A recent copy of the BACP house journal, Therapy Today, made the extraordinary claim that “…the Memorandum of Understanding…protects clients against homophobia and transphobia…” (Broughton, 2025: 28). (The Memorandum, or MOU, is a major UK policy agreement geared to ending alleged conversion therapy.) Peter Jenkins explores the evidence which clearly contradicts this statement, and links it to the current vogue for decolonising narratives within therapy.
Decolonisation of therapy is clearly now the order of the day. This development comes almost 60 years after most colonies won their formal independence from the metropolitan powers which had ruled them, in some cases for centuries. Therapists are now being advised how to decolonise their consulting rooms and their practice with clients. Therapy training programmes are geared to overturning received wisdom regarding theory and practice as being Eurocentric and oppressive. We seem to be on the cusp of a brave new world, where historical injustice can be banished from therapy, although perhaps not yet eradicated from wider society, at least not just for the moment…
The figure of Frantz Fanon, psychiatrist and activist in the bitter Algerian struggle for independence from French rule, is a key reference point in current discussions about decolonisation. According to Turner, one of the leading advocates of this political turn within therapy: “As Fanon says, colonisation also involved the standardisation of ideas, the belief being that Western ways of thinking were the right ways, and that any other perspectives on knowledge were inferior in comparison” (2025: 31).
Fanon and decolonisation
So, who was Frantz Fanon, and why is he so important in this debate? Frantz Fanon was born in 1925 in Martinique, a French colony in the Caribbean, to a comfortably middle-class family. His father was Black, his mother mixed race, with European ancestry from Alsace in France. He was wounded on active service in the Second World War, fighting for the Allies, and then trained and worked as a psychiatrist in Algeria (Caute, 1970). He became an active member of the Front Liberation Nationale in the Algerian revolution against French control, until his death by cancer in 1961. As a psychiatrist, he experienced and analysed the reality of racism, colonial oppression and their damaging day-to-day effects on both the colonised and on the colonisers. He produced a series of powerful books on this issue, which gained him an international reputation.
Fanon’s key message was that colonisation impoverished both colonisers and the colonised, requiring intense political and military struggle in order to achieve liberation and full independence. He reserved his special ire for pressures on the colonised or newly independent states to unthinkingly follow the discredited practices imposed on all aspects of life. He dismissed these effects as ‘sterile litanies and nauseating mimicry’. In other words, “Let us decide not to imitate Europe” (Fanon, 1969: 252). He made a particularly close study of the damaging impact of colonial attitudes on the emerging practice of Algerian psychiatry, and the risks of uncritically adopting existing European/colonial models of practice (Fanon, 1969: “Colonial war and mental disorders”, 200-250).
Decolonising the Irish MOU?
Given his unflinching stance on this issue, it would be interesting to know what Fanon would have made of the uncritical export last year of a key UK therapy policy document, the Memorandum of Understanding on Conversion Therapy (MOU), from a major metropolitan power, i.e. the United Kingdom, to the main therapy associations of its former colony, namely Ireland? There has been a complex and conflicted history of Irish and British relationships over past centuries. It might have been advisable for there to have been at least some token attempt at revision and adaptation of the MOU to Ireland’s unique circumstances (MOUI, 2024).
However, this largely straight cut-and-paste version of the Memorandum, committed to outlawing all forms of alleged conversion therapy on grounds of sexual orientation or gender identity, appears to have been adopted by the three main Irish therapy associations, lock, stock and barrel, without any significant changes at all. Sauce for the (obviously non-gendered) goose, perhaps? It would also be worth knowing if the Irish version of the MOU covers children as clients in therapy (BACP, 2024). Or perhaps this was left as a minor detail to be sorted out at some later stage? After all, the process of decolonisation has clear limits, it would seem. This is particularly the case when it comes to considering the exceptional needs of trans ideology with regard to therapeutic work with children.
