Open Letter Regarding CAPPP Training Event: Working with Transgender Clients with Lynda Quick

I am writing this open letter to express my concerns regarding the training organised by CAPPP with Lynda Quick to take place on Saturday 19^th November about working with transgender clients (https://cappp.co.uk/event/working-with-transgender-clients-with-lynda-quick-2/).

Before I outline my concerns, I want to explain why I am communicating these in an open letter, rather than using a direct and private complaint as a first point of call. This is because I believe it of the utmost importance to convey a message both to trans, nonbinary, and gender-diverse members of the public, and to (potential) attendees of the training. (I will subsequently refer to trans people as an umbrella term, including nonbinary and other gender-diverse experiences such as genderfluidity within this umbrella. I recognise and acknowledge that this use of an umbrella term is itself imperfect, and commit to adapting my language as consensus about the most appropriate and sensitive language evolves within the community.)

On the 17^th October I became aware that non-CAPPP member, non-therapist members of the trans community were seeing adverts for this training, and heard not only the upset, but profound disquiet regarding the contents of the training as described in the advert. It is already common for trans people’s relationship with those in the (so-called) “helping professions” to be uneasy and distrustful, resulting from experiences of gatekeeping and medicalisation, and what was read in the advert fed into these experiences and confirmed the reasoning for distrust. As a result of the uneasy relationship and troubled experiences, many trans people will no seek support from counsellors or psychotherapists when this may have been of support to them. I therefore believe it is important to communicate publicly about this matter such that individuals across the umbrella of the trans community have the chance to see that many therapists are not in agreement with the stances suggested by the advert, and that we are willing to speak out to support the community, whether or not we ourselves are directly affected.

I am confident that there will be practitioners attending the training (or considering doing so) who have a genuine desire to develop their practice to be more supportive of trans people. My message to these practitioners is that it is vital to be aware that this training is far from a be all and end all regarding working with trans people. My hope is that the responses to this letter of other therapist signatories working with trans people goes some way to reflect that there is good-enough practice and thinking out there. The remainder of this letter will highlight key points of what I find troubling about the advert; perhaps these points will also support you in growing your understanding of the population.

I first highlight that the outline of the workshop reads to me as giving a highly medicalised view of trans experience. It can be helpful to understand the medicalised aspect of trans people’s lives, but it is just that – an aspect. Some trans people have a more medicalised or less medicalised way of talking about their transition, but to limit our learning about trans people to solely a medicalised narrative is reductionist, and does not prepare us for working with the many other things that happen in trans people’s lives. This problem would concern me less were the training not advertised as such a broad introduction to working with trans people, and the title and advert more open about a medicalised focus.

The advert states that “[g]ender reassignment has been described as a selfish experience”. This is true: such descriptions emanate both in public arenas and in the interpersonal lives of trans people. What is shocking to me is the manner in which the paragraph launched by this statement continues as if the description is accurate and useful. Many trans people are faced with cisgender (cis) people around them repeatedly demanding that the trans person thinks about how their transition affects others. It could be very reasonably argued that these are examples of cis people being selfish about transition.

Even when these demands are not being made, transition is a deeply interpersonal experience, with others’ acts such as naming and pronouning playing a significant role. It is therefore absolutely commonplace for trans people to think about others as they take steps to transition, considering what communication will be effective for communicating changes in a way such that those around them are able to adapt.

The language of “quality of life” is also worthy of examination. There can indeed be serious negative ramifications to transition such as being cut off by family, socially isolated, an impact on job prospects, and more besides. However, the language of the advert, of selfish trans people failing to think about these, reads to me as a serious incident of gaslighting – blaming the target of abuse for the abuse they experience. To find such gaslighting seemingly recommended to be undertaken by therapists is deeply disturbing. When looked at in this light, I find what seems to be recommended here profoundly unethical.

The use of language that gaslights trans people is particularly worrying in the current political climate, in which trans people are commonly demonised by politicians, the media, and other public figures with prominent platforms. It concerns me that CAPPP are promoting training in practice that plays into these demonising narratives, and, as such, perpetuates and indeed contributes to the risk of harm to trans people; not only is gaslighting in therapy sessions a harmful practice, but giving further platform to such narratives increases the risks to safety faced by trans people on a day to day basis.

Finally, I wish to comment on the graphic selected for use with this advert, of plastic figures with lightbulbs instead of either breast tissue or genitals. This graphic actually made me laugh out loud, seeming to me to rise to a level of self-satire, taking the reductionism of a medicalised model to even greater heights by reducing trans people to our primary and/or secondary sexual characteristics. Such a sexual-characteristics-focused view of trans people is drastically less common within the trans than the cis population. For example, while no trans person has asked me invasive questions about my genitals without valid reason and a respectful attitude, many cis people have, including on first meeting me. My personal experience on this matter is shared by many other trans people, and suggests that it is not the trans community who are fixated on our sexual characteristics, but others looking in, sexualising and reducing our experience.

I end with my view on the image used linking back to the reductionism of my initial point made about medicalisation and reductionism.

To link back to my initial arguments for making this letter public, I hope these points can support therapist readers in thinking critically about the narratives we see and hear regarding trans people, and about developing rounded rather than reductionist practices with the population. To trans readers, I am sorry that as a profession we have let the community down again. I hope that you can find some hope from the voices of therapists who are speaking up and trying to build better practice.

I welcome and encourage people to comment as a way of signing and adding your own points in support of this letter. I particularly encourage cis allies to show your support. Perspectives from people whose loved-ones have transitioned (or plan to do so) would also be much appreciated – while the impact on yourselves was not my central concern, I do believe your experiences have also be reduced, and your own voices are therefore very much welcomed and valued in support here.

Warm wishes,

Francis Myerscough

Francis is an HCPC-Registered Music Therapist, and founder of Phoenix Song Project, a community-led music therapy organisation by and for trans and nonbinary communities. They are research active, have spoken (European Music Therapy Conference 2022, Bochum Salus Project Intersectionality Summer School) and have forthcoming publications internationally (Music Therapy Perspectives, Oxford Handbook of Queer and Trans Music Therapy, British Journal of Music Therapy) with regard to inclusive practices in music therapy, and particularly concerning experiences of gender diversity and so-called “invisible” disability.