Strange - on this first day of the Jewish New Year - to be on
this side of the "pulpit" - so to speak - talking to
a group of people on issues which I feel should be of concern
to us both in the present and for the future as members of a therapeutic
congregation.
The idea of "Looking Forward" is perhaps in keeping
with a new start and maybe, for today, I can feel a little rabbinical
- not so much as a leader but in the tradition of the rabbinical
commentators who debated their ideas and opinions long and loudly!
And as with any sermon, I hope you will both perceive in it the
message the rabbi has intended but also take and leave what you
will and debate them yourselves long and loudly.
The ALGBP approached The Pink Practice, a counselling and psychotherapy
practice for people who are lesbian, gay, bisexual and transgender,
for someone to present a paper to share with the conference ideas
and concerns for the future of counselling and psychotherapy in
and with the lesbian, gay, bisexual and transgender communities.
The original intention as I understand it had been for a few papers/presenters
to be on the panel. As there are only two presenters here today,
the context for delivering this paper has changed and I am anticipating
that there will perhaps be more focus on my ideas than I have
prepared for.
I have been thinking of this paper as a discussion document which
raises questions and concerns which I have and which I hope other
lesbian and gay colleagues will also be interested in addressing.
I am hoping it will be an opportunity to reflect on one's own
ideas and what's happening "out there" but also to reflect
on what we'd like to see happening 'out there'.
I want to address the impact of ideology on practice and
the impact of these ideologies on our community. I hope to
raise questions concerning the decisions we participate in as
to the kind of resources we make available and examine the messages
we give our community about the role of psychology and counselling.
Please note that I make no distinction between the terms counselling,
therapy and psychotherapy and use them interchangeably. I am more
inclined to make a distinction between the different schools of
therapy and counselling.
There may be times when I say "lesbian and gay" but
I am referring to a broader community which includes people who
would define as transgender, bisexual, queer and so on.
It may help to set the context for this paper by describing my
work and some theoretical influences. I work in as a counsellor
with the Pink Practice, in a GP practice and also teach. My background
is in social work and then counselling which I have been doing
for over fifteen years now. I used to practice with a strong psychoanalytic
bias and have also been influenced by the developing ideas from
within the practice of family therapy.
The Pink Practice offers consultations on a one-off or short term
basis to work lasting several years. Our theoretical orientation
is systemic and social constructionist which means (to us) that
we think about people as living in a social world, being in relationship,
continually coming into being through relationshipping and creating/influencing
our realities through the language we and others use to describe
ourselves, our experiences.
The Pink Practice was established in 1989 as a response to many requests for lesbian and gay counsellors/therapists. Clients seemed to want a counsellor who would (i) not focus unnecessarily and/ negatively on their sexual orientation and (ii) might have an
understanding of the culture(s) in which lesbians and gay men
lived. Lesbians and gay men were having difficulty locating counsellors
they knew to be gay. Requests for lesbian or gay counsellors were
met with dis-ease by the majority of counselling organisations
and often left individuals feeling pathologised. This, unfortunately,
is still very much the case. The Women's Therapy Centre, for example,
will not agree to refer lesbians to an out lesbian counsellor.
The account I have been given by them is that they believe it
could be harmful to the therapeutic relationship.
Hypotheses such as this - to disclose the sexuality of the therapist
to the client could be harmful to the therapeutic relationship
- are confirmed time and time again because the ideology informing
the choice of theory and practice will influence which descriptions
are brought forth of what happens in the therapy and by whom.
As we increasingly allow ourselves to be affected by post-modern
ideas, therapists are feeling drawn to examine their hypotheses
and reflect on their own ideology and the ideologies underlying
their practice and being recreated through it. It is not
difficult to see how therapy involves various practices of power.
Accounting for one's ideas and assumptions, for one's theoretical
preferences and explanations of methods to clients has, for the
most part, been an unvisited "no-go" area of therapy.
Therapeutic mystique has unjustifiably been incorporated into
therapeutic practice as if a necessary requirement for the success
of the work. Clients are then excluded from areas of decision
making about the process, from the choice of ideas to draw on
and from participating in an aspect of co-creating the conversation.
