The Memorandum of Non-Understanding

(Originally published here. Thanks to @Teridactyl for the tip!!)

In December 2020 Transgender Trend sent a letter by post to CEO Dr Sarah Niblock, Chairman Martin Pollecoff and every member of the board of trustees of the UK Council for Psychotherapy (UKCP) regarding the Memorandum of Understanding on Conversion Therapy. We also sent an email to Dr Niblock alerting her to this letter and asking her to ensure that all board members would see it. After no response, we emailed again in January 2021 and received the reply that UKCP had not been picking up post due to the pandemic. We were asked to email the letter, copying in Alex Crawford, the Governance Manager, who would ensure that everyone would see it. We received confirmation of receipt of our letter and that it had been passed on. Over a month later we emailed again, asking when we might expect a reply and received this response from Alex Crawford:

“Your correspondence has now been received and considered by the Board of Trustees. They asked me to pass on their thanks to you and to confirm that they note your comments.”

We responded:

“Thank you for your reply.

Our letter to the board did not consist of ‘comments’ but of detailed annotated questions of great importance about the Memorandum of Understanding on Conversion Therapy. 

We consider this issue of crucial importance to the current debate over the treatment of gender non-conforming children and adolescents. Being given permission to intervene in the Keira Bell Judicial Review is an indication of how highly our work is regarded in this field. We are the UK’s leading organisation calling for evidence-based health care for children and young people presenting with gender dysphoria; we consult widely with government and other bodies and our work is referenced globally for its high quality of evidence and argument.

We did not write to UKCP idly but with the intension of clarifying the evolution of the MoU in which UKCP played a pivotal role.

Could you pass this reply on to the board and Martin Pollecoff please and say that we are still expecting a response in kind to our letter and documents.”

As we have still not received any response to this email or our letter, we have decided to publish our original letter in full here.

Our letter to UKCP re the Memorandum of Understanding on Conversion Therapy

Dear Martin Pollecoff,

I am the director of Transgender Trend, an organisation for parents and professionals concerned about the teaching of gender identity in schools and the use of medicalised pathways for children and young people with gender issues. Our website is a respected evidence-based resource, used by governments and public bodies worldwide.

My expertise in this field was recognised when I was granted permission to intervene in support of Keira Bell’s Judicial Review, brought against the use of puberty blockers and cross-sex hormones at the Tavistock and the question of whether those under 18 can give consent to life-changing treatments. On December 1st 2020 the High Court ruled that these are experimental treatments and cannot be given to children in most cases without seeking approval from a court. This result was a vindication of all those clinicians, therapists, and parents who have argued and gathered the evidence that the watchful waiting approach to children with gender distress is the correct one.  

I’m writing to ask for clarification regarding the evolution of the Memorandum of Understanding on Conversion Therapy in the UK which the UKCP initiated and organised. I believe that the addition of ‘gender identity’ to the MoU in 2017 created a climate in which therapists felt unable to question a child’s belief in being ‘trans’.

I apologise for the length of my letter, but I have considerable concerns about the MoU in its present form. I believe my questions need answers as they have serious implications for your profession and clients. As Chair of the Board of Trustees you need to know this.

Below is a narrative account of the evolution of the MoU, taken from published sources, and the minutes of the UKCP board meetings, all of which I have referenced.

As I understand it, in June 2014 UKCP published Conversion therapy: Consensus statement at the request of the Department of Health which was supported by the British Psychoanalytic Council, The Royal College of Psychiatrists, BACP, Pink Therapy, The National Counselling Society, Relate, Stonewall and PACE.

[This link has since been removed]

The above document was the basis for the Memorandum of Understanding on Conversion Therapy in the UK, November 2015, which banned conversion therapy that would attempt to change sexual orientation. This was on the basis that such reparative therapies are quite rightly understood to be harmful, unethical and without any evidence base.

[This link has since been removed]

Following the publication of the 2015 MoU, I wrote to UKCP in March 2016 with my concerns that there were moves to add gender identity to the MoU. I am attaching a copy to this letter.* I would urge you to reread my 2016 letter which contains my well-evidenced argument that gender identity should not be added to the MoU.

However, those wanting to add ‘gender identity’ to the MoU were successful and in October 2017 the Memorandum of Understanding version 2 was published, proscribing gender identity conversion therapy. It should be noted that ‘gender identity’ was not defined except in a circular way and that no evidence is given that gender identity conversion therapy exists or is practised by any professional therapist. 

[This link now points to the revised version below. The original 2017 MoU2 can still be viewed here.]

This version was updated again in July 2019 with additional signatures endorsing the MoU.

