Stephen Pattison (1988, 1993, 2000) notes that the term "counselling" is often used but rarely defined.
What is pastoral care?
He argues strongly in favour of a definition and proposes this: "Pastoral care is the activity carried out by representative Christian persons and aimed at eliminating sin and suffering and presenting all people in Christ perfectly before God."
I am not suggesting that we adopt this definition of pastoral care. I think it is inadequate and misleading in a number of ways, and since it is over three decades old, I imagine Pattison himself would not be happy with it. But it is a helpful starting point because it makes the following clear: that definitions are important, there are different definitions of counselling, we are looking specifically at Christian counselling, theological concepts such as sin, grief and sanctification play a role even if they are not explicitly mentioned as they are in his definition.
Do transgender and intersex people want or need pastoral care?
This question must be asked. And the answer is: in many cases, no more than any other person. Some trans and intersex people do not seek pastoral care because of their identity. Others may have specific pastoral care needs related to their gender identity or to being a person with intersex characteristics. For example, an intersex person may seek counselling if they need medical help because of their variation.
When thinking about pastoral care for trans and intersex people, it is important not to suggest that trans and intersex people are a problem. They may face experiences and circumstances specifically related to their identity, but so do many other groups of people.
So here is the first key thought from the UK. In the words of the Archbishop of Canterbury (ABC 2017) (in response to the Church of England's General Synod vote not to "take note" of the House of Bishops' proposal that the Church should be more welcoming to LGBTIQ+ people but same-sex marriages could not be solemnised in its churches): "No human being is a problem or an issue. People are made in the image of God. All of us, without exception, are loved and called in Christ. There are no 'problems', there are simply people".
I find this statement both moving and profound. It also appeared in a letter that launched what later became Living in Love and Faith (LLF), a major Church of England project offering 'Christian teaching and learning about identity, sexuality, relationships and marriage'. I was a counsellor for LLF for the first fifteen months, but then withdrew because some people in the project clearly see trans, intersex, lesbian and gay people as a problem. Or behave as if we don't exist. For example, my friend Sara, who is intersex, shared her personal experiences and her work with academics in this field with LLF, but these perspectives were missing from the published LLF book.
Although gender diversity is treated respectfully in the LLF resources, the organisers have repeatedly proposed a working group on gender identity and transition. This is in an attempt to make sense of recent societal 'debates' about trans people. This proposal, which is currently on hold, has met with strong opposition from myself and others because it risks repeating society's debates by taking gender-critical views at face value, undermining the Church of England's generally affirming policy and practice in relation to trans people, and implying, contrary to the Archbishop of Canterbury's statement, that trans people may well be a problem.
Despite these examples of LLF's non-compliance with this basic principle, I consider this guiding principle to be fundamental, which is why I started with it: "No human being is a problem or a matter. People are made in the image of God. All of us, without exception, are loved and called in Christ. There are no 'problems', there are simply people."
Pastoral care is always an encounter with a person or with people.
Pattison defined counselling as an "activity". I prefer the word "encounter" - encounter with another person or with a group of people. This central idea relates to a sentence from the previous one: "Human beings are created in the image of God". Anyone who overlooks this fundamental truth runs the risk of objectifying people. Pastoral care takes place in an encounter with a precious child of God and should not be understood as an "encounter with a transgender or intersex person", but as an encounter with a person who happens to be transgender or intersex.
Pastoral care means listening to people's stories.
We may have read many books and articles about trans or intersex people, but in counselling we have an encounter with someone who has experienced gender diversity or gender variance. We have the privilege of listening to someone's personal story. The usual rules for confidentiality in counselling apply.
