When the Professional is Political and Personal: Queer Psychologists reflect on debating gender identity within the profession

During the month of Pride, four queer psychologists (from a larger working group discussing and challenging transphobia within the profession) reflect personally on the felt impact of transphobia and cis-privilege. Pseudonyms have been used throughout.

The Political Context

2020-2021 has undoubtedly been a year of both forward movement for trans rights and aggressive backlash against this. Advances have been made internationally against conversion therapy -- the practice of coercively attempting to change an individual’s sexual orientation or gender identity. 

Meanwhile, in December 2020 the UK High Court ruled that children under 16 years old could not consent to ‘puberty blockers’, which delay the onset of puberty to allow trans-identified youth time to explore gender identity and expression, and any possible further transition. This ruling has been condemned as denying young people’s right to make decisions about their own medical care, as set out in the UN Convention on the Rights of the Child and the Gillick competence principle, which operates across a wide range of health and social care practices and supports young people’s right to make decisions where they are deemed competent to do so. Whilst a partial easement was made in March 2021 -- with the High Court handing down a judgment that parents can consent on behalf of their child for hormone treatment -- the original ruling remains in place. 

Trans youth continue to face obstacles to care and distressing delays in access to treatment (sometimes over two years for a first appointment). The Tavistock Gender Identity Service (GIDS) has faced criticisms from both trans-affirming and ‘gender-critical’ groups and increasing scrutiny from the media. This group is aware that clinicians at GIDS face personal attacks, including death threats, threats of personal litigation, and fear of being ‘outed’ in their own gender identity.

Transgender people across the world face attacks from numerous angles, including politically motivated attacks, rollbacks of civil and human rights, neglectful and obstructive healthcare systems, physical and emotional violence, and the disproportionate impact of the COVID-19 pandemic. At the same time, London saw thousands of protestors take to the streets for Black Trans Lives Matter during the pandemic, and there is -- after years of marginalisation -- a sense of rallying behind trans people by the LGBTQ+ community in rejection of continued assaults from minority transphobic Gay and Lesbian groups.

Debate and polarisation in wider society has been reflected within the health professions, including psychology, with prominent names in clinical psychology writing ‘gender critical’ opinion pieces in psychology publications and academic journals (which we will not link to and bring more attention to here), with heated back and forth commentary. This piece is not intended to contribute to the debates around the lives of transgender individuals, but to provide a forum to share and raise awareness of the emotional impact of these discussions.

(​Single quotation marks have been used to indicate 'gender critical' as a contested term. See article.)

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Sophie 

What is it like to be a queer clinical psychologist? I don’t pretend to speak for all queer psychologists, but for myself the experience is one of pain and exhaustion.
Clinical Psychology often feels like more than just a job – it’s not something that switches off when you get home (in pre-covid times at least). Whilst I do not expect all clinical psychologists to hold the same views, I would hope that we can all stand by values surrounding offering respect, empowering others and fostering growth. 

Though we often consider ourselves a ‘questioning’ profession, we do so with empathy and an interest to better understand others’ perspectives. With this in mind, I have personally found it very jarring to see some of the views shared within clinical psychology about transgender people, particularly from those in leadership positions who have a considerable platform to influence others.

Often, discussions about transgender issues can become fraught over points about what is or is not transphobic. We know from recent advances in our understanding of other forms of discrimination, such as sexism and racism, that biases often exist at an unconscious level. 

Transphobia maintains a power structure where trans people are treated as ‘less than’, compared to cisgendered people. Transphobia is not always the outright espousal of anti-trans views, it can be more subtle than that. Transphobia is present in any assumption that to be transgender is ‘worse’ than being cisgender, and that to be exposed to or have to share a space with someone who is transgender can cause harm.

Health services for gender diverse people, including those within the NHS, are certainly not beyond discussion. Many transgender people themselves would agree that these services have room to improve. 

