Topic: therapist seems pushy?

[Maddie]

Friday I got reacquainted with a therapist I was working with last year.  He counts transgender issues as one of his primary specialties and has counseled people through complete transitions. He's the third counselor ive tried since I started transitioning again, and worked with each at least a year.  He is by far the most knowledgeable, though all 3 advertised trans specialty.

In our previous work, he gave me the push and assisted me with name and gender change, and coaxing me towards bottom surgery. I think his pushing is because of changes in medical insurance now covering this surgery in this state.  At the same time he has been discouraging me from considering things like FFS, and to some extent BA, I think because these are not covered by Medicare insurance. I am covered by Medicare and Medicaid, and my HRT co-pays are incredibly good. Same for the therapy, and possibly GCS.

In this telemedicine session, I was trying to talk about issues seeking employment and relocating, as my new name and gender.  My hope is for a new life and live it right. Hoping that transitioning is the way. I will most likely lose my insurance!! but i could succeed and maybe even get insurance coverage for all procedures, not just GCS.  Maybe even electro! Or earn and save to pay it myself. That's who the winning version of me is. Not being like the very depressed and unstable man on disability who I have wasted my life being.

These are all wonderful opportunities.

I don't think he believes I can do it, which is why it seems hes pushing
me to get the GCS now while it is covered.
Another transitioned client notch in his belt?
Concern of future policy changes that could take the coverage away?

Told him I'm not ready for bottom surgery, still want to learn more about different procedures. Acclimate to the knowledge available.
 I pointed out that in my current situation I will never afford the genital area electrolysis needed.
I'm really more concerned about what I can do about blending in physically.  Females run in groups for safety. As I am I'm a loner. I would very much like to assimilate and survive.

I told him i want to work with him about these issues and things like:

I don't think I hate my genitals. That much. Occasionally disappointed.

Not particularly attracted to, nor desired having, a vagina.

Despite these points, I have real dysphoria in the sexual act, and desiring/envisioning/mindsharing being the female partner.  More intense when I'm in those situations -it's really been a long while now. It's been easy to just feel numb sometimes instead of dealing with surgery I don't desperately crave.

Clocks ticking though.
I didn't change my name and GENDER MARKER to not do it...  I'm confused.

I told him I want to work on all the above before contacting GCS surgeons.
I've been on HRT around 9 months

So he said my homework is he wants me to contact the two surgeons in the state doing vaginoplasties and inquire about getting on their waiting lists and insurance approval.

Nothing about what I said.

Am I wrong to question?  Can anyone offer a third perspective?
I haven't been able to sleep lately and I've been thinking weird.
Thanks

[Battle Goddess]

I've had times with therapists where I've been left feeling that they haven't understood my needs or haven't listened well to what I've been saying to them. Sometimes it's made me mad; sometimes it's just left me perplexed. It inevitably gnaws at me between sessions.

My own experience has typically been that either I've misunderstood them or they've misunderstood me, and as long as I make a point of raising my concerns in the next session, things have always worked out. As in, "Duh, Battle Goddess, you're one of the original deep thinkers, aintcha?"

I guess what I mean is that yeah, your tdoc might have an agenda, but almost surely not. Even if tdoc does, it may be completely different than what you're perceiving. You'll never know until you talk it out with tdoc, and being able to talk it out is important for your relationship.



What do you mean about sleep and weird thoughts? Did you mention this to tdoc?

[ramilove]

Maddie
"I pointed out that in my current situation I will never afford the genital area electrolysis needed."
If GRS is covered by insurance would not the electrolysis required for the GRS not also be covered by insurance?
Rami

[AllieSF]

Rami,

I am not sure where you live and who your insurance carrier is.  I do know that if you live in a State the requires Gender Affirming procedures and surgeries, then you may want to check around for an insurance company that covers more or all procedures.  I live in the san Francisco Bay area of California, Northern California for Kaiser Insurance.  Kaiser in particular cover most of the items, including genital electrolysis, I think facial electrolysis, GCS, BA and FFS.  Some friends of mine used Kaiser for that.  Now Kaiser coverage is different in every region and State.  So, you will need to check that too.  There are other companies out there that may be similar.  You just need to check them all out.  I had my BA and FFS recently.  I just found out yesterday that both have some Medicare coverage issues and am hoping I will not have to pay anything more.

