Sexuality and Gender for Mental Health Professionals

A Practical Guide

Christina Richards, Meg Barker

• Publisher: SAGE Publications Ltd
• Year: 2013
• ISBN:
  9781446293133
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

Questions of sexuality and gender affect everyone and therefore have an inevitable relevance in the consulting room. Yet with interpretations and manifestations of both varying greatly from person to person, understanding the inherent complexities of sexuality and gender can be a daunting task for the health professional. Breaking down these complexities this practical guide familiarises the reader with all of the common and many of the less common sexualities, genders and relationship forms, and explains experiences and issues relating to each. The book contains:

-Explanations of various forms of sexuality, gender and relationship structures

-Common concerns relating to specific groups

-Key practises relating to specific groups

-The treatment of specific groups in contemporary Western society

-Details of some rules and ideals that are commonly found within specific groups

-Suggestions for professional practice with these groups

Ideal for all members of the multidisciplinary team, this accessible book is relevant to practitioners across theoretical backgrounds. Whether you are a trainee or qualified psychotherapist, counsellor, nurse, medic, psychiatrist, social worker or applied psychologist, this is a vital text for your professional practice.
CHRISTINA RICHARDS is Senior Specialist Psychology Associate at the West London Mental Health NHS Trust (Charing Cross) Gender Identity Clinic. MEG BARKER is a senior lecturer in psychology at the Open University and a sex and relationship therapist.

INTRODUCTION

Gender and sexuality are complex, and contested, to the point at which no definition can adequately encompass them. They have excited debate in academia, medicine, psychology and the personal, legal and political domains, as well as elsewhere, and no doubt will continue to do so for the foreseeable future. Of course, this creates a quandary for the busy professional who needs quick, accessible information on these important topics in order to go about the business of their day-to-day work. Should one reach for academic theoretical texts, which may be lengthy and not grounded in the reality of clients’ lives, or for a concise clinical text which risks compromising complexity through brevity? Or should one look to community literatures which give a grounded view, but may miss aspects relevant to clinical decision making? To some extent the answer is “Yes”. Given time, professionals should engage with all of these literatures, and indeed in order to become a specialist one would certainly need to. In this book, however, we have included something of each so that professionals can be confident of having a basic understanding, in a reasonable period of time, and a direction for future education as time and necessity dictate.

THE CONTENT

Most books for professionals in this area that we have come across have approached the topics in one of two ways. Some describe ‘normal’ human sexuality and/or gender and include much briefer mention of those who fall outside of this in some way (quite often in a tokenistic and/or pathologising manner). Others focus specifically on genders and sexualities which fall outside of normativity, for example concentrating on sexual and gender minorities. In this book we have adopted a third way, giving equal consideration to the diversity of sexualities, genders and relationship structures, including those which are more and less normative in wider society, and considering how such norms shift across time and within different groups. Of course no book could give complete coverage to all possible identities and practices, and we have been forced, of practical necessity, to include some generalisation where in fact there is complexity, and to avoid some repetition (where practices and identities have similar issues) in service of readability. We hope, however, that we have included in an accessible manner most of the identities and practices that a professional is likely to come across during the course of their career, and have also provided the necessary information to find out more on each item.

Gender, sexuality and relationships are of relevance for everyone, whether we see ourselves as located within the ‘norms’ of remaining a masculine man or a feminine woman throughout our life, of being heterosexual, and of aiming for a monogamous committed relationship; or whether we are located outside of this in some way, for example in the case of lesbian, gay, bisexual and transgender (LGBT) people, or those who challenge conventional ideals of sexuality, gender and relationships in other ways, such as asexual people (who don’t experience sexual attraction), those who operate outside the dichotomy of men and women, or who question the divisions between romantic and other kinds of relationships. In all of these situations people engage with sexuality, gender and relationships.

Wider views of all these areas have also shifted markedly in the last few decades, for example in: changes in gender equality; societal acceptance and recognition of diverse genders, sexualities and relationship forms; and the increased prominence that sex and romantic relationships have been afforded (the sexualisation of culture and the idea that it is imperative to be in a couple). This means that people are more aware of the various identities and practices that are possible in all these areas, and also that they may experience more anxiety about them.

