The BPS : failed and still failing – and failed again.

You may have read our open letter [see here] to Professor Tony Lavender, Chair of the Practice Board of the British Psychological Society. We have had a number of responses to the letter supporting our view. This week (2 September) we received this response from Professor Lavender. Below it is our reply (sent today 3 September).

Dear Pat, Peter, and David

I am writing in response to your recent open letter, ‘The BPS and Gender: Failed and still failing.’

I understand that over recent years, you have raised these issues on many occasions and have received numerous in-depth answers which explain the BPS position, and which fully respond to your concerns. This has included responding to complaints, open letters, and concerns about specific members raised under our member code of conduct. The BPS has taken your concerns seriously and has addressed them with a considerable amount of care and attention as well as significant organisational resources. Because of this, it seems unnecessary to repeat information which has been communicated to you on multiple occasions previously, much of which is also publicly available.

Our Guidelines for psychologists working with gender, sexuality and relationship diversity are broad guidelines which set out general principles for psychologists and those working in associated fields. The guidelines clearly state they are not for the specific clinical treatment or assessment of gender dysphoria or incongruence. The society has stressed on multiple occasions that the guidelines do not relate to children and young people under the age of eighteen. So, while we note your concerns in the context of the Cass Review, we cannot agree that it is valid to project them onto guidance which is designed for adults. However, we do agree that there is a need for increased clinical guidance for professionals working with children and young people in the complex area of gender dysphoria. We have already indicated to NHS England our strong desire to join a consortium of relevant professional bodies to identify gaps in professional training and develop training materials to upskill the workforce. You will also know that the BPS recently created a Children and Young People and Gender task and finish group to look at the critical issues relating to children and young people and gender. This work is currently underway. 

In relation to the Cass Review, we cannot accept your view that the BPS is somehow ‘anti-Cass.’ Our response, as stated by Dr Roman Raczka, to the final report of the Cass Review commended Dr Cass for her ‘thorough and sensitive review into an area that is highly complex and controversial to many.’ He went on to state that, ‘Dr Cass and her team have produced a thought-provoking, detailed, and wide-ranging list of recommendations, which will have implications for all professionals working with gender-questioning children and young people. It will take time to carefully review and respond to the whole report, but I am sure that psychology, as a profession, will reflect and learn lessons from the review, its findings, and recommendations.’ This analysis of the final report and the resulting implication for psychology is currently underway. To support the cross-organisational group of members collaborating on our response, we reached out to the wider BPS membership to submit their evidence-based contributions. It does not appear that you took the opportunity to input into this important work. 

I note your concerns that any perception that the BPS had adopted an ‘anti-Cass’ position could endanger the organisation’s important relationship with NHS England. I am pleased to be able to reassure you that the BPS continue to have a positive relationship with NHS England. NHS England did recently approach the BPS to provide a statement relating to theirannouncement on the expansion of services for children and young people. On this occasion we politely declined as our consultation work with members was ongoing. NHSE readily understood and referred to our initial response to the final Cass report as “supportive.” 

The BPS recognises that the society may adopt policy positions that some of our members disagree with, but these policy positions are arrived at by assessing the evidence base, accessing the relevant expertise of our members as well as providing opportunities for our wider membership to feed their evidenced-based reflections through our consultation processes. While the BPS acknowledges that you remain dissatisfied with the society’s views on gender, with a membership of more than 65,000 passionate people, it is not expected that all our members will hold a single, unified view on any issue. Diversity of thought and opinion is a welcome hallmark and an inherent strength of both our profession and of our organisation.

Kind Regards

Tony Lavender.

This is our reply:

3 September 2024

Dear Tony

Thank you for your response of 2 September to our open letter of 14 August.

We find it difficult to believe that you wrote this reply although you have signed off on it. Accordingly, what follows is not directed at you personally.

Does no-one at the BPS recognise the very serious reputational mess that the BPS finds itself in on this matter? Apparently not. The tone of the response is arrogant, defensive and patronising to senior long-term members who have spent many hours over the years contributing to the Society, latterly to attempt to orient it to a better and more responsive and responsible course. The response is so inappropriate and, in a number of ways dishonest, that it requires point-by-point dissection and this follows below in the order offered by your response.

Your opening paragraph states:

I understand that over recent years, you have raised these issues on many occasions and have received numerous in-depth answers which explain the BPS position, and which fully respond to your concerns. This has included responding to complaints, open letters, and concerns about specific members raised under our member code of conduct. The BPS has taken your concerns seriously and has addressed them with a considerable amount of care and attention as well as significant organisational resources. Because of this, it seems unnecessary to repeat information which has been communicated to you on multiple occasions previously, much of which is also publicly available.

