Author: ncfed

Scenario: A learner on a counselling course has expressed gender realist/critical beliefs online or elsewhere. Transwomen in general were described as ersatz (an inferior substitute for the real thing) or, pretending to be women. Students on the course who are offended by these statements suggest to the tutor that ethics codes (BACP / BPS) have been breached and they complain to the tutor. They ask for the matter to be discussed at the next tutorial event. The student fears, as did James Esses in his legal action against Metanoia that they will be thrown off the course, or, cancelled.

The Law: Gender critical beliefs are Protected and cannot in ANY context be subjected to a detriment, including harassment or disciplinary action, provided that they are not expressed in a way that is “objectively abusive.” In law there is a distinction between “offensive” and “abusive.” The courts in the Forstater Ruling have been clear; a belief is protected even if it is offensive, shocking, or disturbing to others. For a statement to be “objectively abusive” and lose its protection, it usually must involve targeting a specific named individual with slurs; threat of violence and incitement to lawbreaking, or, persistent targeted bullying in a workplace or clinical setting. So a generalised statement about the nature of biological sex and its relationship to gender identity, while controversial, does not meet the legal threshold for “abusive” that would strip a person of their Article 10 Free Speech or Equality Act Protections.

The counselling authorities may take a different line, and claim that a hostile description of trans people, such as “pretending to be” or “not real,” breaches the Ethics Code of Respect. Most codes of ethics (including the BPS and BACP) base “Respect” on the principle of “honouring the dignity and worth of all individuals.” An authority would argue: while you have the right to believe sex is immutable, using words like “pretending” or “Ersatz” is harassing or demeaning conduct. They will try to classify the language as a “lack of respect” even if the belief is protected. They say such language denies an individual’s “personhood” or is an attack on their dignity.

The Defence

A professional body cannot simply redefine “Respect” as “Anything that makes people feel validated.” If a therapist believes that “trans people are the sex they were born as,” then calling the alternative “pretending” “passing off as” or “Ersatz” is a logical extension of that belief. A belief is protected, however rude it seems, providing that it is seen as worthy of respect in a democratic society, so a counselling authority cannot easily claim that stating the belief breaches their internal code of Respect. The expression of the belief is not an ethical breach provided it is not done in a way that constitutes illegal harassment (such as targeted bullying or shouting).

This puts counselling authorities in a bind. If their DEI claims the student is a bigot, or subjects them to the any form of harassment because of their views, they are the ones breaching the code of Respect. Their only course is to accuse the student of disrespectful “tone” but that is a very high bar to prove and as far as I know, has never succeeded. The term “trans women are men pretending to be women” is not abusive “tone”.

Regarding The Harassment Angle

The attempt by “offended” fellow students to “debate” a specific student’s written words in a classroom, especially when these words have been “cleared” in a former disciplinary action, is highly likely to meet the legal definition of harassment under Section 26 of the Equality Act 2010. Harassment exists in a professional or educational context where it creates an intimidating, hostile, degrading, humiliating, or offensive environment, and it targets a specific individual – the hapless student- for a protected characteristic (their belief).

Such a co-ordinated action by a group of offended students colluding to write to a Course Tutor, is not equivalent to a group of offended citizens writing to a newspaper. It is a form of collective policing, less interested in debate and more concerned with sanctioning a person whose views are antithetical to their view of what a counsellor “should be”. When they organise to complain about a fellow student, this satisfies the definition of Harassment and is itself a Breach of the BACP Code of Ethics. Forcing a public debate on a students protected belief confers humiliation and is hence harrasment.

Ironically, it is these hostile actions, not the protected belief that likely violate several BACP ethical principles, Namely:

1. Respect: Failing to respect the Protected belief of a colleague.
2. Integrity: Attempting to use the academic forum to “re-try” a matter already settled by an employer and the Free Speech Union ( in this specific case) .
3. Justice: The BACP requires counsellors to be committed to the “fair and objective treatment of others” and the “avoidance of discrimination.” Targeting a peer for a legally protected belief is a failure of this duty.

The “UnSafety” Accusation
Students often claim they feel “unsafe” because of a peer’s views. Courts are increasingly sceptical of this. “Subjective” feelings of being unsafe do not override “objective” legal rights to hold a belief. A school or college has a duty to protect a student from their peers “cancel” campaign just as much as they have a duty to ensure the environment is inclusive. Tutors and Department Heads need to know that they have a Statutory Duty Of Care to protect a student from harassment by peers, for views that are protected under the Equality Act 2010. Learning providers should not “side” with students who disagree with those views; this may be hard for an individual tutor who holds ideological beliefs, but, the education environment has pivoted and teachers must obey the law.

If a student is pre-emptively warned of a targeted campaign or, witch-hunt- by a body of students who are hostile to their protected beliefs and right to express them, they need to write to their Learning provider to make it clear that their peers request to “debate” or “complain ” is an act of targeted harassment and a “hostile environment” that makes them feel unsafe in the peaceful continuance of their studies. The letter should contain an assertion that the views they hold are Protected under the Equality Act 2010.

Acceding to a debate on a settled issue and protected speech is unacceptable. While counselling courses often debate “ethics,” this should be limited to course content. The validity of a student’s protected conduct should never be the subject of a classroom discussion . Discussions of ethics should always be in general terms. Should a tutor allow students to target one individual, especially by a form of ambush, the College itself becomes liable for the harassment. They are essentially allowing a bunch of peers the right to be judge and jury regarding a matter that is non-negotiable in law.