However, I think it is important to be mindful of when academic discussion of these services begins to question the identities and perspectives of transgender people themselves. Also when these particular services are ‘critiqued’ with a much greater frequency and intensity than others you have to stand back and wonder what else is taking place here, and whose views and narratives are being privileged over others. 

Gender is not a ‘banned’ topic for discussion -- many trans people and their allies are also interested in deconstructing the concept of gender -- but again we need to be careful of when our discussion begins to invalidate others. 

For many of us, these issues are not just professional issues to be ‘debated’, but deeply personal issues that affect us and those around us.
Seeing certain views expressed within clinical psychology (CP) makes me question whether I will be accepted in CP spaces, and makes me feel hesitant about being open about my own identity. Trans clients often report very negative experiences with health services and are over-represented in mental health services relative to their small population numbers. 

It is concerning to think that some psychologists will be taking these negative views and ideas into the clinic room with them. I also think of trans members of our profession, who may feel particularly alienated and unsupported. As we look to increase diversity in the impression, this gives a worrying signal to those joining the profession who are gender diverse.

Seeing posts about transgender issues in clinical psychology social media groups brings up strong emotions. I feel frustrated by the skew in the information posted about transgender people, with little positive and empowering content shared on platforms such as Facebook and Twitter. These groups and profiles reach thousands of psychologists across the country and for many are a key way of interacting with their professional community, sharing resources and learning. CP training courses often cover little material, if any on gender diversity, so for many psychologists, online groups alongside mass media will be their only exposure to these topics. 

From experience I know that for those who have trans experience themselves, or work with transgender populations, there is a feeling of inhibition to post and take on the negative comments that often follow. It is telling that some queer psychologists have felt the need to create separate online spaces, in a large to explore our own reactions to watching the proliferation of anti-trans psychological content. 

We do not all need to agree, but when many people are expressing that they find certain material hurtful and discriminatory, is there not some responsibility to listen and try to understand why this is felt?
I am also very mindful of psychology’s dark and troubled history regarding the treatment of oppressed groups. Some of the debates being had currently echo discussions from only a few decades ago about whether children might be being encouraged to think that they are gay, the threat of violence from gay men, the idea that a gay identity might be formulated as a form of repression or trauma response. We now consider these ideas abhorrent, but these were mainstream ideas in psychology in the not too distant past. 

We are all undoubtedly influenced by the environment around us and we are all learning, but I think it is important to consider how you might look back on your current views and practices, and whether they will seem defendable.
 

Frankie
As a queer, cis-gender woman and clinical psychologist, I have experienced an increasing sense of discomfort and alienation at the discussions within clinical psychology around best practice for working with transgender people, which I have been trying to reflect on and interrogate. 

Why do comments around “formulating” transgender identity (e.g., the ‘causal’ role of trauma, ASD, parental projections in ‘becoming’ transgender) feel so uncomfortable to me? I recognise that this comes from parallels in how psychology and other health professionals have historically responded to sexual orientation – as something to be “explained” and possibly “treated” to allow people to “fit” more comfortably within society from the perspective of the dominant position. 

The underlying assumption appears to be that diversity needs a causal explanation and that preventing diversity (or creating normality) is preferable.
Why do all the calls for freedom of speech and the importance of debate leave me frustrated and suspicious? Because again, as a woman and queer person, I am aware of how ‘science’ and ‘debate’ has been abused by prevailing institutions of power to maintain the status quo (think about “scientific” enquiry into whether women are intelligent enough to vote as one example) and how without diverse perspectives this ‘science’ will likely remain fraught with biases and unexamined assumptions.

Finally, why do I feel resistance to the narratives around “protection” (e.g., of children, women, trauma-survivors, people with ASD)? Because the idea of “protection” has long been used and weaponised by dominant power structures to maintain control or whip up fear about an ‘other’, often based on unjustified assumptions and prejudices (think about associations made about gay people and paedophilia, to name one abhorrent example). Who is really being protected? By whom? For what purpose? For what reason? And has the group that is being protected asked for this?

