The transformational power of queer-affirmative therapy – from patients whose lives have been changed

I love this article.

I want to talk at a tangent because "affirmative approach" has been targeted by anti-trans activists in the UK and it's useful to look at what it means so you can debunk it.

Imagine a person ("Bob") who is being viciously bullied by a manager at work. This is causing them stress, and low mood, and maybe even depression. They see a therapist.

Bob: "I think my manager hates me".
Non-affirming therapist: "I think that's unlikely, let's look at other things that might be happening. Maybe you're just misunderstanding your boss?"

Bob: "I think my manager hates me".
Affirming therapist: "That sounds like an unpleasant situation. Can you say more about why you think your manager hates you?"

Affirmation does not mean "I accept everything you say, I do not examine it, I do not explore it with you". Exploration is a good thing. Exploration with the intent to change someone's identity is, obviously I hope, a bad thing and is conversion practices. (This cannot be "conversion therapy" because it's inherently abusive, and abuse cannot be therapeutic.)

The UK had a Memorandom of Understanding for conversion practices. That's linked here: https://www.bacp.co.uk/events-and-resources/ethics-and-standards/mou/

Here's the important bit that shows exploration is both allowed and expected; and that affirming therapy doesn't push people into a particular pathway and does not rush people towards medical or surgical transition. (I mean, the wait list for English gender services are something like 10 years at the moment.) Also important that I state, clearly and unequivocally, that trans people deserve good quality health care, provided in a timely manner, and that includes medical and surgical transition.

6 This position is not intended to deny, discourage or exclude those with uncertain feelings around sexuality or gender identity from seeking qualified and appropriate help.

This document supports therapists to provide appropriately informed and ethical practice when working with a client who wishes to explore, experiences conflict with or is in distress regarding, their sexual orientation or gender identity.

Nor is it intended to stop psychological and medical professionals who work with trans and gender questioning clients from performing a clinical assessment of suitability prior to medical intervention. Nor is it intended to stop medical professionals from prescribing hormone treatments and other medications to trans patients and people experiencing gender dysphoria.

For people who are unhappy about their sexual orientation or their gender identity, there may be grounds for exploring therapeutic options to help them live more comfortably with it, reduce their distress and reach a greater degree of self-acceptance. Some people may benefit from the support of psychotherapy and counselling to help them manage unhappiness and to clarify their sense of themselves. Clients make healthy choices when they understand themselves better.

Ethical practice in these cases requires the practitioner to have adequate knowledge and understanding of gender and sexual diversity and to be free from any agenda that favours one gender identity or sexual orientation as preferable over other gender and sexual diversities. For this reason, it is essential for clinicians to acknowledge the broad spectrum of sexual orientations and gender identities and gender expressions.

There's one part of the article I want to quibble with a bit.

Despite national standards for talking therapy – guidelines set by National Institute for Health and Clinical Excellence – outlining that 95 percent of referrals should start treatment within 18 weeks, research released last year by The Royal College of Psychiatrists tells a different story. With over 1 million people on waiting lists for specialist mental healthcare and extended wait periods, 43 per cent of adults reported a deterioration of their mental health, with 78 percent seeking help from emergency services or crisis lines.

In England we have two broad categories of talking therapy provided by the NHS. There is "NHS Talking Therapies", which used to be called "IAPT (improving access to psychological therapies)". These are provided by primary care, they have a four tier model, and they're for people who don't need secondary specialist care. The provided alongside or instead of medication. They're mostly for people with less intense depression, anxiety, and so on. This is what the article is talking about when they reference the NICE guidance. We do keep statistics on access, and those are found here: NHS Talking Therapies Monthly Statistics Including Employment Advisors, Performance August 2023

That shows that 89% of referrals started treatment within 6 weeks, and 98% of people started treatment in under 18 weeks.

That's an unfortunate confusion, because the article has a very strong point about secondary care "community based psychological therapy". These are an alternative to mental health hospital inpatient admission and wait lists for these (combined with the need to hit a very narrow window of ill enough, but not too ill) is an injustice that causes harm. While this type of therapy is available privately, regulation of private therapists is a bit of a mish-mash and private therapy can be very expensive and very very harmful.

Anyway, these are minor points. I love this article, and thank you for sharing it.