Conclusion: We have seen professionals like Kathleen Stock and James Esses institutionally persecuted for views that some people find unacceptable. This has been reinforced by a DEI structure that mandates a particular belief system in the name of equality and inclusion. The legal landscape has changed.
Any coordinated attempt to “no-platform,” denigrate,  or “penalise” a peer, or question their fitness to be a therapist, represents a Breach of the Law and the Ethics codes of the counselling authorities. Because the person who is the subject of this opinion piece has already been cleared with the help of the FSU, they have the “pioneer” advantage; the legal heavy lifting has already been done. A student is not at the mercy of their Learning Authority. They should remain firm that their lawful private beliefs are not a curriculum item for their peers to dissect.

A Reflective Position Piece on the Intersection of Protected Belief, Law, and Professional Ethics

This article is a clinical exploration of the psychological and linguistic tensions currently facing the profession. It is intended to foster dialogue and reflection on the maintenance of clinical boundaries and the integrity of professional language in the light of recent legal rulings. It represents the author’s protected philosophical beliefs and clinical reflections.

On social media, I have noticed gender realists becoming rude about trans people. I have cautioned against this, but it led me to thinking what may be causing a sense of aggression toward a bunch of gender questioning people, instead of the neutral feelings they nurtured in the past.

I used to think that gender confusion was a mental health condition of diverse origin that needed to be understood, and my feelings were neutral too. I confess that I experienced an aversive reaction to those people in whom trans presentation looked perverse, with a gross exaggeration in their performance of what is considered womanly – such as extreme makeup (“woman-face”), exaggerated fingernails and sexualised clothing. It was like a caricature of what it is to be a female. And I would recoil from it. I asked myself why?

Then it brought to my mind Little Red Riding Hood’s wolf dressed up in grandmother’s clothing; a story that acts as a powerful metaphor of archetypal protection. In this story, grandmother is the ultimate figure of safety, nurture, and the female lineage. By dressing in her clothes, the wolf isn’t just “identifying” as a grandmother; he is hijacking a symbol of safety to gain access to a vulnerable space and destroy the girl who will birth the next generation. Not to be trusted, a predator likely to attack and destroy. Clearly the man in woman’s clothing brings about an atavistic and emotional reaction that requires understanding.

In recent years there has been a big societal change. The speed of this change can be defined as “culture-shock”  – something that always generates resistance. Resistance to rapid cultural shifts isn’t necessarily “bigotry” or “phobia”; it is a deeply embedded psychological and biological survival mechanism where rapid change, especially if proposed by people who are not one’s peers, gives rise to cognitive dissonance.

 My own neutral and compassionate feelings were intruded upon by an increasingly vocal ideology from ‘out there’. Like the frog sitting in water who becomes increasingly warm, without recognising his discomfort, I had no idea of my shifting mindset. Integrating bizarre new expressions such as ‘people with cervixes’ into my linguistic map, was hard for my epistemological reality. I was born into a society where women had to strive for their rights and opportunities. My mother was among the first to be allowed a vote.

It was not “trans” people per se I found troubling; it was the people claiming to “ally” with them, with the full paraphernalia of tabards and lanyards, champions, certificates, displays of kink (why?), ad-hominem attacks on those who had a different worldview, and the infiltration of ideology into the workplace by a partial DEI. I and others developed trauma-by-proxy on behalf of the people I saw persecuted for their opinions.

All this went on under the radar, such that it surprised me to have reacted with pleasure when the Supreme Court pronounced their ruling on sex and sex-based rights. My clinical self was able to accept “labels” such as gender-fluid, binary, etc. while believing that inner experience and beliefs did not transcend biological sex. I retained a sense of concern for, and compassion to gender-questioning people, even while feeling fully congruent with the change in our law.

However – the kickback and the explosion of vicious ad-hominem attacks by the trans movement – mostly the allies infesting our public spaces and institutions, unwittingly transformed my feelings (and that of so many colleagues) regarding trans people into something more unpleasant. I found myself wondering – these ideologues with their acronyms and their “champions” like “Big Brother” telling us how we MUST feel and act – do they realise to what extent they are really helping trans people? Through conflation with their own variety of bigotry, they are fostering the very antipathy and stigma that they are complaining about.

Perhaps this is why, when I find someone labelling me as “cis” – I find my hackles rising before I set it aside, reminding myself that there is only one class of women, with many variations, all excluding males. I strive, constantly, not to conflate this ontological exasperation regarding the attempted dismantling of the “category” I belong to.

I see this exasperation reflected in the tendency of some of my colleagues to be disparaging toward “trans” people in their language. Some propose to redefine trans people as “pretenders” (in the military sense, trying to reclaim something that is not theirs). I have seen other therapists invite us to redefine men who use adaptations to look like women as “transvestites” rather than trans-women. I am uncomfortable with this too, since the motivations for dressing as a woman have always existed. I’m reminded that people like Danny La Rue, RuPaul and Dame Edna Everege made cross-dressing their theatre and did not offend, since they did not lay claim to “be” female. We could accept the performance while drawing a line regarding clinical belief. There is no dissonance when there is honest artifice rather than enforced belief.

In the light of the new Law on sex, there are attempts to muddy the water by defining gender identity (feelings and beliefs) – using the term “identifies as…” as an expression of one form of reality, which it is not, in biological terms. We are asked to cement this story for respect, and to avoid minority stress by using pronouns that our common language has evolved to define a biological separation between men and women, or to express plurals such as “they”.