Regarding your therapist being pushy.  If he is, I think that he is trying to be helpful, looking at your situation and seeing, from his point of view, what could be a successful course of action.  I totally agree with Battle Goddess's recommendations.  Talk it out with your therapist.  It will be good for you and him!  I wish you the best of luck,

Allie

[randim]

Hi Maddie,

Seems doubtful your therapist has an ulterior motive.  Maybe a high percentage of his clients have opted for surgery so he has that in his mind as the best treatment for dysphoria based on his experience.  Can't really say. My therapist has certainly pushed me in some ways -- join a support group, get out in public, come out to my family, etc.. But at the end of the day, we are the clients, it is our lives, and we have to make the decisions.  A good therapist is going to respect that and work within your boundaries. You set the pace, and the direction and when to go and when to stop.

[madeleine]

Hi Maddie,

My therapist gave me "homework" too.  She suggested that I make an appointment to talk to a doc about HRT.  I also wondered, a little, if she was pushing me. 

Here's my take on it: therapists are usually pushing for positive change in their clients lives.  Otherwise, they are just listening to us bitch - and that is important - but usually they're aiming a little higher.  You and your therapist may disagree about what positive change is and that is what you can talk to him about.

And I don't think my therapist actually wanted me to immediately make an appointment and start HRT right away. I think she wanted to me to find out what would happen.  Would I do it or shy away?  How would it make me feel?

I agree with everyone else here: ask your therapist why he asked you to do this. Rather than have theories, then you will know.

[TonyaW]

Maddie
"I pointed out that in my current situation I will never afford the genital area electrolysis needed."
If GRS is covered by insurance would not the electrolysis required for the GRS not also be covered by insurance?
Rami

Maybe sort of.  I was told it would be covered but I'd have to fill out claims myself.  That means there would be no in network providers and I'd never have enough electrolysis to get anywhere close to that deductible.

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[Julie H]

No matter what the therapist says you need to go at your pace not theirs. If you aren't ready for grs then it's not time.

[Mary1]

No matter what the therapist says you need to go at your pace not theirs. If you aren't ready for grs then it's not time.

Totally agree....

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[Rakel]

...I told him i want to work with him about these issues and things like:

I don't think I hate my genitals. That much. Occasionally disappointed.

Not particularly attracted to, nor desired having, a vagina.

Am I wrong to question?  Can anyone offer a third perspective?

Maddie,

You are not wrong to question.  Nobody should ask you do do something you are not prepared to do on your own.

 I think you just answered your own question. You can live your life as you see fit. There are many ways to live as much or as little transition as you feel comfortable with. If a vagina is not in your immediate future, then put any actions concerning this on hold until YOU are ready to pursue this, if ever.

If you feel that this therapist is pushy, then, by all means, get a second opinion. This is about YOU, not what someone else expects of you.

Take care.

[ToriJo]

Maybe sort of.  I was told it would be covered but I'd have to fill out claims myself.  That means there would be no in network providers and I'd never have enough electrolysis to get anywhere close to that deductible.

If there is no in-network provider, ask your insurance for an out-of-network exception. I was able to get my out-of-network electrolysis provider treated as in-network this way, since it's not reasonable to say "go in-network" and then have nobody in-network!

For the OP:

It sounds like you don't want to get on wait lists right now or to talk to GRS doctors. That's fine. Tell your therapist that - tell your therapist you aren't feeling a lot of genital dysphoria right now. You're the client, you don't have to do anything you don't want.

It would be horrible to have this surgery if it's not what you want. Don't let anyone pressure you into it if you don't want it (or if you don't want it right now).

[TonyaW]

If there is no in-network provider, ask your insurance for an out-of-network exception. I was able to get my out-of-network electrolysis provider treated as in-network this way, since it's not reasonable to say "go in-network" and then have nobody in-network!

Never got close to the in network deductible either. I  hope to meet it and out of pocket max so I'll look into it. Be nice to get my electrolysis free for a year. 

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[Maddie]

Thank you all for responding.