Point 6 in the 2019 version contains this new stipulation “This  position is not intended to ………stop medical professions from prescribing hormone treatments and other medications to trans patients and people experiencing gender dysphoria.” I understand this sentence to mean that therapists treating young people and children who are already taking these hormones cannot be accused of a different form of conversion therapy. I am referring here to the growing evidence that puberty blockers put an adolescent on a one-way path to transition; that far from treating gender dysphoria, these hormones lock a child into a permanent opposite-sex identity and the gender dysphoria in many cases persists.

The use of these drugs for young people who in 80-90% of cases would otherwise desist, the majority growing up to be lesbian or gay, is the opposite of good curious open-ended therapy. As the inclusion of this sentence is the main change between the 2017 and the 2019 version of the MoU, I believe it has been inserted to prevent critics from arguing that puberty blockers themselves are a form of conversion therapy for teenagers and to silence those who point to the overwhelming evidence of adverse side effects from cross-sex hormones.

The MoU governs most therapeutic organisations in the UK including those treating children. In all versions of the Memorandum it is stated that training organisations should refer to the BPS Guidelines for Psychologists Working with Gender, Sexuality and Relationship Diversity, July 2019. It is clearly stated in these guidelines that they are intended for work with children. Referencing Rapid-Onset Gender Dysphoria and the disproportionate number of young girls presenting to gender clinics, authors of a recent letter to The Psychologist stated that the current BPS guidelines “effectively prohibit psychologists from taking a questioning approach and applying ethical practice in these situations.”

It is a matter of concern that the latest version of the MoU, July 2019, is signed by Gendered Intelligence. This organisation is an activist group, set up by and for transgender people, whose staff come from an arts, youth and community work background.  Its mission statement is “to deliver arts programmers and creative workshops to trans youth from across the UK in order to increase the quality of young trans peoples’ life experiences.” As such it campaigned for gender self ID in the recent review of the Gender Recognition Act, for the deletion of single-sex exemptions to the Equality Act (which as you are aware are there to protect women and girls as a sex class). Their staff have no therapeutic qualifications. Their aims and activities listed on their website contain no references to therapy services. It’s also important to note they are an organisation which caters for 8-25-year-olds.

Stonewall, listed as a supporter organisation of the MoU since 2017, is also a political campaigning group with no obvious link to psychotherapy. They have campaigned for reforms to the Gender Recognition Act to include no need for any medical or therapeutic assessment, for a system of self ID to obtain a Gender Recognition Certificate and for the removal of the single-sex exemptions in the Equality Act.

I have looked in detail at the minutes of UKCP’s Board of Trustees to chart the path of the MoU as it debated and then adopted the addition of ‘gender identity’ and have questions about the following minutes.

1/ April 16th 2016 item 14 from the Board’s minutes said:

14.8. After an involved discussion, it was agreed that JC and Peter Kunzmann (PK) will re-draft the MoU2 into a version they are comfortable with and then send the re-drafted version to the Board by email for their approval. This is to be done before the next MoU Group meeting on 5 May 2016. 14.9. Once approved, the new JC / PK version will be presented to the MoU Group on behalf of the Board by MP.

What happened to James Caspian and Peter Kunzmann’s report? Did the Board see a copy of the report? Was it sent to the MoU group by yourself? Did the MoU group respond to this report? If so is it possible to see a copy of their response?

2/ July 15th 2016 item 17 from the Board’s minutes said:

17.1. MP updated the Board and thanked JW for all her work as Chair of the MoU Group.

Does this minute mean that Janet Weisz as Chair of the MoU group had finalised UKCP’s version of the MoU to include ‘gender identity conversion therapy’? Did the board as a whole discuss the report? The minute says you updated the Board; what did your update say?

3/ April 20th 2018 item 3 from the Board’s minutes:

3.1 The UKCP Chair spoke to his report and the discussion included the following points

• Memorandum of Understanding on Conversion Therapy (MoU)

The Board had an in-depth discussion of the situation described in the UKCP Chair’s Report and possible ways forward. Following the discussion it was agreed that KC will attend the next 2 MoU meetings and, if appropriate, invite the chair of the MoU Group to the next Board meeting on 13 July 2018.

Was this discussion about a further update of the MoU? Was this the “full formal review” promised within 12 months of 2017 version 2 MoU? What were the terms of reference for this review? Was any research with or formal feedback from therapists working in the field of gender identity conducted? Were new groups invited to attend this review?