The term “identity” is a psychological construct which is always real to the individual, but is not to be mandated on the beliefs and experiences of others. We are not, for example forced to accept that a person declaring themselves to be a “hat” is one. Hence, coercion to accept identity as “real” does not signify a truth with which I must agree. The therapist can respect (without concurring) the distinction between objective reality and a client’s sincere impressions, such as the anorexic who insists that he or she is fat.

Dealing with an client in the counselling space is a nuance I am trying to maintain here as I navigate a very fine line between my clinical background, which views the trans issue through the lens of possible mental health and distress – and my personal boundaries as a woman who has strongly experienced that her reality is being erased.

As a clinician, I caution against the private in-group insults and jibes, that I see among colleagues in spaces online. I view these reactions as a projection of the hostility which has been levelled against them, not only by activists, but also by their own Professional Associations. So, is there a better word to use as a descriptor for people who HAVE made alterations in body and appearance to live “as if” they are a sex that they are not? You might ask why the word “trans” won’t do? For some, this term is wrong because of the inference that someone has “become” what we congruently believe to be a fiction – as if someone has waved a magic wand to effect a real “transformation” from a “pumpkin” to “Cinderella’s carriage.”

Could we call them ‘as-iffers?‘ Maybe not. One possible term I have investigated is ‘Ersatz’. It is a term suggesting that the appearance might be there, but the biological substance is missing. That symbolically (in the context of semiotics) captures the feelings that this adjustment is merely an imitation (see disclaimer below). Other possible linguistic terms include ‘purported’, ‘simulated’ or ‘asserted‘ males and females.

As a clinician, while believing that sex is binary and immutable, I will take care not to invoke “minority stress” – a syndrome that our professional associations are using to explain the mental distress caused by stigma. It is the same as the effort we take with obese individuals not to invoke weight stigma. Here is why I continue to caution people against using disparaging language, even while I understand why they do, given the ad-hominem attacks they experience for their beliefs. Clinicians with protected beliefs about sex are humans too; we react to external attacks and institutional coercion with human emotions, especially if forced to act incongruently with our professional judgement.

The point I am trying to make is the classic irony of activism: the more aggressive the “kickback,” the more it alienates the very people who began with a stance of clinical curiosity or neutral concern. By resorting to foul language, professional coercion and ad-hominem attacks, activists essentially “prove” the point that the movement is driven by an ideology of enforcement rather than a pursuit of evidential healthcare or equality for all.

I see among too many members of the BACP in their social media accounts, this tendency to unprofessional reductive language and the mantras of activism with its logos, symbols and flags. This was particularly apparent in a recent post by one of their Trustees. The BPS purports to a higher level of academia, which is more subtle. Psychologists do not call each other names; they simply rewrite the “received truth” through editorials, silencing of alternate views, platformed articles and the quiet removal of scientific neutrality nicely dressed up as social justice.

I will continue to call out language that belittles the people we care for as well as the therapists who care for them, whatever their beliefs about sex. However our first priority is in the performance of our statutory duties. This is the only way to protect our professional integrity among others who do not. It is through appropriate language, debate, freedom from practice coercion and mutual respect that we will restore balance and integrity to our work.

PS this is an academic explanation of psycho-linguistics, not personal beliefs, to map the difference between the signifier and the signified.

Molly, an experienced therapist and gender realist, recently found herself in a ten minute introductory conversation that felt less like a consultation and more like an ideological audition. The potential client has arrived to discuss ongoing therapy, but emerges with a demand for a pre-emptive alliance in response to the therapist confessing that she is a gender realist. She made it clear that she has many trans friends and that, in her view, it was simply awful to feel one is in the wrong body. She then issued a challenge that many modern therapists now dread: she asserted Molly was “not like her” and insisted on knowing if they shared the same views on gender before therapy could even begin.

Molly’s response to this included an explanation that she is a member of Thoughtful Therapists a group who believe that sex is binary and immutable, she emerged feeling “discombobulated” she mentions “a nail in the coffin” when the client declared the awfulness of being in the wrong body. The relationship had fractured and specifically she is very anxious – a risk of being REPORTED as a transphobe.

There are many therapists in the group and they are all offering advice, such as putting your gender realist credentials on your CV. What I also find interesting is the rescue response of some members, taking on the role of “counsellor”- you did well, you kept your head, it went fine. It didn’t go fine. The therapist’s emotions are not to be soothed away, there is something very important to be learned.

I find myself reflecting: What is really going on, what is the solution and what about all this belongs to Molly?
It isn’t uncommon for a client to “contract” for a specific reality before the therapy has even begun.  What has happened here is a mini psychodrama. In clinical terms, the client is asking for a Pre-emptive Alliance based on ideological alignment rather than therapeutic trust. When a client says they need you to “share their views” because of their social circle, they are effectively asking you to join their “silo.” For the therapist, this is the moment to be “robust, fearless and professionally aware”. If the therapist doesn’t know how to do this several things are happening.

THE SECRET MESSAGE IN THE CLIENT’S WORDS
Let’s revisit what the client actually did. She created a hidden act of social aggression, by saying “you are not like me” implying that she has a high moral ground that the therapist appears to lack and is therefore not to be trusted. It is a subtle form of bullying, and a drama triangle is created, where the client becomes the aggressor and Molly is the victim.  What is interesting is that “inside her head” even if she is not showing it, Molly has accepted the role of victim because her emotions have been engaged. What the client is doing is an act of projective identification: she is “shoving” a feeling of wrongness /unkindness into Molly, “I will make you feel as uncomfortable, ‘outside’ and unkind as I feel.”

