20 September 2014

Spreading the word on the Accredited Voluntary Registers - The PSA responds



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…)



Thank you for your efforts to raise awareness of Accredited Voluntary Registers in counselling and psychotherapy. The Professional Standards Authority respects your view with regard to statutory regulation, and we agree that public awareness is essential to the success of the accredited registers approach.
We note that on your blog, you raise a concern about public protection – if a practitioner was removed from a register but continued to practice, a member of the public would have no way of knowing. As you know, we require organisations holding voluntary registers to publish these decisions, but this only protects the public if people check the register and ask for practitioners on accredited registers.
The Authority believes that the most effective way to raise awareness of voluntary registers is to disseminate standard messages to the approximately 53,000 registrants of 13 AVRs to use in their interactions with members of the public as well as health and care professionals. These have been provided to registrants by the organisation holding their accredited register.
In addition to tapping into the awareness raising ability of registrants, the Authority has an active stakeholder education programme and has ensured that information about the scheme is available to the public through information sources like NHS Choices. News and updates on the scheme have appeared in NHS publications such as the NHS England’s CCG bulletin, or the Chief Nursing Officer’s bulletin. The Authority is working to improve the accessibility and visibility of information about the scheme and will continue to promote the scheme.  The Authority has a communications plan in place to raise awareness of the scheme and it would be content to discuss with you.

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? 




16 September 2014

Counselling Sally - a mutually therapeutic relationship with a rescue dog

by Amanda Williamson

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










10 September 2014

What the public want in respect of the regulation of counselling and psychotherapy

by Amanda Williamson

[NB This post is an excerpt from a longer article on the issue of regulation]

This is the question that my colleague Tina Welch and myself posed to members of the public in June 2013:


THE DEBATE:

Should Counselling and Psychotherapy be regulated professions?

Therapists have been in debate regarding this issue for many years. Some are staunchly for regulation, some are staunchly against.

I would like to ask THE PUBLIC their opinion, to help inform therapists.

Q: How important is the statutory (compulsory) regulation of counsellors and psychotherapists to you?

                            1 I am strongly against statutory regulation
                            2 I am slightly against statutory regulation
                            3 I don’t care either way
                            4 I am slightly for statutory regulation
                            5 I am strongly for statutory regulation


Finally, are you aware that Counselling and Psychotherapy are currently unregulated professions in theUK?




We asked a total of 117 adults to rate the importance of statutory regulation according to the above scale. 40 were male, 77 were female. 5 people were therapists and 2 described themselves as having a background in mental health.

The findings



The answer to our first question gives what I believe to be a very clear message about what the public want. 


In answer to the question asking whether they were aware that counselling and psychotherapy are currently unregulated professions in the UK, 75 people were not aware of this fact and 41 said they were aware. 1 person was unsure whether they knew or not. 

Of those that didn't know, many expressed surprise at this fact and assumed that they are regulated professions (I would like to collect data on that specific issue next time - how many people assumed the professions are regulated and/or are surprised to discover they are not?)

A number of people said that there should be more polling of public opinion on this matter. 2 of the people that expressed this were personally strongly against statutory regulation, but welcomed this research being done.

So not only do the majority of people we asked want regulation, but many assumed it was already in place.

8 September 2014

The PSA, the AVRs and Informed Consent in Counselling and Psychotherapy



by Amanda Williamson

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.



22 July 2014

Challenging Prejudices around Sex Work

by Amanda Williamson

I have been pondering on this blog post for several months now. I have opinions about sex work that some people might struggle with. I have found myself pussyfooting around the issue and worrying that my network won't be able to handle my thoughts and beliefs around sex work...

Could this be anything to do with my Catholic school upbringing? Might I, even though I believe I have forged my own moral compass by being curious and genuinely open to taboo issues, actually still be being influenced by others' attitudes towards sex, taught to me decades ago? When I started secondary school, a convent grammar school, I had to read two books before term started. The New World Bible and Girls Growing Up. I didn't read the bible before I started school (rebel). I couldn't wait to get stuck into Girls Growing Up though. I can't find any reference anywhere to this book online, not even an illustration. It was basically a book to explain the changes of puberty (I remember misreading "pubic" as "public" and making my parents laugh) and sex. The narrative focused on a married couple with kids who, once the kids went to bed, talked about their day and then expressed their love for each other with a very gentle sounding lovemaking, in bed of course, that involved the woman lying back and the man taking the initiative. The whole purpose being that they express their love so intensely that they can make a baby out of it to prove their love (or something like that).

