perhaps like that of a parent?) Can you find a way to hold a course with them, or is it time to move on? 

Dealing with ending friendships is a whole post in itself. And while not everyone is into Relationship Anarchy, disrupting the presumed hierarchies among friends, romantic partners, (and bio family too), by treating them all with more equality is something many could benefit from.

If any of what you have read feels familiar and challenging and you would like to talk about it in therapy, please contact me here.

Further reading:

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.

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)