You imply that the BPS has been more than helpful, bending over backwards providing us with plentiful information in an open and transparent manner. That does not square with our experience. Only recently there was the example of the highly irresponsible actions of the editor of The Psychologist (supported by the Chair of the Editorial Board) in posting and retaining a link online to the Singapore-based Gender GP, a supplier of puberty blockers, despite being shown specific warnings from the NHS and the clear position taken by Cass concerning puberty blockers. That link remained online for several months after the representations had been made and rebuffed, and it was only taken down – without acknowledgement to us – after a judge had issues a warning about Gender GP in the High Court. We made a formal complaint about the rude and inappropriate response made by the two men. This was rejected out of hand. No acknowledgement, no reflection, no learning, no apology. The Chair of the Sexualities Section has repeatedly criticised Cass and insulted psychologists he deems supporters of Cass/Gender Critical and has cast disparaging and unprofessional aspersions on social media on LinkedIn. The BPS argued that it should be dealt with by the HCPC and their decision was that this did not reach their threshold for investigation as a fitness to practice issue. On then requesting that the BPS formally investigate (under the BPS’s own Member Conduct Rules and Social Media Guidelines) it refused to act (or may have done but the Complaints Process does not allow complainants any meaningful feedback). Issues of confidentiality regarding complaints aside, some years ago there was an undertaking to publish anonymised data about the types of complaints that were being received, investigated and their outcomes. This appears not to have been done, and it is our view that beyond fitness to practice responsibilities taken by the HCPC there are member Conduct Rules, Code of Ethics and Conduct, Social Media Guidelines and rules for members undertaking official duties for the BPS which should be in force but about which there is no feedback given in terms of application. The BPS is not a learning organisation in itself or for its members.

Your comment about information being publicly available mystifies us. One of our enduring complaints is the lack of information for members. It is our group, as well as others on social media, who have been the source of much information that should have come from the BPS.

It is galling and insulting to be admonished in the second paragraph with 

“The guidelines clearly state they are not for the specific clinical treatment or assessment of gender dysphoria or incongruence. The society has stressed on multiple occasions that the guidelines do not relate to children and young people under the age of eighteen. So, while we note your concerns in the context of the Cass Review, we cannot agree that it is valid to project them onto guidance which is designed for adults”.

We need to remind you that it was as a result of a lengthy complaint by one of us (which required considerable persistence) that it was finally made clear two years after publication of the 2019 Guidelines that the Guidelines were for adults/over 18s. On 9 April 2021 the Director of Membership and Professional Development wrote to confirm to us that

“…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 rot adults. We will implement this urgently.”

The belatedly “adults only” badging would not have happened had it not been for this hard-fought complaint and the rebadging did not remove ambiguities in the content of the guidelines that had implications for a philosophy of practice for young people. 

The concerns of the Cass Review on children’s gender services subsequently raised wide ranging issues of 

• service philosophy; 
• exploratory versus affirmative psychological practice;
• diagnostic overshadowing;
• the needs of detransitioners.

All of these critical matters are largely downplayed, disregarded or ignored in the revised 2024 adult guidelines. You cannot surely think that at age 18, the radical paradigm shifts proposed by Cass suddenly do not apply? 

The 2024 edition of the Guidelines is a document entirely discontinuous with, and dislocated from, the services which will be developed from Cass, and you actually confirm that with your ridiculous phrase “…we cannot agree that it is valid to project them onto guidance which is designed for adults“. Please do not think it is remotely permissible to bandy the word “project” about in this fashion with clinical psychologists and please endeavour to reflect how utterly patronising and inept these two paragraphs are.

Regarding your third paragraph – is the BPS anti-Cass? The balance of evidence so far is certainly that it has not been interested in, or has been defensive about, the highly relevant recent history of disquiet about the psychologist-led GIDS service that finally led to the Cass Review. This can be evidenced in detail by scrutinising what the BPS has said and done on its website and in The Psychologist, latterly and most blatantly in relation to the revision of the adult Guidelines which we emphatically argue above should show some continuity and consonance with the Cass paradigm shift. The Guidelines patently do not. We would direct you to the following: https://www.bps.org.uk/news/bps-response-new-nhs-england-regional-model-gender-identity-services-children-and-young-people.This is an alarming response following proposals from Cass that GIDS should close. It focussed away from the service philosophy and inadequate psychological practice issues then emerging, and on to waiting time problems. It placed its concern with the current GIDS psychologists rather than showing any curiosity that possibly damaging practices might have been going on there in psychology-led services for children and young people: 

We are aware that some BPS members will work across the Tavistock Clinic and that this news might be unsettling and upsetting for them. We would encourage any members who are affected by this to seek support from their Union or by contacting the BPS where we will work, as their professional body, to support them accordingly.