The client also mentions that she has many trans friends, adding that it must be dreadful to be in the wrong body – inviting the therapist to agree, to tell a lie by exclusion (the therapist believes that the body is just as it should be) or to disagree and confirm that she is a bad person. The therapist is being told to affirm a biological impossibility (a body being “wrong”) on behalf of people who aren’t even in the room. Well, they are in the room now, using the client as a proxy for all the gender-confused people whose experience of being in the wrong body is “awful”. Molly’s hesitation is noted because the initial contract was not intended as a debate about politics, and control of the narrative is lost.

This is what Molly experiences as a nail in the coffin. It is a powerful metaphor. The nail could be seen as the Performative Kindness being demanded of Molly, resulting in surrender of control to try and maintain engagement with the client and please her sensibilities.  The coffin is collapse of the therapeutic space in which Molly is now buried.  The drama triangle is firmly anchored – the therapist is, in this moment, disempowered; if she agrees with the client she is a liar to her own beliefs; if she does not she is a persecutor in the client’s eyes.  I suspect that Molly is now experiencing a strong personal countertransference, focusing on her own emotional survival and professional survival under the client’s subtle personal attacks.

 A 4th party therefore enters the room, the Professional Association, and the anticipated feelings that association will have toward her if the client accuses Molly of being transphobic. Molly is now experiencing institutional countertransference. When a therapist is “alarmed” by a statement of difference, they have lost their Professional Agency. They are no longer listening to the client; they are listening to the imagined voice of a disciplinary panel. Hence  Molly starts talking to herself about her assumptions where “wrong-speak” is treated as a high-level offence. Being different from a client is not a reportable offence but being hostile to the MoU may be.

Molly may think that she has scraped out of the interaction with dignity, but she has lacked the right words to deal with the situation, possibly because was side-lined by the unexpected direction of the conversation. Her discombobulation afterwards is a powerful message that something needs attention. We need to attend, not try to soothe Molly’s feelings away.

THE THERAPIST ISSUES
We may ask ourselves what causes Molly to be caught in a drama triangle in the first place – and not to recognise it when it occurs. We become therapists because we want to help, we are nice people and often driven to please or placate. Our personal traumas that we believe we have managed in personal therapy have been triggered.

If we can recognise the immediate descent into the victim position – where the client infers we are not kind enough, we must take ourselves out of the drama triangle at the speed of light. To explain one’s position on gender or, that one is a member of Thoughtful Therapists,  is defensive and makes things worse. To anchor our status as a coach, not a victim, a far better response might be:

You are right, we are different people. Might this be part of the issue that brought you here, the difficulty relating to people who may not share all your views in life?

It is true that I am not you and have not lived your life. How might my being ‘different’ actually serve us here, perhaps by offering a perspective that isn’t already inside your own head?”

I hear a concern that if I don’t share your specific views, I won’t be able to truly hear you or hold your distress. Does it feel as though my ‘difference’ is a barrier to us working together?”

I am curious about what has led you to say this to me.

The other statement for which a prepared answer is needed is the attempt to engage the therapist in performative kindness toward a group who are not present to speak for themselves “it must be awful to be in the wrong body” – setting Molly in a loaded empathy trap. The client tries to pull Molly into a rescuer role for a very variable group of people.
I find myself resisting this pull to empathy because I have so much experience of wrong embodiment, among people with anorexia, or with obesity, or with other forms of dysmorphia. BUT it would be defensive for me to call on this experience and put myself in the position of persecutor (using my professional status to belittle the client). I will say instead:

You feel very strongly that the experience of trans people is one of profound suffering. Is this so? How does this affect you?

How do you personally deal with this sense of awfulness, is it something you would like to explore in therapy?

JUDGEMENT FREE REFLECTION
Bottom Line: in this interaction, the therapist has reacted to statements rather than sit in the place of evaluating them and being curious about what has led to them. This asks what anxiety in the therapist has been triggered. I have come to think that the solution is for no therapist to LABEL ourselves as gender realist or make a political statement of allegiance or membership of any activist group (including of therapists). Activism of any kind in a therapist may not be helpful.

We need advance preparation for what to do when these conversions of belief and ideology show up. We also need to be professionally  secure, and if we are not because of where we work, this needs to be addressed.

FEAR OF SANCTION: 
Where does this come from, is it realistic? If realistic what is the evidence?   BE CLEAR – a professional body can try to initiate a conduct hearing, they have to prove that you have breached your duty of care. Molly is entitled to have gender realist beliefs and must treat patients under the Montgomery Ruling 2015 to avoid harm at all costs. That is a legal imperative; the MoU is just a guidance. BE CLEAR –  A professional authority cannot sanction you for focusing on your Duty Of Care under Montgomery. See https://eating-disorders.org.uk/the-mou-conversion-practices-and-the-law/

CONCLUSION : This was not a scenario that requires us to agree that the client was difficult or that the therapist was the only sane one in the room. That may be true. But a nuanced learning is needed. I hope that this short case evaluation has helped.

As I ponder the MoU and its rationale among the counselling authorities, I am reminded that the  basic philosophy about gender identity comes from a subtle reframing of what it is to be human according to our Society “social justice” perspectives. Contemporary gender ideology increasingly treats the physical body as incidental and something to be overridden by internal identity rather than integrated and accepted. This shift is not just philosophical. It is reflected in concrete practices such as  medical interventions and the intractable imposition of the MoU over gender “therapy”.