4/ July 13th 2018 item 2 from the Board’s minutes:

2.1.5 Re: Point 3.1.2 concerning the Memorandum of Understanding (MoU) on Conversion Therapy, the Chair of the MoU Group will be attending the Board meeting this afternoon.

2.1.6 The Chair reported that the MoU on Conversion Therapy in the UK Version 2 had been launched in Parliament and the Chair handed out a leaflet from the launch event.  

2.1.7 The Chair reported that new member will be joining the MoU Group to replace a vacancy following a recent resignation.

2.1.8 It is likely that the MoU Group Chair will mention the Gender Recognition Act (GRA) during this afternoon’s discussion. Under the GRA those wishing to transition will no longer require a medical diagnosis.  

2.1.9 The GRA is currently out for consultation and will be published in October 2018. The Chair proposed that we find out from our members whether we should support the GRA.  

Why was the Chair of the MoU attending the meeting? Was it to discuss the inclusion of the paragraph on hormone treatments which was to be included as part of point 6? Was the Board fully up to date at that point about the Gender Recognition Act 2004? Did the Board have an informed discussion of the issues, in particular the campaigns to drop all requirements for a medical diagnosis before transition? Were any of the Board concerned about the issues that self ID would raise? Why did you propose that the Board should “find out from our members whether we support the GRA”? The GRA had been on the statute book since 2004; was the UKCP not aware of its provisions? The chair of the MoU Group Dr Lyndsey/Igi Moon attended the meeting; what did you discuss? Was the change to point 6 discussed with her?

5/ December 13th 2018 the Board discussed a Private Members Bill on Conversion Therapy but there is no further reference to the MoU in any of the minutes to date. The MoU version 2 revision A was published on July 3rd 2019. Was this signed off by the board? Was there any discussion of the changes to point 6 in the MoU? Did the board discuss the inclusion of Gendered Intelligence as a co-signatory to the MoU?

6/ The 2019 version says that the “text of the MoU will be kept under review and altered, if necessary, in the light of new research or the appearance of unintended consequences. A full formal review will be conducted every three years from the date of the MoU hard launch (July 2018) The next review is due in July 2021” Is that review now underway? If so who is conducting it? Can the Board assure me that a full range of views will be taken into account? Can Transgender Trend put in a submission to the review? Are you aware this recent research published by the BMJ found little evidence that gender identity conversion therapy is an issue? https://bmjopen.bmj.com/content/8/12/e022425.full

I apologise again for the letter’s length but I believe these are crucial questions which need answers. I believe that my letter to UKCP in March 2016 was prescient. I outlined the experimental nature of the medical treatments being given to young people and children, I raised serious concerns about the affirmative approach to gender dysphoria and its potential to mask other reasons for a wish to transition, such as anxiety, autism, sexual abuse and other mental health conditions. I was right to be concerned about the historically unprecedented rise in girls wanting to escape from their bodies by changing sex and I was right to highlight the use of social media and the influence of trans rights campaigners. Three High Court judges listened to evidence such as this and I would urge you, your board and officials to read their judgement in full. 

I feel the landscape has changed over the last four years. There are more dissenting voices being heard in the therapeutic world, whistle blowers from the Tavistock are being listened to and critiques of the long-term effects of medical transition are widely available. Finally, we have the words of those who were affirmed in their belief that their problems stemmed from their biological bodies, young female detransitioners who have paid the highest price for a no-debate affirmative approach to their distress.

I hope you and your community are listening to the debate as it progresses and that you will be able to answer my questions in good faith.

I am speaking to politicians and seeking a meeting with the Government Equalities Office. At this meeting, I intend to raise the question of the MoU in the light of the High Court ruling. I would also welcome the opportunity to discuss these issues with you at any time.

* Our original letter to UKCP and other signatories to the MOU can be viewed here. The response from UKCP to a further letter can be viewed in this post.

Postscript: The Memorandum of Understanding was updated in September 2021. The latest version can be viewed here: https://www.bacp.co.uk/events-and-resources/ethics-and-standards/mou/

This version contains one change at point 17. The previous version advised that training organisations should refer to guidelines written by the British Psychological Society; the new version advises them to refer to “the latest guidelines from professional associations who are signatory organisations on working with gender and sexually diverse clients.” Point 22 still states “The next formal review is due in July 2021.”

There is one new supporter organisation, Centre for Mental Health, and two new signatories: ReThink Mental Illness and Mental Health Network (NHS Confederation). The latter is chaired by a person who, after the Keira Bell v Tavistock case, should know more than anyone the risks to young people of an affirmation-only approach: Paul Jenkins, CEO of the Tavistock and Portman NHS Foundation Trust.