New guidelines for working therapeutically with Sexual & Gender Minority Clients

It’s already shaping up to be a good year for gender and sexual diversity in mental health. Last month the BPS (British Psychological Society, the organisation that oversees all practising psychologists in the UK) released the document ‘Guidelines and Literature Review for Psychologists Working Therapeutically with Sexual and Gender Minority Clients‘, which can be viewed for free online here. Although aimed particularly at those delivering therapy in sexuality/gender-focused settings, this advice has relevance for health professionals working in all areas. The report states its aims: ‘These guidelines have been developed in recognition of the importance of guiding and supporting applied psychologists around their work with sexual and gender minority clients in order to enable their inclusion in clinical practice at a high standard. They also aspire to engender better understanding of clients who may have suffered social exclusion and stigmatisation in order to reduce the possibility of this in the clinical arena.’ Attention is given to the harm caused in the past by perspectives in mental health about sexuality, which began to be put right the the removal of the diagnosis of homosexuality from the DSM in 1973. However, there is still a long way to go before services truly are inclusive and sensitive to the needs their clients, regardless of their sexual or gender identity. High levels of mental health problems have been reported in this client group, but they often experience difficulty accessing services, and may experience discrimination (unintentional or otherwise) from uninformed professionals.

It’s a large document that I’m still in the process of digesting, but so far I’ve been struck by how inclusive and wide-ranging it is. The report discusses ‘less-visible’ sexualities and identities, such as the spectrum that gender identities can take, forms of bisexuality and more fluid identities. Controversial and often-overlooked topics such as non-monogamous relationships/orientation, BDSM and sex-work are also tackled. It is worded sensitively, with effort to use quotes from service-users and use current phrases and slang, to bring professionals closer to the world inhabited by the clients they may meet.  The report encourages professionals to consider their own understandings of gender and sexuality, the context we live in and how this has shaped our own and others’ perceptions of.There is also a focus on doing away with myths that perpetuate throughout the system about certain identities, and a strong opposition to attempts to ‘cure’ a sexual or gender identity. It seems to be a really positive and well-researched report that would be beneficial to individuals working in a wide range of sectors, to inform and advise on a range of issues with working with this client group. If you’ve seen the document, what were your thoughts?

Bisexuality in the UK

On February 15th a report was published bringing together research and information on the UK’s bisexual population. In particular the paper highlights the discrimination bisexuals face, often related to misconceptions, negative stereotypes and ‘invisibility’ within the community. It seems amazing that it’s taken this long for us to have a paper of this kind, but hopefully it is a step towards greater public and professional awareness of this often unseen group. It has been produced by BiUK in conjunction with the Open University, Bi Community News and the Bisexual Index. You can read it here.

Twice as nice? Or double the discrimination?

The paper offers some definitions of bisexuality, explaining that many different forms of identity may come under the umbrella of the term. Bisexuality includes individuals who are not attracted exclusively to one gender (regardless of whether they engage in sex or relationships with individuals of more than one gender), people of fluid and changeable sexuality, individuals who do not see gender as an important factor in attraction and those who dispute the concept of a gender binary in sexual attraction. A bisexual need not actively engage in relationships with people of different genders or have an equal preference for different genders. Not all individuals who fit with the used definitions may actually use the term ‘bisexual’ to describe themselves, picking a more precise term or preferring not to label themselves.

Biphobia is a term used to describe discimination against bisexuals on the basis of their sexuality. Distinct from homophobia, bisexuals may experience discrimination both within the heterosexual and homosexual community. This can often centre on beliefs that bisexuals are confused, promiscuous, greedy or not acknowledging that bisexuality truly exists. Presentations of bisexuals in the media have often conformed to stereotypes and further perpetuated myths. Female bisexuals are often presented as people who break up relationships, tease and generally exist for the fantasies of heterosexual men. Bisexual men are an even lesser spotted species, often considered to be an insecure individual’s ‘stepping stone’ before fully coming out as gay. Much progress has been made in recent years about tackling homophobia, but prejudices against bisexuals are rife and even seen in the communities that seek to promote gay rights. This can lead to bisexuals feeling alienated and having to conform to either a ‘gay’ or ‘straight’ identity in order to be accepted.