In effect, the therapist is accountable only to other professionals
in being able to explain their practice and the client's access
to their therapist's thoughts is restricted.
Behaving in a transparent manner with clients does not
involve loss of expertise by the therapist. Sharing one's thoughts
and confusions at times can make for most helpful shifts in the
work.
For example, a client who feels worthless in many relationships
may feel it is a unique experience to be asked by the therapist
for their opinion on which avenues to follow in the conversation
or for the therapist to explain their thoughts, their dilemmas
about how to proceed in the conversation and ask the client for
suggestions or guidance. The therapist has to be prepared for
a greater openness and curiosity about the client's ideas about
the therapeutic conversation. There will be a shift in the balance
of power with clients feeling more able to comment on the therapist's
behaviour and ideas and generate descriptions of their experiences
despite or outside of the therapist's preferred stories of human
behaviour. What one might be encouraging is a shift from interpretation
to story generation, from a one-up one-down relationship to a
co-constructive relationship where everyone's ideas count, where
clients' ideas count.
How constrained is our practice by the ideas embodied by the institutions which trained us?
And how do we know how these constraints operate?
How recent are these ideas and the debates about them?
How have these institutions thought about "homosexuality"?
How do they "know"?
How come they have changed their ideas?
What is your account of how change occurs in institutions?
This is an important question because changes are happening
and we need to be able to have accounts of these changes and contextualise
any invitation to a party.
For years lesbians, gay men have been excluded from so many psychotherapy
and counselling trainings. So now more of these institutions are
specifically opening their doors to us. Why? Have they
succumbed to the mainstreaming of certain liberal ideas? Has their
theory of "homosexuality" changed? Can one really separate
out one bit of theory and say "Well, yes, since the cultural
revolution, we can now admit we got that bit wrong. We have replaced
it with a more ethically sensitive piece of theory"? Can
we really expect to take out, surgically remove, one element of
the theory and replace it with something less controversial? The
practices of many such training institutions have bordered on
fascistic with regard to "homosexual" (often only prospective)
trainees. What does it mean for lesbians and gay men to be entering
into the previously forbidden zone in order to do therapy trainings.
Are we assured no negative knock-on effect into our community
of the institution's recent history/stories? In what ways might
the history of the training institution's relationship to sexuality,
gender and power be affecting your practice and our communities?
What are we bringing home?
We need to examine the ideology behind the theoretical approach
we favour. Why?
For example, the analogy I used above of performing surgery on
a body is perhaps not inappropriate and reflects the positivist
discourse of biological science which is one of the main underlying
principles influencing so much of psychoanalysis and other therapies.
Biology in itself is not dangerous. How it is used by popular
and powerful discourses to uphold certain values and beliefs is
of concern. The question might be, for example, "How would
the principles of biology work for me/us or against me/us?"
and/or "Who is most keen to uphold the principles of biology
and why?"
Fundamental assumptions and basic principles are difficult to
spot because they are thought of as "common sense" and
lie most comfortably in the taken-for-granted ideas of a person's
everyday life. A grave danger is to assume therapeutic methodologies
are free of those same assumptions and that there is a "neutral"
space for therapists.
This diagram (Leppington 1991) illustrates the relationships between
different levels of therapeutic context and the influence they
have on each other.
Examining the circular relationship between our conversations
and our ideology is not a comfortable process. We need to be able
to practice with a reflexivity about the taken-for-granted ideas
at work in our therapeutic conversations or we can fall prey to
the very ideas lesbian, gay, bisexual and transgender people are
trying to change. Reflexivity creates the possibility of
continually asking oneself "What am I not noticing?"
The epistemological emphasis then shifts so it is not just "I
know what I know because I understand how to help people say what
they really (sic) feel." so much as "What ideas am I
drawing on that are bringing forth this particular description
of experience?" What we generate as information (a description),
how we know what we know and the context in which the conversation
emerges are inseparable.
It is important then to make a shift from subscribing to theories
as if they were truths which required an unswerving allegiance
to treating all theories as ideas which are more or
less helpful with different people and/or at different times.
Theoretical orientations are not clubs which we join. If they
are, they are likely to close down therapeutic opportunities.
