George* grew up in rural South Africa, the nephew of a famous evangelical pastor. Five years ago, at age 16, he came out to his family. They responded with a ceremony to “drive the devils out of him,” intended to turn him straight.
This type of reaction is still common in religious circles. Though South Africa’s post-apartheid constitution, adopted in 1996, is one of the world’s most progressive and the first to protect lesbian, gay, bisexual, transgender and intersex (LGBTI) rights, the lived experiences of people like George point to a major gap between policy and reality.
“On paper, South Africa is a wonderful place to be sexually and gender diverse,” says Juan Nel, professor of clinical psychology at the University of South Africa in Pretoria, who has a doctoral degree in psychology. “But that legal framework does not translate to the daily reality for many individuals, who continue to experience exclusion, discrimination, ostracization and, in some instances, homo- and transphobic victimization.”
Problems range from inadequate medical and psychological services for transgender South Africans who seek gender reassignment surgery to violent acts such as corrective rape. Studies indicate that LGBTI individuals are some of the most discriminated against in the country. For example, a 2016 survey of South African adults found that 72 percent feel same-sex activity is “morally wrong” (Progressive Prudes Surveyopens in new window, 2016), while Nel’s research on hate and bias identified sexual orientation and gender identity as two of the most common targets of those committing hate crimes (Hate and Bias Crimes Monitoring Form Projectopens in new window, 2017).
To begin to close the gap between laws and attitudes, in 2007 Nel partnered with APA and the International Psychology Network for LGBTI Issues (IPsyNet) to advocate for the sexually and gender diverse in South Africa. And in 2013, he helped launch the Psychological Society of South Africa’s (PsySSA) Sexuality and Gender Division, of which he is vice chair.
Now, the division, which has grown to 50 members, has released affirmative practice guidelines for psychologists who work with sexually and gender diverse individuals—the first practice guidelines of any kind released by an African psychological society. In addition, the division has published position statements on numerous national and international concerns, advanced scientific research on LGBTI issues and assisted South African universities with curriculum development. The group hopes this work will serve as a model for other African nations, many of which still treat homosexuality as a crime.
“Because of South Africa’s very progressive legal framework, it’s been relatively easy to do LGBTI work here,” says Suntosh Pillay, a clinical psychologist and member of PsySSA’s Sexuality and Gender Division, who has a master of social science (MSocSc) in clinical psychology. “What’s been more challenging is changing attitudes, because as much as the laws can change, influencing social and cultural attitudes can be quite difficult.”
Progressive movement
Among psychologists, one of the motivations for advocating for the LGBTI community is to right past wrongs: During the apartheid period, psychologists provided the South African government superficial scientific justification for persecution based on sexual orientation, including forced conversion therapy and gender reassignment surgery.
“If psychology was part of the problem, then it also needs to be part of the solution,” says Niel Victor, MSocSc, clinical psychologist and treasurer of the Sexuality and Gender Division.
This lens of professional atonement, as well as a broader effort among psychologists to dissolve the heteronormative structures and ideals of South African society, led to the launch of the division and explains why social justice efforts are just as central to its mission as traditional research and practice. Psychologists officially began that work in 2007 with formal responses to national, continental and international issues arising in the areas of sexual and gender diversity. Under Nel’s leadership, PsySSA released a science-informed statement evaluating—and condemning—Uganda’s proposed Anti-Homosexuality Bill in 2009. The statement cited international and South African research to explain the nature of sexual orientation and the detrimental effects of discrimination on the basis of it.
“The Sexuality and Gender Division has become a springboard for our work,” says Chris McLachlan, MSocSc, a clinical psychologist who specializes in transgender issues and is a reverend at the Reforming Church in Pretoria. “Because these statements are professionally advanced, it gives our words more gravitas because we have academia and private practice behind us.”
More recent efforts to address LGBTI issues include the division’s push last year for the South African government to expand medical care for transgender people.
The group also released a broader position statement in 2013 emphasizing that sexual and gender diversities are normal variations that do not cause pathology and encouraging practitioners to adopt “a stance of openness, acceptance and affirmation” toward LGBTI patients. The statement is grounded in a South African body of research, including Nel’s study of hate crimes and an assessment Victor conducted of LGBTI individuals’ experiences in psychotherapy.
