This blog is on a subject I have deliberately avoided in the past. The main reason for that when this subject has been discussed by me, in groups or with another therapist, I often end up feeling like I am in some way sexist, stupid or unethical.
It is therefore a bit of a risk for me to broach this publicly on my blog (even though it is only read by around 8 people currently!), but I feel very strongly around this subject and the people I meet and the work I do in my private practice continually confirms many of the points I hold as true, as being valid.
Right, I have avoided enough, I will name that which scares me!
Single sex counselling services.
By this I mean organisations that have either all male or all female staff, the majority of these are all female in terms of staff, but some will take on male clients, though not all will do this.
Even as I write that, I can feel my frustration grow as the sentence implies immediately that if someone has been hurt, neglected or abused by someone of a specific gender, they cannot then be treated effectively by a person of that gender, which as I type just sounds like complete nonsense.
Most of these services and the people who work within them are confident that if a person has been subjected to sexual violence, emotional or psychological abuse by a man, then they should not and cannot be treated by a man due to the risk of re-traumatisation or the client feeling too scared (having too much negative transference) for an effective therapeutic relationship to develop.
While a very simplistic view, I agree that they will be a number of clients entering such a service that would meet that particular set of criteria and it would not be of benefit for them to be faced with a male therapist if they had experienced a recent trauma through the actions of a man.
However, I think that people and the way they process their experiences are so much more complicated and unique than this kind of thinking and organisation plans for.
When working with trauma, one must also take into account that persons experiences in childhood. Did they have secure attachments with their caregivers? Is their pattern of attachment insecure, ambivalent, disorganised? Did they have experiences as a child that may be influencing their reaction to their more recent experiences? Have they ever had an attachment or experiences around a person of the same gender that may have been damaging to them psychologically? Are their vulnerabilities and insecurities able to be addressed by someone of the same gender, or would they be exacerbated because of their previous experiences of people of the same gender. Most importantly of all, what does the client want?
Will the sum total of the clients experience mean that even though they have had more recent experience of abuse at the hands of a person of the opposite gender, as they present to you, are they are actually more impacted by their experiences of attachment figures of the same gender? If they are, then they will likely want to work with a therapist of the opposite gender.
I have worked with many people who experienced sexual or physical abuse as a child at the hands of their father, but as adults have found that their experience of and relationship with their mother was such that when they came to working with a woman they were not able to trust them or engage with them positively. However, a large part of the work they needed to do was around their attachment and experience of being with, and around a male, and this work is often much easier and more psychologically congruent, to do with a man.
This is not a one size fits all scenario here. Some women need to work with a female counsellor. Some men need to work with a male counsellor. I am not a fan of single sex counselling services but appreciate they can really help some women and men feel safe and engage with the vital counselling they need and with as little re-traumatisation and drama as possible.
My one and only point here today is that this is not the case for every client and if a particular geographical area is serviced by only one rape and sexual violence service and they only offer female counsellors, then they are excluding a significant proportion of the clients who need that service from accessing them. Furthermore, if that client is not in a financial position to pay for their own therapy, then what do they do?
From where I sit, therapists and counsellors cannot afford to be binary and inflexible in their approach or organisation. Every client is different and will often have needs that are not met by a one size fits all approach, which is what a lot of the services and counsellors that are out there offer.
If I did that in my private practice, I have no doubt that I would be twiddling my thumbs for a large part of the week, rather than being in the position where I am having to organise a waiting list for the first time.
As a profession, counselling and therapy needs to be more open to the differing views and opinions of the people working in it, as well as the people accessing the services. The IAPT service that is provided by the NHS is collapsing under the weight of its inflexibility and the disastrous way it is managed and organised.
Despite this, I do not see the people at the top making the decisions learning from this. Counselling organisations continue to be run by managers, either by people with no practical experience of working in the field, or by terrible counsellors, who could not make a living as a counsellor so manage a service instead and squeeze as much money out of the people using it or funding it as they can.
My CV is replete with my history of working within different organisations. I have had a couple of good managers, but mostly I have had very bad managers, who cared more about statistics and money than the clients using the service. This is the main reason that I now work for myself as after thirteen years of failing to change things from the inside, I retreated and decided to help people and provide services to people that I know will help them and will be based on what they need, rather than what the organisation I work for is able to offer.
As a profession we need more flexibility and acceptance of difference in not only our clients, but also the therapists and counsellors that support those clients. Too many people have hard and fast, inflexible beliefs that are more suited to a medical model approach than a counselling and therapy-based approach.
Only when we appreciate fully the uniqueness and diversity of the many wonderful, varied and talented counsellors and therapists out there, will we be able to see the individuality and underlying need and vulnerability of our clients and then provide them with the support and service that will help them achieve what they wish to in the therapeutic space.
Single sex counselling services need this flexibility too, otherwise they risk alienating a significant proportion of the people who desperately need their service and as a result potentially re-enforcing the negatives around the individuals experience.
In the therapy world, nothing is ever black and white. The individual interpretation of experience will always mean that everything is a very subtle and often shifting shade of grey, I believe our approach to it and the way we work within it should be the same.