Those who fit within the ‘norms’ may worry about how well they fit, attempt to fit too rigidly, and experience difficulties when they don’t adapt to wider cultural shifts. Those who are ‘outside the norm’ in some way may experience tensions with others (including experiences of discrimination and alienation), pressures to conform in other ways, and questions about how to live their identities and practices without much of a rulebook.

Consequently gender, sexuality and relationships can relate to the kinds of problems that people present with in a variety of ways, and it can also be difficult to determine when they are of relevance, and how. For example, one person may not find being something other than heterosexual and cisgender (see Glossary) remotely difficult; another might struggle due to concrete experiences of prejudice and discrimination from those around them; and another’s difficulties might be related more to their own anxieties about how others might treat them. Some people have rigid assumptions about what it means to be a man or a woman and become very distressed trying to match up to these, while others might flexibly engage with masculinity or femininity, and others find different ways of conceptualising gender which are more congruent.

For readability we have kept references to a minimum and focus on providing further reading for those who wish to engage in further education. However, all the chapters are grounded thoroughly in the relevant research literatures and in existing guidance from national psychological, psychiatric and therapeutic bodies. We have also drawn upon community literatures in order to consider the group norms and diversities of experience in each area, and – of course – brought in our own clinical experience.

TERMINOLOGY

The book focuses on the overlapping areas of gender, sexuality and relationships in its three main sections, and we expand upon the ways that these link together throughout. By gender we mean a person’s sense of their own identity in relation to being a man or a woman, or identities beyond this conventional gender dichotomy (see Chapter 5). We cover the relationship between gender and biological sex in more depth throughout the first section of the book, and particularly in Chapter 3. The term sexuality refers to types of sexual attraction, identity and practice as well as to people who do not experience attraction. By relationships, we mean primarily romantic relationships which are either monogamous or non-monogamous in structure (see Chapters 13 and 14).

PRACTICES AND IDENTITIES

We differentiate between practices and identities throughout the book. People may practise something (and indeed be very good at it), but do not have it as an identity. For an (non-sexual¹) example; the first author likes to toast, that is she likes to heat bread and then cover it in butter and marmalade for breakfast. She clearly toasts (practice), but does not define as a toaster (identity). Similarly, many people have played computer games, maybe on a console at a party, or minesweeper or solitaire on the office computer or a mobile phone app. Such people do not define as gamers (identity), even though they do game (practice). In contrast some people buy magazines and attend large gaming conventions as well as having advanced computers. They may queue up at midnight for the latest game release. They are gamers (identity), usually for the things that they do in addition to their actual gaming. Indeed when queuing up at midnight for the latest game (and so not at their computer) they would state that they are still gamers – it is who they are, not what they happen to be doing. This is exactly analogous with sexuality. A man may have sex with another man (practice) and define as something other than gay or bisexual (identity). For this reason sexual health professionals have terms such as MSM (men who have sex with men) and MSMW (men who have sex with men and women) as these terms do not denote identity, but simply practice.

SAFER AND LESS SAFE TERMS

We have ensured throughout the text that safe, or perhaps we should say safer², terms are included in italics in the first instance. Thus we have gay as a safe term and gay thereafter. In contrast, unsafe terms, or terms which relate to a problematic concept (either generally or in that specific instance), are usually in ‘scare quotes’. For example, ‘homosexual’ is in scare quotes because gay or lesbian are the preferred terms. (For this reason translators rather than interpreters are often preferred in professional practice as if you say ‘gay’ to a client it would be unfortunate if it was communicated as ‘homosexual’). Italics have also occasionally been used for emphasis – as above with safer, but are never used with an unsafe term.