Listening to the stories of trans people is a central part of my collaborative work in this area. In This is my Body (Beardsley & O'Brien 2016) we have included clinical, historical and theological articles, but half of the book is a collection of narratives written by trans and intersex Christians. My current collaborator, Rev Dr Chris Dowd, interviewed twelve transgender Christians for his doctoral thesis, and their stories form the core of our book Transfaith (Dowd & Beardsley 2018). Our latest book, Trans Affirming Churches: How to Celebrate Gender-Variant People and Their Loved Ones (Beardsley & Dowd 2020), is based on focus groups in which we interviewed trans people, their parents and partners. "Listen and share" is the first recommendation of the study by Dr Esther MacIntosh and Dr Sharon Jagger (2021: 103f.), Supporting Trans and Non-Binary Staff and Students.
Pastoral care includes the willingness to hear from people who have suffered greatly because of their transgender or intersex identity.
There are a growing number of autobiographical works by trans people, including trans Christians. The book Heaven Come Down: The Story of a Transgender Disciple by Chrissie Chevasutt (2021), published last summer, recounts her tumultuous struggle with being a Christian and transgender. Although Chrissie's story is ultimately life-giving, her experience was particularly intense and is not atypical. Chrissie writes of her recent workshop, "I simply told stories, true stories that opened hearts in incredible ways, rather than information and education. By the end we were all broken up and in tears. ... I was shocked myself at the raw, visceral pain we all encountered." Her description points to the next central idea.
Pastoral encounters are based on mutuality and can involve shared feelings.
Pastoral care, especially when offered by a religious leader, involves a certain imbalance or apparent inequality, but the encounter can and should be reciprocal. The encounter between counsellor and parishioner is similar to the therapist/client model, providing safety and boundaries for both parties. Transference and counter-transference must be managed and negotiated. The encounter may cause a "raw, visceral pain" in the pastor that needs to be processed, perhaps in supervision. If the counsellor feels "overwhelmed", he/she should refer the person to another counsellor or a specialist.
Every person's path is unique.
When comparing the stories of trans and intersex people, common themes emerge, but each person's journey is unique, so assumptions about outcomes or processes are not helpful.
Pastoral care is always sacred, because it is an encounter with a beloved child of God.
Listening to another person is itself a 'sacred space' in which their journey can be told to another and recognised as sacred. In a letter to the UK government in April 2022, several church leaders described transgendering as a "sacred journey of becoming whole: valued, honoured and loved, by self, by others and by God" (Chalke 2022). Some conservative Christians rejected this phrase and questioned the sanctity of trans people. A year earlier, in February 2021, US Roman Catholic Sister Luisa Derouen (2021) had strongly affirmed the sanctity of trans people based on her two decades of pastoral care for hundreds of trans people:
"Transgender people are much more attuned than most of us to the reality that we humans are a complex, mysterious body-mind creation of God, and they want nothing more than to honour that reality (sic!). Their process of transition is a process of growth towards wholeness and holiness. What they are experiencing is a classic Christian conversion of life, a transformation into God. What I have witnessed hundreds of times in their lives is what we Catholics call the Paschal Mystery."
God is involved in this encounter.
Explicitly or implicitly. In 1996 Jay Walmsley founded the Sibyls, a UK-based Christian spirituality network for trans people and their families to offer mutual spiritual and practical support. In the early days, understanding clergy celebrated Holy Communion at each meeting, and weekend meetings took the format of retreats, including daily devotions, but with other times when people could talk to each other. Many Sibyls have tried to figure out how to manage or express their gender diversity in this caring, prayerful atmosphere.
In the US, Sister Luisa Derouen focused on the spiritual accompaniment of LGB and, more recently, trans people. When pressed by her bishop to explain the Church's official teaching in these encounters, Derouen (2014:17) argued that her "role was not to impose a moral position, but to accompany people in their relationship with God".
Be open and honest about your theological position!
The Church of England is officially committed to LGBTI+ people, but some of its congregations hide their opposition to hormonal and surgical interventions for trans people. "Pastoral care" in these settings can include counselling people not to transition or, if they have already done so, to de-transition. It is distressing for trans people to find that the church they attend does not affirm trans people for theological reasons. Trans people want trans-inclusive churches to publicly state this (Beardsley & Dowd 2020: 128-132; McIntosh & Jagger 2021: 106-108).
