Position Statements

Summary  

The New Zealand Psychological Society opposes the use of so-called ‘reparative’ or ‘conversion’ therapies. These so-called therapies include any psychological approach or intervention that seeks to convert, repress and/or eliminate any person’s same-sex or non-heterosexual orientation, attractions, desires, identities and behaviours, or any person’s gender identity or gender expression that does not meet expectations based on their sex assigned at birth. The Society considers these so-called therapeutic practices unethical and contrary to the interests, wellbeing and safety of takatāpui and LGBTQI+ peopleⁱ. In opposing these practices, we join with many other professional bodies including the New Zealand Psychologists Board, Australian Psychological Society, Psychotherapy and Counselling Federation of Australia, The Royal Australian and New Zealand College of Psychiatrists, New Zealand Association of Counsellors, British Psychological Society and the American Psychological Association. We are also a signatory to the international IPsyNet Statement on LGBTQI+ concerns - https://www.apa.org/ipsynet/advocacy/policy/statement-commitment     

Accordingly, the New Zealand Psychological Society requires that Psychologists in Aotearoa/New Zealand, must abstain from being involved in any ‘reparative’ or ‘conversion therapies’, and adhere to and be directed in their work with people with diverse genders, sexualities, and sex characteristics by the New Zealand Psychologists Board published best-practice guidelines Working With Sex, Sexuality and Gender Diverse Clients (2019) and the Code of Ethics for Psychologists Working in Aotearoa/New Zealand (2002). 

Position Statement  

1. Same-sex or non-heterosexual orientation, attractions, desires, identities and behaviours, non-cisgenderⁱⁱ gender identities and expressions, and diverse sex characteristics are normal and healthy variations of human functioning, relationships and bodies; these are not psychological illnesses, syndromes, or disorders (American Psychological Association, 1975; Coleman et al., 2011; New Zealand Psychologists Board, 2019), and therefore they do not require therapeutic interventions to change them.  

2. There is no research-based evidence to suggest that so-called ‘reparative’ or ‘conversion therapies and interventions’ are effective or successful. To the contrary, there is research-based evidence to suggest that such so called ‘reparative’ and ‘conversion therapies’ can be and are frequently harmful, distressing and indeed dangerous (Cheers et al., 2020; Fish & Russell, 2020; Green et al, 2020; Turban et al, 2020) 

3. People with diverse genders, sexualities and sex characteristics are particularly vulnerable, due to experiences of minority stressⁱⁱⁱ and might be under considerable influence to comply with the normative expectations of others. The presence of minority stress is often misconstrued by advocates and supporters of so-called ‘conversion therapies’ to be part of the psychopathology inherent to diverse genders and sexual orientations and unethically used as a motivation to practice ‘conversion therapy’ (Mental Health Foundation NZ, 2018; Rosik, 2001).    

4. Psychologists in Aotearoa New Zealand are subject to and must operate within their Code of Ethics. The NZ Psychological Society argues that registered psychologists who are involved with the production, offering, delivery, or support of so-called ‘reparative’ or ‘conversion therapies and interventions’ are doing so in violation of the NZ Psychologists Code of Ethics.  

5. For best practice guidelines, psychologists in Aotearoa/New Zealand should refer to The New Zealand Psychologists Board Best Practice Guidelines Working With Sex, Sexuality and Gender Diverse clients, published in 2019. This is available on their website.  

References 

American Psychological Association (1975). Policy statement on discrimination against homosexuals. American Psychologist, 30, 633 

Coleman, E., Bockting, W. O., Botzer, M., Cohen-Kettenis, P. T., DeCuypere, G., Feldman, J., Fraser, L., Green, J., Knudson, G., Meyer, W. J., Monstrey, S., Adler, R. K., Brown, G. R., Devor, A. H., Ehrbar, R., Ettner, R., Eyler, E., Garofalo, R., Karasic, D. H., … Zucker, K. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13(4), 165–232. https://doi.org/10.1080/15532739.2011.700873 

Cheers, H., Rickman, M., Campbell, E.M., & Ewings, S.J. (2020). Proposal of alternative solutions to address children’s rights violation: Conversion therapy. Social Work & Policy Studies: Social Justice, Practice and Theory, 2(2). https://openjournals.library.sydney.edu.au/index.php/SWPS/article/view/14075  

Fish, J. N., & Russell, S. T. (2020). Sexual orientation and gender identity change efforts are unethical and harmful. American Journal of Public Health, 110(8), 1113–1114. 

