Universal Transition Therapy: Common Sense or Assumption of Inferiority?


“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.


About Author

Suzi Chase writes about transgender issues through both fiction and non-fiction. She has had careers in teaching and software engineering and has raised two children.


  1. Wow, this a a very well written and thought provoking article. I’m of 2 minds about this topic. On one hand I think that the person who feels this way is the only one that can make this sort of decision. On the other hand young people who are going through this don’t always have all the facts etc to sort all of this out for themselves and need help. I like the idea of there being a resource that acts as a filter to stop impulsive people from getting on hormones and having surgery. I don’t believe that resource should be the gate keeper either (and I don’t know how to make sure there’s a balance either).

    One of my best friends used to transport mental patients and the large majority of his transports were TG folks that were self destructive. In talking to them they regretted changing their bodies and weren’t happy, and of course couldn’t go back. I did some digging into data on failed transitions and thankfully there’s not that many. My friend of course was going to see only bad cases and not good cases (people that are happy with their transition are unlikely to be in his car being taken from facility to facility).

    I don’t think another person (educated or not) has the right to say that you can transition, but this other person can’t. I do think a qualified person can determine whether the subject has done their homework, understands the risks, understands the affects (good and bad) of their decision and let them make the choice. That won’t guarantee they are making the right choice, but at least its an informed choice. As an adult we should be free to make our own choices, especially when it comes to bringing our inner and outer selves into alignment.

    Thanks for the article! I actually read it a couple days ago and have been thinking about it and wanted to respond 🙂

  2. *

    ”She’s too young to decide to be a girl.’ said no one ever to the cisgender girl.’

    As far as I’m concerned in my 40+ years time of transition to post-op and beyond, I felt hindered with each and every demand for new mental assessments. I can wallpaper a mansion using my four decades of clean mental health reports.

    ‘Confusion’? Hey, I already had all my years since earliest childhood persisting my gender identification as female that should have counted for something, certainly not ‘confusion’. I was a rational adult making rational adult decisions when I began transition.

    ‘Not as a normal life change’? In my perspective, my transition through completion was about as ‘normal’ in my life as any other medical need.

    ‘Fragile’? If I had been so ‘fragile’, then how do they explain my endurance where, no doubt, a cisgender does not tread? Harassment. Bigotry. Discrimination. Prejudice. Workplace retaliation. Loss of employment and loss of earning capacity.

    How many cis people seriously entertain the plan to commit legal fraud by going to court to change their identification, going to SSA to change their records, going to MVD to obtain a changed licence, collecting pages of documents to file for a passport? Really? If there is such a flood of illegality, then perhaps the system needs to attend to that issue and leave us to our privacy.

    I was directed to attend mandated M to F counselling despite a medical diagnosis of female inter-sex, which seems that should have over-ridden such a demand – but no. Not even my post-op psychological sessions allowed for any future green lights in my favour.

    One counsellor during the 1990s held fast his mindset of two out-dated, old school philosophies:

    – (1) M-F were primarily homosexual males seeking to normalise their homosexual relationship as ‘heterosexual’

    – (2) M-F could not possibly have a Lesbian orientation.

    Jump to the past year. I have sought medical services of a sexual nature routinely available to the cis community, yet my medical team impose that I attend psychological counselling at each event to substantiate my mental capacity. This imposes the added burden of financial expenditure not easy on my budget.

    Curious. When I broke my toe in two places, my same medical team did not demand psychological counselling for that treatment.

    Nor when I require a new prescription for my eyeglasses.

    Nor when I was in a car collision; not once did any medical professional demand I prove my capacity for medical care for my multiple traumatic injuries. Worst of that endurance was when surgeons were quite eager to remove both my liver and gall bladder without so much as a fine ‘How do you do’; I had to assert my emphatic ‘NO!’ to get their attention that I had the mental capacity to know an alternative that has done me quite well.


  3. I believe that ultimately the going through therapy should be a choice and a requirement but as or right now, it is what it should be, a requirement. I would make the same argument for anyone that is being discharged from the armed forces that have seen combat as the consequences of PTSD is often violent and in one way or another, a loss of life is involved. During my time discharge, aside from making a Marine to civilian life course mandatory pre-discharge, Marines were to be undergoing a mental health screening during both in-processing and out-processing.

    The difference between the other examples and transitioning falls on whatever perspective our fidgety society has arbitrarily deemed as the acceptable norm and the current violence that is associated with transitioning. The number of deaths/murders to the trans community presented in one articles here is a statistic that is unquie to our community.

    I 100% agree with you though I may have a weird way of showing it, that it is not right to force therapy, but I am also happy that this it is currently in place as it seems to be a necessary evil, because it has the off chance to save the lives of a few.

    The root problem of it all is what you said in the introduction of your article. The definition you give to those 3 words is exactly what society thinks of in association to therapy. Take the power away from the world, take the negative connotation away from it and speaking to a therapist no longer becomes associated to the incapable or the fragile, but simply someone seeking advice. Oversaturate the word like the current generation has done to the word “literally.” I literally cannot differentiate sometimes between when someone is using “literally” in a literal sense or using “literally” figuratively and we NEED the word “literally” to mean what it means because there are no other words that literally means what literally does (ARRRRGGGGGHHHHH!!!!!). Where was I?…yes… throw away words like “coach”, “consultant”, “advisor”, coordinator, as they are all therapist in nature. Athletes will be seen in the interviews after the game saying “I just listen to my therapist and gave it 110%”. Students for 4 years of high school and 4 years of college would be often heard saying they need to meet their grade therapist or go to occupational therapy, and businesses will often hire a therapist to consult…i mean provide therapy to fix whatever it is they need to be fixed. This way when someone says that they need to see a therapist, it won’t is met with a raised eyebrow and the thought of “what’s wrong with you?” but instead met nothing because seeing a therapist is just something everyone does.

    I’ve lost my chain of thought now and my brain is just stuck on the sombre demise of the meaning of “literally”. An image of a fresh grave and a headstone reading “here lies literally – for his unique service to language, xxxx-2016” and the lonely sounds of a solo bugle playing Taps in the background.

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