“We must constantly remind ourselves, and remind our colleagues, that social justice is relevant to how we practice every single day,” says Pillay. “It’s relevant to the decisions we make when we see clients, what we put into the curriculum, the kind of research that we do, the kind of language that we use.”
Practice guidance
In 2017, the research and advocacy led by the Sexuality and Gender Division culminated in its biggest accomplishment so far: the creation of 12 affirmative practice guidelines for psychologists who work with LGBTI populations. The division sees these guidelines as essential for helping to dismantle the heteronormative ideals that pervade South African society.
“Very few psychology professionals are competent in dealing with the sexually and gender diverse, and some of them continue to hold their own prejudices,” Nel says. “As a result, interactions with psychology professionals are not as affirming as we believe is required, especially given that those interactions are often the last safe space for marginalized people to seek out support.”
For example, a therapist may ask a male client if he has a wife or girlfriend without considering that he might be gay. In more extreme instances, health-care professionals have broken confidentiality and exposed patients’ sexual or gender identities to mutual acquaintances.
Often, psychologists are well-intentioned but unequipped to handle LGBTI issues in the South African context. For instance, LGBTI guidelines from other countries typically advise that therapists encourage patients to come out publicly, but Pillay says this can be dangerous in a hostile society.
“We therefore advise practitioners to navigate this issue very carefully, balancing it with the pros and cons and the real risk that people face if they’re to come out in our society,” he says.
The 12 guidelines cover nondiscrimination, the necessity for an affirmative stance, LGBTI developmental pathways, handling intersecting discriminations and continued professional development. Each guideline contains a rationale and supporting research as well as instructions for applying the guideline in personal,institutional and societal contexts.
For the guideline that covers intersecting discriminations, for instance, the document cites research on the “matrix of identities” that contribute to a person’s self-concept. It encourages practitioners to consider issues around poverty, unemployment, race, culture, language, refugee status, HIV/AIDS and urban versus rural residency.
Though the guidelines are informed by work done by APA and the British Psychological Society, they differ in several key respects from guidelines issued by those organizations. Rather than focusing on sexual orientation, for example, they address a broad spectrum of sexual and gender identities. The guidelines also are directed toward all psychologists, including researchers, rather than practitioners only. Most important, the guidelines are grounded in African and South African bodies of knowledge, drawing almost exclusively from research conducted on the continent.
So far, the document has been incorporated into clinical psychology programs at multiple South African universities and used to conduct professional development workshops. The guidelines have also attracted interest from outside the psychology discipline, including from social workers, public health professionals, physicians, nurses and surgeons. Several government offices, including South Africa’s Department of Social Development, for example, have requested formal training based on the guidelines.
“Already, the affirmative practice guidelines have helped us create a platform from which to develop more inclusive curricula and spearhead continued professional development in psychology and beyond,” Victor says.
An expanding reach
Outside PsySSA, the resources and conversations generated by the Sexuality and Gender Division are also making a difference.
“Where I’ve really seen the impact is when sexually and gender diverse people are faced with a situation where there are no safe spaces left,” says Victor. “I’ve increasingly seen safe spaces being created—in the clinic, in therapeutic rooms and at universities—based on our practice guidelines and ongoing work in this area.”
The division also continues to stimulate research in new areas specific to South African society, such as Pillay’s pioneering survey of gay South Africans of Indian descent. Members of the division currently have several academic studies in progress, including new studies of hate and bias in South Africa and the ethics of working with marginalized populations.
Another major focus area moving forward involves applying the insights within the affirmative practice guidelines to new domains, disciplines and populations. Psychologists who are studying trauma, sexual assault and education, as well as leaders in the fields of public health and social work, hope to develop their own practice guidelines with assistance from Nel and his colleagues.
Meanwhile, the Sexuality and Gender Division is working directly with activists in other African countries, including Tanzania and Cameroon, who hope to establish a tradition of affirmative practice for the sexually and gender diverse. This work requires patience—in some countries, homosexuality is still punishable by death—and creativity. Victor says a human-rights framework doesn’t resonate with most Africans—social justice campaigns for LGBTI rights feel colonialist because of their Western origins. Instead, focusing on health, wellness and scientific research tends to be more effective.
“We don’t want to be seen as a colonizer of other countries; we want to open up the doors for people to empower themselves,” McLachlan says. “Our work throughout Africa is more about sharing what we have learned so that they can develop their own guidelines.”
*Name changed to protect privacy
