NEIL YOUNG outlines how we as therapists can support social change through a deeper understanding of our own gender and sexual identities.

AS A PROFESSION grounded in the principles of compassion, empathy, authenticity and congruence, it is curious how little critical attention is given to the importance of gender and sexual identity development and expression as part of accredited psychotherapy training as well as in the day-to-day working of major therapy and counselling bodies. For this reason, I was really encouraged when UKATA invited me to Liverpool to deliver an extended workshop at the ‘Beyond the Rainbow: Gender and Sexual Diversity’ conference in April 2018.

When I run workshops about gender and sexual diversity, therapists and other professionals who attend are often surprised that my focus is not so much on exploring the experiences of lesbian, gay, bisexual, trans and queer (LGBTQ+) people – even though this is covered as key material – but that I work to create space where people can authentically explore their past, present and future stories about their own gender and sexuality, sometimes for the first time, supported by the creative use of art materials and the imagination.

The seminars, conferences and events I facilitate are all-too-rare spaces that spark rich discussions, allow for uncertainty and move participants – including me – to gain greater awareness and insight of their sexual and gendered selves and how this may intersect with other aspects of their identity, including race, class and disability. They provide the opportunity for us as therapists to explore the assumptions, privileges and/or prejudices that may, at least in part, be blind spots within ourselves and in our work with clients in relation to issues of gender and sexuality.

In this article, I offer an overview of some important social context about the experience of sexual and gender minorities in the UK. I then offer a series of tips for client work, adapted from those that appeared in an article I wrote last year for the BACP University & College Counselling journal (‘Young people: not straight, not narrow’ – Young, 2017).

The ‘straight is great’ (and normal) mantra

From birth all of us have been subject to homo-, bi- and trans-phobia, which are all prejudices that seek to privilege heterosexuality – usually within marriage and tied to conventional, binary gender roles – over all other forms of relating. This structural privilege has made ‘coming out’ a necessary and ongoing process for LGBTQ+ people so that our lives can be rendered visible and valuable. It is interesting that as we have seen the levels of anti-LGBT prejudice fall in the last twenty years – with legal and cultural change – we are now seeing a sea change among teenagers and young adults who are increasingly resisting traditional, binary gender identities and not defining themselves as heterosexual.

Nonetheless, while there has been a positive change in attitudes towards lesbian and gay people – at the height of the AIDS crisis in 1987, 64% of people surveyed by the British Social Attitudes Survey believed that same-sex relationships were ‘always wrong’ and this fell to 19% by 2017 (NatCEN,2017) – there remains a significant minority of the population actively holding homophobic and transphobic views. Moreover, we remain caught in the midst of moral panics that fan the flames of hatred against trans children, young people and women – with the occasional salacious coverage of a pregnant trans man thrown in for good measure – while bigoted views about bisexuality remain widespread and often unchallenged.

The impact of such toxic learnt prejudice on people’s behaviour, sense of self and quality of life is all too real. The UK Government’s National LGBT Survey, which reported in July 2018, found that 68% of people with a minority sexual orientation avoided holding hands in public with their same-sex partner (Government Equalities Officer, 2018). The fears that interrupt ordinary, loving contact between LGBTQ+ people are often driven by the trauma of being physically, verbally and/or sexually assaulted in the past. Importantly, these common experiences of hatred – whether recent or historic – act to push LGBTQ+ people back towards the closet, driven by a desire to be safe and complicated by whatever homo-, bi- and transphobic prejudice individuals have internalised. This year a Stonewall survey found that over a third of trans people had experienced a hate crime in the previous 12 months (Stonewall, 2018) while similar hate-based crimes against lesbian, gay and bisexual people went up 78% between 2013-2017, with Black and Asian LGBT people disproportionately affected (Stonewall, 2017).

In light of this evidence, it is perhaps no wonder that according to the Government survey a quarter of LGBT people have accessed mental health services in the past year (Government Equalities Officer, 2018). Notably, 2% of people had experienced and another 5% had been offered ‘conversion therapy’, which is essentially an unethical, abusive attack on someone’s sexual or gender identity dressed up as professional psychological help.