The “De-pathologisation” model that the MoU is designed to impose, relies on moving Gender Incongruence to a sexual health chapter, confirmed by  the recent WHO Pivot on Gender “treatment”. This is not a scientific shift, it is a total ideological pivot, replacing a Clinical Map for a Social Justice Map, that has given rise to unfairness to women in sport and invasion of women’s spaces by men.

The BACP and BPS current stance operates on a logic that, if gender incongruence is not a “disorder” they argue that diagnosis is a form of gatekeeping and oppression. Therefore any psychotherapist who insists on a “differential diagnosis” (such as looking for autism or trauma) is framed as being obstructive or harmful.

The Principle of Respect means accepting the person’s internal “identity” as a supreme truth. The body, or a malfunctioning brain or physical malfunction are secondary or even irrelevant.  The Association position is: if we do not provide immediate medical and social affirmation, this population is at an extreme, unique risk of suicide and catastrophic emotional harm.

So, I have asked, if gender incongruence is not a mental health condition, why are we told that failure to accede to medical transition will “lead to risks of suicide or emotional harm?” Clearly – by claiming that medical intervention is the only way to prevent suicide, they are implicitly treating the condition as a critical mental health emergency while explicitly labelling it as “not a mental health problem.” So, they get round this conflict of logic in this way:

The Minority Stress Argument.
To bridge this gap, they use the concept of Minority Stress proposing that risk of emotional harm in gender-questioning people is not caused by THEIR issues or sex identity. It is caused by “transphobia” and the “lack of affirmation” from society and clinicians. That is one reason why we SHOULD use their pronouns.

The Clinical Counter-Argument: There is no high-quality, long-term evidence (as noted in the Cass Review) proving that medical affirmation is the primary or most effective way to reduce emotional risk. In fact, many other populations suffer “minority stress” without clinicians being told that “failure to affirm” constitutes a harm risk. The research we have suggests that medical transition may not “make people happier.” (see stats at the bottom of this piece).
If the BPS/BACP argues that bodies must be changed to prevent emotional harm, they are essentially endorsing “Crisis Affirmation.”
In addition, you cannot reduce minority stress via medical intervention. A trans women will still in most cases look male and will be obliged (at the risk of sexual assault) to declare their natal sex to a romantic partner.

The legal risks
Reliance on mitigating minority stress has legal risks.  Under the Montgomery Duty (2015), a clinician cannot be coerced into a “crisis” decision that ignores other “material risks” (like the “starving brain” or autism). If you affirm a patient based on the “reducing minority stress argument” and ignore possible underlying comorbidities, you will be vulnerable to a malpractice claim if, years later, the client regrets transition and suffers harms to health.  The court will ask: “Why did you bypass a standard psychiatric, psychological and physical assessment for a ‘normal variation’?”

The Law on Material Risk
The insistence on affirmation and using someone’s chosen pronouns conflicts with our common law understanding on sex. It  is a deliberate deflection to avoid confronting real clinical issues. The Montgomery (2015) Ruling doesn’t care if the WHO or the BACP thinks gender identity is “normal.”  If a treatment or a treatment approach carries a material risk – such as making or ignoring a physical or emotional illness or leads to permanent medicalisation – the clinician MUST disclose it.  If BPS/BACP Guidance tells us not to do this because it is “bad manners” or causes “minority stress” due to “disrespect,” they are telling you to violate the Duty to Do No Harm. Ideology is not a defence for negligence.
If a therapist follows the current BACP/BPS Guidance and the patient later sues for damages you will be investigated for a breach of clinical standards, not your ideology.  The Therapy Authorities will be seen as having induced a Tort of Negligence by providing guidance that explicitly discourages your permission to investigate mental issues that will lead to assaults on physical health and future risks to it. But you will face the penalty – not your Counselling Authority.

Regarding the MoU, and current guidance on the use of pronouns
The affirmation, anti-conversion thinking is that the failure to use a client’s chosen pronouns breaches good manners, increases minority stress and fails to show unconditional positive regard to the patient. The BPS has even uncovered an old 2018 document on the effects of “misgendering”.

You may have a personal dislike of describing a client as what they are not (in law) , using a recognised form of common language. In other words, you have the right not to call a biological “he” a “she”.
Here is how you may protect your rights and freedom of belief. In a therapy setting, the therapist’s role is to maintain a “neutral” space for exploration. A psychotherapist has a primary duty to explore the patient’s internal world, their beliefs and feelings, without pre-emptively validating or cementing a specific identity before a full holistic assessment (including physical co-morbidities) is complete. In other words, if a patent were to insist that they are a hat, you have the right to explore that belief and what may have given rise to it, without pre-emptively agreeing with the patient that they may sit on your head.

Using “preferred” pronouns is a clinical intervention that signals a conclusion has already been reached. If you use the client’s pronouns before any underlying morbidities are ruled out, you would be  prematurely “affirming” a state that may be a symptom, not an identity.

In other words, using the clients preferred pronouns because you are forced to, is a symbolic affirmation. If a psychologist uses the client’s he/she/they/ zie or it,  before a full differential diagnosis is complete, they have “collapsed the space” for exploration. They are no longer a neutral observer; they have become a participant in the patient’s internal narrative.

The legal arguments against pronoun coercion

1             Montgomery” and “Consent” Justification. Under the Montgomery Ruling (2015), you are legally obliged to avoid any action that creates a “false sense of security” or bypasses the disclosure of material risks. Compelled use of preferred pronouns in a clinical assessment of a minor, or vulnerable adult with, say,  an eating disorder, can be viewed as Diagnostic Overshadowing. It reinforces a detachment from the biological body at a time “when the patient is clinically ‘untethered’ from reality.”   By refusing to use their pronouns, you are upholding your duty to keep the patient focused on their biological vulnerability.

