Diversity
Authored by Henry Strick van Linschoten
Human diversity is a reality – in psychotherapy, in sexuality, in the therapeutic relationship, and in relationships generally. Diversity is more often seen and defined too narrowly rather than too widely. Differences in genders, in ethnicity, in religion or spirituality, in class, in educational attainment, are more quickly identified. But these days there is a growing awareness of diversity in health, in personality, in able-bodiedness, in neurodiversity, in trauma and abuse background, in genes, in epigenetic, prenatal and perinatal history, in culture, in age… And last but not least, differences in sexuality, in orientation, in identity, in behaviour, in standards, in views about relationships.
Differences
The problem with diversity is not that it exists, i.e. that there are differences between people, but in what we do with them. In that respect the word ‘diversity’ is somewhat suspect, in that it can be used and is used as a euphemism, to deny, diminish or belittle the importance and severity of the issues. As long as we notice differences in a neutral way that is fine. The human mind operates cognitively to a great degree by noticing similarities and differences. But things go wrong when differences are arranged into a hierarchy of good and bad, better and worse, when they are the basis for applying prejudice, or when they trigger overwhelming feelings and we become cognitively impaired.
Dealing with differences is a real challenge for psychotherapists. Sexism (prejudice or discrimination based on a person’s sex or gender) can trouble the relationship on two counts: it is unethical; and it is likely to make the psychotherapy ineffective or impossible. Racism and ableism can be just as damaging, even when they are more indirectly related to sexuality and sexual or gender expression.
All forms of discrimination, prejudice and stigma are problems for the person, the group, or the societal structures who have the power and the privilege. They are not problems for the oppressed groups in the sense that they are the ones who need to change or adapt to the rulers / oppressors.
Intersectionality
Intersectionality can be defined as a full understanding of the complexity in living, people and relationships. It was given its name by Kimberlé Crenshaw in 1989, although the underlying concept had been around at least since the 1970s. Crenshaw (1989) is very clear and describes the essence. At its origin was Crenshaw’s statement that the feminist analysis of the discrimination suffered by women was insufficient for black women, and that the intersection of race and gender was linked to constitute a qualitatively different type of oppression. A recent book on intersectionality is Collins and Bilge (2016). More directly focused on sexuality and psychotherapy is das Nair (2012). Collins (2006) focuses on black sexual politics.
For the analysis of the structural basis of racism, “white privilege” (Bhopal, 2018; Eddo-Lodge, 2018) and “white fragility” (DiAngelo, 2018; Lipsitz, 2006) are key concepts. These books are important material for therapists to read, and are directly applicable to our work.
Diversity poses many issues for psychotherapists, more than can be discussed in this section. A major helpful insight is the idea that statistical frequency, and descriptive observation of how a majority of people choose to act, are not a good guide for norms and standards to set about what people express, nor of how an individual behaves, or of what can be expected of one individual human being. Being red-haired, being Jewish, being gay, being neuro-diverse, differences of sex development, are all statistically “qualities” of minorities. None of them justify discrimination, exploitation, or a limitation of people’s human rights and autonomy. The equal rights accorded to all humans in the Universal Declaration of Human Rights and the International Covenant on Civil and Political Rights make no distinction between differences which are unalterable and fixed, and ones that are the result of personal choices and decisions made by a person.
Clearly within the general spectrum of diversity, it behoves counsellors and psychotherapists to be deeply non-judgemental and accepting of the diversity of their clients in all respects, including their gender, sexuality, sexual and relational behaviour, as well as in their feelings and fantasies. This may not always be easy for the counsellor, especially if they differ substantially from their client, if they have different values, or if they have neither experience nor much knowledge of aspects of the identity and behaviours of a particular client. This goes so far as to mean that if there is enough difference, or lack of knowledge about aspects of a client or prospective client, a therapist may be under a clear ethical obligation to refer the client to another more knowledgeable, more similar or congruent practitioner.
