Non-judgmental listening approach

In many reports and committee minutes, listening to the client in a confidential setting retained a central place: Liz Elking, who joined the London Walworth centre as a counsellor in 1974, said that the Brook method was to ‘listen hard, put all the alternatives and try to help the youngsters to reach their own decisions’ (Elking 1974). The roles of staff, in terms of whose responsibility it was to listen to clients and take notes about their needs, differed between regional centres. In Birmingham, from the start, social workers worked alongside doctors and nurses. Indeed, at his or her first appointment, every client in Birmingham was interviewed by a social worker trained in interviewing techniques, whereas in London this interview was conducted by the nurse, who ascertained the reason for the client’s visit and completed the particulars of registration. The interview provided an opportunity for BAC staff to listen to the client’s needs and anxieties and assess the potential need for referral to further counselling services and therapy. A consultation with the doctor followed this first in-depth interview (Birmingham Brook Advisory Centre 1967). In London, at first, social workers had limited power in the centre, since doctors were in charge of the counselling and listened to the clients. But before long, Helen Brook realised that social workers would help give the clinic an unclinical atmosphere, moving away from the ‘doctor-patient relationship’(Brook 1987). She was convinced that social workers were essential for developing a trusted relationship with the clients and allowing the latter to feel listened to. From that point on, social workers had extended responsibility in London clinics. In 1975, Dr Ruth MacGillivray, who was the doctor in charge of the London BAC, announced in the magazine GP that counselling was not the exclusive territory of doctors. In her view, nurses and social workers could also be good counsellors provided that they met the essential criteria, namely ‘emphatic listening and the ability to talk simply about anatomy, physiology, sociology and to draw analogies which can be easily understood’ (MacGillivray 1975).

Another paramount element of the way BAC members understood their work was the perceived absence of moral judgement. There was a tension inherent in this, since BAC members were navigating between adopting a pioneering approach to the unmarried via a non-judgmental acceptance of young people’s sexuality and spreading a vision of heterosexual monogamy and sexual responsibility via their heteronormative advice.

In 1969, the task of Brook was defined in terms of education and responsibility and referred to the attitude that individuals working in the centre should adopt: ‘to help young people between the ages of 16 (age of consent) [and] 25 to accept responsibility for their emotional lives without attempting to impose external moral standards’ (Hunter 1969). BAC were first staffed by doctors and nurses trained in family planning practice; their attitude and personality to the young needed to be ‘satisfactory’, meaning tolerant and non-judgmental (Brook Medical Advisory Committee 1964). The doctors usually had added experience in child development and/or psychiatry.

The founder Helen Brook would compare the doctors’ work in Brook centres with that of ‘non-moralising mother-figure doctors’ (Brook 1967). This alleged non-judgmental attitude was particularly well perceived and valued by clients. In a 1967 article published in the Birmingham Post, the local newspaper that extensively covered the heated debate preceding the opening of Birmingham BAC, a young white couple shared their experience at BAC. The ‘girl’, aged 21 years, engaged, explained that she had been sleeping with her fiancé since she was 16. She mentioned that she had had ‘a major scare’ and phoned a FPA clinic for help. She was told they could see her, provided that she was getting married in the coming 3 months. Since she was not, they directed her to BAC. The girl explained that she was ‘apprehensive’ before phoning BAC but was amazed by the reaction on the other side of line; the receptionist asked her about the urgency of her needs. The client thought “that was marvellous: they were concerned with your needs, your real needs, and not to sit in judgement on your morals” (Cases and Circumstances 1967).

The ‘motherly figure’ mentioned above by Helen Brook was a recurrent trope deployed by BAC workers when they described their role towards their clients. Time and again, Brook referred to the mother figure: ‘for a young woman the security of a mother figure with the expertise of highly qualified doctors is of untold value when things go wrong, as they so often do, when one is young and experimenting and exploring’ (Brook Advisory Centre). Dr Fay Hutchinson, the clinic doctor in London, in a paper presenting her work at a conference on psychosexual medicine in 1982, would also make this analogy. Referring to a case of a 16-year-old client she said: “When she undressed for examination, you could see the frightened little girl she was, who needed mothering and tenderness. Studying the doctor-patient relationship I realise that “mothering” is not the only role I have, though it is one I feel comfortable with” (Hutchinson 1983, 172).