I recognise that sexuality and gender identity are not the same and perhaps comparing societal reactions misses the nuances involved. But perhaps history is repeating itself with the next “yet to be fully understood and accepted” aspect of the beautifully diverse species that are human beings.  If so, it is all of our responsibilities to listen, learn, and support the fight for gender equality for all. 


Nisha
As a cisgender queer person of colour it is dismaying and worrying to see history repeat itself in our profession. Seeing members of our psychology community, particularly those working with the most vulnerable in our communities, perpetuate harmful narratives about trans people and pushing to deny them gender affirmative care is deeply concerning. 

I hoped that we, at last, were starting to move beyond having a gatekeeping role for legitimising trans and non binary identities, to a more open, supportive relationship where people could explore their gender identity and whatever other struggles they might be facing (relating to their identity and not) safely and with positive regard. That is our core mission isn't it? To give people opportunity for safety and self-expression insofar as they are not abusive towards others or at immediate risk to themselves?

It worries me that the opposition to this stems from poorly conducted research and individual case studies. We need more research into the health needs of trans people, including youth, but that requires proper funding and resources. It does not need bitter acrimony and I would rather we paid attention to the needs of the people before us, rather than thinking we know better than they do what their gender identity is or ought to be. I had a conversation about this with another queer cis psychologist of colour and they had this to add:

"I find it really disheartening that people who should be trained to be curious and exploratory - and frankly should know better as a result -are relinquishing the opportunity to work with others on their liberation. For some reason, they’re not willing to look deeper into the worlds and feelings of people who are confined to the bodies they are not sure they belong in, but instead look to attack those people who need assistance to unlock themselves from an incongruent way of living. 

Hiding behind their own feelings, without deeper exploration of their upset, hurt and anger, they lash out and use a biological essentialist argument - which we know not to be true - in the pursuit of binaries that hold no space for atypically biological and gendered people (as opposed to typically male and female bodies.)

I find it sad that, from what I can understand, these attacks and inability to see the humanity in others comes from a place of relative privilege and an unwillingness to help one's fellow human into being, less it diminishes their own relative position in a social hierarchy. I suppose it’s hard to acknowledge one's own sense of suffering and dare I say, identification with oppression, so it becomes easier to form feelings against that - to other oneself from that pain."

These are strong words I know, but these practices have very real and lived consequences for the trans and non-binary people I know, love and respect. They also have very real consequences for the likes of me. Seeing some of the arguments against inclusion of trans people in safe spaces by certain high-profile psychologists and their invalidation of diverse gender identities remind me of the heterosexist behaviour I have long put up with on my way in to the profession, which led me to hide myself for the sake of self-preservation. That can be exhausting and I can see things that I have learned from inclusive and kind queer spaces that I have been privileged to be part of, which I use to help people as a psychologist. I would love to share that with others in the fields I work in and collaborate with them to create practices and spaces that are even better. 

However, this kind of behaviour leads me to feel a bit vulnerable and I find myself testing the waters to know if I am safe to bring that experience in and to honour those that have worked so hard to create such lovely spaces that I have learned from in the first place. I do not think this dilemma should be necessary for me to navigate and I think it contributes to the pathologisation of queer communities.

Some of the arguments also remind me of how psychology as a profession has actively harmed lesbian, gay and bisexual people; professionals thinking they know that someone is 'really' gay (or not) and deciding for them that it would be in their 'best interests' to make them straight. At times, mental health professionals still conflate sexual minority identity with mental illness and it does feel like transphobia is the acceptable face of prejudice towards queer people. I am wary of the harm that we can cause, even unwittingly, and strive to address this. 

Thankfully the people I work with closely do care and strive to do better, but it does not take much to make careless comments and that can make a huge impact on trust and willingness to engage. This is particularly so amongst trans youth of colour, who may be most likely to become homeless and least likely to get gender affirming care, even as things stand.