I have come a long way since then, which was 31 years ago (yikes). I have more knowledge, maybe even wisdom, personal experience and been exposed to a whole spectrum of sexual behaviour through acquaintances and clients I have worked with, from asexual to monogamous, adulterous, polyamorous relationships, exchanging sex for money and coercive or forceful sex.

I'll say it now, the only time I feel that sex is wrong is if it is forceful or coercive. For the sake of clarity,  sex with children is always coercive in my opinion as well as sex with people who you are in a position of power over e.g. therapists' clients. Read more about this here: http://www.amandawilliamsoncounselling.co.uk/2013/05/sex-in-forbidden-zone-by-peter-rutter.html

Please also note that I am well aware of the issues with forced prostitution and trafficking which I believe are wrong. However, I also have the capacity to see that full service sex work (commonly referred to as prostitution, although sex workers dislike that term) does not necessarily involve force or coercion.

Whether somebody chooses to abstain from sex, or whether they choose a monogamous or polyamorous relationship is not a problem to me, provided nobody is being hurt in the process.

It goes to follow then, that full service sex work is not a problem to me, provided the sex worker and the client are both consenting adults. I would prefer that people did not engage in polyamorous relationships if they are having to lie about it to their partner. That is deception and I believe that almost all of the time this is ethically wrong. But I am aware that me thinking something is wrong does not mean that the rest of the world will agree it's wrong. Hopefully everybody (besides certain sociopaths) would agree that forceful or coercive sex is always wrong (excluding consensual BDSM practices, talking of which, research seems to indicate that BDSM practitioners may be psychologically healthier than non-practitioners).

Why sex work is okay

I actually think that full service sex workers provide a very much needed service, particularly so for disabled people or those with mental health issues that might make finding a partner (whether that be for a full relationship or just for sex) incredibly difficult. What many people don't seem to appreciate is that sexual needs are pretty much universal. We are (most of us) wired to want sexual release. Many of us want both an intimate emotional connection and a physically intimate connection. Even a monogamously wired person may not be able to have both those needs met in one relationship.

As for people without any disability or mental health issues, if they aren't hurting anybody, why is it a problem for them to pay to have sex with a sex worker? Why is it somehow preferable for them to go to a bar or club, buy drinks for a potential sexual partner, or treat them to dinner, with the purpose of wanting to have intercourse at the end of it?

I suspect that sex work is tarnished with old attitudes that are perpetuated. I hold my hands up, I have probably passed judgment on sex workers in the past due to ignorance, insecurity and societal and religious expectations.

No Agenda

I would like to be clear here that I have no personal agenda. I am not a sex worker and it wouldn't work for me personally. I have a comfortable spot on the sexuality spectrum that would make it difficult for me to have sex with somebody I did not know. That doesn't mean I am somehow morally right. It's just what is right for me. Some people get a lot of enjoyment and a buzz from sex with a stranger. Each to their own. I appreciate why gambling is so addictive but my brain isn't wired to get a thrill from gambling either.

Acceptance of individuality

Wherever it is I am on the spectrum of sexuality, I appreciate others' positions (as long as they aren't being forceful or coercive with sex). 

A Therapeutic Contract

I might be taking a risk here by saying it, but full service sex work can be compared (and contrasted) with counselling and psychotherapy. A client is paying for a service that involves a certain amount of intimacy. For some clients, being emotionally intimate may be more excruciating than being sexually intimate and therefore forming a relationship with a therapist may feel fundamentally more risky or scary than paying for sex. There are therapists that traverse the two issues although the UK law on sex surrogacy is ambiguous. Sex therapists deal explicitly with issues of sex and I suspect have a more open mind about sex work than the average person.