Nevertheless, this emphasis on the mother figure also had the potential to undermine the autonomy of young people: doctors and counsellors should be understood as another form of authority. Indeed, despite a focus on the non-judgmental attitude, young people were still deemed as a vulnerable category of the population that were in need of advice. BAC doctors and counsellors acted as guides and gatekeepers through young people’s journey towards sexual maturity. Brook doctors and counsellors saw white young middle-class women as responsible young adults who attended the clinic because they were in steady relationships and wanted to protect themselves against unwanted pregnancy. They were perceived as mature enough to make their own decisions. Their behaviour was construed as the ‘norm’ from which other groups deviated. In the first annual report of BAC published in the Family Planning Journal, Faith Spicer explained that ‘the greatest proportion of people coming to the centre are young women, quite sure at the time that they have a steady relationship who wish to discuss, often in great detail and sometimes together with their young men, methods of birth control’ (Spicer 1966). These young people were depicted as ‘responsible’. However, any deviation from this model was deemed problematic, and race and class appeared as key elements to define vulnerability. This definition ran against the idea of a non-judgmental approach to teenage sexual needs. Promiscuity, in particular, was pathologised as illustrated by the following quote from the founder of the centre, Helen Brook: “If a girl is promiscuous, you have got to ask why. Promiscuity is a sign of some sort of disturbance. They are the ones who need the most love and the most help” (Brook quoted in Birmingham Sunday Mercury 1966). Promiscuity was usually associated with sexual knowingness on the part of white working-class girls and perceived to be the result of the emotional instability produced by socially deprived backgrounds. Contraceptive counselling therefore functioned as a way of teaching the middle-class values of protected intercourse in a committed relationship and maintaining emotional safety.

For white working-class young women, contraception was described as a means of control; their lack of control over their reproductive bodies condemned them to unwanted pregnancies and abortions. White young working-class women were usually described as having more sexual experience than white young middle-class women, and as such needed more counselling in order to avoid the risks of unprotected intercourse. Indeed, those of lower socioeconomic status, who belonged to classes 4 and 5, were deemed to be at higher risk of unprotected sex since they were ‘socially and emotionally deprived’. These white girls were said to be used by boys as ‘sexual conveniences’ (Crabbe 1978).

Besides class, race was also a key element in defining the vulnerable category that deviated from the white middle-class norm and again partly challenged the vison of a non-judgmental service. Speaking at a conference on ‘Accepting adolescent sexuality’, the first black BAC counsellor Pauline Crabbe, the former Welfare Secretary for the National Council for the Unmarried Mother and Her Child, first black woman magistrate, explained that young black boys, usually from African-Caribbean backgrounds, shared many common problems with socially deprived white teenagers: ‘lack of incentive, lack of opportunity, poor housing, an educational system that failed them, limited job prospects and poor communication within the home’ (Crabbe 1978, 172). This led them to place more importance on sexuality. However, black boys were presented as opposing contraception and encouraging parenthood, while at the same time deemed ‘unprepared to accept the continuing responsibility of fatherhood’. In this sense, they failed to conform to the norm of protected intercourse in a steady relationship. Similarly, assumptions about the apathy of young black women who ‘got themselves pregnant’ also permeated Crabbe’s work. Writing in a 1978 special issue on fertility in adolescence, she flagged up the difficulties faced by young black girls who became pregnant: ‘black girls who have babies in their early teens are especially vulnerable. They are less likely than white girls to fight their way back into education or training for a job and they tend to sink into apathy more quickly and accept a second child because they feel already permanently enslaved by the first birth’ (Crabbe 1987, 173). In drawing on this vocabulary, Crabbe referred to black girls as slaves of their men’s desire. This was a strong wording that distanced their attitudes by sending them back to the time of slavery, and in so doing stressed their differences, therefore othering their behaviours from those of white girls. Crabbe suggested that one of the means to tackle this issue was contraceptive education, in which black adolescent girls would be taught to ‘value their freedom and to show their men the benefits of partnership before they accept responsibility for parenthood’ (Crabbe 1978, 173). While recognising the specific needs of young black girls, these remarks draw on some negative stereotypes about the alleged ‘apathy’ of black girls who became pregnant and the reluctance of black boys to form committed relationships. However, Crabbe also considered black girls to be the ones that made the decisions within the relationship, since they were said to be influenced by the ‘old matriarchal tradition of the West Indies’. Counselling was therefore perceived as a way of teaching white middle-class ‘British’ values around ‘sexual responsibility’ and committed relationships to these young women, so that they could ‘rebel against the prison sentence of early maternity’.

