Is the BPS able to tolerate controversy and step up to the current debates?
Pat Harvey posts…
Background
In 2020, I became aware of some of the extensive issues involved in this case:
“The tangled case of the brothers who became girls, aged seven and three. A couple’s own son transitioned – and within months they were given a baby to foster, who became a girl too.” (https://archive.ph/3rEQw)
The details of the discussion of psychological considerations presented in this court case are very disquieting. Accordingly, I went to the current 2019 British Psychological Society Guidelines (currently downloadable at https://www.bps.org.uk/guideline/guidelines-psychologists-working-gender-sexuality-and-relationship-diversity ). I was naively hoping that my professional body could offer a position statement which would fairly represent a weighing of the dilemmas that would help a court case such as this one.
The document resembled no professional guidelines or policy guidance that I had ever seen during a long NHS clinical, service manager and trainer career, or as a member of the Mental Health Act Commission (precursor to the CQC) or as a panel member of an independent inquiry.
The content of the guidelines was very brief, sketchy yet dogmatic. There was no proper respectful recognition of current controversial clinical issues or social and political context. One approach only appeared to be acceptable, that of non-questioning “affirmation”. Consent issues were not considered. Sexuality and lifestyle issues such as kink and BDSM were lumped together with gender. There were hugely important omissions, such as the dilemmas of working with people who have a sexual interest in children. The limits of the research base were ignored.
I made a very detailed formal complaint about the form, the content and what I had discovered about the process of generating these guidelines. This served to illustrate and to confirm the experience of others – that the BPS complaints procedure was neither adequate, nor was it even followed. The complaint dragged on for months, deadlines were missed, I had to deal with different individuals at different times and important points in my complaint were missed. Unacceptable assertions about the status of evidence were dismissed with “we are a broad church”. The irony of this in the context of an “affirmation only” approach in the guidelines was lost. Only my persistence in the face of these failures got the complaint to Stage 2.
The complaint was closed with little by way of any positive outcomes. There were formal apologies for procedural failing. There was an evasive reply to the assertion I made that the members of the group which generated the guidelines had not all signed off on them. The crucial matter of their woeful inadequacy in the matter of providing responsible guidance for distressed gender questioning children was evaded by a retrospective formal addition, stating “For adults and young people (aged 18 and over)”. This was unaccompanied by any formal public announcement to members, many of who might still be working from the original, unamended version. The contents however, remained ambiguous with respect to age as with the implications that the following paragraph was applicable to minors:
“Assistive reproductive options may be needed and should be discussed openly and frankly, perhaps especially in the case of trans youth who are seeking treatments which will remove reproductive options at an age below that which people commonly consider becoming a parent”.
Hence, since 2020 until the present time, the professional guidance for psychology practitioners and non- psychologists, provided by the British Psychological Society are still held out on their website as follows:
‘These guidelines are aimed at applied psychologists working with mental distress, but may also be applied in associated psychological fields.
The principles they are based upon are derived from both the literature and best practice agreement of experts in the field and may also be applied to other disciplines, such as counselling, psychotherapy, psychiatry, medicine, nursing and social work.”
In my view this is nothing short of a scandal, a failed responsibility to the public. The national Gender Identity Disorder Service was, after all, psychologist led.
Events since 2022, further actions
In August 2022, after the Cass interim report and the subsequent announced closure of the GIDS, I wrote to the Practice Board of the BPS.
I am reproducing the letter in its entirety, followed by the response I finally received in November 2022, after a number of email prompts from myself. I make no further comment beyond my letter and the response in order that the reader might make their own judgement.
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Letter to British Psychological Society Practice Board
From Pat Harvey AFBPsS., C Psychol.
16 August 2022
Re BPS 2019 GSRD Guidelines
I am writing to you as a BPS member and an interested party in the process and development of BPS policy statements and the publication of guidelines for psychologists and other professionals working with clients who access services for problems relating to questioning their gender identity.
My interest has developed sequentially from
- Experience during 30 years of clinical practice in adult mental health services with Male-to-Female clients, then termed Transsexuals and Transvestites.
- Experience directly related to certain high profile and media reported cases of individual families in court.
- Engagement with the BPS complaints procedure (August 2020 – April 2021) in respect of the 2019 GSRD Guidelines and the public statements of the Chair of the Task and Finish group responsible for producing those guidelines. There are detailed responses from Karen Beamish which should be available on file.
- Responsibility for public content of the critical Twitter account @psychsocwatchuk
- Articles published under my authorship on BPSWatch.com.
- A chapter authored by me on the 2019 GSRD Guidelines in the forthcoming book British Psychology In Crisis: A Case Study in Organisational Dysfunction edited by David Pilgrim. Phoenix publishers (2022 in press).
I believe that the British Psychological Society has a duty to develop policy and best practice relating to matters central to psychology in the interests of the public and to assist its practitioner members. It also has a duty to keep its members properly informed, but the BPS has a recent history of lack of openness and transparency which operates to the detriment of that those duties. Accordingly, I am writing to you with a series of questions which I believe members have the right to have answered and to be updated on as soon as possible, even if merely to be told that a process of consideration is ongoing.