2. The “Equality Act” Justification (The Forstater/Mackereth Precedent)

Under the Equality Act 2010, gender-realist beliefs (that sex is biological and immutable) are a protected characteristic. Any organisation that compels you to use language that contradicts this belief-particularly when it conflicts with your clinical observation of a patient’s physical health, constitutes Harassment and Compelled Speech under the Equality Act. While we are told to respect the client, Respect goes both ways. The BPS/BACP cannot force a therapist to lie about biological reality if it violates their professional and protected beliefs.
The BACP may rely on the need to give the client unconditional positive regard. This does not require colluding with their system of beliefs, no matter how intense. The current position on gender “therapy” could be regarded as a Breach of Fiduciary Duty: Charity resources are used to promote a guidance that creates potentially uninsured financial risk for its members. As things stand, ideology is not a defence against Negligence – as evidenced by emerging cases of compensation against affirming psychotherapists in the USA and UK with severe financial penalties.

3 The Human Rights Act Article 9 and Article 10

Under the Human Rights Act and the Equality Act 2010, you have protection against compelled speech. Whatever reasons your authority give you , they may not violate your freedom of Conscience (Article 9) and Freedom of Expression (Article 10). Furthermore, as a clinician, you may claim that you cannot ethically use language that you believe to be clinically harmful or factually inaccurate regarding a patient’s sex-based physical risks. I have known of several therapists working in the NHS who have been belittled and sanctioned for refusing to use a client’s personal pronouns that conflict with their sex. In all cases the therapist has succeeded with harassment law.

THE SOLUTION
You have the right to decline without sanction, to work with a gender questioning client. Or, preferably, be clear about your position on pronouns, and use a neutrality approach. To be respectful and polite you may say to a client that you will use their name rather than a label while you find out what is best for their physical and mental wellbeing.
Be aware of what is really going on in the counselling world. The following table makes the position clear

Issue	BACP/BPS “Respect” Model	“Lawful” Model
Pronouns	Mandated as “Affirmation.”	Viewed as a Clinical Intervention requiring caution.
Justification	Reducing “Minority Stress.”	Maintaining Diagnostic Integrity and Montgomery Compliance.
Conflict	View as “Transphobic/Conduct.”	Viewed as Protection against Negligence/Tort.

How to deal with the “minority stress” argument: The Gender Minority Stress Model (GMS) posits that the mental health disparities seen in gender-questioning people (anxiety, depression, suicidality) are not caused by internal pathology, but by a hostile social environment. By centring “Minority Stress” as the primary clinical concern, the BACP/BPS achieves three things that are legally and clinically dangerous:

First They Presume the Identity: To have “Minority Stress,” the person must first be a “Minority.” By applying this model immediately, the clinician is presuming the child or adult’s gender identity is a fixed fact, rather than a phenomenon that requires differential diagnosis. Then, it asks us to replace Diagnosis with Advocacy: If the “problem” is external (society’s reaction), the therapist’s role shifts from a clinician who assesses the mind/body to an activist who “affirms” the identity to reduce that stress. Finally, it creates a hostile environment trap for you. If you insist on investigating the reasons for this identity position, the BACP/BPS  guidance frames the therapist themself as a source of Minority Stress.

You can deal with this by asserting that minority stress is a subjective construct. It relies on the patient’s perception of hostility. This perception itself may be a symptom of an underlying condition, not a  reflection of reality. It is your clinical duty to determine what ELSE is causing their distress. This could be an eating disorder or high levels of autism. Using the term “minority stress” as a catch-all explanation for distress is diagnostic overshadowing by another name.

A personal word.
I have questioned my own Professional Authority on their current gender guidance. They gave me no evidence of the safety of the application of the MoU. I have had no guidance regarding risk assessment for transition regret.  Because of this, I have alerted my Insurers that their guidance currently places me at risk of malpractice if I follow the Society Guidance. Or the risk of a conduct hearing if I do not. This puts therapists in an impossible bind.

When I have presented this “conflict” to the BPS they have suggested that I use my own “judgement” to work with gender questioning people.  It means that the MoU may be functionally meaningless in law.

The Summary:  Our Association’s current position is logically incoherent and clinically dangerous. They claim gender incongruence is a ‘normal variation’ to avoid the ‘stigma’ of diagnosis, yet they simultaneously weaponise suicide or emotional harm statistics to coerce clinicians into bypassing the Montgomery Duty of Care. If a condition is truly a ‘normal variation,’ it should not require a therapist to surrender their clinical judgement under the threat of patient self-harm. Forcing us to bypass the investigation of physical and mental co-morbidities is a breach of safeguarding and a failure of professional ethics.”

******Some Facts for your Knowledge on Transition Regret or Failure*******

While many activist organisations point to short-term observational studies to support “gender-affirming” pathways, major systemic reviews conducted between 2024 and 2026 have found these “foundations” to be scientifically unstable. The most comprehensive review to date, led by Dr Hilary Cass, 2024 concluded that the evidence for medical interventions (puberty blockers and cross-sex hormones) is “remarkably weak.” The review found no high-quality evidence that medical transition improves gender dysphoria or mental health outcomes in the long term for children and young people. Because of this lack of evidence for wellbeing, NHS England moved to restrict the routine use of puberty blockers, citing that the benefits do not clearly outweigh the risks.

