Autobiography: In Therapy, Part II.

That first session wasn’t actually the commencement of our “talk therapy;” I spent the whole first hour with Ms. Smith (still not her real name) filling out forms and discussing treatment goals and taking care of other such administrative matters. It wasn’t until the second session on the 26th, also a Wednesday, that we got down to business.

I drove down to her office after work, as before. I was excited. I’d been taking steps toward transitioning for several months, as I mentioned last time; these steps had consisted mainly of superficial things like learning about makeup and women’s clothes, although I was also enduring my excruciating first sessions of permanent hair removal via electrolysis.

That’s as much as I felt I could do on my own, but I was impatient. I wanted to receive an official, medical diagnosis, in accordance with the Standards of Care (SOC), so I could begin taking official, medical hormones. Ms. Smith could do this for me, just as she had done, she’d reassured me during our first session, for many other patients.

In her office for that second session, I eased down into the chair opposite her desk and shifted my weight around, finding the most comfortable pose. This was a historic occasion; I wanted to be as completely at ease as possible when I began sharing these thoughts I’d never spoken aloud before.

Ms. Smith sat at her desk chair and picked up a notepad and pen. I nodded in recognition informed by 142 reruns of The Bob Newhart Show. Yes, psychotherapists use notepads and pens. This seemed legit.

Source: blog.transgenderzone.com

Source: blog.transgenderzone.com

She wrote something at the top of her pad, probably my name and the date, then drew a horizontal line straight across. Then she spoke.

“So tell me,” she said, “When was the first time you remember feeling a sexual attraction to another man?”

If I were a filmmaker, and indulged in clichés, here’s where I’d add the sound effect of a needle being dragged across a vinyl record. My jaw fell open.

“Uh …” I said. My eloquence failed me. I was astounded. If I’d made a list of twenty questions I thought were likely to be the first thing my gender therapist asked me, this would not have been one of them. The question practically dripped with ignorance.

If I’d made a list of twenty questions I thought were likely to be the first thing my gender therapist asked me, this would not have been one of them. The question practically dripped with ignorance.

Nothing else she could have said would have filled me with more dismay. I’d embarked on this relationship confident I was putting my fate in the hands of an experienced professional, and with her very first question I realized she didn’t know shit about gender dysphoria or transgender people.

“I, uh …” I continued. Seriously? I thought. She’s really asking me this question?

Maybe some of my cisgender readers don’t understand what the problem was. Probably not many of you, if you’ve been reading this blog for long, but I’ll explain. “Gender dysphoria” describes an individual whose gender does not match the sex he or she was assigned at birth. “Sexual orientation” refers to whether a person is gay or straight or something else. Put simply and universally, “gender identity” is who you want to be, while sexual orientation is who you want to be with.

So a person assigned male at birth, but who is transgender, may be attracted to men, like heterosexual women, or may be attracted to other women, like lesbians. I don’t know the percentages, but they’re not important. What’s important is that sexual orientation and gender identity don’t track with each other; one doesn’t predict the other. That’s a Transgender 101 fact.

Ms. Smith’s question revealed not only that she was unaware of this, but moreover, she took it for granted that, as a person raised male who was seeking treatment for gender dysphoria, I must naturally be sexually oriented toward men. And that this “fact” was somehow so basic to my nature and so necessary to a diagnosis of my condition that it was the very first thing she asked me about.

“Never,” I finally answered. “I’ve never felt sexual attraction toward men. Why would you ask that? That doesn’t have anything to do with my gender identity.”

Now it was her turn to look shocked. “Uh …” she said.

Inside my head, I was spiraling into dismay. Since the epiphany I’d experienced the previous summer, transitioning was all I could think about. I was impatient to begin the medically sanctioned component of my transition. I wanted it done yesterday. But the SOC was both gatekeeper and keymaster—without an official diagnosis, there would be no Dana (or Vandy Beth), only Zuul. It was almost February now; if I left this “professional” and sought out another therapist, it could delay me another month or more getting the help I needed.

Gratuitous Ghostbusters references are always in order. Source: tashasthinkings.blogspot.com

Gratuitous Ghostbusters references are always in order.
Source: tashasthinkings.blogspot.com

“I thought you said you’d treated this kind of condition before.”

She nodded vigorously. Her tone of voice was defensive. “I have, yes! And, I—you mean to say you’ve never been attracted to another man?”

Oh, brother, I thought. This is going to be a bumpy ride.

I decided to keep seeing her rather than start the process over again, but we didn’t have the therapeutic relationship I had expected. I spent most of our sessions explaining the transgender experience to her instead of the other way around. In addition to the gender identity/sexual orientation blind spot, she admitted she’d never even heard of the SOC. I ended up printing out a .pdf of the latest version I’d found online and giving her a copy.

Of course I was irritated. I understand the need for “gatekeepers;” a gender transition wreaks great changes in a person’s life, and while it’s uncommon for a person to misdiagnose him- or herself, it does happen. It’s valuable to have an infrastructure in place like the SOC.

But that’s just it: the procedure is badly flawed, if therapists who don’t really know what they’re doing, like Ms. Smith obviously didn’t, can advertise that she has expertise in these matters. It can ruin lives.

Still, I got what I needed from her. About a month and a half after our first session, after four or five sessions total, she wrote what’s called a “referral letter.” This was a letter addressed to my primary care physician, printed on her letterhead stationery, confirming my self-diagnosis of “gender identity disorder” (which, again, is what it was called at the time).

We finished that session, and I was done with her. I would resume psychotherapy some time in the future, but never again with Ms. Smith. I would only see her one more time, and that wasn’t for psychological reasons.

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


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