Are the GSRD Guidelines being reviewed?
I understand that the 2019 GSRD Guidelines may be in the process of revision. I make this assumption on the basis of the twitter exchange below and because the 2019 Guidelines themselves have disappeared from the webpage https://www.bps.org.uk/guideline/guidelines-psychologists-working-gender-sexuality-and-relationship-diversity without explanation.
Why is there no explanation or clarification?
There have been several ambiguous undertakings made to myself, to others and on the webpage to review the 2019 Guidelines over a two year period:
- “in the light of the outcome of the Bell vs Tavistock Judicial Review”, November 2020.
- “These guidelines will be reviewed following the outcome of the Bell v Tavistock appeal process” https://www.bps.org.uk/guideline/guidelines-psychologists-working-gender-sexuality-and-relationship-diversity
- “In the meantime the Chair of the Practice Board has already put in place plans to commence a review of the gender guidelines upon the conclusion of the appeal.” (Karen Beamish to me 9 April 2021)
- On Twitter to an individual (see above) “following the Cass review” 1 August 2022.
This is a completely unacceptable way to keep members updated. It is also extremely confusing since the 2019 GSRD Guidelines had a retrospective caveat added as a direct result of my complaint (“we have offered to put a statement on the front of our guidelines, on our website and all points/places where the guidelines are referenced to confirm that the BPS guidelines for psychologists working with gender, sexuality and relationship diversity are for adults. We will implement this urgently”) in April 2021. However, the Tavistock cases related to issues of consent of minors under 18. The remit of the Cass review is that it is the Independent Review by a paediatrician of “gender identity services for children and young people”. So, rhetorically – to emphasis the confusion of the BPS – how are those external drivers central to the decision to review guidelines explicitly stated since 2021 as applying only to adults?
Will the supposed review result in guidelines for children and young people?
It is clear that there has been a “moving picture” with regard to external events, first legal, then with the Cass Review and now the planned closure (in the wake of criticism about service accessibility failures, failures of service integration, ideology, data collection and research evidence base) of Tavistock GIDS. That moving picture, which will undoubtedly develop, cannot preclude the provision of guidelines for practising psychologists in the meantime. The BPS has provided nothing useable for its members to date: there is not any set of psychological principles that support ethical and reflective psychological practice, principles that would weather a changing legal social and political milieu.
The BPS should seek confidently to espouse key psychological principles in this contested area and take a lead. These principles include
- Psychological understandings of the formation of identity within a developmental context.
- Psychological understandings of the issues of informed and valid consent, especially in minors.
- Heterogeneity of factors bearing down upon gender questioning in individuals, complexities and persistence or otherwise of their clinical presentations.
- Importance of family dynamics, peer pressure, social contagion and the problem of psychological reductionism within a wider social context.
- The pitfalls of biological and medical reductionism, e.g. “transgenderism is innate”.
None of this was addressed in the 2019 “affirmation only” Guidelines.
In recent service delivery for gender questioning and distressed children and young people, the foremost service, GIDS, has been psychologist-led. It is therefore astonishing that there have been no effective guidelines for psychology practitioners forthcoming from the BPS as our professional body. The BPS must grasp this situation and take a lead.
Should revised Guidelines separate Gender from Sexuality and Relationship Diversity?
I raised this in my complaint. The independent investigator brought in at stage 2 did not supply a definite answer; nevertheless he agreed this was an important question for any future revision to consider. He stated the following, reported to me in the letter concluding the complaint investigation from Karen Beamish dated 9 April 2021:
“In a future review, there should be further consideration of the issues to validate their inclusion or alternatively to provide any clarification needed…… it should be something for the Practice Board to consider under its remit to lead on the development of the guidelines.”
There are good reasons for separating the topics. Some are as follows:
- Gender guidelines should firmly be covering the whole life span. Sexuality and relationship diversity is largely applicable to adults with some references to adolescent development.
- It is strongly argued by many that gender questioning should be conceptually separated from sexuality in order to allow for more complex understandings. These understandings would allow for the very different principles of consent to be satisfactorily unpicked. Legal issues are also very different: for example, in the case of minor attracted persons (MAPS) who present commonly with very difficult challenges for practitioners where borderline illegal behaviour is involved.
- The respective research and evidence bases are addressing different issues.
- For political and social context reasons, gender has overshadowed sexuality in the 2019 Guidelines despite the demographics of numbers presenting in a clinical and counselling context and the differing expertise required of practitioners
- BDSM and Kink should not receive consideration when other more prevalent clinical problems of sexuality and lifestyle such as MAPS require attention. This should not have been inserted via an inane caveat “these Guidelines do not, however, relate to anything non-consensual”. As indicated above, consent in sexual relationships is a complex matter, not a binary “consents vs does not consent”. When clients present in a clinical setting it is highly likely that consent will be one concern in the distress or in the perpetration of abusive behaviour. A quick inspection of “Consent” on forums for BDSM/Kink indicates a much more nuanced and sophisticated understanding than the throwaway approach of the 2019 Guidelines.
