Archive for the ‘therapy’ Category

Autobiography: In Therapy, Part II.

Thursday, December 3rd, 2015

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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Autobiography: In Therapy, Part 1.

Tuesday, December 1st, 2015

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.

If you’d like to support my writing efforts, please consider making a monetary contribution, either at:

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or PayPal:


 

Thank you!

 

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.