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Guidelines for Psychologists Working with Gender, Sexuality and Relationship Diversity

These guidelines relate to gender, sexuality and relationship diverse (GSRD) adults (aged 18 years and over).

19 June 2024

BPS Guidance

By BPS Practice Board

The guidelines relate to gender, sexuality and relationship diverse (GSRD) adults (aged 18 years and over).

That is, broadly people who do not identify as heterosexual, monogamous or cisgender.

This includes lesbian, gay, bisexual and transgender (LGBT) people as well as people who identify as asexual (do not or rarely experience sexual attraction), are agender (have no gender), have a non-binary gender (have a gender other than male or female), are pansexual (have attraction irrespective of gender), and many other groups.

The guidelines do not, however, relate to anything non-consensual.

The identities and practices considered here are not in themselves pathological, and are part of human diversity.

These guidelines are aimed at applied psychologists working with mental distress, but may also be applied in associated psychological fields.

The principles they are based upon are derived from both the literature and best practice agreement of experts in the field and may also be applied to other disciplines, such as counselling, psychotherapy, psychiatry, medicine, nursing and social work.

Download the guidance

Statement on the assessment by psychologists of transgender or non-binary people seeking medicines or surgeries associated with gender

Psychologists are reminded that they must practice within their competency (HCPC, 2015; BPS 2017, 2018).

In order to protect the public, the BPS makes clear that in order to assess gender dysphoria or incongruence and make referral for hormonal treatments, anti-androgenic treatments, other medicines; or surgeries such as genital surgeries, chest surgeries, facial surgeries, surgeries which remove reproductive capacity, or other surgeries in this field, psychologists must be statutorily regulated by the HCPC and receive specific post-doctoral training.

This training must be significant formal training and supervision from someone with recognised expertise in the field who has considerable experience in making these referrals. At present this would be a consultant psychologist or consultant medical doctor at an NHS Gender Identity Clinic.

This must occur before they are able to make independent assessments and recommendations. Psychologists in this field must also be practising within a highly specialist multidisciplinary team and undertaking ongoing specialist CPD relevant to the field.

Frequently Asked Questions

Why did you undertake this review? 

All our guidance documents are subject to a full review every five years to ensure they are still needed, are relevant, and reflect current legislation, evidence and practice and an interim review after 2.5 years. 

Who did you consult with to undertake this guidance review? 

BPS members with extensive and relevant experience were consulted, as well as external independent experts, and the BPS EDI board.  

The drafting of the document was done by previous authors, however the peer review was undertaken by independent experts who were recruited to a criteria and were not involved in  the writing of any of the previous versions.  

We have an anonymous audit of their comments and how these were attended to which is available on request.  

Why have you not produced guidance for psychologists working with U-18s?

The purpose of this interim review was to assess the content in the guidance and update where necessary and appropriate.

We know that the area of U18s and gender incongruence is a challenging and often highly politically charged one, which is why we have begun recruitment for the Task and Finish Group. We estimate this work will take approximately 18 months. 

What has been updated/revised in the guidance? 

As part of the review the BPS has revisited the whole document to assess the content and whether it is fit for purpose, paying particular attention to areas where we have previously received criticism and concerns have been raised.  

This includes sections on the use of preferred terminology, for patients and clients, making it clear that it does not advocate or recommend the use of so-called 'reclaimed' terms but that this should be a discussion between each psychologist and their patient/client.  

Any suggested examples of reclaimed terms have been removed.  

All references to affirmative therapy have been removed. The guidance follows the essence of non-judgemental practices, making clear it is acceptable to explore, compassionately challenge, and hold uncertainty with clients as long as their practice does not consider a GSRD outcome to be less acceptable in principle than a heterosexual, monogamous, or cisgender one.

Specific questions re. The new CYP Gender Task & Finish Group

What is the role of the new Children and Young People and Gender Task and Finish Group? 

The BPS Children & Young People Gender Task and Finish Group is commissioned by the Practice Board (PB) jointly with the Equality, Diversity & Inclusion Board (EDIB).  Its function is to provide up to date input in the development of a discussion paper regarding Children & Young People and Gender. 

The group will provide expertise and evidence and to draft content for the discussion paper. The discussion paper will be neutral, it will outline the topic without drawing conclusions or positions. The aim of the paper will be to outline the area in order to generate discussion and constructive debate amongst the membership in order to potentially inform any further work in the area. 

What is the process for recruitment to the new CYP workstream?

Recruitment for the group (including the role of chair) has now closed. Its members will be announced in due course when the group begins its work. 

Selection will be made based on our pre-established criteria and recruitment for the chair will be made first, who will help with the selection of members. It will be an anonymous process.