The BPS and Gender: Failed and Still Failing

The following open letter was sent on Wednesday 14 August 2024.

Professor Tony Lavender, Chair of the Practice Board of The British Psychological Society

Dear Tony.

We write this open letter to you as Chair of the Practice Board, under whose scrutiny and authority the updated Guidelines for Psychologists Working with Gender, Sexuality and Relationship Diversity were released in June 2024 (https://explore.bps.org.uk/content/report-guideline/bpsrep.2024.rep129b). You and your Board members, as well as the President (copied in), bear a collective responsibility for the claims we make about the gross inadequacies of the document that we elaborate below. One of us (Pat Harvey) was involved in direct discussions with you and the then President-Elect prior to that document’s publication. You were made fully aware of serious concerns about the positioning of the British Psychological Society on the controversial matter of gender prior to release  by senior clinical psychologists, some with extensive experience in this area of work.

In the light of those continuing concerns, and in the context of recent relevant events, we are appalled by what you have now ratified as the official and definitive BPS position on Gender. We believe that the content of the document and the gross ideological bias of the authors will bring the BPS into further disrepute. Moreover,  it will isolate the Society from the wider community of professional bodies and their practitioners, who are now engaging in an active debate about gender services, led by the NHSE.

The letter by Dr Hilary Cass written in May 2024, but released on 7 August, sets out a catalogue of serious failings in the adult Gender Identity Services in which psychologists have been centrally involved (https://www.england.nhs.uk/wp-content/uploads/2024/08/PRN01451-letter-from-dr-cass-to-john-stewart-james-palmer-may-2024.pdf). The following from Cass will suffice to illustrate:

Clinicians who spoke to me felt that, in common with the population that is presenting to children and young people’s services, the majority of patient presentations were extremely complex, with a mix of trauma, abuse, mental health diagnoses, past forensic history, ASD and ADHD, and therefore this limited assessment was inadequate. These other clinical issues were not addressed or taken into account in decisions to prescribe masculinising or feminising hormones.

The revised BPS Guidelines downplay any notion of the common presence of  serious  mental health problems in gender confused individuals, be they adults or children.  Instead, they encourage an essentialist view of gender identity as a coherent psychological phenomenon. This ‘stick of rock’ approach to personal identity reifies transgender patients as if they are all psychologically identical, which is crass and implausible (an approach called ‘diagnostic overshadowing’). The latter then deflects needed clinical attention from the very diverse biographical contexts of gender confused presentations. As a result, common and variegated mental health problems, along with disavowed same sex attraction often underlying the gender confusion are ignored. Indeed, the gender ideology that permeates the Guidelines actively assumes that, in the main, the only distress that transgender patients experience is socially created by minority stress. 

The empirical evidence does not support this thesis. Transgender presentations often arise from biographical contexts of trauma and are attended by a range of anxiety and depressive symptoms, with some patients having marked autistic tendencies. In the case of children, the homophobia of parents is at times relevant. In some adult cases, the presentation reflects extended fetishism (‘autogynephilia’) or masochistic castration fantasies (see later). Contrast our points here about complexity with the reductionist certainty of the Guidelines: 

“…marginalisation due to a GSRD identity or practice. This marginalisation can cause distress leading to mental health problems…” .

This emphasis in the Introduction (Page 4) continues throughout the brief document, locating and thereby reducing the diverse psychological distress presenting to practitioners: 

“…It is the marginalisation and repression that causes the difficulties, rather than the identities and practices themselves”.

Whilst, paradoxically, the BPS promotes the notion that working with gender identity requires highly specialised practitioners, diverse gender identities are normalised

…”diverse gender identities are a normal part of human diversity…”

and non-problematic

“…Any exploration of a client’s identity or practice will be on the understanding that GSRD identities and practices are as legitimate an outcome as any other…”.

This is patently untrue and irresponsible: it is an ideological assertion not a conclusion derived from a balanced consideration of psychological complexity in open systems. The “understanding” that is here being required of a practitioner is a judgemental ideological position. If adopted by the practitioner in each and every case it may actively encourage clients to enter a biomedical pathway of hormones and surgeries which involve serious iatrogenic risks. 

The Guidelines promote the unwise adherence to an approach that culminates in distressed detransitioners and those who come to regret the biomedical approach encouraged by practitioners in the past. Detransitioners report that they were insufficiently assessed or challenged by clinicians and encouraged instead to believe that a trans identity will be a legitimate and beneficial outcome. 

As Cass noted in her review, there is no evidence that ‘gender medicine’ is either safe or that it achieves its claimed goals of psychological wellbeing. Accordingly, two major medical ethics criteria are breached : first, ensure beneficence and second, ensure that no harm is done to patients (non-maleficence).  Your support of these Guidelines makes the BPS explicitly culpable in supporting an unethical approach to clinical care.

