Amanda Williamson Coaching and Counselling Service in Exeter, Devon

I have wanted to blog about transphobia for a while but am aware that I most likely can't do the subject justice. But if I can at least make a handful of people think about their prejudices around gender then I will consider this to have been a worthwhile post. This is also my version of a cyber *hug* for somebody on Twitter that encounters a lot of hatred and abuse for being a trans woman.

What is transphobia?

It is the prejudice and negative attitudes and/or hatred towards people who are categorised as transitioning/considering transitioning/transitioned from the gender they have been assigned by the cultural definitions of male/female (binary gender), and those that don't identify with either culturally assigned gender (known as non-binary gender).

The issue has been highlighted to me since increasing my use of Twitter and encountering the extreme hatred towards some that are not cis (short for cisgender; when the sex/gender you know yourself to be correlates with the one you were originally assigned).

I have a long way to go before really understanding the experience of somebody who is not cisgender. I recall watching a couple of documentaries in the early 80's about men transitioning to women. It never occured to me that what they were doing was wrong or unnatural in any way. I was aged around 10 and I distinctly remember thinking how devastating it must be to realise that your outward appearance is the opposite of the gender which your actual self identifies with. I didn't know the word cisprivilege then but the fledgling concept developed within my psyche. I trusted that if somebody feels that way then they must have the wrong bits and bobs to fit with the societal expectation of the outward appearance of the gender they are. Surgical correction made perfect sense.

What is gender anyway? When in deep, authentic "I-Thou" relationship to another, gender falls away, along with age, race, class.

So I am absolutely perplexed at the hatred that I bear witness to on Twitter.

But I have become aware that I am unwittingly contributing to that hatred, which is a horrible thing to admit, but my own prejudices around gender, although not wrapped up in hate, or born of hate and fear,  might even contribute to the culturally backward thinking attitudes that we have. For example, I thought that I was pretty liberal for being cool with trans men and women, but it was only in the last couple of years that I appreciated the concept of being genderqueer or non-binary. I had assumed that people were either male or female (trans or cis) and it took some serious rethinking to realise that I had been effectively blanking out all those who identify as neither.

We seem to be attached to polarised thinking. Black or white, rich or poor, good or bad, male or female, gay or straight...

Remember the hatred towards homosexuals 20+ years ago? Of course hatred and intolerance still exists now, tragically, but we have come a long way from the days of being okay to call homosexuality unnatural and thinking that gay weddings are an abomination. It is becoming more accepted that sexuality is a spectrum that we don't have to plant ourselves firmly at either end of. Again, we have a L-O-N-G way to go but we are getting there. In this country and is my part of the UK at least I would not describe our society as homophobic. There remain some ignoramuses who remain homophobic but they are becoming more and more the minority.

BUT we have a transphobic society. Many people are unaware of the concept of a gender spectrum. Many, many people are not even aware of the issues faced by anybody affected by transphobia. And I, seeing through my cis eyes, filtered with my cis brain, have taken my cisprivilege for granted way more than I would prefer to admit.

Somebody pointed out to me recently that the 90's film Ace Ventura Pet Detective is transphobic. I vaguely remember watching it back in the day and nothing registered. But seeing the relevant scenes today, with my eyes open more than they were then, I was absolutely appalled. Not just at the film itself, but at how I hadn't appreciated in my 20's how blind I was to the hatred and abuse inflicted on those that are not cis.  I can appreciate now how distressing and abusive a trans woman might find the film's (non) handling of trans issues.

I'll call it a day for now. I would like to write more about the topic as I learn and understand more. I'd like to blog a full on rant about TERFs (trans-exclusionary radical feminists) women who dish out abuse and hate to trans women (very much "I-It" relating).

One more point. Please let me know if you are trans/non-binary and find anything that I written in any way disrespectful. I don't know what it is like to be you but I do know that there are many things I don't know and I am open to being educated.

Ignorance isn't bliss. It means hurting others without even knowing it.

* The picture above is from the album artwork for I am a Bird Now by Antony & The Johnsons. A beautiful, soulful album. The song You are My Sister never fails to make me cry.

Recently I wrote about the issue of the Professional Standards Authority (PSA) Accredited Voluntary Registers. (AVRs). Specifically, the registers that are in place for the voluntary regulation of counsellors and psychotherapists. I highlighted the problem with the fact that although they are there as a measure of public protection, the onus is on the public to ensure that their therapist is on an AVR and certainly most of the members of the public I ask are not aware of this scheme. 

Through a mutual contact, I have been liaising with a PR guy for the PSA. He kindly introduced himself, in a virtual manner, said that he'd been following my blog and offered assistance if I had any questions. Not one to refuse a kind offer I immediately put the following for him to ask the PSA:

"Most people looking for a counsellor don't know about the AVR scheme. So my first question is, I'd love to know who can change this and how."