And who sets the membership guidelines for such clubs? I want
to encourage other therapists to play with a post-modernist perspective
and see theories as perspectives which take account of subjectivity
in all ideas at work in the therapy.
A key question that I think we need to get to grips with is whether
we think we are uncovering "the truth" (a story of something
that pre-exists - not something emergent) or creating our realities.
I believe language does not reflect an objective picture of what
life is like but that it is used to create and shape realities,
descriptions, stories. This is an important distinction for therapists
to make if we are to open ourselves up to participating in process
of exploring what other stories have been excluded by society,
by others, by positivist approaches to therapy - both for our
clients and for us as lesbian and gay therapists.
Bateson (1970) quoted Korzybski when he said "The map is
not the territory". I would paraphrase that to say the map
is not always an agreed description of the territory. Have you
ever tried to find out how to get from London to Wales on the
train by using the A.A. atlas? It has no train lines in it. A
"good" atlas will include several maps of the same terrain
telling different stories. But the amount of descriptions of a
terrain or a person's or community's experience are infinite.
In therapy, it is not the story, the description alone which is
important but the experience of mapping, the telling, the creating
of the story which will have an impact.
How do we account for the fact that between us we could bring forth lots of different descriptions of a person's concerns?
Do some of us believe we are likely to be more right than someone else with their approach?
Is our "diversity" enough of an answer?
I am less concerned with "right" than with what the
implications of a particular story are for a person and what impact
there has been on the client and on the therapist of the process
of the bringing forth of that story, description of their circumstances.
What are we bringing home?
How are the training's we have received meeting the needs of our communities?
How are the trainings influencing our communities?
For example, at the Pink Practice we sometimes need to refer to
other therapists or organisations when this seems appropriate.
But few training courses teach Couple Counselling as part of the
training - as if the individual's experience is divorced from
their current environment/relationships; as if lesbians and gay
men only need individual therapy.
Many callers request short term work and yet we have enormous
difficulty finding therapists outside of The Pink Practice who
will offer short term work or work on a consultation basis. It
is my understanding that most therapy courses do not teach short
term work and in not doing so can imply to the trainees that "the
longer the treatment the better" just like the point Doug
Carl (1990) makes about the belief many gay couples have to counterbalance
i.e. that gay relationships are less likely to "work"
and therefore, the longer the relationship, the better! I hotly
dispute the idea that the longer the therapy the more effective
it will be. There are some systemic therapists who believe that
after six sessions the therapy becomes part of the problem. There
are times when this idea makes me more mindful of assumptions
the client and I might be making about what constitutes helpful
therapy.
In our contact with other lesbian and gay therapists we so often hear that they "do not do" short term work.
What does this mean? Does it mean I believe short term work to
be less effective? Does it mean I do not feel confident to do
it? Does it mean I only do what my training institution taught
me to do? Does it mean the client is clearly 'in denial'? Does
it mean my timetable will be thrown out by that? Does it mean
I don't give a damn as to what is needed by our community?
In my experience, many therapists practising only longer term
work know very little about recent developments in short term
therapy but still seem monogamously attached, as if by honorary
allegiance, to their own (sic) school of practice. I find the
implication that practitioners offering only longer term work
have the monopoly on effecting the most significant change in
the world of therapy to be arrogant and ignorant. More significantly,
it can close down opportunities for change in therapeutic work
with people and for the development of one's own professional
practice. Short term work is often seen as an economically led
practice as opposed to being useful in its own right.
It is the same with frequency. Clients often ask for fortnightly or monthly consultations, for example. It is very disappointing to hear colleagues say, "I only see people a minimum of weekly" when we practice with a flexibility about frequency and
see it working for people and hearing the request in the community
for a more varied service.
Are our communities so sick that each prospective client
must be received into long term therapy, weekly? I think you would
agree not. The community is strong, creative and able in so, so
many ways.
What does it mean then for us as a community to be amassing armies
of counsellors from within our own ranks to have counsellors (expert
lesbians and gay men) tell their countrymen and women what they
"really" need. This therapeutic "knowledge"
which seems to me to be mainly about resources, creates a story
for us as a community. Counselling has become such a commonly
used resource in our community. It often appears to me that lesbians
and gay men are already quite able in the area of self reflexivity.