Green, A. E., Price-Feeney, M., Dorison, S. H., & Pick, C. J. (2020). Self-Reported Conversion Efforts and Suicidality Among US LGBTQ Youths and Young Adults, 2018. American Journal of Public Health, 110(8), 1221–1227. 

Mental Health Foundation New Zealand (2018) Rainbow communities, mental health and addictions – a submission to the Government Inquiry into Mental Health and Addiction- Oranga Tāngata, Oranga Whānau https://www.mentalhealth.org.nz/assets/Our-Work/policy-advocacy/Rainbow-communities-and-mental-health-submission-to-the-Inquiry-into-Mental-Health-and-Addiction-08062018.pdf  

New Zealand Psychological Society (2002). Code of ethics for psychologists working in Aotearoa/New Zealand. New Zealand Psychological Society. 

New Zealand Psychologists Board. (2019). Best practice guideline: Working with sex, sexuality, and gender diverse clients. http://www.psychologistsboard.org.nz/cms_show_download.php?id=594 

Rosik, C. H. (2001). Conversion Therapy Revisited: Parameters and Rationale for Ethical Care. Journal of Pastoral Care, 55(1), 47–67. https://doi.org/10.1177/002234090105500107 

Turban, J. L., Beckwith, N., Reisner, S. L., & Keuroghlian, A. S. (2020). Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults. JAMA Psychiatry, 77(1), 68–76. https://doi.org/10.1001/jamapsychiatry.2019.2285 

i Takatāpui: Takatāpui refers to Māori who are not heterosexual and/or not cisgender. It is used both as a gender identity (similar to transgender), as an attraction or sexual orientation (similar to lesbian, gay, bi or pansexual). It is also used as an umbrella term for all non-heterosexual and/or non-cisgender Māori people (similar to rainbow community). Note that not all Māori who are not heterosexual and/or non-cisgender will identify with the term Takatāpui. (Trans 101: Glossary of trans words and how to use them, Gender Minorities Aotearoa, Wellington New Zealand, 2020, https://genderminorities.com/database/glossary-transgender/ )
LGBTQI+: Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, + other non-heterosexual and/or non-cisgender people. Often used as an umbrella term.
ii Cisgender: Cisgender (cis) is a term for people whose gender is the same as their assigned sex at birth.
iii “Minority stress refers to the stress associated with being marginalised, discriminated against, or having different cultural and/or social frameworks to the majority of the population.” NZ Psychologists Board (2019) Best Practice Guidelines on Working with sex, sexuality and gender diverse clients, 7

Caring for the natural world is critical to our own wellbeing.We are an integral part of nature and yet we have been slow to recognize the detrimental effects we humans are having on the environment.To accept nature’s nurturance while allowing our lifestyles to undermine its life-giving capacity is to jeopardise our own health and future survival.¹

As psychologists, we function to promote the wellbeing of society. So it is vital that as a discipline, we acknowledge the profound impact humans collectively are having on the environment and urgently work to counter the ill-effects to the health and wellbeing of people and planet.

WHAT WILL WE DO?

We acknowledge that the implications of environmental damage and climate change bring in new responsibilities and require an extended understanding of the nature of wellbeing. We will work to ensure that psychologists contribute to mitigating the ill-effects of a climateturbulent future, strengthening our capacity as practitioners at individual, community, governance and academic levels. We will work with other disciplines, agencies and networks to achieve shared understandings, pooling energies and insights to influence and to find our way through conflict; to shape thinking, provide direction for interventions, and contribute to the task of mobilizing a collective response towards a healthier sustainable future.

To start this process the New Zealand Psychological Society (NZPsS)

• Recognises the need to actively encourage psychologists to promote understanding of the human and psychological dimensions of global climate change and to develop the role of psychology in climate change issues affecting New Zealand.
• Commits to auditing the Society’s own environmental impacts and developing sustainable practices and strategies to reduce its contribution to global climate change.
• Seeks opportunities to work with government, political organisations and other agencies to ensure they understand the potential roles (policy, practical and research) for psychology in promoting understanding, encouraging climate-friendly practices and responding to communities and individuals experiencing climate related distress.