The “Quality of Evidence” Problem; Systemic reviews from the University of York and recent 2025/2026 reports have identified a persistent pattern in the literature used to support the MoU’s ideological position: Many studies that show “positive outcomes” suffer from high rates of “loss to follow-up” (up to 36% or more). This means we often only hear from the people who stayed in treatment and were happy, while those who desisted or detransitioned, simply disappeared from the data.

The Cochrane-style reviews often rate the certainty of evidence for “improved wellbeing” as Very Low. In evidence-based medicine, “Very Low” means the true effect may be markedly different from the estimated effect.

Latest Findings: New research (2024–2026) has begun to look at Desistance and Detransition, which directly contradicts the “wellbeing” narrative: The “Wait and See” Outcome: Historically, studies (such as those from the Dutch clinics) showed that a large percentage of gender-distressed children would desist (return to their birth sex) if not put on a medical path. A 2024 study of 237 detransitioners found that 70% realised their dysphoria was actually related to other issues (trauma, autism, or eating disorders). This proves that for many, medical transition was a misdiagnosis, not a wellbeing intervention.

The Long-Term Reality: 10-Year Lag: A significant data point is the Time-to-Regret. Most studies used by the BPS/BACP only follow patients for 1–2 years. Using 12-month data to justify a lifelong medical path is a Failure of Duty under the Montgomery Act, which requires the disclosure of long-term material risks. Research indicates that “regret” or the realisation that transition did not solve the underlying distress often takes 8 to 11 years to emerge.

Precise Definition: The MoU on Conversion Therapy

The Memorandum of Understanding (MoU) on Conversion Therapy (Version 2, 2017/Updated 2021) is a voluntary, non-statutory agreement between over 25 UK health and therapy organisations (including the BPS). It defines “conversion therapy” as any model or viewpoint that assumes one sexual orientation or gender identity is “preferable” to another and seeks to change or suppress it. Crucially, Paragraph 5 states that the MoU is not intended to prevent exploratory therapy. It claims to support therapists in helping clients “explore” and “clarify their sense of themselves.”

THE BPS AND THE BACP: The central tension, which I have identified in their Guidance (and the stance of the Public Affairs Board) effectively treats any exploration that doesn’t end in “affirmation” as “conversion practices.”

In fact, the BACP’s position is often seen as more “ideologically locked” because their Ethical Framework is frequently interpreted as a mandate for validation over investigation. Their guidance on the MoU version 2 has threatened therapist autonomy, by suggesting that any therapist who does not affirm a client’s self-identified gender may be practising “conversion therapy.” This is the same “chilling effect” as with the BPS.

In their view, gender misalignment is a normal variation of human experience, not a mental disorder. They explicitly align themselves with the WHO’s ICD-11, which moved “Gender Incongruence” out of the mental health chapter and into a chapter on sexual health.

The Logic of the Therapy Organisations promotes De-Pathologising of Trans Yearnings and Respect as the Primary Goals.
The Council of Europe aligns with the therapy organisations in assuming that if a phenomenon like thinking or wishing to be the sex you are not, is “normal” (like being gay), the primary role of the therapist is not to “treat” or “diagnose” it, but to: Affirm: Support the individual’s self-identification as a matter of human rights. Mitigate Minority Stress: Focus on the distress caused by society’s reaction to the person, rather than any internal pathology. Remove Barriers: Ensure that the path to transition is as smooth and “respectful” as possible which involves medical and surgical transition.

THE THERAPIST MANDATE
Under the MoU we must surrender the goal of getting a gender questioning person to accept their body/sex, even where we are convinced that sex is binary and immutable, a Protected View supported by the Supreme Court Ruling on Sex and Sex Based Rights. There are other requirements, such as we must accept their “gender identity” if it differs from their biological sex, as valid- as explained above under the Code of Respect. When a male says he is female, (or vice versa) we must accept this as a normal variant of human identity, in the same way as accepting that gay and lesbian identity is NOT pathology.

YOU MUST USE THEIR PRONOUNS?
The  Guidance requiring us to use the person’s chosen pronouns is for good manners and any departure would be harming the patient (misgendering). Thus, affirming, via pronoun use, is the necessary clinical intervention to reduce “minority stress.” You may not be forced to do this, see the legal comments below.

DO NOT PATHOLOGISE OR EXPLAIN?
The Guidances issued by the Therapy Associations suggest that if we try to link their identity to a mental health condition such as autism, or childhood trauma, as a way to “disprove” the “flawed” identity, the BACP/BPS will likely view this as “reparative” logic. It may become a conduct issue or reframed as “conversion therapy”. You can argue against this, as I explain below.

THE FAILURE OF LOGIC
The Supreme Court Ruling on sex puts therapists in conflict with the MoU and with the Ethics Codes of their Associations.

The Code of Respect ; Respect goes both ways and it may be unlawful if a therapist is coerced against their choice to use common language that defines biological sex (calling he “she”) and is then forced to agree that a client is what they are not, in the Law. Coercion is a breach of your Association’s Public Sector Equality Duty. And may be unlawful.

The Code of Do No Harm ; Certain conditions give rise to problems with embodiment and identity. Anorexia is a good example. One way to avoid present and future harm is to rely on a client’s”capacity” to understand the considerable risks, socially, emotionally and physically, of transition.
Where eating disorders are comorbid with gender questioning, dietary chaos BOTH affects capacity to make life-changing decisions, AND magnifies physical risk. Capacity in eating disorders is affected by pre-existing neurological confounders (cognitive inhibition, set shifting difficulties / rigidity). These neural factors are worsened where there is dietary chaos.