I sent this late on Thursday night and by the close of day Friday I had a response (which impresses me greatly having been hugely frustrated with the bureaucracy that some organisations seem to have to wade through before responding…if they respond at all…)



Although I am impressed with their clear vision for raising awareness of the AVRs I think there's a long way to go. 

A few weeks ago I noticed that NHS Choices don't mention PSA AVRs at all on their pages on counselling and psychotherapy. This is hardly a successful raising awareness of the scheme by NHS Choices. 

Closer to home,  I was told back in June by a fellow therapist that he had gone to his GP surgery in Exeter to discuss his concerns about the Palace Gate scandal with the practice manager who promised to alert the surgery staff and notify the new practice manager who was due to succeed him soon. About 10 days ago another therapist went to see the same surgery and asked the new practice manager about his awareness of the PGCS scandal. He had no idea of it and worst of all, the practice nurse pulled a leaflet out of her bag and said "We send people there all the time". Palace Gate also known as Phoenix Counselling is an agency that has no membership of any regulatory organisation let alone an AVR and that is run by therapists who have been struck off the BACP twice and claim that 59% of their clients are signposted by GPs. There seemed to be no awareness whatsoever of the need to advise patients that the onus is on them to check that there therapist is on an AVR. Worst of all, NHS patients are still actively being encouraged to go to an agency that has been exposed in the national press for unethical practice. 

I telephoned my own practice manager who I assumed would be well versed in the situation seeing as I had made several trips to see my GP around issues of stress that the bullying and intimidation I had encountered in raising the complaint against PGCS. My GP was well aware of the outcome and I showed him the statement prepared by 27+ local counsellors. However, the practice manager again knew nothing of the matter. She has been helpful since then and I am now in the process of disseminating information regarding the PSA AVR scheme for Devon GPs.

I will continue to liaise with the PSA regarding the education of all concerned about the existence of the AVRs and will do what I can. I am also dedicated to pushing for regulation (preferably via the existing PSA scheme) and will continue to work away on that.

I would like to be part of a profession that acknowledges it's shadow side and can take care of those that take advantage of and exploit their clients. The way I experience it, at the moment, there's nothing to stop that.

As for any therapists or referring agencies reading this - are you taking responsibility for helping protect clients by spreading the word regarding AVRs? 

Is it possible to counsel a dog? People do use animal assisted therapy and I've heard really good things about it. Animals are intuitive and don't talk nonsense. 

Dogs strike me as being particularly mindful - they live in the here and now. They don't dread what's around the corner, unless horribly abused and even then they show steadfast loyalty towards their abuser. 

Flossie and Vicky

I grew up with dogs - two gorgeous rough collies; Vicky and her daughter Flossie. Even so I was petrified of strange dogs. I think somebody told me at a very young age that all dogs have rabies and I believed them. This was pre-zombie-obsession days. Fear of rabies, hydrophobophobia was all the rage for kids in the 70's. Vicky and Flossie had lovely lives and their distinct personalities will always be cherished.


Can you counsel doggies?

Would a dog ever need counselling? What about a dog with anxieties and fears? How would you even counsel a dog, when counselling is a talking therapy and dogs can't talk (not much…although I did have a neighbour who taught his rough collie how to say "Where's your mama")?

Stella the very cool dog

What got me thinking about this was when I was walking my dog this morning. Sally is the first dog I have owned as an adult. I fostered a good friend's dog for almost 2 years whilst he went abroad. My friend forked out for all the expenses and the lovely Stella was mature, well behaved, well loved and frankly one of the coolest dogs around. So this was a lovely favour to give my friend. How many dogs have their own leaving do when they go abroad? Saying goodbye to her was painful and when she passed away the pain was felt all over again. 

Rescuing a difficult dog


Stella left in 2011 and by 2013 the gap in life was apparent. The family made the decision over a period of months to take on another dog. I wanted to take on an older, rescue dog for many reasons. I wanted to give a difficult dog a good home and show him/her that life can be okay after all. And so after enquiring about a dog called Frazer, the rescue centre managed to persuade me that Sally would be much more suitable for our set up. Sally was apparently confident bordering on aggressive, but the confidence meant that she could be left on her own for half a day with no anxiety. We took her on in December 2013.

Sally came with a whole list of instructions. We had to agree to complete muzzle training, enroll her in dog training classes, organise for her to be spayed, ensure that she never, ever was allowed off lead, to ensure that she could never escape (road sense = zero), buy special raised bowls because dalmatians get a twisted gut if they stoop to eat and drink. She was sketchy, boisterous and really quite unruly.