MOU: ignoring age boundaries within therapy
The export of the MOU to Ireland almost carbon-copy style sits uneasily within the current vogue for decolonisation, that is, if Fanon is to be taken seriously here. The main compelling reason for challenging the imposition of the MOU on Irish therapists, is, however, that it is simply a very bad policy (Jenkins, 2021). The concept of conversion therapy relies on an emotive persecution narrative, supposedly directed against people wanting to question or change their biological sex. Yet evidence for the existence of conversion therapy is underwhelming, outside of anecdotal cases in largely religious settings. But, above all, the MOU will not come clean as to whether it applies equally to children as well as to adults, that is to a gender-questioning child in primary school, as well as to a troubled autogynephile middle-aged male. To state the obvious, these are very different client groups, and require very different responses from a therapist.
Usually, age boundaries are seen as a critical watershed within any reputable form of therapy. Therapy with children is usually held to require specialist training, supervision, and applied knowledge of safeguarding law, given the unique vulnerabilities of this client group. This is particularly relevant to the United Kingdom Council for Psychotherapy (UKCP), as it includes therapy bodies which specialise in work with children. Seeking clarification as to whether the MOU included children, the UKCP was apparently informed in 2018 that the MOU did not include therapy with children. Then shortly afterwards in 2019, and without any formal consultation, it seems that the MOU now did include work with children (UKCP, 2024). This sudden about-face and apparent lack of transparency became a major factor influencing the UKCP Board’s decision to then leave the MOU in 2024.
Post-modernism and protective age boundaries
This apparent oversight by the MOU about children as clients actually reflects a key foundational strand of post-modernism. This is that age-related protective boundaries are essentially oppressive in nature. The other linked strand here derives from the work of Michel Foucault, arguably the founder and Godfather of post-modernism. Interestingly, in terms of decolonisation, Foucault took little active interest in the Algerian struggle during the 1950’s, despite his earlier membership of the French Communist Party (Macey, 2019: 82). Foucault had an enduring fascination with sexuality, but with something of a major blind spot here, concerning emerging post-colonial perspectives on this issue. According to Guesmi, commenting on allegations made against Foucault after his death, “Foucault completely disregarded the colonial subject from his writings on sexuality” (Guesmi, 2024). So, decolonisation was apparently something of a blank page for Foucault.
On the related and crucial topic of age boundaries, Foucault took part in in public discussion in 1978 about proposals to change the law in France regarding sexual activity by children aged 15 and over. Foucault stressed the need to avoid imposing legal prohibitions which could override children’s own ability to consent to sex with adults. He asserted categorically that “an age barrier laid down by law does not have much sense” (Foucault, in Kritzman, 1988). Hence, the MOU’s reluctance to be pinned down on whether its policy remit covers children under 18 seems to closely follow this post-modernist rejection of the need for protective age boundaries for children.
The counter argument here will, of course, be that Foucault was simply discussing proposed changes to the law regarding the age of consent for gay sex, whereas the MOU is chiefly concerned with sexual orientation and gender identity. These are clearly distinct and quite separate concepts. However, the central problem here is that the construction and popularisation of strongly contested twin fantasy concepts, namely those of gender identity and of the transgender child, ultimately reflect a wholly adult-centred approach. This perspective is geared primarily to meeting adult needs and desires. Ignoring the siren calls for increased childhood autonomy, this approach is actually centred on completely removing the existing legal and social safeguards which currently protect the physiological and sexual development of children.
MOU as protection against homophobia?
This problem is illustrated by the recent claim, referred to above, in the BACP house journal, Therapy Today, to “…the Memorandum of Understanding, which protects clients against homophobia and transphobia…” (Broughton, 2025: 28). In fact, leaving the undefinable term ‘transphobia’ out of the equation for the moment, the evidence does, rather inconveniently, tend to point the other way.
The MOU is a deeply flawed and rather deceptive policy document. It has been very carefully drafted so as to avoid any direct reference to the use of affirmative therapy. The latter is, in any case, more accurately defined as gender identity affirmative therapy. Gender identity is a client’s internal sense of gender, which may be at odds with their sex recorded at birth. The MOU claims that it does offer space for exploratory therapy, but in practice this is largely limited to clients who are unhappy or in distress about their gender identity. However, clients who are totally convinced about their gender identity may be just as much in need of patient, respectful exploration of their situation as those who are deeply conflicted about it.