Therapy should be encouraging that ability, building on the idea
of the expertise of each individual in therapeutic and other contexts
and not be trying to relocate all the expertise in the counsellor
or in the process of counselling.
So many members of the lesbian, gay, bisexual and transgender
communities can be overheard as using/ misusing psychology terms
in their everyday conversations. Listen out for them and see how
often you hear them being used to positively connote someone's
behaviour or choices. So many clients present in counselling with
a negative psycho-jargoned description of themselves as if this
is what they felt was expected from them in therapy! In my
experience, people have come to use the language of counselling
to negatively interpret themselves or each other.
What does this tell us about our practice or about the discourses
in which we are invited to participate and in which we choose
to participate?
What then is the role of the therapist in the lesbian, gay, bisexual and transgender communities? I think the role of therapist is not about curing the individual from the horrors of their past but a sense making process through conversation which helps people to know how to go on, to know how to make sense of their lives, to examine how their thinking, how their descriptions, their language, works for them and works against them. The therapist in the lesbian, gay, bisexual and transgender communities
is, in my opinion, in a very powerful position. They can help
to create more of a story of personal inadequacy, a story of the
individual (different to individuality) or they can help to bring
forth other descriptions of ability, agency, choice, social context,
a story of a group and by implication group experience, group
history and group strength.
These last few points may sound strange. What has therapy with an individual got to do with the whole community? Everything. We influence the language, we influence a story of individuals and a story (or lack of it) of group; we build on a story of
ill health as well as of ability; we create a story of change
at a personal level and, to our loss, only extremely rarely, a
story of change at a level of society.
There are times, particularly in work with lesbian, gay, bisexual
or transgender couples, when I find myself pointing out to people
that they are pioneers, that there are not always models available
to us which can offer guidance on how to proceed in relationships.
There is no right way of "doing" a relationship. We
are learning to make up the rules as we go along. It takes courage
and we often doubt ourselves, referring to our heterosexual counterparts
who are themselves struggling with received ideas about being
in relationship. It seems to me that similar struggles face us,
as lesbian, gay, bisexual and transgender counsellors in our therapeutic
practice.
How do we, like the couples who search for useful ideas, decide
which ideas or practices are useful to us, to our clients and
to our communities and which ideas or practices are not? And what
do we do with our self doubt as to the legitimacy of our own opinions?
Can we, should we rely on our training institutions and registrative
bodies, such as the UKCP or BAC, to support us in our clinical
decisions?
If I have a vision for the future of counselling and psychotherapy
with the lesbian, gay, bisexual and transgender communities, it
is for us as practitioners, to be critically involved in examining
the premises which underpin all our practices. It is important
to consider the ethical implications of our preferences. I feel
it is essential to review one's relationship with the theory and
to treat theories as stories, as ideas which can be more or less
helpful. I feel we have to break free of the need for approval
and membership of institutions for it can only be honorary, tokenistic
and temporary. Yes, we can sit on boards and committees but let
us be circumspect about the meaning for all parties of this participation.
Let us examine the most taken-for-granted assumptions which influence
our choice of therapeutic style - so freeing ourselves up from
having jumped the hurdles of acquiring a qualification in the
professional arena and so allowing ourselves to participate in
our communities with an openness, a preparedness to co-story with
other lesbians, gay men, bisexual and transgender people, create
our own discourses, our own theories in a manner which allows
us to play with them and not become so attached to them that we
become the custodians of fixed ideas, of truths and of exclusive
expertise.
[With recognition of the contributions of Gwyn Whitfield also
at The Pink Practice for the conversations we have about therapy
and in developing ideas for this paper.]
References
Bateson, G. (1973) Steps to an Ecology of Mind. Paladin. London
Carl, D. (1990) Counselling Same Sex Couples. Norton. London
Leppington, R. (1991) From Constructivism to Social Constructionism and Doing
Critical Therapy. Human Systems Journal of Systemic Consultation
and Management Vol.2 pp79-103