Is Affordable Counselling Cutting Psychotherapy’s Throat?

WinningCompetion-300x167Psychotherapy is a profession in crisis. If you work in the NHS, you will know this already. Despite Government commitments to do more, therapy posts have been cut and health care providers are paying less and using more volunteers. If you are in private practice you will be well aware how hard it is to make money, particularly if you are just starting out. More practitioners are competing for the finite number of clients who can afford £50 or more a week to spend on their psyche.

The financial situation of therapists was highlighted last week in the election campaign for the position of Chair of UKCP. Martin Pollecoff, who is positioning himself as the change candidate, pointed out that the profession is prone to hold the “wonderful 1970s idea that if you did the right thing then a higher power would take care of the money”1. Psychotherapy needs to sell itself, says Pollecoff, and he is pledging to make this a priority if UKCP members elect him as Chair.

It is welcome to see a senior psychotherapist be so honest about the problem and offer a solution. Unfortunately, our financial concerns as a profession usually get expressed in forum threads that bemoan the situation but offer few answers. A prime example of this was a discussion on CAPPPchat (www.cappp.co.uk), a forum for therapists in private practice in South West England. The spark was an advertisement from a low cost Bristol counseling service, Affordable Talk (www.affordable-talk.co.uk), recruiting therapists to work Friday evening and weekends at £15 an hour. The consensus was that this was “minimal wage for anti-social hours”:  too low to cover supervision; insufficient to attract therapists with the necessary training and experience; and, overall, reflective of a devaluing of the profession.

Presumably Affordable Talk thought they were offering an opportunity to Bristol therapists to work a few more hours to the benefit of less well off clients. Sex Therapy Bristol approached Affordable Talk for comment. They declined, stating that this was “not a debate/discussion that we wish to enter into”. Whatever Affordable Talk’s intention, the thread revealed that a lot of therapists in private practice are concerned about what they earn per hour and believe that services offering low cost therapy might undercut their private practices.

So does low cost counselling undercut more expensive private practice work? Providing concessions to less well off clients is a longstanding tradition in psychotherapy. But low cost services are something different. They sell themselves to a less well off demographic rather than offer a portion of their time pro bono. They can do so because therapists who work for them are ready to accept a lower hourly rate.

To identify why they would do that, we have to look at how prices are set in psychotherapy. Unlike other professions, our hourly rate is not set by results. Rather our price is determined by our qualifications, our experience and what we think we are worth. Some therapists who work for low cost counselling services may be doing so out of altruism, but others do so because their labour is judged by the market and themselves to have a lower value: they have a lower level of training and less experience. None of this means that they are not excellent therapists, but we are not a profession that determines price by clinical outcomes.

The service that so upset therapists on CAPPP chat, Affordable Talk, is the low cost affiliate of Talk in the Bay, a commercial counselling service based in Cardiff (www.talkinthebay.co.uk). Sessions at Talk in the Bay start at £45 compared to £25 at Affordable Talk. No business will undercut its own products unless it believes there is a different market that wants something cheaper. So the CAPPP chat commentators are both wrong and right: Affordable Talk is not a threat to private practitioners who charge £45 an hour. It is a cheaper product aimed at a market that can only bear £25 an hour.

However, in the terms by which psychotherapy sets price, it is likely to be delivering therapy using staff who are less qualified, less experienced and whose time is valued less by the market and by themselves. This conclusion is supported by the fact that the therapists listed on Talk in the Bay’s website are a different team. That does not mean that the low cost team is less able or effective. Outcomes in psychotherapy do not set price. However, the different teams will reflect differences in experience, training and individual expectation of earnings.

However, we should nonetheless be concerned about the extent to which the growth of such services as Affordable Talk reflects a wider devaluing of the profession. It is no coincidence that the proliferation of charities and other organisations offering affordable therapy has taken place in parallel to the huge increase in the training of therapists. It is important to understand that it is a symptom of a wider problem within the profession rather than a cause in itself.

Psychotherapy as a service profession has failed to understand market forces and use them to its advantage. We have preferred to let the money, as Martin Pollecoff reminds us, take care of itself. Unlike doctors, accountants and solicitors, our services are not required by everyone. There are only so many of the financially secure but worried well to go round. We face a zero sum game in which any expansion is at the expense of our peers. The only strategies to address this are either to increase the size of the market by promoting what we do, or putting up barriers to entry to restrict the numbers who train and qualify. Psychotherapy has done neither.

Not since the counter culture of 1960s and 70s has psychotherapy actively promoted itself as an activity that can be life enriching as well as problem solving. Instead, different approaches to therapy have sought to advance the interests of their specialism at the expense of others. This tendency has been exacerbated by the splits within the profession. The limited number of clients able to pay the fees of senior professionals has forced them to use teaching and supervision to supplement their income. Even greater benefits came to those who had the creativity and ego to establish their own approaches and become the established leaders in promoting, training and supervising new ways of working. What has developed is a de facto pyramid scheme where the rewards go to those who lead the profession as writers, teachers, supervisors and therapists. This has encouraged the creation of more courses that continue to churn out more therapists, most of whom will never make a decent living.

Government policy exacerbated this situation by attempting to make therapy a commodity that can be accessed by all. The profession has supported this development for reasons that included more jobs training more therapists. The result has been a further increase in the number of therapists, many of whom will be pushed into private practice as Government policy flipflops from investment in services to austerity cuts. Rather than ensure that trainings are restricted as a barrier to entry, psychotherapy has lowered those hurdles.

So what do you do with all the new practitioners that the therapy training industry produces? One answer has been to set up low cost counselling services that offer lower wage hours or volunteer placements to the host of underemployed trainees and graduates. Low cost counselling is a result of the problem of oversupply of therapists; a symptom rather than a cause.

If private practice psychotherapy wants to get more clients, it needs, as Martin Pollecoff, says, to sell itself. We cannot do anything about the number of practitioners now in the market, but we should be watchful of moves to expand the profession further. The priority for those of us in private practice and the professional organisations that represent us is to educate the public about the differences in what we offer.  Low cost counselling is a good thing, but it is not deep psychotherapy practiced by highly qualified professionals who have spent years studying and honing their skills.

Psychotherapy can be radical and transformative, not only personally but politically too. R.D. Laing was arguably the last British psychotherapist to successfully take that message and apply it publicly to society. In recent years those who lead the profession have been content to back the commoditised, quick fix approaches that have suited Government and to benefit from the proliferation of training courses. The benefits and value of long term, deep psychotherapy is what we need to sell to the public if we want to assure our economic future. Low cost counselling is not cutting the throat of psychotherapy. Rather it is the profession itself that is committing suicide by not paying attention to promoting its collective interests.

