The history of abusive practice amongst the ‘psy’ professions (psychology, psychiatry and psychotherapy), now thankfully mostly on the wane, has resulted in a very uneasy relationship between these professions and those of us identifying as lesbian, gay, bisexual, transgender or queer (LGBTQ). The early years in particular were marked by the brutality of aversion therapies of various kinds in which clinicians sought to ‘cure’ LGBTQ people of their ‘disease’. Much of this activity was informed by ideas from psychoanalysis, in particular Freudian and post-Freudian thinking about ‘correct’ sexual development. Later theories about behaviourism in psychology, and how we might seek to condition particular responses in people, as we do when training a dog, further fuelled this cruel but ultimately ineffective industry.
In recent years, however, there has been a growth in LGBTQ affirmative psychotherapies of various kinds, primarily driven by work in the UK and US. There are similarities between LGBTQ affirmative therapies and feminist and multicultural therapies and the growth in LGBTQ affirmative therapies mirrors the growth in black and feminist affirmative psychotherapies. These therapies involve positive recognition of the diversity of human sexual and gender experience, with therapists actively ‘affirming’ these identities and practices as valid. A lot has changed since those early years. As Brown puts it, “in 1973, the notion that psychologists might be interested in serving the needs of lesbian, gay or bisexual (LGB) clients in an affirmative manner was unknown” (p. xi).
The foundations for gay affirmative practice were built with and alongside the lesbian and gay civil rights movement in the 1970s and 1980s. The removal of homosexuality per se from lists of mental disorders, the increase in lesbian and gay (and later bisexual, transgender and queer) “affirmative” scholarship, and the growing belief in equality for LGBTQ people, were important factors in this history. However, it was not until the late 1980s that LGBTQ affirmative therapies began to be properly formulated and discussed within the psychotherapeutic community. In the UK, the most significant development in the field of LGBTQ affirmative therapies can be found in the Pink Therapy series of books. The strong versions of affirmative therapies do, however, offer a serious challenge to particular elements of contemporary psychotherapeutic practice, notably the notion of ‘therapeutic neutrality’, which is the idea that therapists should be neutral on moral matters.
The idea of therapeutic neutrality that remains central in most psychotherapeutic practice is seriously challenged by the affirmative therapies, for these therapies involve a deliberate attempt to bring the political into the therapy room. When thinking through the idea of a therapist maintaining ‘neutrality’ the risk, in political terms, is a denial of difference. The feminist political philosopher Iris Marion Young (1990) has convincingly shown how such a denial of difference stems from the moral ideal of impartiality (similar in practice to the notion of therapeutic neutrality), which inevitably results in relations of domination and repression. Young argues that the moral ideal of impartiality is a search for an abstract universal position detached from the particularity of existence, from our history, culture and personal perspective: in other words, a traditionally masculine notion of the political sphere where the personal must be relegated to the private. She argues that the ‘view from nowhere’ denies difference in three ways: (1) denial of the particularity of situations through the adoption of a universal position; (2) abstraction from our particular, personal and embodied desires to take the perspective of a rational agent; (3) reduction of the plurality of life into a singular universal.
The moral ideal of impartiality is not only an impossible fiction but also ideologically pervasive for the way it justifies the notion of the impartial or neutral decision-maker, whether this is within the public sphere of politics or the private arena of counselling and psychotherapy. There are consequently many dangers with the notion of a moral ideal of impartiality, not least the silencing of individuals and groups whose needs do not conform to the universal as constructed. It is here where we see the loss of the particularity of the lesbian, gay, bisexual, transgender or queer subject, and the silencing of their specific needs. Through the gaze of therapeutic neutrality we lose sight of the particularity of sexual minorities and their specific therapeutic needs, needs that result from our immersion in a world in which oppression is still rife and identities are forged, at least in part, through particular group membership. Disadvantage accrues with difference and privilege with the identity of the mainstream, which is unfortunately still the Anglo-white-heterosexual-able-bodied-male subject within the West. The failure to take group differences seriously is an inevitable consequence of the ideal of (individual liberal) impartiality. LGBTQ affirmative therapies seek to tackle this problem head on through an honest and open acknowledgement of the role of politics in all aspects of life, including the therapy room.
Finally though, a word of caution, we should be careful not to get too complacent in thinking that we are beyond prejudice, with all therapists engaged in ‘affirmative’ practice, and the march of progress inevitable. Attempts to ‘cure’ LGBTQ people of their ‘disease’ continue in many parts of the World, with it possible to find examples of people practicing ‘conversion therapy’ across the globe, and even in the UK. Indeed, there has been resurgence in this form of unethical practice in the USA, at least in part as a response to the increasing equality for LGBTQ people in law. Continuing progress towards equality and widespread social acceptance for LGBTQ people (or any other minority for that matter) is not a given. History is replete with examples of societies in which rights were taken away and recent global political events should act as a reminder to us all that we must never think the battle for equality is over and done with once and for all.
References & further reading
Bayer, R. (1981), Homosexuality and American Psychiatry: The Politics of Diagnosis. New York: Basic Books.
Brown, L.S. (2000), Foreword. In: Handbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual Clients, eds. R.M. Perez, K.A. DeBord & K.J. Bieschke. Washington, DC: American Psychological Association, pp. xi-xiii.
Davies, D. & Neal, C., eds. (1996), Pink Therapy: A Guide for Counsellors and Therapists Working with Lesbian, Gay and Bisexual Clients. Buckingham: Open University Press.
Davies, D. & Neal, C., eds. (2000), Pink Therapy 2: Therapeutic Perspectives on Working with Lesbian, Gay and Bisexual Clients. Buckingham: Open University Press.
Fassinger, R.E. (2000), Applying counseling theories to lesbian, gay, and bisexual clients: Pitfalls and possibilities. In: Handbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual Clients, eds. R.M. Perez,K.A.DeBord&K.J. Bieschke.Washington, DC: American Psychological Association, pp. 107-131.
Nakajima, G.A. (2003), The emergence of an international lesbian, gay, and bisexual psychiatric movement. J. Gay & Lesbian Psychotherapy, 7(1/2): 165-188. Reprinted in: The Mental Health Professions and Homosexuality: International Perspectives, eds. V. Lingiardi & J. Drescher. New York: The Haworth Press, Inc., pp. 165-188.
Neal, C. & Davies, D., eds. (2000), Pink Therapy 3: Issues in Therapy with Lesbian, Gay, Bisexual and Transgender Clients. Buckingham: Open University Press.
Young, I. M. (1990). Justice and the politics of difference. Princeton: Princeton University Press.
Langdridge, D. (2007). Gay affirmative therapy: A theoretical framework and defence. Journal of Gay and Lesbian Psychotherapy, 11 (1/2), 27-43.
Langdridge, D. (2014). Gay affirmative therapy: recognizing the power of the social world. In M. Milton (ed.) Sexuality: Existential Perspectives. Ross on Wye: PCCS Books. [pp. 160-173, ISBN: 9781906254704]
Richards, C. & Barker, M.J. (2013). Sexuality and gender for mental health professionals. London: Sage.
Shaw, L., Butler, C., Langdridge, D., Gibson, S., Barker, M., Lenihan, P., Nair, R., & Richards, C. (2012). Guidelines for psychologists working therapeutically with sexual and gender minority clients. Leicester: British Psychological Society. [Download from: //www.bps.org.uk/sites/default/files/images/rep_92.pdf]