WHAT INTERESTS US?

While there are many questions that have captured our attention the following have a psychological focus:

• What does it mean to live sustainably? How will this impact on our consumer and carbon rich lifestyles? What can be done to communicate environmental messages so that sustainable lifestyles are adopted?
• What effects will climate change have on people’s lives, health, wellbeing, cultures and communities? How can those impacts be ameliorated and what adaptive responses are needed at the individual, community and government level?
• What can we do to flourish in a finite world within ecological and social limits? How can cities become places for nature, promoting the wellbeing of an increasing population?

WHAT WE CAN OFFER?

To counter environmental degradation and facilitate action based adaptation, mitigation and transformation psychologists can offer:

• Interventions to ensure understanding of the causes and consequences of environmental degradation, especially climate change (given the 2014 NZPsS AGM remit).

- Knowledge based interventions to stimulate interpersonal/public discussions and enhanced engagement in climate action

- Process-based interventions to facilitate the development of self and community efficacy in community-led solutions

• Interventions to overcome emotional responses associated with this understanding. These responses including depression, anxiety, helplessness and hopelessness
• Community-based climate protection interventions to facilitate:

- A reduction in urban energy consumption

- More sustainable urban waste disposal and water conservation

- Low carbon urban living transitions to sustainability

- Consumer/citizen participation in above (i.e. environmental conservation)

- Citizens, communities, commerce and councils (local governments) working together to contribute to sustainable urban development

- The formation of people-networks that encourage new ideas and promote the learning, experimentation and creative problem solving required for resilient communities.

Note that psychologists in many parts of the world are moving to use their expertise in these endeavours. Health professionals will be increasingly involved in a comprehensive response to climate change and the transition required to sustainability. The NZPsS’s responsibility is to ensure that our own psychologists have the opportunity to contribute to these endeavours in the near future.

April 2018

¹ Adapted from the Climate Psychology Alliance (CPA) website introduction to the Transpersonal Narratives in Eco-Psychology Conference 24-26th November 2017, Cornwall, U.K. http://www.climatepsychologyalliance.org/events/others-events/249-transpersonal-narratives-in-ecopsychology

Child poverty and mental health-  A literature review

The delivery of mental health services in Aotearoa/New Zealand have been more heavily influenced by the Diagnostic and Statistical Manuals (DSM) of the American Psychiatric Association than any other diagnostic and classification system.For practitioners such a system furnishes the words and concepts that can shape thinking, structure assessments, and provide direction for interventions.It influences both what we communicate and how we communicate.The DSM categorical system has proven to be a potent conceptual framework for thinking about mental illness and those who struggle to maintain good mental health.

For these reasons the release of the new Diagnostic and Statistical Manual of Mental Disorders – 5 th Edition (DSM-5; APA, 2013) in mid-2013 has been of considerable importance. We acknowledge the efforts of the American Psychiatric Association to provide an update which reflects the current state of knowledge about mental disorders¹.They have endeavoured to obtain consensus where much remains uncertain and provide a framework within which clinicians can work to enhance the wellbeing of service users. We are aware of the well documented difficulties experienced during the preparation of the new manual - within the sub-groups of the Task Force who developed the text, as well as the pre-emptive and reactive critique offered by commentators and organisations worldwide.

We agree with the position statement published by the Division of Clinical Psychology (DCP, 2013), a Division of the British Psychological Society and the Open Letter authored by the American Psychological Association’s Division 32 Committee on DSM-5 (Division 32 Committee, 2011). We share their concern about both specific changes that have been implemented within the DSM-5 and the overall assumptions about the aetiology and resolution of mental disorders. The scope and scale of specific changes has resulted in many revisions lacking clarity, lacking broad empirical support and having little clinical utility. Most mental health services are delivered within primary care settings by practitioners with limited specialist mental health training. The categorical adjustments appear to do little to aid these practitioners in identifying and understanding the problems faced by their clients. Indeed, there is concern that there may be over pathologising of those seeking assistance.