  1. https://www.linkedin.com/pulse/protecting-our-financial-future-martin-pollecoff?trk=hb_ntf_MEGAPHONE_ARTICLE_POST
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UKCP Suspension “Not Routine” says PSA

First Suspension of UK Accredited Register by PSA

The belief of the United Kingdom Council for Psychotherapy (UKCP) that it is the quality mark for high standards in psychotherapy has taken a battering this week. Far from being the acme for quality in the profession, its accreditation has been suspended by the Professional Standards Authority (PSA), the public body that answers to Parliament for standards across a range of therapeutic professions.  It took the keen eye of blogger Phil Dore at unsafespaces.com to alert the psychotherapy community to the suspension, the details of which have been available on the PSA’s website since 7 December 2015 following the decision of the PSA’s Accreditation Panel in November.

When news of the suspension broke online over the New Year holidays, UKCP members contacted the organisation with understandable concerns about what it might mean for their own training, accreditation and professional liability insurance. UKCP responded on 4 January with a statement that said it was “currently renewing the accreditation” of its register. This was an “annual process” and involved making “a small number of changes” to its complaints and conduct procedure. The “S” word was not mentioned. Everything, it appears, is business as usual.

Enquiries by sextherapybristol.net have confirmed that the suspension did result from UKCP’s annual review application. However, the PSA stated that UKCP’s suspension is “not routine” and added that this is the first time it has had to take the step of suspending a register’s accreditation. The decision is clearly extraordinary and UKCP has the dubious honour of being the first UK psychotherapy body since registration was introduced to have its accreditation suspended. The PSA would not comment on the statement issued by UKCP.

Rather than a matter of minor tweaks to the UKCP’s accreditation, the PSA’s concerns about the standards operating at UKCP were such that it was deemed not to meet two key standards in the PSA’s Standards for Accredited Registers:

  1. Standard 2: the organisation demonstrates that it is committed to protecting the public and promoting public confidence in the occupation it registers.

The PSA has not made public exactly how UKCP has fallen short. However, to meet this standard an organsiation need “to demonstrate that its purpose and directives are focused on public protection, that in carrying out its voluntary register functions public interest is paramount and that professional interests do not dominate or unintentionally subvert that interest”.

  1. Standard 5: the organisation demonstrates that it has the capacity to inspire confidence in its ability to manage the register effectively.

Factors the PSA will take into account in making a judgement on an organisation’s ability to meet this standard include its “leadership, its reputation within and outside its field, the skills and experience of those involved in its voluntary register functions, its operational efficiency and its openness”.

UKCP’s failure, for whatever reason, to meet these standards calls into qustion its fitness to perform its function. For UKCP to represent this as just a routine step in the annual accreditation process would appear to back-up some of the PSA’s concerns.

UKCP’s long-suffering members have been grumbling for years about various aspects of its management and functions. Concerns frequently expressed include:  the gradual collapse of members’ morale and readiness to volunteer their time; a decline in the activity of member committees; a thin schedule of professional conferences and training; and a website that has frequently crashed and lost member data. For those who have expressed such misgivings over the years, it will come as no surprise that UKCP is the first accredited register to be suspended by the PSA pending improvement.

The accredited register regime established in the UK has come in for plenty of criticism for lacking bite. However, the PSA has for the first time suspended the accreditation of a registering body because it is not fully fit for purpose. Over the last few days many UKCP members have reasonably asked why the suspension was not communicated to members. In response to questions from sextherapybristol.net , the PSA responded as follows:

“The decision not to require UKCP to announce suspension was made based on the evidence reviewed by the Accreditation Panel. The Panel did not consider the concerns identified to be an immediate risk to public protection which required registrants to stop using our quality mark immediately. In general, the decision to require an Accredited Register to announce an outcome such as suspension is made on case by case basis and proportionate to risk.”

The PSA added that it will clarify this in its Accreditation Guide in due course.

While the PSA’s concerns are evidently serious enough to warrant UKCP’s suspension, it is some reassurance that its shortcomings do not, in the PSA’s view, represent a risk to the public. However, UKCP members still remain in the dark about what exactly has led to the suspension. As the relatively new PSA cuts its teeth on UKCP, it might consider requiring that a suspended accredited register inform its members of where it needs to make improvements. That would certainly prevent UKCP presenting a matter as extraordinary as suspension as just a routine part of the annual accreditation carousel.

Posted in Professional Standards Authority, PSA, Regulation of UK Psychotherapy, UKCP, United Kingdom Council for Psychotherapy | Tagged , , , | 3 Comments

Is this Little Pink Pill the Female Viagra?

pinkpill

What would Frances Kelsey have made of the new libido pill for women, Addyi (generic name: flibanserin), recently approved by the US Food and Drug Administration (FDA)? Kelsey, who died last month aged 101, became one of the most respected women in US medicine for her role at the FDA in keeping the drug thalidomide off the American market1. Thanks largely to her, Congress passed the 1962 Kefauver-Harris Drug Amendment, requiring that all manufacturers provide “substantial evidence” of a drug’s safety prior to FDA approval. Kelsey was a scientist who followed the evidence, so she is unlikely to have been convinced by the lobbying campaign that argued that, despite Addyi’s modest performance in trials and worrying potential side effects, it should be approved because, while many treatments exist for male sexual dysfunction, no such treatment is currently available for women.

Addyi image 4Addyi may help some women who experience low desire. But claims that it will be the “female Viagra” are premature hype. For a start, Viagra and Addyi are very different. Flibanserin, to give Addyi its generic chemical name, is an anti-depressant similar to the SSRI (selective serotonin reuptake inhibitor) group that includes Prozac. It operates on neurotransmitters, chemicals released by nerve cells in the brain to send signals to other nerve cells. It is believed that what excites us is driven largely by the neurotransmitter dopamine (addictive drugs for example flood our brains with dopamine), while what brings us down is driven by serotonin, the neurotransmitter thought to be an active agent in depression. The balance between these chemicals in the brain seems to modulate normal sexual response. By increasing the former and reducing the latter, flibanserin should regulate how horny someone feels.

However, neuroscience still has a sketchy understanding of how this brain chemistry works, and flibanserin failed to have much effect when it was first tested as an anti-depressant and was turned down by the FDA. In contrast, Viagra-like drugs for men increase blood flow to the penis to establish and maintain an erection. They act through the better understood mechanics of the cardiovascular system (Viagra itself was a originally a heart disease treatment).

How effective flibanserin will be in helping women with low desire has also been questioned. One clinical trial found that women treated with Addyi experienced, on average, one ‘sexually satisfying event’ a month more than women given a placebo treatment. According to the FDA, between 8 and 13 percent of women who take the drug will see some improvement2. This is a pretty small number, particularly when that improvement might amounts to only one satisfying experience. So flibanserin is in no way a woman’s Viagra.

Equally worrying are the drug’s potential side effects, which include drowsiness, dizziness, fainting, and lowered blood pressure, all of which may be exacerbated if the drug is taken with alcohol, hormonal contraceptives, or any of the other medications many women rely on, such as anti-depressants. Dr. Adriane Fugh-Berman, director of the PharmedOut project at Georgetown University, has gone so far as to label Addyi “a mediocre aphrodisiac with scary side effects.”3

Then there is the issue of how much the drug costs. Viagra is taken on demand, making it fairly cheap, whereas Addyi must be taken daily, making it more expensive. Cash strapped public health services like the UK’s National Health Service, which already put sexual satisfaction low down the list of patient priorities, are less likely to adopt the drug, particularly given its lacklustre trials performance and apparent side effects.