The risk of harm is strong if powerful hormones are given to a person already compromised by malnutrition. But as far as I know, the risks of eating disorders in a gender questioning person have never been evaluated. We hence require extreme caution for gender treatment in the eating disorder patient at any age. This is because their capacity to understand the risks of transition may be impaired by pre existing difficulties with thinking exacerbated by nutritional impairment. In such people, medical interventions will add to existing harms.

DUTY OF CARE AND TRANSITION REGRET
Capacity, physiology and Transition Regret intersect with failure to do holistic, evidence-based evaluations – none of which are proposed by our professional bodies. The current malpractice cases such as Fox Varian in the USA and R Herron in the UK, make this need for clarity compelling.

Other conditions that may affect capacity to assess present and future risks of medical interventions, include Mitochondrial Disease, which “mimics” autism. Therapists wishing to protect themselves from malpractice charges, as well as to protect a vulnerable client, have a Duty of Care to do extended and holistic assessment. Our Duty of Care requires us to consider all adverse or social experiences that have culminated in gender incongruence. A therapist’s first duty is to the Law of Consent, not your Association’s Guidance. Should your Association be insisting that you must ignore a “material risk” (like the impact of starvation on the brain or neurological “impairments”), they are telling you to commit a TORT* OF NEGLIGENCE. In other words, they could be forcing you to act outside the law.

AFFIRMATION VERSUS THE MONTGOMERY DUTY 2015
The Montgomery v Lanarkshire Health Board [2015] UKSC 11 ruling – is one of the most significant Supreme Court judgments in the history of UK medical law. It mandates the investigation and disclosure of all “material risks” of any intervention. It was first applied to medical procedures but the Principle is extended to psychological practice too.

These risks include the physiological and cognitive impact of co-morbidities like Eating Disorders, comorbid mental health problems, or metabolic problems. Furthermore, by discouraging the rigorous investigation of the “starving brain’s” role in gender distress, which can also arise in cases of mild metabolic disorders,  the MoU policy places members in direct breach of their statutory obligations under the Children Act (1989/2004), where a child’s physical welfare and safeguarding must remain paramount.

 IGNORING OR NOT ASSSESSING a client FOR CURRENT AND FUTURE RISK IS THAT TORT OF NEGLIGENCE. Since the counselling authorities have as yet to provide evidence-based guidelines for assessing that risk, their ideological stance places members in direct breach of their statutory obligations under the Children Act (1989/2004), where the child’s physical welfare and safeguarding must remain paramount. As things stand now with all the Authorities aligned with the MoU under their “social justice” position, ignoring or not requiring testing for that current and future risk is a Tort of Negligence as identified above.

YOU ARE NOT COMPELLED TO AFFIRM : Being compelled to affirm is a breach of the Dignity at Work Guidance, and a breach of your Protected Beliefs if you are a gender realist. You may “affirm” that a client believes that they are a sex they are not, or “feels” like a member of the sex that they are not. But you may not be compelled to agree that they are the sex that they are not – because the legal framework for sex is enshrined in law. If you work in a professional environment where you are belittled for this position, or you are are accused of being unprofessional, you may seek lawful protection against harassment or victimisation.

RISK CANNOT BE EVIDENTIALLY ASSESSED: The current “Affirmative” framework imposed upon therapists, suggests that you must support and not question clients in accessing medical interventions if they shout loudly enough for them. It is your lawful duty to firmly establish the risks. But in the absence of formal evidence-based guidance – I have asked for it, but have never received it – how is this possible? I have yet to find any Supervisor who can tell me how the risks of say – infertility- can be appraised by a person who is not at the age where such motivations become compelling. We know many young people seeking transition are at the stage where they are neurally primed to prioritise escape from emotional discomfort rather than engage in rational thought. Any external mandate from your counselling authority requesting you to follow their Guidance, effectively requires practitioners to act ultra vires (beyond or in conflict with their legal duties).  By prioritising identity validation over holistic clinical assessment, the guidance compels a practitioner to bypass the Montgomery Duty (2015).

The Montgomery Ruling mandates the investigation and disclosure of all “material risks”.  These risks including the physiological and cognitive impact of co-morbidities like Eating Disorders. Furthermore, by discouraging the rigorous investigation of the “starving brain’s” role in gender distress, which can also arise in cases of mild metabolic disorders,  the Society’s policy places members in direct breach of their statutory obligations under the Children Act (1989/2004), where the child’s physical welfare and safeguarding must remain paramount.  IGNORING OR NOT ASSSESSING FOR CURRENT AND FUTURE RISK IS THAT TORT OF NEGLIGENCE.

LEGAL CHALLENGES TO THE MoU AND RECEIVED GUIDANCE FROM OUR PROFESSIONAL OVERSEERS
Legally, a professional body should not issue guidance that overrides a clinician’s common law duty to prevent negligence to the client, put themselves at risk of financial claims for malpractice by the client,  or fail their statutory duty to protect a vulnerable person from the “impairment of health.” The time for arguing about current regulatory guidance is done. In the absence of scientific evidence, I have alerted my Insurers about these matters and may use my professional judgment, take supervision from a professional who knows the law and who is not motivated by ideology. Then I will meet my duty of care to clients and validate the protection of my indemnity insurance, in the event of any sanction.

POSTSCRIPT * In English law, a Tort is a civil wrong that causes someone else to suffer loss or harm, resulting in legal liability for the person who commits the act. Unlike criminal law (where the State punishes a person), Tort law allows an individual (the “Claimant”) to sue for compensation.