A response (https://www.bps.org.uk/psychologist/time-honest-reflection-not-defence) from senior members/practitioners to this BPS reaction stated :

These constitute serious criticisms of a flagship psychology-led service, resulting in its closure to protect patient safety. In this context, the statement issued by the BPS is profoundly inadequate. It offers no acknowledgement of the severity and range of these problems, or of the harm done to some children and young people. There is no reflection on mistakes made or lessons to be learnt. Defence, not reflection, has been a theme throughout the story of GIDS. Many clinicians, parents and patients have raised repeated concerns about the practice model. Ex-patients have discussed feeling rushed into body-altering interventions which some have come to regret. Criticism has grown louder recently, following a 2018 internal report, a judicial review in 2020, damages awarded to the Trust safeguarding lead and an ‘inadequate’ CQC report in 2021, plus increasing media coverage. Concerns that GIDS was operating outside usual clinical practice were first raised, however, in 2004. Critics have consistently been labelled bigots or transphobes and ostracised.

Key people at the BPS remain openly hostile to Cass. The Chair of the Sexualities Section has stated publicly that he will be part of a group criticising her Review and its evidence base. The BPS appointed two new members to the working group for the revised Guidelines who were implacably trans-activist and anti-Cass. They are employed in private service provision, Gender Plus, who will get their clientele (including some children) from those who wish to by-pass service strictures in the new NHS provisions. The BPS as a body have been constipated in producing any fully worked out response to Cass. Roman’s response is far from that – it is just a place holder. This is a marked deficit in timeliness and enthusiasm, critical or otherwise, given that psychologists have such a central role to play – no signs of BPS reflection or audit of what went wrong. What has he or anyone else done to action his comment ‘I am sure that psychology, as a profession, will reflect and learn lessons from the review, its findings, and recommendations.’  Not happening and no proposals to make it happen. This response demonstrates that very clearly.

You refer to our failure to contribute to the project identifying the implications of the Cass Review for psychology (https://www.bps.org.uk/news/members-encouraged-contribute-cass-review-project ). Have you considered how that was phrased by the BPS Comms Team? Fill in an online form and “Members are reminded that contributions should be evidence-based”. So, individual members are supposed only to send in opinions which are evidence-based. When part of the problem in previous services was poor evidence, when Cass has extensively, and over a long period reviewed evidence, what is an individual psychologist going to do to produce a contribution which is evidence-based?  This was going to discourage more people than just ourselves from thinking there was much point. Maybe, given our experiences, that was deliberate.

In noting in our letter to you that adult gender services were now also to be reviewed, we have stressed above the discontinuity of paradigm between remodelled children’s services and the stale narrow re-statement in 2024 of a BPS position that had been extant from 5 years before in the 2019 Guidelines. Can you believe that these guidelines will say anything whatsoever in terms of their content to impress policy makers that the BPS can assist them? The BPS is stuck in its activist capture demonstrated with evidence in our letter.  The appointment of Moon and Zitz to a team led by Richards was doubling down on existing massive bias in the ideology of the authors. Your last paragraph 

The BPS recognises that the society may adopt policy positions that some of our members disagree with, but these policy positions are arrived at by assessing the evidence base, accessing the relevant expertise of our members as well as providing opportunities for our wider membership to feed their evidenced-based reflections through our consultation processes. While the BPS acknowledges that you remain dissatisfied with the society’s views on gender, with a membership of more than 65,000 passionate people, it is not expected that all our members will hold a single, unified view on any issue. Diversity of thought and opinion is a welcome hallmark and an inherent strength of both our profession and of our organisation.

is patently ridiculous and insults our intelligence. Everything in this last paragraph is untrue. To use common parlance, the whole reply is gaslighting. How could a small writing group of six who shared clear common affiliations with trans activism such as WPATH and BAGIS and working for Gender Plus represent a breadth of viewpoint? Why choose an additional psychologist such as one still aligned with GIDS instead of someone from the thirty-five experienced psychologists who had left that regime? Why had two of the previous authors taken the decisive decision to have their names removed from the 2019 document? Despite seismic shifts in the context of gender services between 2019 and 2024, the BPS made decisions which showed no reflection of that and reinforced its capture by trans activists, a narrowing of dogmatic prescription rather than more nuanced, diverse and inclusive perspectives. It is beyond irony that you trumpet diversity of thought and opinion in your defence of an entirely exclusive and inflexibly rigid document. The Society has dug a deep hole for itself, and it keeps on digging. Your Comms-Speak response confirms this: “65000 passionate members” is taking that rhetoric to its silly apogee.

Withdraw the guidelines now. 

Yours sincerely,

Pat Harvey, David Pilgrim, Peter Harvey,

BPS members, Clinical Psychologists.

BPSWatch.com, @psychsocwatchuk