For all the above reasons, Addyi is no Viagra. It works differently, is less effective, has more side effects and costs more. Moreover, it will not match Viagra as a means to rejuvenate sexual performance in later life; Addyi is for premenopausal women only. As it is taken each day to improve desire, rather than when sex is anticipated, Addyi is not going to be used recreationally like Viagra, taken by guys who suffer no dysfunction but just want to lengthen their performance. Some women also report that Viagra improves sex, although as the drug is not licensed for use by women research is limited on why this might be the case.

If Addyi is notable for one thing it is the lobbying campaign that was conducted to get FDA approval. Sprout Pharmaceuticals, who bought the rights to the drug after it failed its anti-depressant trials, hired a clever PR agency, Blue Engine Message & Media, to market the drug as a treatment for women with desire dysfunction. Blue Engine identified the lack of drugs for female sexual dysfunction as an FDA blind spot and set up an “independent” campaign organisation, Even the Score, that was successful in gaining backing from influential US women’s groups and sexual health bodies. The icing on the cake was to colour Addyi pink to complement the little blue pill that it so clearly is not. The irony of using such a gender stereotype to push a self-proclaimed “feminist” campaign seems to have escaped most commentators.

So once again we have a drug company pushing a treatment for commercial as much as scientific reasons, and critics have charged that this is a Big Pharma plot to medicalise female sexual problems. Of course, as most sex therapists are only too well aware from their clients’ experience, low desire, lack of arousal, weak erections or premature ejaculation can as easily be attributed to non-medical causes such as anxiety, relationship difficulties, depression and any of the other stuff that life throws at us and which unbalances our physical functioning. Talking treatments can often be as effective as medical interventions.

The sad truth is that Addyi’s marketeers are right in one important fact. Female sexual desire is under-researched and less understood than the mechanics of the male erection. But how men’s brain chemistry changes in arousal is as little understood as the process in women. Addyi might yet be found to work for some men who have low desire, and Viagra might well have some positive impact on female sexual experience.

The champagne corks may be popping among shareholders of Sprout Pharmaceuticals, but the likelihood is that after an initial surge of prescriptions most women will decide that Addyi’s limited effectiveness is not worth the expense or the safety issues. For those women for whom Addyi works, the FDA decision is good news. But Addyi is unlikely to do for women what Viagra did for men with erectile difficulties.

  1. http://www.theguardian.com/world/2015/aug/09/frances-kelsey-doctor-who-kept-thalidomide-out-of-us-dies-aged-101
  2. http://www.theatlantic.com/health/archive/2015/08/why-flibanserin-is-not-the-female-viagra/401789/
  3. “5 reasons to be sceptical of the new ‘female Viagra’ ”http://www.vox.com/2015/8/18/9173067/flibanserin-female-viagra-science
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The Naked Selfie: Citizen Porn or Self Exploitation?

kim-kardashian-teaches-how-to-take-a-perfect-selfieIt’s a good bet that most of us over the age of 50 have never sent a sexy picture of ourselves to a lover or partner. However, given current trends, we sexting virgins are set to become a smaller section of the sexually active population. A recent UK survey of 14 to 16 year olds found that young adults are increasingly familiar with the sending of sexual images, and that their attitudes to the material are increasingly non-judgemental1. Some 40% did not see anything wrong with a topless image and 15% did not take issue with any naked image. Data on sexting among mature adults is harder to come by, but anecdotally it is clear that attitudes are changing. Sharing explicit images is becoming a more widespread means of sexual communication, whether you are a teenager experimenting with how you look, an adult joining a dating site or someone looking online for a casual encounter with someone who shares their sexual preferences.

The selfie is a perfect example of Marshall McLuhan’s dictum that “the medium becomes the message”: the combination of phone, camera, image editing and storage technologies is changing not just what but how we communicate sexually. Dating behaviour, for example, is now driven by the impression you create in photos – posed, taken and edited by yourself. It has never been so easy to experiment with how you want to be seen by potential sexual partners, to excite a lover by exchanging intimate pictures of each other, or just to send topless shots or penis pictures for fun. Images are now as much part of the message of sexual conversation as the words we choose. What Zoe Williams termed “citizen porn” is now well and truly out of the dark room2.

The image-as-conversation is a new and potentially exciting departure in human sexual communication. Image exchange has a long history in courtship, but its boundaries have always been set by the cost of technology. Now we all have the means to share our selves in ever more intimate ways. Pornography likewise was until recently a top-down media where consumers, mostly men, got what was made available. However, the ubiquity of technology now enables us not just to consume pornography anywhere but also to create it for ourselves.

There is no shortage of warnings about the impact of pornography in society, but the medium is outpacing the debate. Pornography long ago lost its 1960s purpose of sexual liberation and narrowed into a sexist and often misogynistic representation of a limited range of sexual activities and physical types. The sexy selfie, however, is not porn as we knew it. It gives both men and women a chance to take control of their image and self express sexually. Driven by ordinary people with ordinary bodies, it may already be starting to shift the entrenched attitudes that society has about default standards of beauty and sexual attractiveness. Generating your own material online, what web marketers call “user generated content”, is now changing porn as quickly as it has changed advertising and public relations. The selfie has the potential to emancipate our sexuality, to increase our agency in how we express it and to encourage healthy sexual self fashioning. Yet it also has risks and the stimulus is offers to greater sexual freedom, may come with a parallel downside.

The more we exist online, the more we develop an online persona; we position ourselves as “professional” on LinkedIn or “family man” on Facebook. We all now behave as brands. Anyone who has written a blog or posted pictures on Tumblr is competing for the attention of others. We want comments, likes, endorsements and “friends” to inflate our online self worth. Selfies can readily become exchangeable commodities that can generate online image value. They also provide a portion of the material that packs social network sites and which remains an irresistible draw to advertisers. The inauthenticity of much of this activity runs counter to the selfie as self-expression. Thanks to the naked selfie, dating sites can easily become market places where the bodies traded are more than likely to be female.

We need to be careful that the sexual selfie does not repeat or perpetuate old patterns, particularly with regard to how women present themselves sexually. In commercial advertising and pornography, the so-called “male gaze” fixes women’s bodies as objects to be consumed or as things to be looked at, and some women internalise that view and self objectify. Some feminist writers have welcomed the selfie as a means to retake control of the female image, subvert the male gaze with ironic posts and break down its faux cheesecake aesthetics. But with male exposure to mainstream porn increasing, the risk remains that women and girls simply try to find a way to fit into that culture. Even when women are posting photos of themselves publicly that don’t depict overtly sexual acts, the images will often still imitate pornographic ones. For every woman who posts a selfie with pride, others will use it to find the validation they cannot give themselves. A study from Buffalo University found that females who base their self worth on their appearance tend to share more photos online and maintain larger networks on online social networking sites. More men are likely to become prone to the same behaviour3.

