Professional skill does not exist in a vacuum

Tris Smith on guidelines.

I am concerned by the letter in the October issue advocating for a regressive change in the BPS guidelines around the treatment of LGBTQ individuals (‘Freedom of expression around diversity guidelines’). I am particularly concerned that the letter offered no evidence in support of this proposed change, instead invoking a need for freedom to use ‘professional skill’.

Thirty years ago homosexuality was considered a mental illness. Presumably professional skill would have suggested the ‘use of many core models (systemic, trauma-informed, developmental) in formulating the factors resulting in the clients’ presentation’, instead of professionals needing to integrate an affirmative stance into their practice?

Psychology and Psychiatry do not exist in a vacuum, and what is considered abnormal is partly a political decision. Regardless of a practitioner’s personal views, they must work in consensus with the populations they treat while respecting the culturally acceptable life choices of their clients. This ethos is unquestioned in relation to a variety of religious and philosophical perspectives.

It is well known that individuals from minorities – such as ethnic minorities – are disadvantaged in terms of mental health treatment (e.g. Royal College of Psychiatrists ‘Racism and mental health’, 2018). Perhaps this is in part because some clinicians feel that ‘professional skill’ can trump guidelines developed by experts in a field after a robust consultation process.

LGBTQ rights, and the rights of every other minority, is a political question. Psychological expertise cannot definitively answer political debates with a moral component – such as the acceptability of homosexuality or transgender identity. Individuals may wish to campaign for changes in political and societal attitudes, but this should be distinct from their clinical work. There are other settings to discuss politics, before discussing changes to interventions.

Psychologists may or may not share their patients’ beliefs, and psychologists may or may not live their lives in the same way as their patients, but psychologists should respect their patients’ choices unless there is good reason. Any ‘good reason’ must be decided by consensus and in consultation with minorities in order to avoid potential bias and prejudice – whether intentional or unintentional.

Tris Smith

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