There is no question there are a lot of bad therapists out there. Too many spend every session letting their client talk and never provide any meaningful feedback, but there are also good ones. Because there are so many bad ones, it can take time to find people who are truly helpful. And this is even more problematic for the transgender community. There are a number of therapists who have added this subspecialty onto their résumé as a way of generating business or raising visibility, but who are essentially ignorant of the issues affecting transgender individuals and can do more damage than good.
The resistance in the transgender community to therapy arises for the most part, I believe, from the fact that too often therapists were the gate keepers who determined who could receive gender affirming care and who would be passed over. Transgendered people rightfully felt like their identities were being unfairly questioned by those who were not living and did not really understand their experience. Your discussion about how many therapists like to put their patients in diagnostic boxes is illustrative of this. If we could be put in a box, then there is another set of boxes that can be checked off to come up with a solution to our “problem“. Thankfully, this paradigm is rapidly disappearing. Many organizations and health providers now allow self identification.
The breakthrough occurred with the realization that being transgender was not a psychological pathology, but a legitimate, naturally occurring and rare, variant of human identity. It is simply who we are. Where there is no pathology, there is nothing to fix. However, having said that, I still firmly believe that a good therapist is essential for transgendered individuals. The reasons are twofold.
This is most easily described by my own experience. When I first accepted my trans identity, I was absolutely certain that I was a binary female. I was energized, freed, more optimistic than I had been in years. The world seemed so much brighter. As time went on, I realized that there was still a nagging doubt in the back of my mind. I had spent decades as a heteronormative adult male. Where did this new certainty come from? Why couldn’t I just continue on as I always had? I retained two therapists. One was an LCSW and the other a very talented PhD psychologist. I knew I needed letters from them to qualify for GRS. In addition, in my state or at least in my area, it was hard to find a healthcare provider for HRT who did not require a preliminary diagnosis from an LCSW. One of the things I learned from my PhD was that mature transgendered individuals always have some level of lingering doubt. She considered this healthy. It meant that I was doing an honest self analysis to be certain what I was all about. For me, everything progressed smoothly and I am now a fully female postop woman. I couldn’t be more thrilled. Her help was invaluable and she recently terminated our professional relationship. She said I did not need her anymore and she could not justify continuing to charge me. It was a bittersweet conclusion to our time together. I miss her.
By contrast, the LCSW was the kind of therapist that you described in your article. She kept trying to put me and my family into various boxes. When I terminated our relationship after about six months, she said that I had four pathologies that she could identify including CPTSD and three others which she never described. She also concluded that my mother and little brother were borderline sociopathic personalities with narcissistic tendencies, though never having met them. On the day our relationship abruptly ended, I later learned that she had had a fight in the morning with her sister and subsequently with a client she met with prior to our session. She was already in a foul mood. It was obvious she had a lot of her own issues to deal with and tended to project her problems on to me. One of the reasons our professional relationship was so short-lived was due to the fact that she kept wanting to psychoanalyze me and find the boxes I fit in. I was there for a much more limited purpose. I was trying to be completely certain that I understood myself and to understand my transgender nature better. She basically ignored these issues during our time together. It was a waste of both my time and money. Quite a contrast to my very effective PhD.
Getting back to my PhD, the second reason she was particularly valuable was in constantly reassuring me that I was on the right track and making progress. I made it clear at the beginning that my goal was to be completely passable and 100% authentic (to the extent medical science would allow) in my female anatomy and functionality. I did not want to be some kind of a hybrid, appearing neither male nor entirely female. For me it was all or nothing for my sense of authenticity and well being. (In saying this I intend no criticism of those whose goals are different or more modest. There are multiple legitimate variants in the transgender community. I would never question what someone else needs to make them happy and fulfilled.) Over the years, there were many times I needed reassurance. I would feel like things were going well and then like my progress had stalled and the HRT was doing nothing further. It was a time of tension and uncertainty wondering how it would all turn out. She continually reassured me that everything would be OK, but my emotions were on a roller coaster ride at times. She was an important calming influence. I trusted her knowledge, experience, and guidance.
The transgender community is rightfully suspicious of the therapeutic professions because for so long we were treated as being mentally ill. Being transgender was something they tried to fix, rather than understand. So much more is known now. Professionals now realize that we are just a normal, if unusual, variant of human gender identity. There is nothing wrong with us, and nothing needs to be fixed. Even with this greater understanding, too many practitioners still treat us as if we have a pathology. The key is to find someone who helps you to understand yourself and find your own answers rather than trying to fix you. They are out there and they are important to each of us. I have yet to find a newly transitioning individual who is not racked with doubt and uncertainty. Their existential angst is palpable. They are so afraid of what their friends and families and employers will think, much less society at large. There is a need for good therapists to help along the way.