To some extent, BAC members tried to address what they perceived as socio-structural inequalities, since they recognised the additional social challenge that black girls, black boys and white working-class girls faced and devoted energy to finding ways of reaching out to these ‘vulnerable’ young people. Nevertheless, in so doing, they eased the process of assimilation into British norms by conveying standards of good sexual behaviour based on middle-class values, namely protected intercourse in a steady relationship. They thus acted as potential levellers of culturally perceived different sexual behaviours, and this attitude contradicted the alleged non-judgmental approach of their counselling services. For Brook members, maturity and responsibility in sexuality equated committed and loving intimacy.

This tension between non-judgmental counselling and the vision of ‘good’ sexual behaviour was also perceptible in the contraceptive counselling provided by BAC. Since the main goal of the centre was to avoid unwanted pregnancy through the provision of contraception, clients were presented with varied methods of birth control, and the doctors talked the clients through the pros and cons of each method. Some methods were deemed more suitable than others based again on clients’ adherence to the white middle-class norms of committed relationships. The majority of clients came to the centre to ask for the pill. The pill became available on the British market in 1961 on prescription for medical reasons, and at first mainly for married women through private agencies such as FPA clinics. At BAC, at first, doctors seemed to be very reluctant to prescribe the pill for those who did not conform to their moral standard of ‘good sexual behaviour’, namely intercourse occurring in a committed relationship. For instance, at a conference in 1966 aimed at social workers, founder Helen Brook presented several examples of young clients attending the centre; one was refused the pill. The white ‘girl of nearly 18’ came to the centre to ask for the pill. The doctor undertook a long counselling session to find out the reasons why the ‘girl’ wanted the pill. The latter was having an affair with a married man and wanted to be protected against unwanted pregnancy. The doctor refused to prescribe her the pill on the basis that her immaturity was ‘appalling’. The doctor acted as a gatekeeper of morality and judged the girl ‘unsuitable to have the pill’ since she was not in a committed, stable relationship (Brook 1966). After the Family Planning Act of 1967, the pill became available for all women regardless of their marital status, on prescription in FPA clinics and BAC and through general practitioners.

At other times, BAC counsellors seemed to privilege the notion of safety of intercourse over moral considerations about the status of the relationship. Counsellors and doctors qualified unprotected sexual intercourse as risky behaviour. They explained that its prevalence was due to several factors: young people lived ‘in the present and did not plan ahead’ (Brien 2020); they favoured ‘spontaneous behaviour’; there was a lack of acceptance of their sexuality on their own part and on the part of others, especially their parents; their sex education was lacking and they encountered practical difficulties with contraceptive methods (Coles 1978). BAC counsellors and doctors’ role was therefore to mitigate these different aspects by recognising young people as sexual beings when they visited the clinics; they tried to instil in these clients a sense of sexual responsibility through the idea that safe sex was paramount, and explained the practicalities of contraceptive methods. Dr Hutchinson made it clear in a talk in 1978 at a national conference on ‘Accepting adolescent sexuality’ that, for young girls, the pill was not necessarily the better choice since it offered no protection against sexually transmitted diseases. In this regard, condoms were presented as the safest method. No mention was made of whether the young people were in steady relationships or not.

Psychosexual counselling, pleasure and gendered sexual roles

However, the key area where emotional labour played a central role and where tensions between non-judgmental attitudes and conservative views on sexual relationship were explicit was psychosexual counselling. Sexual counselling had been a focus since the interwar years, but gained in popularity after the World War II, when the emotional stability that depended on the sexual harmony of British citizens was deemed fundamental to the rebuilding of society (Chettiar 2013; Chettiar 2015). Moreover, the development of sexology, with the success of the Kinsey report and its ‘Little Kinsey’ British counterpart (Bingham 2012), put the search for sexual pleasure at the centre of postwar Britain and the stability of relationships. In order to help couples reach sexual satisfaction, many family planning clinics members turned to psychosexual training, which was heavily influenced by psychoanalysis; FPA members were trained by Michael Balint and later the Institute for Psychosexual Medicine (Rusterholz 2020).