The lack of a broad research base suggests that we are a long way from having a single bio-medical explanation for mental disorders, even if this is achievable or desirable. We ascribe to the view that while neuro-biological causes and associations of a minority of mental disorders may one day be uncovered, current research suggests that the vast majority of the challenges to good mental health experienced by service users result from a range of factors, including; social, cultural, political, psychological and biological. In order to respond respectfully and effectively to each individual service user and those that support them, the practitioner must look beyond the mental disorder and develop an appreciation of the complexity and uniqueness of the individual and their social and cultural context. In responding to the person rather than the disorder we work to reduce stigma and enhance personal agency and growth. A psychological framework goes a substantial way to achieving this through the process of case conceptualisation and the utilization of practice-based evidence to guide and support individually tailored assessment and intervention.This is the “paradigm shift” called for in the DCP statement and is one which we wholly endorse.

Finally, it may well be the case that the DSM-5 is ‘fit for purpose’ within the 3rd -party payer healthcare system found in the North America. This is not the system we currently have in New Zealand.To be competent practitioners we are required by the New Zealand Psychologists Board (2011, p4) to have an “…appreciation of the cultural basis of psychological theories, models and practices and a commitment to modify practice accordingly.” We believe that it is inappropriate and potentially dangerous to support the wholesale adoption of a categorisation system that was developed with no consideration of our local philosophical, cultural, and professional practice needs or wishes. We welcome alternative models developed in Aotearoa/New Zealand that embody the relational principles set out in Te Tiriti o Waitangi and broader concepts of hauora/well-being considering the needs of individuals in the context of their whanau/families, immediate and wider communities.

We recognise that our members and colleagues may choose, or be obliged by their employers and other agencies, to make use of DSM-5 diagnoses in their work. We urge them to do so cautiously and with awareness of potential pitfalls. For a reflective and culturally competent practitioner this will require a good understanding of the DSM-5 and the practical and ethical implications of its use. Psychologists should also be familiar with alternative classificatory systems, and the unique considerations and responsibilities associated with practice in Aotearoa/New Zealand.

¹ This term is used here because of its general use within DSM-5. However, we recognise that this label is not value free and would not recommend its general use.

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: APA. Division of Clinical Psychology (2013). Division of Clinical Psychology Position Statement on the Classification of Behaviour and Experience in Relation to Functional Psychiatric Diagnoses. Retrieved from http://dxrevisionwatch.files.wordpress.com/2013/05/position-statement-on-diagnosis-masterdoc.pdf Division 32 Committee (2011). Open Letter to the DSM-5 Task Force. Accessed 17 May 2013, http://dsm5-reform.com/the-open-letter-to-dsm-5-task-force New Zealand Psychologists Board (2011). Cultural Competencies: For Psychologists Registered Under the Health Practitioners Competence Assurance Act (2003) and Those Seeking to Become Registered Retrieved from http://www.psychologistsboard.org.nz/cms_show_download.php?id=62

Every person should be able to access the expertise and services provided by psychologists. Psychologists are qualified and registered professionals with the knowledge and skills to provide services in a wide range of areas. These include

• Clinical psychology
• Counselling psychology
• Developmental/child psychology
• Educational psychology
• Criminal justice/forensic psychology
• Health psychology
• Community psychology
• Industrial and organisational psychology
• Neuropsychology
• Kaupapa Māori psychology
• Sports psychology

Psychologists provide services to individuals, family/whanau and communities in a variety of contexts. These services are based on the four ethical principles of the Code of Ethics (PDF) for psychologists in New Zealand.

• Respect for the dignity of persons and peoples
• Responsible caring
• Integrity of caring
• Social justice and responsibility in New Zealand

Funding should be sufficient to allow all New Zealanders access to the psychological services they require to reach optimal health and wellbeing. The Society believes that equity of access to psychological services is an important social justice objective which needs to underpin policy, funding and service delivery decisions. These decisions should focus on the provision of high quality, evidence-based psychological interventions and facilitate the development of teamwork amongst service providers.

The Tavistock principles (PDF)  for health care provide a useful basis for funding decisions.

The New Zealand Psychological Society recognises cultural competence as a core competency for psychologists. This includes an understanding of the principles of protection, participation and partnership with Māori as tangata whenua. It also includes respect for diversity and a recognition that all people, live and develop within their social cultural and community groups.

The New Zealand Psychologists Board has a responsibility to ensure that cultural competence underpins its role in the protection of the public of New Zealand through the registration of psychologists and the management of competence, conduct and fitness issues. Providers of training and professional development also need to ensure that cultural competence informs the content and delivery of education and training of psychologists.