So-called “conversion therapies”
There has been substantial clarification of the position of psychotherapy concerning so-called “conversion therapies” set out in the UK’s “MoU on Conversion Therapy in the UK” of October 2017 (Conversion Therapy, 2017). This clarifies the position on the whole range of expressions of gender identity and sexual orientation, for which it is stated that any forms of therapy designed to change them are unethical; such forms of therapy are also held to be potentially harmful. This is a major source of guidance, certainly in the UK, but valuable to consider in all countries, as to the attitude to take to the widest range of diversity in sexuality and gender of our clients.
Conclusion
The following conclusions can be formulated about the implications of gender and sexual diversity for counselling:
- Therapists should not judge their clients or attempt to change them as regards their sexuality or gender. On the other hand, reflective clarification of uncertainty can be a very positive contribution, when clearly called for.
- When working with clients who are very different, therapists should not use the therapy as a way of learning about diversity for themselves. Beyond a certain point therapists need to refer to others who have experience with a particular community or range of behaviours that they are unfamiliar with.
- It must be possible for the therapist to be neutrally and empathically present to narratives and parts of life in which clients talk about what they are doing in their relationships and sexual activity, even with major differences with the counsellor. Changing how people are is not on the agenda – the focus of therapy must be on the aspects of their client’s life that the client wants to work on.
The diversity that the counsellor has to accept and deal with, extends to the field of relationships – although that received much less attention in the recent Conversion Therapy (2017) MoU. It is sometimes held, especially by people with a religious affiliation, that sex must only take place embedded in a highly mutual, interactive, long-term, emotionally close and stable relationship. This is then contrasted with sex where there is less intimacy and commitment, and where the (sexual) partner or partners may be substantially objectified. Examples include anonymous sex, “swinging”, “polyamory” or (ethical) non-monogamy, and certain paraphilias (formerly called “perversions”) – distinguished, as in the latest DSM-5, from paraphilic disorders in which people are severely distressed, or do harm to others. Commercial aspects of sexual activity, up to and including forms of sex work (not “prostitution”) also need to be re-evaluated and seen in a new light. Dimen (2003), a clinical psychologist and relational psychoanalytic psychotherapist, is vociferous in her warning to avoid the idea of intersubjectivity as a new orthodoxy and a new semi-religious standard of judgement for sexual and intimate relationships. As was Benjamin (1988), half a generation earlier.
References
Benjamin, J. (1988). The bonds of love: Psychoanalysis, feminism, and the problem of domination. New York: Pantheon Books.
Bhopal, K. (2018). White privilege: The myth of a post-racial society. Bristol: Policy Press.
Collins, P. H. (2006). From black power to hip hop: Racism, nationalism, and feminism. Philadelphia, PA: Temple University Press.
Collins, P. H., & Bilge, S. (2016). Intersectionality. Cambridge, UK: Polity Press.
Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 1989(8, 1), 139–167. Retrieved from https://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8/
das Nair, R., & Butler, C. (Eds.). (2012). Intersectionality, sexuality and psychological therapies: Working with lesbian, gay and bisexual diversity. Chichester, West Sussex: Wiley-Blackwell.
DiAngelo, R. (2018). White fragility: Why it’s so hard for white people to talk about racism. Boston, MA: Beacon Press.
Dimen, M. (2003). Sexuality, intimacy, power. Haworth, NJ: The Analytic Press.
Eddo-Lodge, R. (2018). Why I’m no longer talking to white people about race. London: Bloomsbury.
Lipsitz, G. (2006). The possessive investment in whiteness: How white people profit from identity politics (2nd ed.). Philadelphia, PA: Temple University Press.
Memorandum of Understanding on Conversion Therapy in the UK Version 2. (2017). Retrieved from https://www.bps.org.uk/sites/bps.org.uk/files/Policy/Policy%20-%20Files/BPS%20Memorandum%20of%20Understanding%20on%20Conversion%20Therapy%20in%20the%20UK%202.PDF