Young women in their teenage years, trying to define themselves as sexual adults, are seen to be particularly susceptible to the affirmation through beauty message perpetuated by commercial media. Yet this need not occasion a moral panic about the sexual selfie or require the application of out-of-date obscene publication laws to police new media. Young adults today demonstrate great awareness and openness about matters of sex and sexuality, and educators and politicians are too quick to comment on a world that is relatively closed to them and developing faster than they can keep up. Teen sexting will require that sex education regimes change to teach young people about the ethics of pornography, privacy and appropriate sexual behaviour. However, we should be wary of painting teenage girls in particular as perennial victims of pornographic culture. Some girls send topless selfies because they crave intimacy, even on someone else’s terms; others do so because they want to make out with someone. The more we can educate and encourage young adults to consider and make informed choices about what they see and post online the better.

The naked selfie is the most recent demonstration of how the internet is changing sexual culture. Communication through and about sex is increasing and that is proving liberating for many. Pornography businesses were early adopters of the web, even arguably pioneers. Yet they now stand in danger of being devoured by the “citizen porn” revolution they helped create. The greatest potential of the sexy selfie is to return sexual image making into the hands of ordinary people with ordinary bodies and to encourage greater communication and greater pleasure. We all have the opportunity to explore its potential, but it will need us to re-examine our ethics, particularly when it comes to teaching young people about the ethics of the sexual image-as-conversation. For now at least, the naked selfie seems a good thing. But if the airbrush is just replaced by photoshop, we will have gained little.

  1. “A qualitative study of children, young people and ‘sexting’.” A report prepared for the NSPCC. May 2012. http://www.nspcc.org.uk/Inform/resourcesforprofessionals/sexualabuse/sexting-research_wda89260.html
  2. Williams, Z. “Now I get the naked selfie – at its core its citizen porn”, The Guardian, 6 September 2014. http://www.theguardian.com/theguardian/2014/sep/05/saturday-sketch-naked-selfie-citizen-porn
  3. Facebook Photo Sharing Reflects Focus on Female Appearance, May 2011 http://www.buffalo.edu/news/releases/2011/03/12339.html
Posted in Female Sexuality, History of Sexuality, naked selfie, Pornography, selfie | Tagged , , , | Leave a comment

Grope Gate Therapist Case Makes the Papers – But Does it Really Help the Regulation Debate?

1241048766_2It is rare that a psychotherapist finds themselves on the receiving end of national press coverage for professional misconduct. However, that is exactly what happened to John Clapham, a therapist operating in Exeter in South West England. Clapham and his organisation, Palace Gate Counselling, were recently thrown out of the British Association of Counselling and Psychotherapy (BACP) for his groping of counsellor employees in a so-called intimate massage treatment session. Until recently such scandals were generally announced discretely in the professional conduct section of Therapy Today. Unfortunately for Mr Clapham, reports of his behaviour were offered to the nation over Sunday breakfast last week by the Mail on Sunday.

Clapham’s clumsy advances to two female counsellors, whose work he was also supervising, were not only unwanted sexual approaches but also gross breaches of professional trust. In addition to the damaging emotional impact, both women claim they were subject to years of intimidation by Clapham and his associates in an attempt to block the various ways in which they sought to raise their complaints. Finally in May this year, a BACP investigation upheld the bulk of the women’s complaints and removed Clapham from its register.

Unfortunately, that is where any sanction ends for Clapham. An investigation by the Police went nowhere and given that BACP registration is voluntary, Clapham can continue to practice and potentially to groom new Sabina Spielreins to play muse to his Karl Jung. The case has raised calls for government to revisit the regulation of therapy and the scandal has momentarily put therapeutic abuse in the public eye. However, the therapy profession as a whole should think carefully whether it wishes to frame the regulation debate in terms of unwanted sexual advances and bullying by a rogue therapist against his employees.

Clapham is an archetypal “little man of the professional class”, the sort of respectable chap whom George Orwell identified as the most suitable protagonist in a good Sunday paper scandal. As such he is a perfect foil for the two women he allegedly groomed. In the grainy snapshot that announces the media’s conclusion on someone’s guilt, the respectable county town psychotherapist morphs into a sinister abuser. In contrast, his victims scrubbed up well for their professional press photos. To borrow terminology from Jung, whose sexual relations with clients seem less and less acceptable with hindsight, this was a story about archetypes: the old man with fading sexual powers fancying himself as Zvengali to the eager trainee Trilbys with whom he surrounded himself. Distilled to its essence, you have less a call to stop therapeutic abuse than another replay of a sex story as old, hackneyed and ultimately ephemeral as the paper that printed it.

Yet who can blame the women involved for seeking this route? Angry at Clapham’s abuse, worn down by bullying from his cronies, unable to get help from the Police, and frustrated by a lengthy and ultimately toothless complaints procedure, the counsellors involved appear to have gone to the press as the only effective means to stop Clapham doing the same to others. In this they have succeeded. For the time being at least, it is hard to imagine that Clapham and his organisation will have new clients queuing up. The pair have also gained useful publicity for their own professional practices and reputations, which given what they have been through seems a fair enough secondary benefit.

However, it remains to be seen whether using their experience to raise the issue of therapeutic regulation in the national press is of long term benefit to the profession. Both the counsellors involved have made clear their support for greater regulation of psychotherapy and they probably introduced the Mail to Catalyst, an organisation quoted in the article that supports victims of abuse by therapists. Following the phone hacking scandal, UK newspapers have more than ever to wrap their grope-and-expose stories in a bigger issue to maintain credibility. Clapham’s victims have skilfully played on that. However, what they failed to do was set a professional context to either the abuse or the need for regulation.

The women deserved their free press punch at Clapham, but they remain self-appointed representatives of the rest of the profession. They might well have benefited from media support from their own professional body, which happens to be the BACP. Given that Clapham was expelled in May, it is surprising that neither the complainants nor the BACP appear to have co-operated on the article, which took some planning and preparation. A press statement from BACP or a quote from a senior therapist would have set the professional context with some important industry messages, particularly that abuse by therapists is rare, that regulation would improve the safety of clients but that regulation is about more than stopping abuse. While there is no doubting their courage and perseverance, neither counsellor has the necessary experience or gravitas to speak for the profession as a whole. Both might deny this presumption, but by going to the media and positioning your experience of abuse as a reason for regulation, you are taking on such a role de facto.

What this story lacks is a credible voice from those who do represent the profession in bodies such as BACP. No further demonstration is necessary of the political naivety of the therapy profession, its lack of media savvy in a media-driven age, and the deficit of courage among its senior figures to speak out regularly in the media. Getting the result you want from media coverage requires more than crossing your fingers and hoping the journalist is on side. It takes preparation and relationship building. This story illustrates the failure of the BACP to establish a strong media presence and to support the media efforts of victims of therapeutic abuse who want publicity for their experience. The end result is that the ethical majority are silenced in these cases, potentially leaving the floor to the angry, the aggrieved or those with an axe to grind.