Bisexuals can often seem invisible when judgements about sexuality are often made based on a person’s current relationship, their involvement in the gay community and even their appearance. A bisexual does not cease to be a bisexual if they marry an opposite sex partner, or same sex partner, or even if they choose to not be in a relationship at all! LGBT campaigning and activism often makes very little mention of the ‘B’, such are in recent discussion over same-sex marriages, and LGBT groups and events (such as Pride) may have little visible represenation for the bisexual community. The difficulties faced by bisexuals can be undermined as people erroneously think that they ‘have it easy’ compared to homosexuals, and some how their struggle is halved by having ‘one leg in the straight community’. Statistics on bisexuals are often lumped together with the other LGBT groups, rather than examined in their own right as a separate sexuality.

One of the most attention-grabbing and upsetting details of the report is the statistics that Bisexuals have poorer mental health than both homosexuals and transsexuals. This is something difficult to publicise without unintentionally feeding into stereotypes of bisexuals as ‘tragic’, ‘dramatic’ or ‘confused’. Indeed, much of the distress experienced by bisexuals has been linked to hostile and unhelpful reactions from others, rather than the sexuality itself. Coming out, an already difficult process, may be more marked for bisexuals who may need to come out when they choose a same sex partner, then again when they choose an opposite sex partner. There has been quite some media attention about depression and suicide in the gay community but similar issues in the bi community seem to have been overlooked. The evidence suggests that Bisexuals are more likely to suffer distress and to have a diagnosed mental health problem. Medical and mental health professionals are often uninformed about bisexual issues and may even make remarks suggesting that the individual’s illness has something to do with their sexuality. This kind of treatment can make it challenging for bisexuals to access mental health treatment and get appropriate care. Manchester group BiPhoria have created a fantastic and informative document for mental health professionals to guide them on working with bisexual clients, I’d really recommend it. Can be read here.

Quotes from BiPhoria

Much of the reccomendations in the report, and from other Bi media sources, amounts to not making assumptions about Bisexuals and considering them separately from homosexual groups. The mental health statistics are worrying and if we’re going to do anything to solve this problem, we need to be sensitive to individuals’ needs and be open-minded to different perspectives. Bisexuality may present in a wide variety of ways so it’s difficult to predict exactly how a bisexual may live their life, or what their experiences will be. As with working with other individuals, an individualised, person-centred approach and a genuine curiosity to learn about and understand another’s view point, can help us to support Bisexuals and help them to become a more visible part of the UK’s community.

Gender Fatigue – Andrej Pejic & the trend for the ‘bend

Edit 22/04/15 – In the time since I wrote this piece I’m aware that that Adreja Pejic has “come out” and transitioned. In light of this I’ve considered whether this piece comes across as mean-spirited. My intention was to criticise the idea that the only kind of acceptable gender non-conforming body was one that conformed to idealised standards of (female) beauty, and that this was not as ground-breaking and empowering as some media sources had made it out to be. I have no issue with Pejic herself and however she chooses to express herself, more the way the media paraded her.

Barnes & Nobel censored this cover, worrying that customers might mistake him for a topless woman

Barnes & Nobel censored this cover, worrying that customers might mistake him for a topless woman

Here comes an unpopular opinion. I am bored of Andrej Pejic. There, I said it.

Yes, he’s pretty, I don’t deny that. I’m not bored of looking at him,  he’s gorgeous and has created some stunning images. What I’m bored of is the way he’s being continually lauded as the patron saint of gender diversity as if he’s the first bloke to ever wear a dress.

You’ve probably heard of the Serbian-born male model, famous for, well, looking like a girl. And not just any girl, a beautiful girl, with the high-fashion look designers crave. Andrei shot to fame following a Marc Jacobs editorial which showed the blond, elfin model in a short dress, showing off his slender, well-oiled legs. A sensation was born and Pejic became one of the first male models to take part in female catwalk shows and fronting many campaigns for men’s and women’s wear. Controversy and world-wide fame insued after he gained a place in FHM’s ‘hottest women’ list, generating some rather ugly transphobic abuse, and when he starred in a push-up bra advert.

Pejic, who does not identify as transgender, has been quoted saying that he enjoys dressing in both masculine and feminine styles and has been mistaken for a girl since he was a child, suffering no hostility for it “I can’t really say that it was ever a bad thing. All I’ll say is … a lot of free drinks!”. Journalists and media have applauded his bravery and defiance in the face of gender-norms, his innovation and his status as an icon of gender-fluidity, someone judged on their ‘merits’ rather than their gender. So does the acceptance of Pejic into the mainstream media and fashion world mean that society is becoming more accepting of variation in gender and individuals whose identity differs from their biological sex? I’m not so sure.

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