We have righted some wrongs, by banning conversion therapy (eventually) and recognising structural disadvantage. However, we can be infected by fear and prejudice as much as any of the people we strive to help. We can also be silent and complicit in the oppression of marginalised groups and it is important we speak up. It's important we continue to address cisnormativity and heteronormativity in our services and appreciate that we as queer people are looking for cues to indicate that the people we work with and go to for support will affirm and support us sensitively and effectively. 

I'm not just speaking for the sake of clients here, but for us as LGBT+ psychologists in the profession. We will all make mistakes and it is important that we are able to address them kindly and compassionately in good faith, but in the context of escalating transphobia they can become more loaded and this gets harder to do. So this is ultimately written in the hope that we can move beyond this and continue making positive progress.


Robin
As a queer, gender-questioning person and clinical psychologist, I’ve felt increasingly alienated, disaffected and disillusioned by repeated transphobic perspectives being shared within clinical psychology and how this is being tolerated and platformed within the profession. 

Individuals continue to defend their views as not transphobic, whilst ignoring trans people’s own definitions of what constitutes transphobia and their lived experience of it.
I have withdrawn from online psychology spaces that I used to participate in for fear of reading more transphobic posts where fellow psychologists are either in agreement or are silent in response. It’s disturbing to see views being expressed which would be immediately flagged for moderation in other online spaces that I participate in, which are not exclusively LGBTQ+, but which are thoughtful about the experiences of marginalised folks and are trauma-informed. What is different about these other online communities that clinical psychologists are missing the boat on? Are we even aware of just how short we are falling from the mark?

Clinical psychology has been more than a job for me, it has felt like an important aspect of my identity and bridges the personal and professional. Many of us feel called to the profession for deeply personal reasons. It is disorientating to feel such a clash in my identity. 

As a queer person, I have begun to feel conflicted about my membership of a profession in which powerful and respected individuals are giving voice to transphobia, unchallenged, especially where some of those individuals inspired and influenced me in my professional journey. I feel great shame about harm being done by fellow clinical psychologists.
As a profession we are very privileged; overwhelmingly white and middle class, typically occupying many axes of privilege. Recently, people have begun to acknowledge and reflect on their white privilege but we don’t seem to be close to reflecting on cis privilege and how that operates. Anti-racist, critical psychology voices have expressed transphobic sentiments. We are still so far from intersectionality. 

It is deflating to see - given our profession’s history in oppressing Black, learning disabled and homosexual people - how our perceived 'expertise', and 'neutral professionalism' continues to blind us and give us a sense that we are an authority to speak on the lives of marginalised people (formulate), othering them in the process. Whilst queer professionals can operate within cisnormativity and cis privilege, we can also bring sensitivity to the topic of gender identity, by reflecting on our own experiences of homophobia.

I am used to struggling with feeling complicit in harmful systems but clinical psychology has been where I feel a kinship in values and allies in change. In particular, critical psychology has felt like an important home and source of allyship, but is now an area where I have begun to feel most unsafe. As a feminist, critical psychologist, it is disturbing to see my beliefs and values twisted to be used against trans people. We need to critique the systems and structures which they are trapped within and must painfully navigate, and affirm their right to live on their own terms.

Trans and gender diverse people are beautiful, which anyone who has spent substantial time in trans communities would know, rather than encountering them solely in clinics, the media, research or academic theory. For LGBTQ+ psychologists, these are not just our service users or 'interesting issues' to debate about; they may be our friends, our family, our partners, us. Trans and gender diverse people have taught me a lot about my own gender. 

We are in the midst of a gender revolution and it has the power to be a beautiful, liberating experience, if we can learn to be humble and open to it.

We are but four queer psychologists from a much wider community and our views and experiences will not reflect all LGBTQ+ psychologists. We invite others, especially trans and gender-diverse people, to share their reflections and experiences in the comments section if they are able and willing to do so.