Therapists are not the Mail on Sunday’s standard readers, so I doubt whether anyone reading this piece had their attention held much past the opening paragraphs and photos down to the regulation issue. While justified and well intentioned, the story remains a breakfast tale of abuse and bullying whose immediate impact on readers is more likely to be titillation and schadenfreud than outrage at an unregulated industry unable to root out rotten apples. By raising the issue of regulation without a solid professional context, the piece runs the risk of painting all therapists, particularly older men, as potential Claphams. Abusive therapists are a tiny minority, and if the profession frames regulation around their elimination it risks making that process a means of preventing the bad rather than encouraging the best. I don’t begrudge Clapham’s victims their revenge, particularly served suitably cold after years of struggle. But exposing scandals in which you are the victim is not the optimum way to advance regulation of therapy, particularly when done without the co-operation and involvement of the wider profession. BACP would be wise to take note and take a close look at its media strategy.

Posted in Abuse in Therapy, John Clapham, Palace Gate Counselling, Regulation of UK Psychotherapy | Tagged | Leave a comment

Tim Lott’s Guide to Family and Couples Therapy

g_logo_smWriting in his regular family column in last Saturday’s Guardian, novelist Tim Lott identified two of the most important elements of couples therapy: unpicking our own self-sustaining illusions and allowing our partners the potential to change 1. Lott’s column is always worth a read for its honest thoughts from the family front line. This week’s contribution was especially welcome for its support for the work therapists do to help families change dynamics that keep them stuck and make them unhappy. Lott writes about family therapy, where the children are as much a part of the process as the parents, but the points he makes apply equally to working with couples experiencing relationship difficulties.

Lott is no stranger to couples and family therapy, as will be apparent to readers of The Love Secrets of Don Juan, his novel of mid-life male mating. So it is welcome to read that his experience of calling in a professional listener, while certainly no cure-all, can offer profound rewards. Couples therapy offers a neutral space where we can be heard by our partners and hear them in return. What makes this necessary, as Lott testifies as both man and writer, is that most of us tend to live our lives on “a diet of self-sustaining illusions”. We believe we are the best judge of our motivations and memories, but forget that we often understand others better than we do ourselves. Frustratingly, it is our partners who understand us best, and vice versa. Yet when they challenge us we often reject their insight and resent them for it. We mistake good communication for them seeing us as we want to be seen, and being understood for having our own delusions fed back to us. A skilled therapist, like a writer, understands this. A good therapist will also know how painful and drawn out a process it can be to help each partner unpick their internal illusions and let them go.

Until we can start to shed these self deceptions and really listen to what our partners are telling us, there is tendency, as Lott correctly points out, for “people who think they know each other [to] construct a series of filters through which they choose to understand matters”. The therapist’s difficult, and sometimes impossible task, is to encourage people to admit that there might be alternative, healthier and more constructive ways of seeing their relationship. Often it is negative patterns from childhood and past relationships that, while not determining what happens today, often influence our responses to what our partners chuck at us. As the writer and therapist Adam Phillips once put it, being in a relationship is like acting in a play for which you haven’t been given a script. You think you’ve forgotten your lines and all that comes into your head are words from other plays you’ve been in. This is one of the ways, as Lott puts his finger on, that we get imprisoned in a family dynamic: “the other members have decided how you are and are therefore reluctant to admit the possibility of change”.

Relationships and families are people making machines. They force us to grow when we had rather be comfortable and safe. The safer and cosier we get, the less interesting we become to our partners. One or other of us is always pushing the boundaries, seeking something new and different in the relationship. It could a change in career that impacts us, a desire to rejuvenate our sex life, or simply being fed up with our attitude to them. Lott has, I suspect, hard earned experience of this dynamic:

“Change is desirable – or at least necessary – in all walks of life. But it can be painful so we actively work against it. To agree to change means defying your family’s expectations… To have a healthy family dynamic, you have to learn to act “as if” the other person is capable of change – or you are condemned to repeating the same behaviour over and over again while hoping for a different result.”

We have to allow others the potential for change. Lott has hit on a truth here, but only expressed part of it. It is hard to make that “as if” leap of faith unless we can hold onto ourselves in the process. We have to allow ourselves that potential too and we need enough belief that what our partner is asking for or embarking on will not overwhelm us. We try and keep our partners where they are because that is more comfortable and secure for us not them. Sometimes that is the result of patterns and delusions we find hard to let go. But it also comes from fear. Those we love are so important to us, so valuable, that we fear any change may be a prelude to them leaving us. We can resent their wish to change and we often fight to the death to keep them where they are, destroying what we love in the process. We need not only faith in our partners but faith in ourselves. As Lott makes clear, no therapist can give you that. It comes from within. A little faith in the other goes a long way in relationships. But it is also our ability to manage ourselves within the ever-changing dynamics of partners and families that makes for limitless possibilities.

1.  http://www.theguardian.com/lifeandstyle/2014/jul/18/in-praise-of-family-therapy.

 

Posted in Couples Counselling, Family Mediation, Family Therapy, Tim Lott | Tagged , , , , , , | Leave a comment

J.G.Ballard: the High Prophet of Contemporary Porn

200px-Crash(1stEd)“We live inside an enormous novel”, wrote J.G. Ballard in the introduction to Crash, his 1973 novel about how sex and technology might interact to create a new pornographic reality. Ballard looked at the 1970s world of mass merchandising, advertising, image politics and easy-to-access technology, and concluded that for the writer “it is less and less necessary for him to invent the fictional content of his novel. The fiction is already there.” In Crash that fiction centres on the obsessions of Dr Robert Vaughan, a stalker-sadist who is sexually aroused by staging and participating in real car-crashes on the concrete motorways and overpasses of West London.

Crash was as ground breaking and prophetic in its exploration of the power of fetishism in human sexuality as Sacher-Masoch’s Venus in Furs a century before. For Vaughan it is the technology of the car rather than the experience of domination and submission that is erotically charged:

“What I noticed about these affairs, which she described in an unembarrassed voice, was the presence in each one of the automobile. All had taken place within a motor-car, either in the multi-storey carpark at the airport, in the lubrication bay of her local garage at night, or in the laybys near the northern circular motorway, as if the presence of the car mediated an element which alone made sense of the sexual act.”

By the 1970s cars were already established as sex objects in consumer advertising. But Ballard’s leap into “auto erotic” sex on wheels was profoundly shocking and the media of the day condemned both Ballard and the book. Outrage also greeted David Cronenberg’s 1996 film of the novel, starring James Spader as Vaughan, and Westminster City Council banned the film from central London cinemas. One year later, however, the online publication of pictures of Princess Diana being cut from a wrecked car in a Paris underpass showed the new power of the internet to stimulate our innate prurience for sex, death and automobiles. Vaughan’s voyeurism for West Way traffic accidents, while unsettling, suddenly seemed less shocking. Twenty years on, dogging in a rural car park is now a staple of tabloid television that titillates under the cover of outrage.

crash_ver1For anyone who knows the book by reputation rather than content, I recommend Zadie Smith’s reflections on the novel in last week’s Guardian. As Smith writes, what is arresting about Crash is not the fact that people have a lot of sex in or near cars, but that “technology has entered into even our most intimate human relations. Not man-as-technology forming but technology-as-man-forming”.

