Autobiography: In Therapy, Part 1.

In my last post, I shared a correspondence from an acquaintance who wanted guidance answering the question, “Am I transgender?” You can read my reply at the link provided.

My acquaintance followed up with a question about next steps:

When looking for someone to talk to about these matters, should I seek out an analyst who specializes in transgender issues, or is a therapist with a more general practice focusing on all sex issues sufficient?

Of course, as before, I paraphrased the question’s actual wording to help preserve my correspondent’s anonymity. But you guessed that, since nobody uses the word “analyst” outside of Woody Allen movies. And inside Woody Allen movies, analysts charge too much.

This is a difficult question to answer. No one’s sure ahead of time what one’s needs are in the psychological treatment realm; that’s part of the point of seeking treatment in the first place. It’s hard to know if the therapist you choose is going to be able to meet those needs. And your choice of therapist is going to be limited by what you can afford and who’s available under your health insurance umbrella.

So as a way of dodging the question entirely, I’ll just share my own experiences with mental health professionals as they relate to my gender identity journey. Maybe that can itself be instructive.

I’ve written before about my aborted “first transition” during my Navy years on Oahu. My second, successful transition began in late 2004, when I realized transitioning was the only way I’d have any hope of a happy and fulfilling life in the long run. I began looking into how to begin transitioning, and my research showed me that gender identity treatment in the United States (and in most of the world) was mediated by the Harry Benjamin Standards of Care (and it still is today, but now it’s more generally known as the WPATH Standards of Care. Any medical or surgical steps toward asserting my true gender, if I wanted to do it the legal and aboveboard way (as opposed to seeking out black-market hormones or silicone injections), would have to be in accordance with the Standards of Care (SOC).

That meant I had to find a psychologist or other mental health therapist and receive an official, medically-approved diagnosis of Gender Identity Disorder, or GID (as it was called by the DSM-IV at the time; now it’s “Gender Dysphoria”). I liked to imagine therapists had this phrase written on a rubber stamp with wide-serif capital letters, and when they accepted my self-diagnosis, it would be stamped on my chart in red ink.GID

I decided to wait until early 2005, when the new year’s health plan kicked in, before seeking treatment. During the open enrollment period in the fall of 2004, I made sure I selected options that would offer me the most coverage for the kind of treatment I thought I’d need.

In January 2005 I began to browse listings of in-network providers from my desk at work, seeing who had the specialty I sought. There was nothing illicit about this, generally speaking, but given the nature of my inquiry, internalized transphobia, and the general state of transgender acceptance at the time, I twisted my body into an unnatural, awkward position to hide my monitor from view of any passing coworkers. You know, because that wouldn’t raise any suspicions itself.

I found two or three counselors whose practice descriptions claimed they had experience with gender matters. None were close to my workplace, but one was way south of town, easy to get to from my house. She didn’t have a doctorate, but there were several letters after her name, which was Ms. Smith (note: her name was not Ms. Smith). I called her up and asked if she could help me. I spoke just above a whisper, my hand cupped over the receiver.

Two-thirds of her responses were, “I’m sorry, could you repeat that? I can barely hear you.” But she sounded confident she knew what she was doing and could help me. I made an appointment for late in the afternoon on the twelfth of January; a Wednesday. I would leave work early so I could just go home afterward.

I arrived early on the day; I’d left work way early in case the traffic was bad, but it hadn’t been. The walls of Ms. Smith’s (empty, except for me) waiting room were covered in inspirational posters, like that cat that’s been clinging to a bar since the early 1970s. On her coffee table, amid the months-old issues of Newsweek and People, were various brochures and pamphlets related to beating substance abuse. I realized that addiction counseling must be the main part of her practice. This didn’t ring any alarm bells; many therapists, I knew, have special interests. It doesn’t mean they can only treat one kind of patient, or that they’re ignorant of a variety of diagnoses. There aren’t many transgender people, so GID probably isn’t the main focus of most therapists. 

There aren’t many transgender people, so GID probably isn’t the main focus of most therapists.

After I’d been in the waiting room for twenty minutes or so, the door to Ms. Smith’s office opened. One woman walked out and headed for the exit, glancing at me only furtively; another woman, middle-aged, kind-faced, wearing a khaki skirt suit, stood in the doorway.

“Are you Glenn?” she asked. I nodded. “Come on in here, then.” She grandly waved me toward the office. She turned and headed back to her desk ahead of me; I followed.

There was no couch, because this was a real therapist’s office, not a New Yorker cartoon. Instead there was a comfortable chair positioned to face her desk chair when the latter swiveled away from the extremely cluttered desk. On the floor, next to the desk, was a white-noise generator, which Ms Smith turned on as she sat. Its purpose was to keep any Nosy Parkers in her waiting room from listening in on her sessions. Of course it wasn’t necessary now; I was her last appointment of the day.

As I sat down I noticed on the wall opposite my chair was a crumpled-up, empty pack of Pall Mall cigarettes, in a frame and captioned with the date of Ms. Smith’s last cigarette.

Aha! I thought. Like the Hair Club for Men president, she’s not just an addiction counselor; she’s a former addict herself!

This made a certain sense; many people with problems draw hope from knowing the person helping them has overcome the same sort of problem. Idly, I wondered what would be hanging in a frame on the wall if Ms. Smith had triumphed over being assigned the wrong sex at birth.

To be continued.


Links to other excerpts in this series are gathered together on this page.

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