Balint was a Hungarian psychoanalyst who worked at the Tavistock Institute of Human Relations in London, one of the key British institutes in psychoanalysis. He devised a method to help general practitioners answer the needs of their patients via training in psychotherapy, as also shown by Robert Irwin in this special issue. Balint was interested in the way that a patient presents his/her illness to the doctor and the latter listens, reassures and suggests treatment. Balint highlighted the dynamic of the relationship between the patient and the doctor, since the way in which the doctor answers the patient in turn shapes the patient’s expectations and manner of articulating his or her needs. As such, the doctor should also be an object of study. Balint believed that a doctor should therefore undergo training to free himself or herself from prejudices (Balint 1957). The training devised by Balint saw doctors exchanging experiences of ongoing cases in small groups and describing their difficulties as frankly as possible, under the supervision of a leader. The dynamic of the group enabled doctors to identify mistakes, blind spots and limitations, allowing a better understanding of their problems and prejudices.

BAC staff underwent this same training, and therefore shared similar views and values. At the London BAC, a consultant psychotherapist attached to the centre held a seminar fortnightly with the doctors. In this seminar, doctors discussed their cases and shared their experiences and difficulties, based, again, on Balint’s technique. The aim of this supervision seminar, explained counsellor Joanna Brien was to work on the assumptions that one held regarding young people’s sexuality and to know what they were, so as to ‘be able to stand back from them’ (Brien 2020). Joanna Brien started working at BAC in the early 1980s after spending a couple of years working for the British Pregnancy Advisory Service—a charity created after the passing of the Abortion Act in 1967 to provide safe, affordable abortions—where she undertook a short period of training in counselling. In Brien’s view, one of the key elements of a successful counselling session was the counsellor’s ‘ability to not impose her own views’. This was perfectly in line with Balint’s training.

While psychosexual counselling did help young people in some ways, with its emphasis on past events and trauma, it nevertheless also contributed to pathologising young people’s sexual behaviours. Psychosexual counselling dealt mainly with anxiety, and as clinic doctor Fay Hutchinson noted, “the younger the client the more areas of anxiety she is likely to have” (Hutchinson 1978). According to Hutchinson, the clients presented with a wide range of psychosexual problems, including lack of orgasm, fear of intercourse, impotence, anxieties related to the body, sexual abuse, same-sex attraction and difficulty with parental relations. Counselling for under-16s was presented by clinic authorities as a way of ‘buying time’ for the girls ‘to continue developing and maturing so that she may make [a] good relationship in the future’.

Over the years, some young men, although still a tiny minority, visited the centres on their own to talk about their fears relating to sexual performance and inadequacy. Orgasmic impairment and premature ejaculation remained the two most common causes for requesting counselling.