Ensure that church facilities and discussions are safe places!
My friend Sara was asked to speak about her experiences of being intersex at a diocesan meeting organised to promote better understanding. Prior to the event, she was the subject of anonymous rumours, but when she reported this behaviour to the Bishop and his staff, she received little support. Similarly, during a private meeting of the LLF project, Sara was attacked by someone who held conservative theological views, which is contrary to the LLF's (Church of England 2019) own pastoral principles on respectful listening to others.
Conversion to Christ does not require someone to deny their gender identity or their reality as an intersex person.
However, some British Christians are calling for this. In a December 2021 letter (Ministers' Consultation Response 2021) to the UK Government on the proposed ban on 'conversion therapy', signed by over 2546 Christian clergy and chaplains, it is claimed that the ban would prevent them from carrying out their ministry.
The letter states that "our churches ... welcome and show love to many people with different experiences and views, including ... forms of gender reassignment". However, their welcome is conditional, as they also believe that "denying the gender we have created is sin. ... It is simply harmful for anyone, especially young people, to believe that their identity is only to be found in their feelings and that they find happiness in abusing and damaging their healthy bodies. But the [government] proposals would seemingly criminalise us for looking after people and trying to stop them from doing this kind of harm."
The general evidence-based consensus (MoU 2022), on the other hand, is that attempting to change a person's gender identity is "unethical and potentially harmful". Responsible pastoral care should be guided by this consensus.
Pastoral care should not contradict the medical or therapeutic consensus.
Clergy and lay people have not only challenged the UK government's proposed ban on conversion therapy, but have also petitioned the Archbishop of Canterbury to withdraw the Church of England's pastoral guidance on praying with transgender people. Both moves challenge the mainstream medical and therapeutic consensus set out in version 8 of the World Professional Association for Transgender Health's Standards of Care (SOC) (WPATH 2022) and tacitly condone pastoral care that runs counter to this consensus by invoking minority clinical opinions or gender critical perspectives.
Pastoral care should be informed. Pastoral care, especially when based on the pastoral care cycle, involves respecting the relevant scientific evidence and best therapeutic practice. Pastors should not counsel people to take actions that contradict medical or therapeutic advice. The research findings of McIntosh and Jagger (2021: 104f.) advise pastors to "learn".
Pastoral care can reduce social stigmatisation.
In the UK, pastoral care is taking place in a new context. The UK Gender Recognition Act 2004 and the provisions of the Equality Act 2010 have reduced decades of social stigmatisation of gender diverse people. Unfortunately, the UK government's 2018 consultation on reforming the Gender Recognition Act has unleashed a torrent of gender-critical rhetoric that has left many transgender people feeling shamed and stigmatised. Earlier this year, the UK government (OAG 2022) unexpectedly announced - contrary to the position of the UK's medical and therapeutic professional organisations (MoU 2022) - that trans people would not be included in its proposed ban on 'conversion therapy'. The backlash has been so great that some transgender people have moved from the UK to other countries.
Counsellors need to be aware of this negative development and its impact on transgender people in the form of verbal abuse and increased fear when using public spaces, especially gender-specific spaces. Surveys show that the majority of the public is in favour of transgender people. Counsellors should explain that although gender-critical views are vocal and ubiquitous in the media, they are in the minority.
Some trans and intersex people have been hurt and rejected by faith communities.
The stories of people reported in the books I have co-authored demonstrate this. Mary, for example, is Roman Catholic and was identified by her parish priest as a potential communion distributor, but the idea was quietly dropped when she transitioned (Beardsley & Dowd 2020: 72).