Where sex work meets therapy

I have for several months been in contact with a sex worker who is also a trainee therapist via Twitter. We met via a mutual contact Phil Dore as this lady, Jemima, has a mutual interest in the regulation of therapy to help protect clients from rogue therapists who abuse the position of trust they hold. My dialogue with Jemima has helped me understand more about the abuse that sex workers face and the assumptions that many people, including therapists, make about sex workers. There was an article written very recently in the BACP publication Therapy Today on women exiting sex work which, whilst an important issue I was pleased to see being discussed, did have a flavour of assumption that all women in sex work would choose to exit if they could. Whilst reading it I thought of Jemima and Tweeted her to ask her what she thought of it. Jemima was so upset she told me that she had cried. She quite rightly pointed out that the BACP Ethical Framework promotes client autonomy and that this attitude is clearly at odds with that. She has written a response to Therapy Today. Jemima mentioned an article a this blog post on the criminalisation of the clients of sex workers in Canada.

I have invited Jemima to be interviewed for this blog post as I believe that she is in the perfect position to lend a voice to this issue. I believe that it is important to realise that there are people who choose sex work and not assume that they are all downtrodden, abused or in need of rescuing. If we automatically take that stance that makes us, the judge, assume a position of power which says more about us and our egos and insecurities and/or ignorance than it does the sex worker.


Q Please can I have a brief description of what you do in terms of how you choose to define yourself professionally? 

I am an independent, indoor, full service sex worker, independent means I do not work for an agency or brothel. Indoor contrasts with outdoor, or street workers, the most common image that comes to mind when people think of sex workers. Sex work covers a variety of jobs, from porn to phone sex. Full service means I will have sex with my clients, under a variety of pre-negotiated (i.e. I insist on condoms) and time limited conditions. People might know the words escort or call girl to describe what I do, though both are problematic for different reasons.

Q How long have you been a sex worker for? 

Around 6 years, which in sex work terms is quite long, there is a joke that sex work years are the same as dog years.

Q What are the best and worst bits about being a sex worker? 

Best bits; working for myself, the boost it has given to my self esteem and confidence, the money, the independence, travelling and meeting new people. The community that other sex workers provide, sometimes the sex. The many older gentleman for whom I provide the only human contact. With clients of any age seeing someone leave happy and relaxed, and being responsible for that is a wonderful experience. Many clients talk to me about their lives and problems, in some ways the kind of trust that the therapeutic alliance is meant to work towards over a series of sessions is achieved far more rapidly. I become someone they share problems and intimate secrets with. It has also allowed me to explore a feminine side to myself I had previously,  for a variety of reasons been unable to express.

Worst; The fear of assault and rape, being raped, not being able to be open about my work, the fear of outing, the fear that stigma may impact on those I care about, unreliable working hours-like many self employed people I spend a lot of time waiting for the phone to ring. A tricky subject much discussed among sws but little understood outside the job is having sex when you are not particularly wanting it. This is not the same as non consensual sex, it is assumed it must be the worst part of the job, but it isn't. It is no different really to anyone else going into work when they don't really fancy it.

Q Can you tell me a little about your psychotherapy training? 

I have to be slightly circumspect here, but I am training to be a person centred therapist on a BACP approved course at an accredited learning provider. (Though the more I learn the more an integrationist approach seems the best).

Q What are the best and worst bits about being a therapist? 

Well I am still in training, and one of the worst things about this is not being able to express my knowledge or experiences. For example when the tutor was discussing the importance of being able to leave clients behind for self care there was so much I could have contributed. To be a successful sex worker, in terms of personal health and self care, you have to be able to leave the clients behind in a very similar manner. In terms of clients who don't show there was also a lot I could have shared, but was unable to. Again when lone working came up there was a wealth of experience I could not share. On another level there is a level of congruence and authenticity denied to me in things like skills practice, since there are whole aspects of my life I have to censor due to stigma.
The self development has been amazing though, I feel I am so much more self aware than I was a year ago, I have grown so much. It has been incredible getting good feedback, and realising I can do this. With those clients I have seen as they open up and trust me I feel incredibly honoured to be allowed into their lives.

Q What do you think of current legislation regarding sex work – what would you change and why? 

Current legislation is a mess. Sex work is legal in the UK, if you work alone and indoors. However those with an ideological objection to sex work as well as those with a religious one have tried to criminalise almost every aspect of life surrounding sex work. Street soliciting is illegal, which criminalised the most vulnerable sex workers, often trans, WoC, substance users and migrants. Working with another person is illegal, technically a brothel (thank you Labour) this means if we wish to share a work space for security and companionship we can both be arrested as the other persons pimp. Sex work is dangerous and isolating as it is and this particular law makes it more so.
Our partners are also criminalised, arrested as our pimps regardless of evidence. then there is the assumptions and stigma, sex workers are evicted, have their children taken off them, loose custody cases, purely because of their job.
We need decriminalisation on the New Zealand model. This moves the regulation of sex work from the criminal to the civil sphere, treats it as any other job, with some particular exceptions around the claiming of benefits.