First day at home, skinny and pensive

To give a brief history - she had been one of 14 dogs living on a large piece of land with little human attention and access only to an outhouse. She was 7 years old, underweight even after a few months at the kennels, very wary of other dogs, knew no commands whatsoever and was not used to leashed walks. She pulled horrendously (I ended up seeing an osteopath with very sore chest and shoulders), lunged for any dog within sight to get in there first and strutted around as if she thought she was the cock of the school.

For the first month or so I had serious regrets about taking Sally on. She arrived with a phantom pregancy and ended up with an infected nipple. Walking her was thoroughly unpleasant, physically and emotionally as it was very stressful. Any neighbourhood dogs that dared to come near her were greeted with aggressive barking. She would freak out and lunge, snapping and growling. Things weren't helped by the owner of a just-as-aggressive dog who allowed her dog to come bounding over and lay into Sally, undoing any good work we were doing in trying to reassure her that other dogs don't have to mean conflict.

Sally was an expert thief and could jump up and swipe things off the kitchen counter, then vomit everywhere afterwards. She could open the bin and tip it all over the floor, covering every square inch of tiles before peeing on it all.

She would growl at my partner and refuse to allow him anywhere near her. Apparently she had never bonded with a human before and she bonded fiercely with me, following me around from room to room, never letting me out of sight. Trying to hide under my bed at bedtime. Except for walk time when my presence was utterly disregarded as she tried to hunt things to tear apart, dragging my arm out of my socket (or so it felt) with her unfeasible strength.

I had anxiety dreams about her - I recall one where I was walking her and realised the leash was merely a strand of parcel ribbon and she could snap it and get run over in a trice. 

I cried in desperation. What have we (I) done? Is it cruel to send her back? 


Transformation

My well known tenacity and determination conquered all and I researched dog behaviour heavily, invested in a few hours with a dog trainer and enrolled her for the dog training classes, fearful that we wouldn't last more than 30 seconds before she tried to kill her classmates.

Over the last 9 months Sally has transformed from a fearful, aggressive girl. Everything that I learned and researched was used to help me understand her lived experience, what the deficits in her life were and how to meet her needs. Sally is now a dream dog. She is obedient, highly affectionate and has even started showing signs of wanting to play with other dogs. 

How did this happen? The neighbourhood dog owners marvel at her transformation. I am thrilled with how far she has come.


Commitment

This type of endeavour is a huge commitment of time and energy. I signed a contract to say that I would abide by certain criteria and requirements and I stuck to it. When things got tough I questioned my commitment but having the integrity to stick with things and not give up, just because the going gets tough, is an important quality I value. Where there's a will, there's a way.


Boundaries

The most important thing I learned is that without a shadow of a doubt, clear, firm boundaries were the key to Sally's turnaround. She did not know that she wasn't supposed to jump up, to walk "nicely" or to sit on her bed whilst we eat. We had to teach her all of these things and ensure that we all stuck to the same rules, consistently.


Empathy

I can't understate the importance of trying to connect with the others' experience, whoever the other might be. This is more difficult with another species but learning about dogs and their particular needs really helped me to see Sally's needs rather than my assumptions of what her needs would be.  For example the dog trainer reminded me that speaking to a dog like you would speak to a small child does not work. Dogs bark at each other so she showed me that barking "Off!" or "Leave it" is actually much clearer communication for a dog.  I also learned about pack mentality and could see how Sally was striving to be top dog, however I also noticed that at the times she seemed to relinquish that role she seemed a lot happier and less stressed. I realised that it was a role she seemed to feel obliged to fulfill but in knowing that it wasn't making her happy I taught her that she didn't have to do that anymore. She could trust me to do the worrying. After some months of boundary testing she doesn't feel the need to test them anymore. 

Dogs can also empathise with us. They know when we are feeling lonely, or impatient, or sad, or angry and will respond. 


Unconditional positive regard

I've had my moments of immaturely calling her names when the chips were down but underneath it all, what has helped our relationship is that I value and respect her sentience. Everything I do for her is with her best interests at heart. Her needs are met - she is comfortable, warm, has affection, good food, exercise, mental stimulation and love (the other name for UPR). 

Again, this can work both ways. In a healthy relationship dogs will demonstrate incomparable loyalty towards their companions. Dog owners know what it is like to be on the receiving end of a dog's UPR.


Congruence

Seeing as I'm checking off all the person-centred core conditions it wouldn't do to miss off congruence. How can one not be congruent with a dog? They know what's what. They are real, always and we can be ourselves in the presence of our beloved companion.



Doggies counselling us?

I started off this article pondering over the parallels between nurturing a rescue dog towards a place of security and contentedness and the counselling relationship. What I realise whilst I have written it is that the therapy works both ways :-)

I didn't counsel Sally, and she certainly didn't give me permission to counsel her, but the core conditions delivered within a context of commitment and clear boundaries seemed to have worked wonders.