When clients relate to me a problem with online porn, Ballard’s vision often comes to mind. Sexual images are now so available on our laptops and phones that pornography has become the new reality of many people’s sex lives. Rather than experience the complex and unpredictable intimacy of sex with someone else, we reach for our device of choice to experience our particular visual turn-on. A simulation of sex by others, be they actors or amateurs, has become the only sex some people can experience. The French philosopher Jean Baudrillard called this characteristic of pornography the hyperreal. Pornography purports to show us the sex of our imaginations. Yet once we have immediate access to sexual ecstasy, what is there to want or desire anymore? Real sex disappears among the pixels.

Despite the outrage it often generates, pornography is just another manifestation of the 24/7 consumerism enabled by technology capitalism. Most of us would consider supermarkets to be convenient and useful, but we know they exploit farmers and put local shops out of business. Pornography brings sexual ecstasy, pleasure and the ability to experience our fantasies whenever we want. But it also objectifies women and may exploit the vulnerable. Yet its convenience makes it unstoppable. While claims that it changes our brains in negative ways are unproven, it is nonetheless changing our patterns and customs of sexual interaction in profound ways that Ballard began to explore forty years ago.

One of the most chilling aspects of his vision is how little individuals and personalities matter when sex and technology collide. There is an icy quality to Ballard’s style that is reminiscent of much of contemporary porn. As one of his characters says of Dr Vaughan:

“[His] interest in myself was clearly minimal; what concerned him was not the behaviour of a 40-year-old producer of television commercials but the interaction between an anonymous individual and his car, the transits of his body across the polished cellulose panels and vinyl seating, his face silhouetted against the instrument dials.”

One of the most troubling aspects of pornography is not that it objectifies and uses women, but that it demonstrates, in Zadie Smith’s words, how “everybody uses everything. How everything uses everybody.” Users of porn are as exploited and objectified by the technology as they exploit and objectify the focus of their fantasies.

So what do we do about this? As I tell clients who struggle with pornography use, there is nothing wrong with viewing pornographic material that involves consenting adults and does no harm. However, we need to remind ourselves constantly that what we are observing, no matter how momentarily pleasurable, is a hyperreal illusion, abstracted from real bodies, pleasures and personalities. We can choose to view it if we wish, but we need to be mindful that the technology medium that delivers it is also choosing and targeting us with advertising. Mostly we are too lazy or habituated to say no to its convenience. In handing over our pleasure to porn, we run the risk of losing our sexual creativity in a new mass marketing exercise.

As Ballard wrote in his introduction to Crash, “The fiction is already there. The writer’s task is to create reality”. Porn is now part of the artificial, techno commercial world that envelops us. If we can be aware of that, then the opportunity exists to step out of it if we choose and explore our own, unique sexual realities with others.

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Counselling Organisation Carries On Despite Serious Misconduct Findings – another reason we need tougher UK regulation

g_logo_smIt is hard to imagine any profession allowing a member found guilty of serious professional misconduct to just carry on working. Yet this is just what happens under the current regulatory regime for counselling and psychotherapy in the UK. Counsellor and psychotherapist are not “protected terms” – anyone can set themselves up as such without training or experience and continue to practice in spite of misconduct findings against them. Professional organisations such as the British Association for Counselling & Psychotherapy (BACP), which accredit members and enforce standards, are overseen by the Professional Standards Authority for Health and Social Care (PSA), which is ultimately answerable to Parliament.  However, even if the BACP expels a member from its register for misconduct, there is nothing to stop that member joining another professional, if any will have them, or just going it alone as an independent. This system is clearly flawed and means that the public, including those in vulnerable mental states, are not adequately protected from rogue therapists who may, at worse, abuse their clients. The potential risk is magnified if it is a counselling service which has been found at fault and then goes on to operate just as it likes and to its own standards.

This is exactly what has happened in South West England, where Exeter based Phoenix Counselling Services has had its membership of the BACP withdrawn as a result of serious professional misconduct. Phoenix, which runs Palace Gate Counselling in Exeter (http://www.palacegatecounselling.org.uk/) and Taunton Counselling Service in Taunton (http://www.tauntoncounsellingservice.org.uk/) , mishandled the relationship with two of its counsellors and supervisees to the extent that the BACP found it to have a contravened “the ethical principles of autonomy, beneficence, non-maleficence, justice and self-respect”. Furthermore, Phoenix was found to lack “the personal moral qualities of empathy, integrity, respect, humility, competence, fairness and wisdom to which practitioners are strongly encouraged to aspire”. Phoenix would appear to have broken so many rules of therapeutic ethics that you would have expected its directors to start reconsidering their careers. Details of the case against Phoenix can be found on the BACP website (http://www.bacp.co.uk/prof_conduct/notices/termination.php).

Phoenix did not apparently appeal the BACP decision. Instead, it published a long, self-justifying blog post (http://palacegatecounsellingservice.wordpress.com/the-conflict/) and withdrew its BACP membership before it was pushed. It has, to date, offered no apology, demonstrated no self-reflection, and announced no review of its practices or systems. It did, however, criticise the BACP process to which it had to submit as lacking in accountability. For an organisation offering counselling, an activity that requires self-reflection from both its practitioners and its clients, to receive such severe criticism and yet conclude that it has nothing to learn is mindboggling. Standards of organisational behaviour so poor as those found by the BACP would never be tolerated in UK public services nor in the majority of public or private companies. So here we have a counselling service that not only fails on many of the requirements of its own profession, but also acts in a way that would be unacceptable in most other professional and commercial contexts within our society.

Phoenix’s response to this process demonstrates not only a breath-taking degree of arrogance, but also a deep level of cognitive dissonance. Despite having been found ethically wanting, their blog insists on claiming that it offers “a person-centred service to our clients” and operates “on person-centred lines as an organisation” (http://palacegatecounsellingservice.wordpress.com/about/). In particular, they claim that “we do not go in for proliferating prescriptive rules and policies”; a useful tendency if you are intent on working to a different set of standards to everyone else. Far from putting effort into self-reflection, Phoenix’s response to the BACP findings is a mishmash of humanistic blog posts, e.g. Lao Tsu on Change or Carl Rogers on People and Sunsets, as if to demonstrate high ethical standards by association. Moreover, it is almost sinister for an organisation to blog on A Person-Centred Take on Conflict Resolution two days after it gets chucked out of the UK’s leading professional association for serious misconduct. Phoenix appears to have a self-righteous agenda that is either blind to or dismissive of any form of criticism or censure.