Q What do you think about the current legislation regarding counselling and psychotherapy? Again; what would you change and why?

I think it would be a good idea! Again it seems that when it comes to sex, people think there are a whole different set of assumptions and norms which must be upheld, norms based on purity culture and the dominance of capitalist patriarchy. People who sell sexual services are controlled, stigmatised, treated as outcasts, people who sell therapeutic services are allowed free reign regardless of the harm they may have done. In sex work terms we talk about harm reduction, therapy needs to place harm reduction front and centre, and there must be mandatory registration and regulation.
This may seem contradictory when I oppose mandatory regulation (or legalisation) of sex work, however it is about understanding power dynamics and who has the power in a relationship. In sex work the worker needs protection, best offered by decriminalisation, in therapy it is the client who needs it, best offered by regulation.

Q Do you experience any misunderstanding or discrimination over the sex work aspect of your lifestyle and if so from whom? 

Daily, society at large is whorephobic and makes huge assumptions about sex workers, as you already mentioned in the discussion of the therapy today piece. However I am very careful about who knows I am a sex worker, and so unless I am campaigning online I can avoid this, although i do not always exercise as much self care as I should. It is hard though when classmates or tutors discuss “prostitution” or trafficking, and make statements that show they have prejudices based on lack of knowledge and I feel unable to challenge them due to fear of outing myself. I know as much about trafficking a many academics, yet have to sit their in silence, seething. I imagine it is similar to how LGBT people feel when they are read as straight and surrounded by homophobic or transphobes.

Q Do you encounter any misunderstanding regarding your therapeutic work? 

Not so far

Q Anything else you want to say?

You mention the fact that some sex workers work with disabled people as part of your changing thoughts around sex work. This is problematic for me and many other sex workers for a number of reasons. Whilst on an individual level it is rewarding to work with people with disabilities, many of whom are denied access to sexual pleasure by the disablism of society and assumptions about people with disabilities being sexless this has nothing to do with the fight for sex workers rights and against stigma.

Many people are unable to have the sex life they desire, for any number of reasons, they may have poor social skills, be physically unattractive, shy, obese, and so on. Whilst these are not structural in nature as disability is (I take a social view of disability, in that it is society which causes some people to be less abled than others) to argue that sex work is somehow acceptable because it provides a sexual opportunity for those who would otherwise not be able to have those opportunities surely should include those without disabilities but with other disadvantages?

People with disabilities should have their right to sexual pleasure respected, and enabled if possible (assuming they are not asexual) On a side note there also should not be assumptions they are heterosexual, or have no interest in subjects such as BDSM. Enabling in this context may or may not involve helping to arrange meetings with sex workers if this is what the disabled person wants. We are fortunate in the UK as many OTs and case precedent means personal allowances can be spent on a sex worker, and carers are expected to respect the disabled person's right to privacy and desire for sex. Although further training is needed and there are still many issues around families who deny their adult children's sexuality and also for those with learning difficulties.

However as important as these issues are the rights of sex workers do not rely on the "worthiness" of our clients. A therapeutic analogy- imagine if the string them up brigade decided that counselling paedophiles should be criminalised, on the grounds they did not "deserve" to be helped? Quite rightly therapists would object, and would highlight how whilst not every therapist wants or is able to work with sex offenders it would be wrong to punish those who did. The rights of the therapist as a worker are not dependent on the worthiness of those they work with.

One last thing, many sex workers are disabled, it is a job that can work well when flexibility is a key requirement. It is so common in the discussion around sex workers rights to focus on the clients, rather than the workers, when discussing sex work and disability it would be good if for a change people's first thought was of disabled sex workers, not disabled clients.

Thank you Jemima for some very thought provoking, educative and interesting answers.


NB This post was updated on 25th June 2014. The link to a sex surrogacy agency has been removed because it was brought to my attention that the agency I linked to was unregulated having had their COSRT membership removed. 











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