Has the BPS reflected upon better process and outcome for reviewing the guidelines?
My forthcoming critical review of the 2019 GSRD Guidelines leads me to suggest
- Appointment of a Chair who is not an activist or campaigner, who can allow debate about conflicting views, and where consensus cannot be achieved can allow the conflict and current uncertainty to be ethically and helpfully represented in the text to help others navigate the difficult cultural climate. The need for a less aligned chair than the chair of the 2019 Guidelines can be seen from problematic statements made in a public academic forum on outcomes of body altering surgery: “sometimes people think there is a debate about that and hopefully I have included enough references for you to think that debate is shut. There is not a debate about this anymore” https://www.youtube.com/watch?v=usyYi3Cevdo (@40mins 27 secs in). In an interview about a specialist post, she stated : ”The details of Gender Diversity can be learned, but an open and inquiring mind cannot. Bigots and exploitative theoreticians need not apply! Clever, open people who are interested in clinical practice, research, truly multidisciplinary working, and developing this emerging field are most welcome.”
- Appointment of members with differing views including from amongst those psychologists with experience and expertise who felt they had to leave their work in services committed to “affirmation only approach” (See Cass Interim report 4.17, 4.20).
- A more lengthy, detailed and critically reflective tone and content, akin to that of the BPS Autism Guidelines (https://www.bps.org.uk/psychologist/working-autism ). In the less than 11 full pages that comprise the body of text of the 2019 GSRD Guidelines, the phrase “Psychologists should” appears 15 times in the 27 headings and an additional 42 times beneath the headings! This is self-evidently not advisory.
- Full discussion and critique of the current evidence and research base and inclusion of methodological problems and criticisms which can allow for readers’ insight into the current situation. This cannot wait for the longer-term findings that may come from the Cass research programme. It is needed now by those tasked to provide services.
- Balanced consultation with users and user groups representing differing perspectives, not, as previously, just Stonewall and LGBT Foundation. Consultation should also be made with “de-transitioners”.
- Sufficient time allowed for well-publicised member consultation, engagement and subsequent amendments.
- All task force members should be expected to either sign off the final revision or be recorded as dissenters with “minority report”. This would indicate a move away from what is perceived as an intimidatory climate where differing views are not permitted (see Cass).
I hope you will be able to answer my questions, inform members of the current situation and produce a very much more helpful set of guidelines for the psychological work within the field of gender questioning.
To quote Cass directly:
“4.19 Speaking to professionals outside GIDS, we have heard widespread concern about the lack of guidance and evidence on how to manage this group of young people.
4.20. Some secondary care providers told us that their training and professional standards dictate that when working with a child or young person they should be taking a mental health approach to formulating a differential diagnosis of the child or young person’s problems. However, they are afraid of the consequences of doing so in relation to gender distress because of the pressure to take a purely affirmative approach. Some clinicians feel that they are not supported by their professional body on this matter.”
This is most definitely applies to members of the British Psychological Society. It will, if not addressed, continue to deplete the pool of psychologists prepared to use their expertise to work with and help gender questioning children and adults.
Reply from BPS
Regarding: BPS 2019 GSRD Letter (August 16th 2022)
3rd November 2022
Dear Pat
Thank you for your letter, we welcome the views of our members. The guidelines are designed to support and enable psychologists to work with people of diverse genders, sexualities and relationships (e.g. lesbian, gay, bisexual and transgender people) in a way that is respectful, inclusive and upholds psychologists’ duties under the Equality Act (2010).
Below is a response to your questions regarding the Guidelines for Psychologists working with Gender, Sexuality and Relationship Diversity.
Are the GSRD Guidelines being reviewed?
Yes, the 2019 GSRD Guidelines are being reviewed. All guidance documents are routinely subject to a review at regular intervals to ensure they remain appropriate given the possibility of changing contexts, legislation and evolving evidence. They may also be reviewed at any point in the case of a major change in legislation, evidence or context. As this is a scheduled interim review of the document, the original authors are leading the review process. The Practice Board will ensure the document is externally peer reviewed before publication.
Will the supposed review result in guidelines for children and young people?
This will be considered by the review group and peer reviewers as part of the review process. The review group will take into account the recent NHS review of The Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Trust in London and the public consultation on a new service delivery model.
The Practice Board will consider any recommendations from the review regarding additional evidence-based guidance for children and young people.
Should revised Guidelines separate Gender from Sexuality and Relationship Diversity?
This will be considered by the review group and peer reviewers as part of the review.
Has the BPS reflected upon better process and outcome for reviewing the guidelines?
We continually reflect on our guidance writing and consultation processes and welcome feedback from members and the public. We conduct all of our work in a context of continuous improvement and in that spirit we are grateful for your comments.
Yours sincerely,
Diversity and Inclusion Team
British Psychological Society
BPSWatch 