Sally now feels safe and content - life is good

Now I'm at the tail end of a horrible experience regarding what I believe to be a deeply unethical therapy experience (which the BACP seemed to agree with given that they withdrew membership) I had at the Palace Gate Counselling Service in Exeter, I have been turning my attention to how to create meaning and purpose out of the experience.

This post is not about thrashing over the ins and outs of that experience. More can be read about that, albeit in a highly abridged version, here.

What the case I was involved in highlights is the problem with the lack of regulation of counselling and psychotherapy and the current limitations of the PSA's AVRs.

Is that last sentence clear? If you are a therapist you will know what I'm referring to, but what about the lay public? I'll clarify rather than thoughtlessly using acronyms…

What the case I was involved in highlights is the problem with the lack of regulation of counselling and psychotherapy and the huge limitations of the Professional Standard Authority's Accredited Voluntary Registers.

Hopefully that's clear? Except that the chances are, if you are not a therapist, that you will have never heard of the PSA nor their AVRs. I speak to my clients during their first session about the lack of regulation and the fact that I am a member of the BACP and that there is a complaints procedure in the event that they feel that I have acted unethically. Almost every single one of them had no idea we were an unregulated profession, let alone the fact that regulation is voluntary (or where to look).

The problem is, that the government see this system as being perfectly adequate to protect the public from unethical therapists, even though most of the public haven't heard of it.. They say that there is insufficient research to demonstrate that the expenditure required to regulate the professions is worth it. First of all, how can they know that when there is no way of collecting facts and figures because there is no centralised system. Secondly, how can a system that clients have no awareness of help?

A potential scenario: A victim of sexual abuse goes to get help and ends up with a sexually abusive therapist who has been struck off - THIS COULD HAPPEN WITH THE CURRENT SYSTEM

As an example, a woman called Sarah might be dealing with a difficult time in her life and struggling to deal with childhood sexual abuse issues. She may have children who have reached the age she was which has triggered flashbacks and be causing her a lot of anxiety. She may discuss this with her GP who may suggest she sees a counsellor and seeing as the NHS list is several months+ long she could see a private counsellor sooner. How many GPs explain that they need to check that any private counsellor they see is a member of a professional body or is on an AVR? Prior to the Palace Gate situation going nuclear and even afterwards, there were GPs in Exeter automatically recommending PGCS; a counselling agency that is run by directors/counsellors who are not members of any professional body. The staff are not required to be members (although some are) and nobody whatsoever is CRB/DBS checked. The staff are clinically supervised by the directors too. So Sarah might be recommended to go to an agency that had it's membership removed twice by the BACP, and could even end up being seen by a therapist who was seen by the BACP as being sexually abusive towards a client.

I don't think that one needs to be a therapist to grasp an idea of how it would retraumatise the client to trust a therapist enough to discuss their experience of sexual abuse and then be used by that therapist for their own sexual gain.

Yet this is the state of our profession. This can happen and at the moment there is nothing to stop it and nobody to take responsibility to ensure that this doesn't happen.

So this has become a bit of a mission for me. I have been in contact and been contacted by a wide variety of stakeholders and information, needs and perspectives are being collated. There are many of us determined to move forward with this.

If my experience can go anywhere towards making this profession an actual profession rather than the current free for all it currently is, then this can only be a good thing for the majority of counsellors and psychotherapists* who work responsibly and ethically and most importantly, our clients.

Informed Consent

"The Person must be given all of the information in terms of what the treatment involves, including the benefits and risks, and whether there are reasonable alternative treatments…"  

(http://www.nhs.uk/conditions/consent-to-treatment/pages/introduction.aspx)

Something that I have spent a long time pondering over is whether to have some kind of health warning on my website to warn of the potential pitfalls of counselling. I have felt rather nervous about that and don't want to scare people. Last week I had a conversation with somebody who made a very valid point. If doctors are required to obtain informed consent from patients before treating them then why not therapists?

There are potential pitfalls of therapeutic interventions but we as a profession do not seem to like acknowledging that fact. It was refreshing to read an article in The Guardian last month regarding the potential side effects of mindfulness. I heard some accusations of scaremongering but I believe that this sort of journalism is responsible.

Counselling and psychotherapy can be very useful and even positive, life-changing experiences for people. BUT, it is not for everybody, not all types of therapy work for all people and things can (and do) go wrong.

I am a realist. Life is life - there are misunderstandings, genuine human error and sadly, some who use their position of trust to exploit. I believe that we need a system that acknowledges this and has a framework to ensure that as few people as possible are negativey affected and if a therapist is being found to be exploitative or abusive then they should be removed from the profession.

That's the sort of profession I would feel proud to be a part of.

*this is an assumption. I have no proof that it is the majority of counsellors and psychotherapists work ethically and responsibly.

To check my registration with an AVR click here.