By Dr Carole Sherwood, Save Mental Health
When the final report of the Cass Review was published on 10th April 2024, many of us hoped this would be a turning point. After the scandal that had led to the closure of the Tavistock GIDS clinic, at last it seemed that children and young people with gender-related distress would finally receive the high quality, evidence-based care they need and deserve.
In her report, Dr Cass noted that: ‘some professional organisations have ducked their responsibility in ensuring that everyone working in this field treated these young people as they would any other’. She called on these organisations to ‘come together to provide leadership and guidance’ to ensure that the report’s recommendations could be implemented.
How have the main therapeutic organisations responded? The British Association for Counselling and Psychotherapy (BACP) has not yet responded at all. When questioned, a senior manager in the organisation claimed that the Review’s findings were “primarily about medical pathways and interventions” and that its members “have no role in either”. This is simply not true as Dr Cass recommends psycho-social support as the first line of treatment. It’s as though the BACP has turned its back on her report with a shrug and said, ‘nothing to see here’.
The British Psychological Society (BPS) on the other hand, sent out mixed messages. On the day the Cass Review final report was published, the BPS’s President-Elect greeted it with a glowing commendation. Yet the Chair of the BPS Sexualities section announced on his social media account that this was a “Bad day for trans youth” This is the clinician who described the NHS’s decision to stop prescribing puberty blockers to children and young people as “bigotry” and likened gender critical therapists to “misogynists” and “incels”. Other senior clinicians in the BPS share his gender-affirming views.
The UK Council for Counselling and Psychotherapy (UKCP), while supportive of the Cass Review, lost its Chair Dr Christian Buckland, and was at risk of losing its entire Board of Trustees, when a group of activist therapists called Therapists against Conversion Therapy and Transphobia forced a vote of no confidence in the Board. Why did this happen? The UKCP had withdrawn its signature from a five-page policy document called the Memorandum of Understanding (MoU) on Conversion Therapy, citing concerns about the safety and welfare of children.
The MoU on Conversion Therapy represents a major obstacle to the implementation of the Cass Review’s recommendations. The reason for this is that it equates exploratory therapy with conversion therapy. In all other areas of psychology and psychotherapy, exploratory therapy is considered best practice.
The MoU was created in 2015 in response to an actual case of conversion therapy. At this time, the document was limited to sexual orientation and applied only to adults. In 2017 the MoU was extended to include gender identity. Then in 2022 it was revised to include children and young people.
The UKCP was not aware that children had been added to the MoU until earlier this year when, following repeated requests for clarification, it was finally confirmed. The UKCP then withdrew its signature explaining that children’s needs are distinct from those of adults.
In its current form, the MoU on Conversion Therapy represents a major obstacle to the implementation of the Cass Review’s recommendations. The reason for this is that it equates exploratory therapy with conversion therapy. In all other areas of psychology and psychotherapy, exploratory therapy is considered best practice. Dr Cass made it clear that having open, exploratory conversations with children and young people about their choices was ‘essential’.
Young people referred to gender clinics often present with a range of complex mental health problems and other factors that contribute to their distress. These need to be thoroughly explored and therapists must be able to have open conversations to establish what is causing a young person’s distress. A particular concern cited by Dr Cass, is that a high percentage of young people referred to the GIDS clinic were same-sex attracted. Nonetheless, they were put on a medicalised pathway. Hannah Barnes in her book ‘Time to Think’ reports that one clinician feared GIDS was performing “conversion therapy for gay kids”. This is unethical.
Yet the new Labour government proposes to introduce a ‘trans-inclusive’ conversion therapy ban. The activist network behind the MoU has strong links to government and is undoubtedly campaigning for the ban. As clinical psychologist Dr Anna Hutchinson has warned: “We cannot both implement Cass and accede to these campaigners demands”. She urges all political parties calling for a law banning conversion therapy to ensure that they are “well-informed” in order to “best help younger people”. The government would do well to heed her warnings. The future of thousands of young people awaiting care for gender-related distress depends upon it.
Carole Sherwood, DClinPsy
Dr Carole Sherwood is a UK-based clinical psychologist. She previously worked for the NHS, specialising in HIV, sexual health, trauma, chronic pain, cancer and palliative care. She now has her own independent practice where she provides clinical supervision. In recent years, Carole has focused on the increasing politicisation of the psychology professions, co-authoring in 2022 an independent report, ‘The Politicisation of Clinical Psychology Training Courses in the UK’, with Dr Kirsty Miller. She contributed to the book ‘Cynical Therapies: Perspectives on the Antitherapeutic nature of Critical Social Justice.’ Carole is a co-director of Critical Therapy Antidote. She is also a member of the Advisory Council for Don’t Divide Us, and founder of the UK campaign Save Mental Health.