The BACP findings against Phoenix concern its handling of its counsellors and supervisees, not its clients. However, for an organisation that claims to see some 160 clients a week and between 400 to 500 clients each year, surely a review of its practices is required to ensure that the problems found in its relations with staff do not extend to its clients. But yet, under the current UK regulations, no one can force Phoenix to undertake such a review or reassure the communities that use its services. Phoenix appears likely to carry on just as before.

Local media, councillors and MPs should make clear their concern on this point and encourage Phoenix to reassure its service users. If no such public pressure is brought to bear, we can only hope that prospective clients do their research online, and ask themselves if such an organisation is likely to offer an effective, ethical service and seek the necessary assurances from Phoenix itself. Local GPs should also consider whether they would wish to refer clients to a counselling service that fails to respond to professional censure. Local colleges and training organisations should ensure that trainee counsellors are not engaged at Phoenix on placement unless the BACP findings are taken on board and practices and procedures overhauled.

Therapy is a profession where you can break the rules and suffer no practical professional sanction. The majority of therapists work ethically and do the best with their clients. All therapists make mistakes and clients have a right to raise those issues with professional bodies. That way we can protect clients and learn as a profession, and the BACP has a good track record of assisting practitioners to reflect on and learn from their client complaints and continue working. However, there are bad apples in every profession, and therapy is no exception. Stronger regulation is needed to highlight misconduct and implement sanctions as appropriate. The fact that a counselling service can thumb its nose at the standards the rest of the profession hold dear and go on working with clients, including vulnerable individuals, without any external intervention is a scandal.

Posted in Abuse in Therapy, Regulation of UK Psychotherapy, Relationship Counselling, Uncategorized | Tagged , , , | 1 Comment

Banning Gay Conversion Therapy is a Poor Reason for Regulating the UK Therapy Sector

g_logo_smStatutory regulation of psychotherapy and counselling is back on the political agenda, now reincarnated as a means to ban treatments which claim to be able to change a person’s same sex preference, often referred to as “gay conversion” or “reparative therapy”. The Labour MP for Swansea West, Geraint Davies, has introduced The Counsellors and Psychotherapists (Regulation) Bill into the House of Commons.  The bill proposes that psychotherapists and counsellors be registered by the Health and Care Professions Council (HCPC). The HCPC would publish a code of ethics that “must include a prohibition on gay to straight conversion therapy”, and abiding by the code would be a condition of a therapist’s registration1. While this Private Members’ Bill stands no chance of becoming law, it has attracted a fair amount of publicity, some cross party political support, and been welcomed by LGBT activists.

Regulating therapy and outlawing gay conversion work are both sound ideas. Given the rapid expansion in the numbers of psychotherapists and counsellors being trained in the UK, it is time for both the profession and politicians to consider strengthening regulation to maintain standards and protect clients. Gay conversion “therapy”, many of whose promoters appear to be Christian fundamentalists, is just the sort of unethical and dangerous practice that regulation would root out. So Mr Davies deserves some credit. But pushing regulation onto the majority of ethical therapists to shut down the unethical few is misguided. Not only does it discredit therapy in general, but it also gets the regulation debate off on the wrong foot.

MPs and therapists have been here before, and not that long ago. In 2009, the Labour government put forward plans for the Health Professions Council (HPC), predecessor to the HCPC, to regulate the profession. These were abandoned by the Coalition in 2011, partly on the grounds of cost, but also as a consequence of resistance from therapists. The HPC, being a government body that regulated medical practitioners, would have replaced oversight by professional associations, such as the British Association for Counselling & Psychotherapy (BACP), with direct regulation by medically focused civil servants. Many therapists felt, with some justification, that the HPC lacked understanding of the variety of approaches and methods used by therapists and that it was not best placed to judge competence. For many practitioners, therapy is a personal craft learned over many years, rather than a medical science that anyone can practice effectively if they have the requisite training. Rather than ensuring ethical professionals using widely differing approaches were included, HPC regulation seemed more about keeping out the rogue few.

By recommending regulation by the HCPC, Mr Davies’ bill serves up the same fare the profession was offered in 2009. Spicing it up by challenging a particular therapeutic abuse will not make it any more palatable. His proposals once again put one aspect of regulation, protection of the public, ahead of other positive objectives of regulation – maintaining a register of qualified professionals, fostering good practice and promoting high standards of training. To frame regulation in terms of protection implies that therapists who seek to abuse their power or practice unethical modalities are rather more common than they are.

Failure to address such concerns and obtain buy-in from the profession doomed the 2009 plans before the economic crisis ruled the whole thing out on cost grounds. The Coalition’s solution has been “assured voluntary regulation”.  The Professional Standards Authority for Health and Social Care (PSA), which oversees professional bodies such as the General Medical Council, and is answerable to Parliament, has taken on oversight of professional therapy bodies like the BACP. This arms length system has gone some way to assuring quality and standards, as the PSA can conduct audits and scrutinise decisions of the bodies it oversees.  However, it still leaves therapists policing one another. Complaint processes remain protracted, complex and stressful for all parties, and it has been argued that the profession is unduly lenient in dealing with therapists who are found to have broken the rules. Unlike doctors, therapists who act unethically or unprofessionally can still, even if expelled, continue to practice, often by simply leaving a particular professional body. “Psychotherapist” and “counsellor” are not “protected titles”, as proposed in 2009. Under the current system anyone can claim to be a professional therapist, even if they are trying to convert the gay into the straight.

This sizeable loophole notwithstanding, the present structure has actually done a reasonable job of highlighting the abuse of gay conversion therapy and rooting it out. Thanks to the efforts of campaigning journalists, notably Patrick Strudwick2 of The Guardian and Channel 4’s Dr. Christian Jessen3, the very few therapists and organisations that practice or advocate conversion therapy have been exposed and expelled from their professional bodies. The BACP and other professional organisations have made their rejection of this abusive practice clear. While nothing can stop faith-based groups, such as Core Issues Trust4, continuing to advocate gay conversion, any potential client with access to the internet has the opportunity to learn that this practice has no place in ethical mental health work in the UK.

However, the UK today is a place where every professional, authority figure is distrusted. Whether you are an MP or a psychotherapist, the public feels the need to be on its guard lest you abuse the trust placed in you. As psychotherapy counselling courses proliferate to the point of being advertised on TV and radio, there are compelling reasons for stronger and if necessary statutory regulation. But the debate about what structures are appropriate needs to start from an assumption that the majority of professionals are honest and genuinely wish to do the best for their clients.

Mr Davies and others may have re-opened the debate, but it is up to the profession to put it on the right track. Rather than starting from the need to root out a particular abuse, the discussion should focus on fostering good practice and maintaining and improving training requirements and standards. The best means of ensuring that clients with alternative sexualities are protected from abusive therapy is to ensure that all therapists learn about the breadth of human sexual preferences in training. There should be greater emphasis on introducing evidence based practice, for example, by ensuring that therapists have easy-to-use evaluation tools that help them identify when they get it right and when they get it wrong in client work. Supervision regimes, which have a tendency to focus on the impact of work on the therapist, need to be adapted to help practitioners learn from evidence of how effectively they work with clients. Finally, there is a case for amalgamating the professional associations to which therapists belong. Accreditation by a variety of different bodies, be it the BACP, BABCP or UKCP, that duplicate the functions of registration and setting standards, is certainly not cost effective and may no longer be credible. Creating a single professional body would simplify for clients the process of assessing, choosing and, if necessary, complaining about a therapist.

