Looking Forward: Perspectives from a Practice Context

Paper presented at the Fourth Annual Conference of the Association of Lesbian,

Gay and Bisexual Psychologies-UK in Nottingham, UK on 14th September 1996

Gail Simon

Systemic & Social Constructionist Therapist

The Pink Practice, London

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.

methodo3.gif 5.2 K

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.]


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