Dr Cass’s letter (note, about adult services in this case)  contains the following: 

“Adverse outcomes • Clinicians informed me that suicides of patients on treatment were not formally discussed in Morbidity and Mortality meetings, with no clear strategy for determining whether there were lessons to be learnt for future cases. • I heard that detransitioners tended to move between clinics, often not returning to their clinic of origin, and there was no system for informing the originating clinic about them. In one clinic regret was treated as a new episode of dysphoria.”

The Cass Final Report (https://cass.independent-review.uk/home/publications/final-report/) has a section on Detransition and makes recommendation (No. 25) about service provision, which is to be followed by NHS England. The authors of the revised Guidelines and the BPS Practice Board should have been well aware of the publicity over the past few years regarding transition regret. The Cass report with the section on “Detransition” was released in April 2024. The BPS Guidelines, released in June 2024, nowhere contain the words, “detransition”, “detransitioners,” or “regret”.

It is our contention that these Guidelines, ratified by the Board which you chair, represent an active barrier to much needed change in philosophy and practice for psychologists working in re-formed Gender Services in the immediate future. Ironically the release of the Guidelines was accompanied by this, in effect, pseudo acknowledgement of the challenging situation since the previous heavily criticised Guidelines had been written 2019: Debra Malpass, BPS director of knowledge and insight [sic] said: 

“We appreciate this is a sensitive, complex and sometimes controversial area. The BPS has worked to produce guidelines that are balanced, accurate and based on principles that derived from both the literature and best practice agreement of experts in the field.” ( https://www.bps.org.uk/news/updated-guidelines-psychologists-working-gender-sexuality-and-relationship-diversity-published)

You informed us that this was to be a revision rather than a rewrite. This was clearly a strategic mistake given the seismic conflicts in the field of gender services that had unfolded since 2019.  In the context of these high profile controversies about children, including a Judicial Review which addressed consent, one of us made a formal complaint which saw the BPS add a retrospective note that the Guidelines had only been intended to apply to over 18s. This had not been evident to practitioners in the first two years after publication!

Owing to its revision status, you told us that the same authors had to be used. Again, given the dramatic changes in the wider context since the 2019 publication, this was clearly a mistake. Furthermore, of the original six authors, two had demanded that their names be removed post-publication. We can reasonably suppose that those dissenters  were unhappy to be associated with the document and that they had not signed off on its final form. This would indicate clear maladministration by those in the BPS responsible for ensuring due process. When the 2024 revision came out, it was evident that two new individuals had been added to the working group to bring the number back up to six. As ever with the British Psychological Society, the process for making those appointments was entirely opaque. The new appointees galvanised and amplified an already rigid and biased approach in the previous Guidelines. In order to understand the wider context of our criticism, some background is needed to explain their personal ideological alliances. The particular and named transgender activists who wrote these Guidelines endorse the wider position of international activist organisations. Indeed, some such as the Chair, Christina Richards, were actively involved in writing those international guidelines for the World Professional Association for Transgender Health (WPATH). As psychologists they are narrowly committed to Queer Theory/radical social constructivism. This position is only one of many espoused by BPS members in their theory and practice and hence the author group is clearly unrepresentative. Here we list the organisations and ideology in which the activist authors of the Guidelines are embedded:

WPATH.  Key to the global controversy regarding gender is the organisation World Professional Association for Transgender Health who produce “Standards of Care”, now on their eighth version (Soc 8). In the last year WPATH has been riven by scandal concerning its suppression of evidence, leaks of its revelatory internal discussions of its pursuit of specific agendas and by its introduction of the sinister Eunuch Gender (see https://environmentalprogress.org/big-news/wpath-files and https://www.theguardian.com/commentisfree/2024/mar/09/disturbing-leaks-from-us-gender-group-wpath-ring-alarm-bells-in-nhs). Despite this, the response of a BPS staffer to a critical comment made on the draft of 2024 was this:

These guidelines align with scientific literature and this is listed in the references section. For example, the largest ever meta analysis undertaken by the World Professional Association for Transgender Health. 

While the Department of Health said NHS England ‘moved away from WPATH guidelines more than five years ago’ the WPATH Soc8 is given as a key reference in the 2024 document by the BPS.

BAGIS. The British Association of Gender Identity Specialists is the UK home for many trans ideologue practitioners who are often also members of WPATH. Prominent members include practitioners at the existing 6 adult clinics which withheld information about outcomes from the Cass Review, notably Walter Bouman, who has heavily criticised Dr Hilary Cass, questioning her expertise and commenting in that context that there is “…a fine line between naivety, narcissism and psychopathy…”.

