An historic document was launched in Johannesburg this evening by the Psychological Society of South Africa. It is a set of practice guidelines for psychology professionals working with sexually and gender-diverse people, fleshing out a framework for ethical, reflective practice in an increasingly diverse, multicultural world. This is a first for Africa.
But is a specialised set of guidelines necessary? After all, South Africa protects sexual orientation in its Constitution, same-sex marriage is legal, gay and lesbian couples can adopt children, being gay or transgender is no longer pathologised in psychiatric diagnostic manuals and the visibility of lesbian, gay, bisexual, transgender and intersex (LGBTI) people is increasing, along with public awareness of how heteropatriarchy and privilege operate.
Professionals of all persuasions might also wonder how working with LGBTI individuals differs from working with anyone else — after all, being respectful, empathic and nonjudgmental is a basic professional requirement.
Didn’t the famous humanist psychotherapist Carl Rogers promote “unconditional positive regard” for all clients?
Even practitioners with no special training in contexts that affect LGBTI people, and who work with policy writing or curriculum design, might attest to simply doing what all competent psychological practitioners ought to do in new situations — namely, have an attitude of openness and curiosity, a willingness to learn and to keep one’s biases and prejudices in check. Most of us are, after all, well-meaning, educated, mature professionals with a moral compass. In this context, specialised guidelines for dealing with LGBTI clients might appear unnecessary.
But there is another side to our professional story.
The history of psychology is awkwardly littered with examples of gross human rights violations, even in the presence of explicit ethics codes. For example, as recently as 2015, members of the American Psychological Association (APA) were exposed for their involvement in the interrogation and torture of detainees at Guantanamo Bay. There is no shortage of formal ethics codes in the United States, yet this professional atrocity found a space to exist.
Closer to home, Hendrik Verwoerd, the architect of apartheid, was a psychologist. He deployed repressive psychological tactics disguised as science to support his warped worldview.
Apartheid existed for as long as it did partly because of the flawed reasoning that supported it, masquerading as psychological science. This was seen in, for example, using invalid psychometric tests that provided false evidence on the intelligence of black people, creating racist diagnostic labels such as “Bantu hysteria” and racial gatekeeping so that, in 1990, 90% of all psychologists in South Africa were white.
The history of gender and sexual diversity is a further embarrassing tale of psychology’s complicity in unscientific and unethical practice.
In South Africa, the Aversion Project was a medical torture programme run between 1971 and 1989, in which gay conscripts were submitted to chemical castration, electric shock treatment or forced “sex-change” surgery meant to “cure” them. It was only in 1978 that homosexuality was finally removed as a mental illness by the American Psychiatric Association. Attitudes, however, are stubborn.
Despite the paradigm shift, sexual orientation change efforts and quack reparative therapies flourish in the shadows. Despite progressive legislation, social attitudes are still entrenched in patriarchy, violence and homophobia.
The rape of lesbians by men who believe that they have the power to change a woman’s sexual orientation by raping her is the tip of the iceberg of violent hate crimes prevalent in society. Many religious organisations continue to use the pulpit to promulgate prejudicial propaganda.
Given that prejudice and hate crimes against LGBTI people continue unabated, the last refuge for many people may be psychological help.
It is essential that, whether practitioners are doing psychotherapy or counselling, carrying out research, teaching and supervising their students or writing policies, they remain cognisant of the specific stressors facing minority groups who live in a violently heteronormative world. Practitioners cannot be complicit in further harm, either deliberately or unintentionally.
Because of the current and historical scientific political climate they find themselves living in, it is evident that LGBTI individuals constitute a special population in need of added expertise and skills. By treating LGBTI patients, students or research participants “just like everybody else” we risk ignoring or denying the unique stressors that influence LGBTI experiences.
Highlighting the specificities of subgroups does not deny our commonalities and shared humanity. In the same way that the African psychology movement — which foregrounds the specific types of experiences shared mainly by black people because of their specific cultural and historical experiences of slavery, colonialism, post-colonialism, apartheid and imperialism — does not deny universal experiences that are shared across time and place.
These guidelines are a call for reflective practice. They start from a point of recognising that practitioners already have the foundational skills required to work effectively with LGBTI people but will benefit from continued professional development in this area that delves deeper into some of the nuances that can be easily misunderstood or taken for granted.
Reflective practitioners question their assumptions and biases about the ways in which they are making sense of their work, both in form and content.
For example, in debates about decolonising the curricula at universities, are we talking about the place of queer theory? Or, in designing parenting programmes, are we accommodating of same-sex couples? Or, in research or psychotherapy, do we understand the subjectively different lived experiences of a trans woman from Greenpoint in Cape Town and one from KwaMashu in Durban? Or, when administering a psychometric test, do we see the heteronormative assumptions certain questions are based on (sometimes as basic as only having a male and female tickbox)? Or, are schools creating spaces for free gender expression?
These are a sample of questions that need answering.
Like any road map, the guidelines are aspirational and can only chart the general direction to avoid becoming lost but cannot consider every unique situation we might find ourselves in. The potholes, speedbumps, crossroads and off-roads will be many. This is why reflection is a vital tool in our work processes. It sharpens our ability to be wise and humble, to know and not to know. The practice guidelines are a catalyst to help us learn and unlearn — to learn new ways of seeing and unlearn old ways of not seeing.
It is also a challenging invitation to recognise what we don’t know — namely our blind spots, prejudices, values, assumptions and the effect of how we have been raised, taught and supervised. These are ways in which our ability to be curious, respectful and open to diversity may have been limited.
Reflective practitioners are aware of the intersections of various forms of experience and identity that affect not only their clients, students and research participants but also themselves.
This is the privilege and the pleasure of having chosen the path of psychology — in improving our abilities to help others, we necessarily also help ourselves.
The set of practice guidelines can be downloaded here.
Suntosh R Pillay is a clinical psychologist in a public hospital and a co-author of Practice Guidelines for Psychology Professionals Working with Sexually and Gender-Diverse People, published by the Psychological Society of South Africa. He chairs the society’s equity and transformation committee