The Counsellors and Psychotherapists (Regulation) Bill has highlighted the need to keep the conversion whackos out of the profession, and Mr Davies should be applauded for making a strong statement. But his Bill is a poor place from which to re-open the debate on the regulation of psychotherapy and counselling. When that debate is joined it needs to focus on the best the profession can do, not the worst.

  1. http://www.publications.parliament.uk/pa/bills/cbill/2013-2014/0120/14120.pdf
  2. “Conversion therapy: she tried to make me ‘pray away the gay’”, Patrick Strudwick, The Guardian, 27 May 2011. http://www.theguardian.com/world/2011/may/27/gay-conversion-therapy-patrick-strudwick
  3. http://www.channel4.com/programmes/undercover-doctor-cure-me-im-gay
  4. http://www.core-issues.org/

 

Posted in Gay and Bisexual, gay conversion therapy, LGBT rights, Regulation of UK Psychotherapy, reparative therapy | Tagged , , , , , , | Leave a comment

Opponents of Same Sex Marriage Look Out of Touch

g_logo_smAs same sex marriages became legal in England and Wales this weekend, it is worth celebrating not only the progressive merit of the Marriage (Same Sex Couples) Act 2013, but also the fact that the opposition to the legislation has been so muted and looks so out of touch. According to a BBC Radio 5 live poll, 22% of British adults would still apparently refuse to attend a same sex wedding, so ingrained prejudice clearly dies hard. Yet in contrast to the situation in the USA, there is no conservative lobby or interest ready to mobilise those who remain uncomfortable with the change. The Church of England has rolled over in time-honoured fashion to the will of Parliament. Even UKIP leader, Nigel Farage, the most likely political figure to support the views of matrimonial traditionalists, has dodged the issue. Public opponents of same sex unions may not all be cranks who think recent floods were a condign punishment from the Almighty for undermining the holy institution of matrimony, but they do look reassuringly marginal and out of touch.

We should remember, however, that the arguments that until relatively recently justified the position that marriage could only happen between a man and a woman, are not ancient. While they are based in part on interpretations of the Bible, which is notoriously inconsistent on matters of sex, they certainly do not derive from any words of Jesus Christ. In fact they were largely developed in the thirteenth and fourteenth centuries to suppress unions, mostly between men, that medieval church and society had not only tolerated but also legalised and celebrated for hundreds of years.

Same-sex unions between men, often called affrèrements or “brotherments”, were not uncommon in Europe in the Middle Ages. Celebrated in church, many of the elements were the same as those found in descriptions of heterosexual marriages. Hands would be placed on the Bible, there would be lighting of candles, the binding of hands, and a kiss to make the ceremony official1. Many of these ceremonies undoubtedly celebrated relationships that were based on family, friendship, religious faith, shared property interests and the like, but others were evidently emotional and sexual unions. Attempts to dismiss this latter element of brotherment as gay revisionism are unconvincing, and demonstrate that historians can be as prone to homophobia as any other group. In medieval Europe, as in many societies throughout human history, same sex preference may not have been the norm, but neither was it always treated as unusual or taboo. Men, including members of monastic orders and the priesthood, formed committed intimate unions and these were sanctioned by the church and celebrated by communities. Women probably did the same, but given their lower social status their unions were recognised in a less formal way that is not reflected in the records.

This relative tolerance began to shift in the twelfth century. The threat to Christian Europe from the Arab Muslim powers to the south and east of the Mediterranean not only led to the Crusades, but also initiated the hunt for scapegoats within Christian Europe, a trend that was exacerbated by the arrival of plague pandemics in the fourteenth century. Jewish minorities were the first to suffer as medieval Church and state began to strengthen their hold on society and root out those whose race, religious beliefs and sexual practices made them “other” in the eyes of the new, more rigid orthodoxy.

It is from this period of pogroms and persecutions that the basic arguments put forward by the opponents of same sex marriage originate. Drawing selectively on the Bible, but mostly from conservative writers of the early church, medieval theologians, including St. Thomas Aquinas, preached that marriage was for the sole purpose of creating children, and therefore should only exist between a man and a woman2. God created the human race in a precise sequence, first the man, then the woman, establishing the archetype of all legitimate human sexual and familial relations. Male and female were uniquely complementary in the eyes of God, and only sexual intercourse for procreation was natural.

These patriarchal arguments were used both to suppress and persecute same sex unions and sexual relations throughout Europe. In most jurisdictions, homosexual acts became punishable by death. By the sixteenth century it would have been impossible for two men, let alone two women, to contemplate a marriage union or for their community to sanction it. Same sex relationships went underground. Even as social change and activism rolled back restrictions against homosexual activity in the late twentieth century, the notion that marriage can only occur between male and female remained strong, particularly in the USA. As late as 1996 President Clinton signed into law the Defense of Marriage Act, which states that “the word ‘marriage’ means only a legal union between one man and one woman as husband and wife”3. The Roman Catholic Church continued to hold the traditional line. In 1999 Pope John Paul II declared that marriage between a man and a man or a woman and a woman, was “incongruous” because of “the absence of the conditions for that interpersonal complementarity between male and female willed by the Creator at both the physical-biological and the eminently psychological levels”4. In the UK, the same arguments about what is “natural” in terms of relationships underpinned the Thatcher government’s passage of Section 28 of the 1988 Local Government Act that forbade promoting the teaching of the acceptability of homosexuality as “a pretended family relationship”.

Given this history it is reassuring that the advent of same sex marriage in England and Wales this weekend has been met with so little resistance and protest from social conservatives. The idea that marriage is only for men and women still gets trotted out, but its hold on society increasingly appears more a matter of ignorance, habit and intellectual laziness than reasoned argument. Some faith communities continue to stick to it, but even the Roman Catholic Church has begun to modify its position. Pope Francis has stated that the church should study same sex unions rather than condemn them. We have certainly come a long way in the last twenty-five years in our attitudes to same sex preference and sexual activity.  So whenever you hear someone pushing the idea that marriage is a male-female preserve, it is worth reminding yourself, and them if need be, that its origins are in the bigotry of the Middle Ages and that is where it should be left.

  1. Boswell, J. The Marriage of Likeness: Same-Sex Unions in Pre-Modern Europe (New York: Villard, 1994)
  2. Reid, C.J. May a Man Marry a Man? Medieval Canon Lawyers Analyze Same-Sex Unions, (Legal Studies Research Paper No. 14-02. University of St. Thomas, Minnesota, School of Law, 2014)
  3. Berkowitz, E. Sex and Punishment. 4000 Years of Judging Desire (London: Westbourne Press, 2012)
  4. Address of Pope John Paul II to the Tribunal of the Roman Rota, 21 January, 1999.
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