Both WPATH and BAGIS have members who strongly espouse variants of Queer Theory (QT) which seeks to support, via discourse analysis, any rejection of what is seen as ‘normal’ sexual conduct and gender expression. This is explicitly on the basis of’ liberation’ and ‘individual authenticity’. At times this libertarianism extends to an ‘anything goes’ stance. The latter legitimises lowering or eliminating the age of consent for sexual activity, castration, bestiality, ‘age-play’ and other fetishes or paraphilias. The latter context means that transgender activists reject the common fetishistic underpinning of autogynephilia in male to female transexuals. Moreover, as well as this extreme relativism, Queer Theory by dint of its radical social constructivism, is anti-realist and so it dismisses a biopsychosocial consideration of material reality (both biological and social), to which most clinical psychologists are committed. 

The BPS has demonstrated an extreme reluctance to acknowledge the need for psychological debate about all of these contentious matters, and has, instead, simply bowed to activist demands and preferences. This has meant that child safeguarding has been eschewed and instead the normalisation of gender education has ignored it as a version of grooming. Neither social contagion nor the role of the internet have been discussed. None of these troublesome issues that practitioners may regularly encounter in services is addressed in the Guidelines or allowed to be explored in The Psychologist. Even more basic discussions about the likely diverse aetiologies of trans identification of such different groups as teenage girls and middle-aged men are suppressed.

PRIVATE CLINICS, GENDER PLUS. These have emerged as privatised alternatives to proper holistic mental health care for children in the NHS. They circumvent objections to the drive that has come from activists to affirm and encourage paediatric transition. This is far more than avoiding waiting lists but is about an ideology of their service philosophy. Since GIDS was shut down and puberty blockers banned in the NHS these private arrangements have taken on a particular political salience. When these private clinics generate iatrogenic harm in some patients (as they will), it will be the NHS that will have to deal with the consequences. This picture is already apparent in relation to those seeking detransition after a biomedical regime has significantly affected their health . Likewise, the diagnostic overshadowing of these clinics means that they do not consider the wider mental health needs of their clients on a long-term basis. Nor do they provide an environment in which long term follow up data can or will be collected to address the deficits in research and evidence base. Gender Plus is a recent arrival on the scene. Its ethos and attitude can be quickly understood from this article from its director, Aiden Kelly, a clinical psychologist, reminding us that as with the GIDS debacle, services are still being led by psychologists: https://www.theguardian.com/commentisfree/article/2024/jul/19/transgender-children-ban-puberty-blockers-wes-streeting?CMP=Share_iOSApp_Other  . This article was reposted – with evident approval – by Dr Rob Agnew, Chair of BPS Section on Gender, Sexuality and Relationship Diversity https://www.linkedin.com/feed/update/urn:li:activity:7220099032344375298/ another vociferous trans activist in a key BPS position.

Given the context of all the above, the constitution of the named author group for the new Guidelines, starting with the retained Chair, warrants particular critical scrutiny viz:

Professor Christina Richards (chair) (2019, 2024) is a transwoman reported to have an intimidating and domineering style by previous insider observers. Richards lost two disaffected authors post-publication of the 2019 Guidelines. The 2024 revision may be seen to have lost some of Richards’  previous directive and declamatory style “…psychologists should…”. In the 2019 publication, in a mere eleven full pages that comprise the body of text, that phrase was used fifteen times out of twenty-seven headings and an additional forty-two times beneath the headings. In the new version, the infamous ‘Slut’ reference is amended and ‘Kink’ is omitted from  favoured BDSM allusions but the 2024 version is still, in essence, the same deplorable document.  Richards has twice been an inappropriate choice of Chair for the previous Guidelines being a proponent of Queer Theory, a self-styled expert author on BDSM and Kink, ‘furries’ and ‘age-play’. Richards is a WPATH chapter author and a BAGIS council member (https://bagis.co.uk/council/christina-richards/). Richards’ credibility as a psychologist with respect for research and open-mindedness was profoundly undermined with a presentation at Lincoln University in which Richards claimed forcefully in relation to outcomes of trans surgery that the debate “…is shut: there is not a debate about this anymore…” (see https://youtube.com/clip/UgkxRGiT6y5ouSa6T9Nes0om-J6HWo7otLDx?si=oIRaEuIZ2ER659rw). Further evidence of an unprofessional biased attitude can be taken from a quote from Richards regarding a specialist gender job advertisement in The Psychologist – “The details of Gender Diversity can be learned, but an open and inquiring mind cannot. Bigots and exploitative theoreticians need not apply!” .(https://www.bps.org.uk/psychologist/featured-job-highly-specialist-clinical-or-counselling-psychologist). The contempt that Richards holds for both routine empirical science, academic freedom (no debate should surely ever be ‘shut’) and alternative theorisations about gender in psychology other than Queer Theory are very evident.

The other authors are:

Martin Milton  (2019, 2024) was Professor of Counselling Psychology at Regents University, and is a consistent defender of transgender demands in the field of psychological therapy.