In 1967 London, Christie Brown (1967) was hired as a clinical doctor; she started a weekly session for what the clinic called ‘girls with special problems’. The sessions lasted 50 min in order to allow the clients to discuss their anxieties at length. Clients were seen as many times as was necessary to make a diagnosis, or were referred to other bodies for help (Brook Advisory Centre 1968, 40). Christie Brown explained that many unmarried girls needed help with emotional difficulties because they had not fully come to terms with the lives they were living. She stressed again that contradictory attitudes made for a difficult decision for these young people: ‘In a society where parents are likely to regard this action as sinful, conflict is inevitable. These young people have usually seriously thought out the terms of their relationship’ (Christie Brown quoted in Daily Telegraph 1967). From 1970, this openness towards youth sexuality extended beyond the notion of safe sex. She underlined the fact that BAC’s focus was on safe sex and avoiding the negative consequences of unprotected intercourse and sought to ‘help some of them enjoy their sexuality’. Thus, for the first time, the notion of enjoyment and pleasure was finally connected to that of young people. Indeed, while sexual pleasure became increasingly discussed and central to the sexual life of married couples from the interwar years onwards (Rusterholz 2019), and thus became a new field of practice in FPA clinics, associating sexual pleasure with young people was still highly controversial since it was feared it would encourage promiscuity. Sex education in school, when not simply absent, focused mainly on combatting venereal diseases; sexual pleasure was never addressed. While the mass media started to address the issue of sexual pleasure for women in the late 1960s and early 1970s, teenage magazines at that time remained fairly conventional, and did not venture into sexual pleasure (Bingham 2012; McRobbie 1991). BAC was the first charity to take on the challenge of offering practical help with the issue of sexual pleasure for young people. This work might have been potentially influenced by the second-wave feminist focus on women’s sexual pleasure, but this influence was never explicitly acknowledged. However, here again, this progressive idea was undermined by conservative views on the ‘right’ type of relationship and gendered sexual roles. Clients were expected to display maturity, and this was assessed based on their adherence to the white-middle class idea of monogamous, heterosexual, committed relationships. Girls who had multiple partners were described as having troubled personalities, either needing attention or rebelling against their parents (Christie Brown 1974). Boys, as a rule, were never described as being promiscuous. This was largely due to a gendered understanding of sexual development where boys were thought of as having a sexual urge difficult to harness, whereas girls were looking for emotional attachment.

Doctors and social workers, when presenting study cases in diverse publications, invariably applied a gendered framework whereby ideas about femininity, masculinity and gendered sexual behaviours were predominant. These ideas pathologised behaviours that did not fit the model. For instance, Dr Margaret Christie Brown from the London centre applied what she called ‘the Freudian theory of psychosexual development’ to help clients enjoy their sexuality. She considered that past events and childhood relationships could act as an unconscious blockage in the sexual life. For instance, she explained that a proportion of girls were sexually unresponsive because they partially rejected their female role and ‘had identified with their father instead of their mother’ (Christie Brown 1974). She explained that these girls had a history of ‘tomboyishness and were ambivalent in appearance and frequently wore boys’ clothes’. They had a dominant personality and were usually ambitious. Helping them to identify these elements by themselves was thought to be a first step towards sexual adjustment and would offer a way out of pathologised behaviours. Similarly, clinic doctor Ruth MacGillivray had a gendered understanding of young people’s sexual behaviours where ‘boys have tremendous sexual drive’ and girls ‘are more interested in attracting the opposite sex for reasons of prestige and companionship. While enjoying mutual caresses, most do not have the same urge for coitus’ (MacGillivray 1975). This gendered view on sexuality presented male sexuality as inherently animal, uncontrolled and driven by impulse. This implies that girls should be responsible for marshalling young boys’ sexual drive. MacGillivray also encouraged girls to consider orgasm as ‘the excitement felt of seeing a pop idol in concert’ and as an ‘unexpected bonus’. She however enjoined them to find a sexual position where their clitoris could be stimulated since it is the locus of pleasure. She nevertheless reaffirmed that penetration was essential in that it allowed for a more satisfactory coit.

The counsellor Joan Woodward from Birmingham used the method of ‘combining an intellectual understanding of the problem, with where necessary, an increased awareness of the emotional and fantasy aspects through the use of dream material, plus a chance to gain practical experiences free of anxiety through the sensate focus techniques’. For instance, she counselled Jane, who needed help because she had lost ‘her libido’. She presented the case by first emphasising the strict upbringing of Jane, daughter of a vicar, where sex was never mentioned. Jane unconsciously blocked her sexual desire in order to ‘remain the non-sexual child her parents have unwittingly made her’. She talked with Jane about her childhood experience and guided her to recognise ‘conflicted emotions’. At that point, Joan Woodward recommended the programme of ‘sensate focus’, used by the sexologists Masters and Johnson, a series of touching without intercourse in order to arouse pleasurable feelings that lead gradually to genital stimulation and eventually sexual intercourse (Woodward 1977). This diversity of techniques points to the fragmented and volatile nature of sexual counselling, where gendered understandings of sexuality cohabited with more feminist notions of female sexual pleasure. This emphasis on teenagers and young women’s sexual pleasure was new in the context of British society in the 1970s, and constituted a continuity with the work done in FPA clinic to encourage sexual pleasure.