Tavistock GIDS and affirmative therapy
However, the evidence base for the effectiveness of gender identity affirmative therapy is remarkably thin, if we simply discount the tranche of policy declarations on the topic by partisan US lobby groups, such as the World Professional Association for Transgender Health (WPATH). The main evidence we can draw on to inform discussion of gender identity affirmative therapy in the UK comes from the experience of the Tavistock Gender Identity Development Service (GIDS) from 2011-24. While affirmative therapy was not the sole therapeutic approach used here during this period, it was clearly the dominant and preferred house style on offer.
“…GIDS director Polly Carmichael and number two Bernadette Wren acknowledged: ‘Of course, our work is “affirmative” in many ways, in that we respect and accept completely children’s sense of themselves…and in some cases, where clinically appropriate, we affirm in the most profound way by providing treatment to alter their bodies’” (Barnes, 2023: 105). “Yet, other therapists working at the GIDS, such as Anna Hutchinson, have disagreed. “The only ‘pathway’ on offer was one toward physical intervention – puberty blockers” (105). “…GIDS didn’t provide different treatment pathways. Ongoing talking therapy, for example, was not something they could offer” (105). “…the service was unable and not commissioned to provide more than one treatment pathway – physical transition” (156). “’Differential diagnoses’ – ones that suggested other factors at play – were discouraged” (167).
MOU as endorsement of GIDS affirmative therapy
The gender identity affirmative approach was, in turn, explicitly linked by Tavistock management to its claimed endorsement by the MOU. According to Dr Bernadette Wren, then Associate Director of the GIDS, the Memorandum did, in fact, signify a commitment to affirmative therapy. This is evidenced by a conference presentation made in 2019 by Wren, a senior clinician and manager at the GIDS:
Slide 14: “Clincians (sic) also have a defence in the fact that many professional bodies now endorse the diagnosis of Gender Dysphoria and the affirmative approach to care via the Memorandum of Understanding. (BPC,BPS, RCGP, UKCP) See Bolam 1957” (Wren, 2019: PJ: emphasis added).
The reference to Bolam, 1957, is significant, but will probably be lost on most therapists working outside the National Health Service. This is a critical piece of case law, which sets the relevant legal standard for defining the competence of the ordinary professional medical practitioner. This standard was later adapted to include therapists in the Landau case of 1961. Wren seems to imply here that the MOU might be seen as setting an industry standard for reasonably competent practice. This standard, i.e. complying with the MOU, could then be used to defend professionals against any future legal action brought by clients for alleged professional negligence (Jenkins, 2023).
‘Conversion therapy for gay kids’
If the GIDS was offering gender identity affirmative therapy almost to the exclusion of other more exploratory approaches, under the apparent endorsement and authority of the MOU, then this very much suggests an approach centred on adult power over children. According to this adult-centred model, adult professionals knew best. Options for choice of therapeutic model were strictly limited. In the main, professionals were generally only prepared to offer therapeutic services which promoted this view, and which were ultimately geared towards facilitating medical transition. In addition, the GIDS appeared to ignore the demographic they were working with, in terms of its clients’ identified sexual orientation.
Barnes reports that one experienced therapist at GIDS “…came to feel that GIDS was performing ‘conversion therapy for gay kids’. It’s a serious claim. …there was even a dark joke in the GIDS team that there would be no gay people left at the rate GIDS was going.” According to this (named) therapist, “… there were there were gay children – who were being pushed down another path.” (161) [PJ: For children referred in 2012] “…over 90 percent of natal females reported that they were same-sex attracted or bisexual…For the natal males, 80.8 per cent reported being same-sex attracted or bisexual” (161). Yet, according to Sonia Appleby, GIDS safeguarding lead, “…staff ‘felt they are coerced into not reporting safeguarding issues, and to do so is “transphobic”” (317).
Conclusion:
So, far from the MOU protecting clients, in this case children, from homophobia, the GIDS seems to have acted more to provide a medicalised conveyor belt for gender questioning, largely gay, lesbian or bisexual children in their teens. This involved moving children towards the prescription of puberty blockers and later facilitating their progression to cross-sex hormones and, ultimately, towards medical transition. The MOU’s vacillating about acknowledging protective age boundaries for child clients can now perhaps be seen in a very different light, given this compelling evidence from the GIDS for the period 2011-24.