Penny Lenihan (2019, 2024) was Richards’ supervisor and is a member of WPATH. Lenihan’s website confirms being a ‘BPS and HM Government Registered Gender Diversity Specialist”. The notion of being a ‘specialist’ in this contested clinical domain is taken for granted without explanation or justification. 

Stuart Gibson (2019, 2024). Nothing of note publicly in relation to transgender activism. His main background is in relation to psychological aspects of HIV and AIDS, and this reflects a legitimate input to the guidance about gay men. As a representative of the LGB rather than LGBTQ+ community he is somewhat of an outlier, but nevertheless he presumably supported and signed off the document we criticise.

The following were newly appointed for the 2024 Guidelines:

Claudia Zitz (2024) BAGIS member, Queer Theory, Gender Plus. Worked at the now discredited GIDS and along with some others in that group is attempting to replicate that pre-Cass clinical model.

Igi Moon (2024) WPATH member, Queer Theory proponent, Gender Plus team member. Moon has been the vocal leader of the MOU on ‘conversion therapy’ campaign and used the BPS administrative system and resources to advance its aims.

Considering how unfit for purpose the 2019 Guidelines produced by the first four authors above were, it was inconceivable that a fresh approach or greater balance would be applied to the Guidelines revision by adding to the reduced group the trans activist hard-liners Zitz and  Moon.  The 2024 Guidelines form a policy ostensibly for the use of, and compliance with, the whole membership. Its authorship as represented above clearly renders the following statement accompanying publication absurd:

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.

The expansionist ambitions of this statement beggars belief in a post-Cass context.

The BPS has embarrassed itself and undermined its public standing by issuing this flawed and highly biased set of Guidelines and demonstrated that as a professional body it is unfit for purpose. The BPS has now further isolated itself from a rapidly moving context of debate and changing practice by adhering to an extremist pre-Cass set of policy expectations.  The Cass review now has the full confidence of the Secretary of State for Health as well as the Association of Clinical Psychologists, the Royal College of General Practitioners, the Royal College of Psychiatrists, the Academy of  Medical Royal Colleges and the British Pharmaceutical Society. In addition, the UKCP has withdrawn its support for the Memorandum of Understanding on Conversion Therapy.  Notably only the BMA, which has also been captured by transgender activists, is swimming alongside the BPS against this broader policy trend. 

Moreover, in that new context, the BPS refuses to encourage and allow the exploration of competing ideas about psychological practice in the area. It fails to reflect upon any lessons learned from the psychologist-led failed GIDS services. Adult NHS Gender Services are now in the spotlight as unfit for purpose. These 2024 Guidelines contain absolutely nothing of relevance to the changes that have to come. This is shameful.

The BPS publication, The Psychologist, has also demonstrated organisational capture. In recent years the editor has repeatedly censored contributions from dissenting voices. He commissioned a trans activist non-member to write (with active help from the staff) an ill-judged article which he published immediately after a Judicial Review. We know the details of this from an irritable exchange with the editor on the matter https://www.bps.org.uk/psychologist/blow-rights-transgender-children). This article, as they say, has aged very badly.  Worse, the editor, a person we have found peculiarly tetchy and thin skinned about any challenge, chose to leave a reference link for the infamous Singapore-based Gender GP online for several months despite protest and evidence of warnings from the NHS.  This was seriously irresponsible.  

We believe that you, the Practice Board and the BPS are failing the membership, practitioners and the public. Meanwhile the ACP-UK’s statement (below) is the one that has appeared on the official NHSE notice of future developments alongside those from Secretary of State Wes Streeting, Hilary Cass, the Chair of the Academy of Medical Royal Colleges and other key players centrally involved (https://www.england.nhs.uk/2024/08/nhs-to-roll-out-six-new-specialist-gender-centres-for-children-and-young-people/)

Professor Mike Wang, Chair of the Association of Clinical Psychologists, said: “The Association of Clinical Psychologists UK welcomes the publication of the Cass Review implementation plan. We have been involved in the development of the implementation plan at every level and we are pleased that NHS England and the Academy of Medical Royal Colleges is relying on senior clinical psychologists to deliver training and to lead the new service hubs. We continue to support the recommendations of the Cass Review and welcome NHS England’s vigorous implementation project”.

We are making the case to you that you and your colleagues, through neglect or active collusion with this ongoing capture, have ensured that the Society has no right to expect a seat at the table of future UK discussions on service delivery and on development of its evidence base. This is a task that psychology practitioners will have to pursue individually or via the ACP-UK or other more widely representative bodies. 

We request your immediate active attention and intervention and a withdrawal of the 2024 Guidelines.

Yours sincerely

Pat Harvey, David Pilgrim, Peter Harvey,

BPS members, Clinical Psychologists.

BPSWatch.com, @psychsocwatchuk

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