In these circumstances, pastoral care is likely to consist of restoring the person's trust in their faith community, guiding them to sources of healing and supporting them in their struggle for integrity and justice. (McIntosh and Jagger 2021: 106, 110f.) advise chaplains to 'influence' and 'resource', which includes reviewing and developing trans-inclusive policies in the settings in which they work.
Trans and intersex people can try to reconcile with their faith and their faith communities.
My friend Shaan Knan (2017), who has curated several queer oral history projects, including Twilight People: Stories of Faith and Gender beyond the Binary, came to this conclusion. In another publication, Shaan Knan (2019: 16) writes: "The gender journey of trans people can bring many uncertainties, sometimes without clear answers. In such cases, one's faith traditions can be the most important source of support in seeking to understand one's gender journey. ... For some people, transition is a spiritual journey that they want to talk about. Faith and community leaders who are open to such conversations and well-informed are in an ideal position to help."
Honouring gender-diverse people in the Bible conveys the message: "We have always been here!"
"Gender-diverse people have always existed in every culture and community, including religious communities. Not all cultures and faith traditions have strictly defined binary gender roles" (Knan 2019: 8). The Jewish Mishnah and Talmud contain numerous mentions of tumtum, which means 'a person whose sexual characteristics are indeterminate or hidden'. In classical Jewish texts, saris can refer to "a male who does not fully develop at puberty and/or someone whose sexual organs are subsequently removed" (Knan 2019: 14). Saris can also refer to a court official. In Genesis, Joseph becomes a sari in Egypt because he is a shaman, an interpreter of dreams. Shamans are also associated with androgyny, and both Jewish and Christian commentators interpret Joseph in this sense (Dowd & Beardsley 2018: 167-171).
Families often need love, reassurance and support from their churches to adjust to their new reality. They also need time to grieve and understand, and that's okay.
Pastoral care can also be expressed in practical ways. Such as the Quaker elder and her husband who opened their home as a safe, non-judgemental space for a young trans man in their faith community as his family struggled with his gender journey (Beardsley & Dowd 2020: 93). His family could visit him whenever they wanted, but the arrangement allowed everyone involved to process what was happening at their own pace.
Pastoral care can be lacking. After her transgender daughter came out, one mother lost both her church and her family because its conservative theology could not accommodate transgender people (Beardsley & Dowd 2020: 91f, 94f). No family should be treated this way by other Christians. In the handbook of my community, the Congregation of Mary, Mother of Priests, it says: "Compassion is an expression of God's love for people and is especially evident in the hearts of Jesus and Mary. Priests of the Congregation" - and I would add, all Christians - "should be known as messengers of mercy, a safe refuge from the judgement of the world."
Some critics of the Church of England's pastoral guidance on praying with trans people complained that it ignored the pastoral needs of trans people's partners and families. As one of three trans clergy consulted and involved in the development of this guide, I can confirm that we did press for mention of trans people's families, but our advice was not heeded. Transfaith (Dowd & Beardsley 2018: 178-200) contains liturgies to help family members come to terms with a family member coming out as transgender and the implications of this.
Consider supporting and collaborating with institutions and organisations that have transgender and intersex clients!
Research by Professor Susannah Cornwall (2021) on the spiritual care of people undergoing transition shows that improvements in the training of both religious leaders and gender medicine specialists have the potential to improve the health and wellbeing of trans and intersex people, and that there are opportunities for pastoral-spiritual care for gender identity clinics.
Supporting people with gender diversity in the development of inclusive theologies!
McIntosh and Jagger (2021: 105) echo McMahon's (2016) call to include gender diverse people in the development of trans-affirming theologies by encouraging university chaplains to nurture those with leadership potential and offer opportunities for reflection.
Churches can initiate projects to reach gender-diverse people.
In January 2022, St Columba's United Reformed Church in Oxford appointed Chrissie Chevasutt as its first trans, non-binary and intersex worker. With organisation, funding and commitment, local churches and national church bodies can make a positive difference to the lives of trans, non-binary and intersex people.