We do recognise that some compassionate professionals may disagree with aspects of the material, perhaps particularly the terminology. In all cases the specific instance with a particular client is paramount. For example, you may come across a client who expresses a preference for an identity term which we have included in scare quotes. Of course we cannot comment on what you do within the intricacy of the situation in front of you. Nonetheless some general guide is needed, and we have gone with language which is currently most prevalent among the groups and communities concerned. To avoid confusion we have included direct quotes, that is those things that people have actually said, or might say, are in “double quotation marks”.

One possible point of confusion is around our use of scare quotes for ‘same gender’ and ‘other gender’. This is done because gender is such a complex matter that even if both parties identify as men, for example, they will not necessarily be the ‘same’. Similarly, as there are people who identify outside of the man/woman gender dichotomy, and as there are many overlaps between men and women, the phrase ‘other gender’ becomes problematic. This is covered in more depth in the first section of the book.

While we generally aim to use accessible and familiar language where possible, we have used some terms which may be unfamiliar to the reader. Therefore there is both a standard glossary and a shadow glossary at the end of the book to aid the reader. The shadow glossary is for terms which are generally not safe. They may be reclaimed and used by clients in which case you may feel free to use them with that client, but not to use them for other clients. This remains the case even if you yourself identify with them.

It is worth becoming comfortable with sexual terms in general. Indeed one should be able to use them with a client without feeling embarrassed simply for using a word. Try saying “fuck” or “cunt” out loud now (we’re assuming you’re not reading this on a train or waiting for a PTA meeting). How do you feel? Could you do it at all?

One of the best ways to establish rapport with a client is to be genuinely matter-of-fact about any aspect of their gender, sexuality or relationship. This does not mean being ‘tolerant’ or ‘accepting’ – only people in positions of power are able to be these things and a sense of this can therefore reinforce a problematic power hierarchy. Similarly, it is important not to use inappropriate words or to mispronounce words. Some people seem to consistently mispronounce words, perhaps because they are unfamiliar, or perhaps to distance themselves from a threatening concept. For example, people might speak of a person’s ‘sec-sue-ality’ (rather than sexuality) or mispronounce ‘poly- aim-ory’ (rather than polyamory), or hyphenate ‘bi-sexual’ (rather than bisexual). Such practices should be avoided. Similarly, it is not acceptable to turn an adjective or a verb into a noun – a person is a gay man, or a trans woman (when their sexuality or gender is pertinent respectively – otherwise they are a simply a man or a woman). They are not ‘a gay’ or ‘a transsexual’: they will doubtless have a raft of other qualities beyond their sexuality or gender.

We have used the words professional and practitioner throughout the book to be as inclusive as possible of all people working in the field, be they counsellors, psychologists, physicians, psychiatrists, therapists, primary care workers, nurses, social workers, etc. We have used client throughout rather than patient, as it is hopefully the most inclusive word for people who may present to any of the above listed professionals.

PATHOLOGY

Gender, sexuality and relationships have long been associated with law and medicine, and each chapter makes reference to how each group has been viewed by these professions. However, it is important to recognise that none of the sexualities, genders or relationship structures that we cover are problematic (or pathological) per se. Consequently, professionals should generally assume that any of the identities and practices covered in this book are irrelevant to the issue before them unless presented otherwise (and should make notes accordingly, leaving out mention of the identity/practice unless directly relevant).

For the non-normative identities and practices that we cover, as mentioned previously, it is possible that clients will experience problems because of the tension between what they’re doing and societal pressures (sometimes called minority stress³), while for the normative ones it is possible that clients will experience problems because of trying to follow a rigid version (in order to remain regarded as ‘normal’). This is a most important point.

In this book we cover some identities/practices which are widely regarded as ‘normal’ and some that are widely seen as ‘not normal’. For people within the norm, problems are generally assumed not to be related to their identities and/or practices, when in fact they might well be – whereas for people outside the norm, problems are ...

Table of contents

• Cover Page
• Halftitle
• Advertisement
• Title
• Copyright
• Contents
• About the Authors
• Acknowledgements
• 1 Introduction
• Section 1 – Gender Practices and Identities
• Section 2 – Sexuality: Practices and Identities
• Section 3 – Relationship Structures
• Glossary
• Shadow Glossary
• Index