“You need therapy!”
Those three words, assuming they are not meant as an insult, carry two powerful implications. First, you are incapable of improving on your own. And second, you are not even be capable of figuring that out without prompting..
Normally, psychotherapy is an intensely personal choice. We are the best deciders how to solve our personal issues and whether therapy is the best solution. Given the expense and time involved, it’s normally chosen only when handling problems without it won’t suffice. Therefore therapy is a prescription given someone only when it is externally obvious their efforts have fallen short.
So what are we to make of the oft-repeated advice that it is unwise to contemplate a gender transition without psychotherapy? This admonition goes beyond, “many have found it helpful,” and even beyond, “problems may arise that therapy could help solve.” As someone who has transitioned, I would wholeheartedly support both those.statements. I also support psychological screening before prescribing transition-related medical care to ensure competence to understand the practical consequences of the decisions involved.
Saying all transitioners should seek therapy goes far beyond that.
It expresses the certainty that a trans person is, by their very nature, incapable of making decisions about their gender or handling the stresses involved. This assumption of incompetence implies a disturbingly low opinion of our resourcefulness and a troubling perception of gender transition as abnormal. When we’re sent the “you need therapy” message, we are being told that our merely being trans points to an incapacity to accomplish what cisgender people do every day without professional support: living as a member of our gender.
A frequent rationalization goes that transition is such a major life change as not to be weathered without professional advice. And yet, similar advice is not given to cisgender people undergoing comparable changes. When someone embarks upon a new career, moves to a foreign country, or goes away to college, we don’t tell them they need therapy to survive those passages. If we truly believed that psychotherapy should accompany all stressful life transitions, we would insist upon it when a convict is sent to prison, when a national guard unit is called up to active duty, or someone enters a helping profession. Even marrying couples or first-time expectant parents, who will be permanently changing their lives in major ways, are typically only given classes or one-on-one coaching. No one ever suggests obligatory psychological care.
No, the identification of gender transition as a process that must be accompanied by psychotherapy is unique. A gender transition is seen not as a normal life change (which it is for millions of transgender people), but as an unconventional move about which one must be cautioned. Transgender people are seen as so fragile, that picking up the pieces of their lives necessarily requires counseling.
Still not convinced? Perhaps it’s time to apply what I’ve begun to call The Cis Test. Look at a statement made about trans people and see whether it would sound sensible if made about cisgender people. If the answer is no, then consider the possibility that it is cissexist.
Imagine cisgender Brad puts on a jacket and tie to go to work. Would anyone say, “Hey Brad, I see you’re about to present as a male. Males are held to stressful standards in our culture and face rigid gender expectations. Do you think before you go out as a male, maybe you should seek psychotherapy? The decision to be a male is a major decision, not to be made lightly.”
Absurd. But isn’t that exactly what we’re saying when we tell a transgender person who seeks to do the same thing — live as their identified gender — that doing it without seeing a therapist is a bad idea?The absurdity comes only because no one questions a cisgender person’s decision to live as their sex assigned at birth. They are assumed to know what they are doing. The opposite assumption is made about trans people — that due to our inherent confusion and fragility, we risk a terrible mistake, or damage by the crushing stress of living as our gender. Transgender people face this paternalistic and patronizing attitude frequently. We are told we cannot be assumed to know what shape body we want without an external litmus test. We are assumed to be lying about our gender for the purpose of passports and driver’s licenses unless we bring medical documentation. (If we don’t know what gender we are, how would our doctors know?) The therapy-for-everyone-who-transitions meme is yet another casual assertion of transgender inferiority and incompetence.
True, there are stresses associated with transition. Family members and friends reject us, society gawks, and the intolerant place obstacles in our way. As is true with any stressful undertaking, some people can handle those stresses, others may need therapy. I wouldn’t dream of saying they should not seek it. But neither would I dream of saying that those who can handle the stress without psychological care should go through the expense of therapy they do not need. No one is saying that people, cis or trans, who face life situations that exceed their coping resources should not request psychological care. But saying that no trans person should transition without therapy goes far beyond that, making a blanket statement about the abilities of all trans people.