What you can do to bring about change

Part of our work as therapists, and arguably as human beings, is to be alive to how systemic power – at the societal, cultural, community, familial and individual levels – plays out for us, our clients and within the therapeutic relationships, we co-create. Understanding the diversity of gender and sexual identities and the ways that trauma can be produced and reproduced by the violent policing of gender expression and sexual identity can help us to deepen the work we are able to imagine, facilitate and bear with people who have internalised toxic prejudice.

Here, I briefly lay out some top tips to support your work with gender and sexual identity based on interviews in January 2017 with counsellors, psychotherapists, a psychiatrist, an academic and a trans and non-binary youth worker (Young, 2017).
• Examine your sexual and gender identity and relationship style: we all have gender and sexual identities; have personal therapy and supervision with LGBTQ-affirmative practitioners where you can explore your own assumptions, beliefs and judgments.
• Proactively educate yourself about LGBTQ issues: we have an ethical responsibility to seek out specialist training and resources to relieve the burden from LGBTQ clients of educating their therapists. For example, sharing this article with other therapists and professionals would be an excellent way to encourage debate.
• Be open and know your limits: let clients know what you do and don’t know about gender and sexual identities and develop referral networks of organisations and individual therapists that you can safely refer on to.
• Be an LGBTQ affirmative therapist: review your marketing and waiting room posters, leaflets and magazines to signal your support for diverse gender and sexual identities. Allow clients blank spaces to write in their preferred gender and sexual identities and check for preferred pronouns.
• Allow space for uncertainty: given the negative historic pressures on clients to conform, having time to safely explore who they are, at whatever age, can be invaluable. • Position yourself against anti-LGBTQ hate: empathise with and support clients who have experienced violence and prejudice to access healthy feelings of anger.
• Too much gender and sexual identity can be a bad thing: be careful not to automatically link everyday problems in clients’ lives back to their LGBTQ identities.

This runs of the risk of pathology and being blindsided to other pressing issues that clients need to explore.

• Be focused on what is happening for the client: avoid stereotypical responses that you would be unlikely to offer heterosexual clients, such as simply suggesting that the client is unsure about their gender or sexual identity or going through a phase.

• Owning your mistakes can help the therapy: for example, if you get someone’s pronouns wrong this can offer the opportunity to repair this rupture with a meaningful, reparative experience.

Therapeutic work focused on gender and sexuality can be hugely rewarding. If these recommendations feel a bit too much, work your way through them one by one or start by picking those you feel drawn to. Remember, as qualified therapists you are already working from a strong set of skills. Evidence from the UK’s largest study of LGBTQ young people found that having a non-judgmental, supportive therapist was the most important factor in facilitating a successful working alliance (METRO, 2016). This article hopes to validate work you are already doing, as well as offering ideas for you to work more deeply with gender and sexual identity issues, both within yourself and with current and future clients.

Neil Young is a psychotherapist specialising in the arts, who delivers bespoke training, conferences and events for therapists, other professionals and organisations.

Neil Young is a psychotherapist specialising in the arts, who delivers bespoke training, conferences and events for therapists, other professionals and organisations.


Government Equalities Officer (July 2018) National LGBT Survey: Summary Report. publications/national-lgbt-survey-summary-report METRO (2016) Youth Chances. 04/National%20Youth%20Chances%20Intergrated%20Repo rt%202016.pdf
NatCen (27 July 2017) ‘Charting changing attitudes – Same-sex relationships’. changing-attitudes-same-sex-relationships
Stonewall (2017) ‘Hate crime against LGBT people in Britain increases by 78 per cent since 2013’. people-Britain-increases-78-cent-2013
Stonewall (2018) LGBT in Britain: Trans Report. trans.pdf
Young, N. (2017) ‘Young people: not straight, not narrow.’ University and College Counselling, September 2017: Volume 5, Issue 3. journals/university-and-college-counselling/september- 2017/young-people-not-straight-not-narrow.