4.6 Affirmative practice and therapy modalities
As a therapist you are likely to have an approach to working with clients. One question might be how affirmative practice sits alongside your modality. Our own view is that it makes sense to think of affirmative practice as a meta-theory or over-arching framework that sits beyond particular schools of therapy in terms of how they work with clients. This is similar to the notion of cultural competence as something overarching that should inform therapeutic work with clients, however we practise.
Cultural competence comprises the awareness, knowledge and skills required to work ethically and effectively with clients who differ from oneself as a therapist. The requirement to be culturally competent is a common ethical and professional standard within the psychological therapies (Soto et al., 2018). What this means is that if you (know you) are not culturally competent with respect to a particular population, you should not work therapeutically with them.
Trans-affirmative practice approaches can be considered as a specific type of cultural competence. Importantly, the research on therapist cultural competence clearly finds that therapists are not good at rating whether they are in fact culturally competent – only client-rated cultural competence is shown to be positively related to clients’ therapy outcomes (Soto et al., 2018). This underlines the importance of therapists taking on board the idea that they may not be – from their trans client’s perspective – practising affirmatively. We therefore need to be aware how our language, approaches and assumptions about the world may not be supportive to clients. It also suggests the value of giving clients space to provide feedback on how they are experiencing the therapy. To consider this more, try the next activity.
Activity 4.6: Thinking about our own modalities
Davies (1996) talks about how we may need to put some of our existing training aside to practise affirmatively, if existing training models had not already addressed the biases against LGBTQA+ people that existed when the founding practitioners of our models were practising. It is important to learn to notice these biases – in the middle of the last century particularly, the profession was much preoccupied with the notion of ‘what causes this pathology’, where today we might not see pathology, only natural difference and diversity, in the case of neurodiversity or LGBTQA+ identity.
What blinkered spots does your own modality have on trans issues? What attitudes and misconceptions have you heard from fellow therapists or read in the literature?
Discussion
A paper by McBee (2013) discusses the history of pathologisation of trans identities and experiences (while also making an argument for the need for ‘a more affirming perspective’). A therapist might question the pathologising nature of the current trans healthcare process, but it is important to understand that the evidence base supports access to transition healthcare for those that want it. Affirmative practice supports the autonomy of the individual trans person to follow a path that’s right for them.
4.5 The impact of misgendering