Last fall was the first time I really started therapy, and that first appointment was really the first time I had ever said out loud to anyone that I had gender identity issues. I had used tools like Psychology Today cross-checked with my insurance to find somebody who I thought would be a good person to talk to that was nearby in the suburb I live in, and she ended up being a really good and supportive person.
She helped me as I talked to the first few people in my life, including my wife, and as I started to move from that first appointment, where i kept saying over and over that I felt ridiculous, to the point where I could finally admit, that yes, I identify as trans.
Unfortunately after a few months, that first therapist had to leave the practice, as she was expecting a child and needed to focus on another practice that was closer to home (if I remember right). Thankfully she did help me get set up with a new therapist at the same clinic, and she was able to even do a joint appointment with the new person that helped me to get adjusted to the new person. And my current therapist has been really great for the last eight months. I've worked towards more self-acceptance, and I've talked to more people, including my closest friend of 30 years and most recently, my sister and her husband, my brother (who passed on the news to his wife) and my parents. That was a huge milestone, and there's a lot more work to do to deal with the aftermath of basically coming out to my family. And I was just getting ready for possibly a somewhat calmer period of adjustment while I focused on some long-term goals like weight loss (I have 160 pounds to lose before I get down to a normal weight, after losing 40 pounds in the last six months) and work on additional coping skills.
But then a couple days ago I got a message from my current therapist that unfortunately something has come up in her personal life, and now she is leaving the clinic too. She too is going to work to help me to find a new person to work with.
We had actually just been talking about whether it would be good for me to work with somebody with more expertise than she had. I watched a good video last night from gender therapist Dara Hoffman-Fox, where they talk about how they categorize therapists as having three levels of knowledge: 1) trans-friendly, 2) trans-aware, 3) trans-knowledgeable.
http://darahoffmanfox.com/gender-therapist-qa-anything-missing-not-seeing-gender-therapist/I think if I remember right that trans-aware was the second level, where a therapist has worked with trans clients before. Trans-knowledgeable therapists have done that but also probably have a good understanding of local community resources and have enough experience to write letters in support of things like hormones and surgery. Trans-friendly therapists probably are a good sympathetic ear, but may not have a lot of experience.
Dara makes some good points in the video about not wanting the client to be in the position of doing too much education of the therapist. That ideally the therapist should be helping with guidance, and that takes experience.
My current therapist put herself in the second category, and so the question is whether I need somebody in the trans-knowledgeable category.
And honestly I don't know.
I am not doing hormones or surgery. It's impossible to know what the future holds. But my focus is on improving my health and working on my relationships with my family members. And developing additional coping skills.
I haven't looked into something like a support group, and I just don't know if that's something I want right now. I don't know if there is a support group for people like me that might not be in a position in life to do the sort of things that are traditionally associated with transitioning. I don't know that I put myself in the nontransitioning category, because I am doing some things like growing my hair longer and changing my clothes over to women's clothes that maybe aren't super duper obviously women's clothes. These things are about helping me to feel better, so I guess they're coping strategies? And maybe it would help to be in communication with people, to feel like I'm less alone. I mean even posting here with an alias was a big step for me. It's hard to know that I'm not in a place where the things some other people are doing is something that's maybe not on the table for me, both because of my health and because I am prioritizing the needs of my family as we try to figure things out. So being around people that might push me to do more than I can handle, that worries me?
And to some extent I worry that a trans knowledgeable therapist might also push me to do more than I can handle?
The metro area I'm in also has a really good gender care center at the university, although there's a big wait, and I have very mixed feelings about seeking care there, because they are in the same medical system as my primary care doctors. So if I went to appointments there, my doctors would see that, and at that point, my status is in the system. And given everything going on in the world, I just don't know if I'm ready for that when I'm not going there to get all of the services a place like that has to offer. If I can get decent help with things like therapy elsewhere, without having that affect my medical record, maybe that's what I need right now?
Also, a lot of the people with more gender expertise are more in the heart of the city. So that means extra drive time for appointments. I have a fairly flexible work schedule, so I could in theory make that work. But it would mean probably putting in work time on the weekends to make up the difference or something like that.
My therapist had found one person with extra expertise she suggested as an option. And that day I first found out my stress levels were super high. So I reached out to this person, first with a rambling voice mail, and then later with a more coherent email. I had read the profiles of this person, checked there was insurance coverage. So I opened up a bit. And frankly I was nervous all night waiting for a reply, waiting to find out. Yay anxiety! And then I found out the next morning that this person just stopped taking my insurance. So that was super disheartening.
And a lot of the people with more expertise, it seems questionable if they take my insurance (a well known national plan), which is very frustrating, even though they take other insurance.
So at my appointment today we talked about this. I had done some research too and found somebody else in the current clinic who might be in trans friendly or trans aware category. My therapist thought that person seemed nice but didn't know too much about the level of expertise, so she'll do some more digging, check on availability and expertise levels. And she'll get back to me with some viable options with both availability and insurance coverage.
I think I've landed on if there is somebody in my local area that has had some experience working with trans people and can help me with other goals like coping skills, maybe that would be good for me now. I can always move to somebody with more expertise down the road if I need that. And I don't know maybe I should take that opportunity now while I am making the shift, if we can find somebody.
I have a lot of anxiety and worry about getting somebody in place in the next couple weeks.
I'm still so in the closet in so many ways, even though I've made progress. I don't even really want to talk about which area I live in here, which may be an irrational worry on my part, as that closes me off from connections and help.
Hopefully we get somebody new lined up soon. If they have good expertise that would be good. It would be nice if that didn't disrupt my work too much, but if there's some disruption in order to get good help, I guess that would be worth it, if it leads to a better outcome. :/
Life is so harrrrrrrrrrd.