Life-long learning is essential for psychologists to maintain their professional competence. Individual psychologists whilst able to play an important part in determining their own professional development needs also recognize that others, (e.g. professional peers, clients and society as a whole) have a contribution to make in identifying important issues for professional development.

Effective professional development for psychologists needs to

• Take into account the breadth and depth of the work of psychologists and the needs of their clients and communities
• Take into account the self-care needs of psychologists
• Ensure the maintenance and development of cultural competencies
• Be based on core competencies and maintain and improve existing skills
• Foster the development of new skills
• Be supported and funded by employers

New Zealanders’ access to psychological services is dependent upon there being sufficient numbers of suitably qualified, registered psychologists available to practice psychology.

Appropriate workforce development strategies need to be in place. This requires the combined effort of Government, the Psychologists Board, educators, employers, consumers, rural communities and psychologists and their professional bodies.

A workforce development strategy needs to address the following

• Recognition of the skills and expertise that psychologists can contribute to health and wellbeing in New Zealand in a wide range of contexts including primary care, criminal justice, education, rehabilitation settings
• Recognition of the contribution that psychologists can make to interprofessional delivery of services especially in conjunction with general practice
• Gathering of objective data on the psychology workforce including projections of workforce need and data on workforce trends
• Recognition of the shortage of psychologists in a range of areas especially in relation to clinical and educational psychology
• Acknowledgement of the important contribution that psychologists can make in relation to the primary health care strategy
• The need for funding for sufficient numbers of places for psychologists to gain undergraduate education and post-graduate qualifications
• Ensuring sufficient numbers of Māori and Pasifika psychologists
• Ensuring sufficient numbers of appropriately funded places for trainee intern psychologists who are gaining practical skills in a range of professional contexts
• Ensuring that ACC, District Health Boards, Ministries of Education, Justice , Social Development, Department of Corrections and other agencies are funded to employ sufficient numbers of psychologists to meet the service needs of their clients
• Ensuring that psychologists’ positions are not being filled by non-psychologists who are unable to provide the level or quality of psychological services that New Zealanders need or expect
• Ensure sufficient funding for research in psychology to support the evidence-based practice of psychology

Psychology functions as a discipline to promote the wellbeing of society. The principle of social justice in relation to psychologists acknowledges the position of power and influence they hold in relation to the individuals, whanau, groups and communities with whom they are involved.

The Treaty of Waitangi is a foundation document of social justice in New Zealand and is the basis for respect and partnership between Māori as tangata whenua and all peoples who live in New Zealand. International agreements such as the Universal Declaration of Human Rights, the International Declaration of the Rights of the Child and the Declaration of Rights of Indigenous Peoples also underpin social justice.

Psychologists along with their colleagues in other professions have a responsibility to challenge unjust societal norms, attitudes and behaviours that disempower people at all levels of interaction.

The New Zealand Psychological Society believes that children, as our most vulnerable members of society need to be protected.  The Society does not believe that hitting and hurting children makes for better parenting nor does it strengthen the family or protect New Zealand Society.  There is considerable research which points to the harmful effects of corporal punishment on children.

The Society supported the amendment of Section 59 of the Crimes Act and notes that the law does not sanction employers hitting and hurting employees or spouses hitting and hurting each other.

The Society considers that reducing the level of violence in New Zealand is a high priority social policy issue. All violence and abuse whether it be physical, emotional, sexual and/or other forms, need to be addressed by a range of policy, economic and funding initiatives. These include the following

• Ensuring that legislation protects the most vulnerable members of New Zealand Society
• Reducing poverty and levels of income disparity leading to hardship
• Ensuring access to psychological and other health and welfare services across all sectors of society
• Ensuring sufficient funding for the recruitment, retention of the workforce involved in the delivery of programmes aimed at reducing violence
• Using evidence-based research to inform policy decisions on preventing violence
• Ensuring that all policy initiatives are properly evaluated
• Ensuring that policy initiatives and programmes in relation to violence are, where appropriate, developed and delivered by the communities to whom they are directed
• Ensuring that cultural competence underpins policy making and delivery of programmes in relation to violence
• Ensuring a more coordinated and collaborative approach amongst government and non-government agencies working in violence prevention