The MOU has absorbed from post-modernism a visceral opposition towards adopting age-related protective boundaries within the field of gender identity affirmative therapy. Under the guise of promoting full adolescent autonomy, it arguably contributed towards reproducing a classic pattern of medical paternalism within the GIDS, with very limited real choices available to child patients and clients. So perhaps the time has come to decolonise the MOU and reject its authoritarian posturing once and for all?
References
Barnes, H. (2023) Time to think: The inside story of the collapse of the Tavistock’s Gender Service for Children. London: Swift.
British Association for Counselling and Psychotherapy (BACP)(2024) Memorandum of Understanding on Conversion Therapy. https://www.bacp.co.uk/events-and-resources/ethics-and-standards/mou
Broughton, E. (2025) “The truth about harm in therapy”, Therapy Today, April, 36(3), pp. 22-28. https://www.bacp.co.uk/bacp-journals/therapy-today/2025/articles-april/the-big-issue
Caute, D. (1970) Fanon. London: Fontana.
Fanon, F. (1969) The Wretched of the Earth. Harmondsworth: Penguin.
Foucault, M. “The danger of child sexuality”, In Kritzman., L. (Ed) Michel Foucault: Politics, philosophy, culture: Interviews and other writings. New York: Routledge. https://www.uib.no/sites/w3.uib.no/files/attachments/foucaultdangerchildsexuality_0.pdf
Guesmi, H. (2021) “Reckoning with Foucault’s alleged sexual abuse of boys in Tunisia.” Al Jazeera. https://www.aljazeera.com/opinions/2021/4/16/reckoning-with-foucaults-sexual-abuse-of-boys-in-tunisia
Jenkins, P. (2021) Through the looking glass: Making sense of the MOU Parts 1 and 2: Critical Therapy Antidote: https://criticaltherapyantidote.org/2022/03/25/through-the-looking-glass-making-sense-of-the-mou-part-1 Through the Looking Glass: Making sense of the MOU – Part 2 – Critical Therapy Antidote
Jenkins, P. (2023) “Therapy and the law”, pp. 171-176, In T. Hanley and L. Winter (Eds) Sage Handbook of Counselling and Psychotherapy. Fifth edition. London: Sage.
Macey, D. (2019) The lives of Michel Foucault. London: Verso.
Memorandum of Understanding on Conversion Therapy on the Island of Ireland (MOUI), 12 July 2024.
Turner, D. (2025) “Unravelling the coloniser’s grip”, Therapy Today, March, 36(2), pp. 30-32. https://www.bacp.co.uk/bacp-journals/therapy-today/2025/articles-march/case-notes
United Kingdom Council for Psychotherapy (UKCP) (2024) Update on conversion therapy. UKCP update on conversion therapy (psychotherapy.org.uk)
Wren, B. (2019) “Ethical issues in the provision of medical interventions for gender diverse children and adolescents”. Association for Child and Adolescent Mental Health, 14th June (Slide 14, Powerpoint presentation, ACAMH Conference). https://www.acamh.org/app/uploads/2015/06/16_05_Dr_Bernadette_Wren.pdf
Legal references
Bolam v Friern HMC [1957] 2 All ER 118
Werner v Landau, TLR 8/3/1961, 23/11/1961 Sol Jo (1961) 105, 1008
By Peter Jenkins, counsellor, supervisor, trainer and researcher in the UK. He has been a member of both the BACP Professional Conduct Committee and the UKCP Ethics Committee. He has published a number of books on legal aspects of therapy, including Professional Practice in Counselling and Psychotherapy: Ethics and the Law (Sage, 2017). https://us.sagepub.com/en-us/nam/author/peter-jenkins
Peter is also a member of Thoughtful Therapists. His critique of the Memorandum of Understanding on Conversion Therapy was described as ‘instrumental’ in persuading the UKCP Board of the case for leaving the MOU in 2024.
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