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What should I expect at therapy


I could use some insight on what I should be expecting from therapy/a therapist.  I have been to 4 therapists and one psychiatrist.  The psychiatrist and 2 of the therapists advertised that they specialized in gender therapy for trans identifying. The first therapist I ever spoke with (via zoom before it was cool) was a fully transitioned transwoman herself. In her practice she was also a life coach.  While I found her to be extremely effective at the life coach part (she talked me through a very dark time and helped me find the strength to come out to my family), I never felt that my underlying issues were ever really discussed or addressed. She diagnosed me as trans after our first discussion after I told her my life story.  After coming out my wife insisted that "it seems odd that you met with this therapist over zoom. Who does that?" (And now thanks to Covid we are all very familiar with "who does that").  She wanted me to go to a different therapist in-person.  I agreed and told her to pick the therapist.  I went to a few in person sessions with the therapist she selected. A therapist that indicated on her credentials that she was a gender therapist.  On the third session that therapist still seemed to be trying to grasp a full understanding of gender dysphoria and what it meant to be on the transgender spectrum/umbrella.  I felt like I was teaching her more than she was able to help me.  On my last visit with her she made a comment that shut me down. She said, "I think I understand now. Have you seen the episode of Friends where everyone meets Chandler's father? He's a drag queen. You feel like that right?" "ummm no not exactly."  I then transferred to another therapist in the same clinic. In fact it was the therapist my wife had been seeing and she really liked her and felt she knew what she was talking about.  We agreed that I would switch to her therapist and she would find another.  After 2 sessions I was feeling really comfortable and in fact validated by this new therapist.  After a few weeks this therapist agreed that my prior diagnosis of gender dysphoria/transgender was correct. When I told my wife she insisted that I speak to "a real doctor". So I found a licensed Psychiatrist that was skilled in gender dysphoria.  After my first appointment with him and all the backstories he said he agreed that I had gender dsyphoria and said the only question is what are you going to do about it. All appointments after that with him seemed like a waste of money and time. He always seemed distracted/uninterested. He never "explored" anything I discussed. I would talk about whatever came to mind. He would bill me (sometimes twice). So I told my wife that it was stupid to keep paying him twice what a therapist costs and I would get a good gender therapist referral from the UofM Gender Clinic.  I began seeing my current therapist. I really like her as a person. But once again I question what am I paying for. I go in every week, talk about whats on my mind. Occasionally she gives me her opinion about whatever I just told her.  She asked one time "what do you get from coming here each week and telling the same stories each time?"  I said, "They aren't always the same story, they are different stories that repeat the same theme in my life. I am stuck. So I come here and I tell you to help me." Aaaaaand we picked up right where we left off.

Question: am I doing therapy wrong? am I expecting too much? Should they be offering more advice or homework or critical thought? Should they be dissecting the themes more? I literally feel like I keep paying for venting sessions and nothing more. I don't like the repeating theme of my stories/life but its all I know to do until the therapist does something with it.

Dear Jessica,

It sounds like you are not getting a quality referal for your gender issues. A therapist who has trained in gender issues should be able to cite their qualifying classrom experience and produce a certification of some sort. Licenced therapists can be either a Masters degree or a Doctorial degree. If transition surgery is in your future, at least one therapist with a Doctorial degree is necessary.

For many late transitioners, we know what we are. We have been struggling with our issues for many years. Some of us find relief in cross dressing alone and they do not desire any permanent transition. Others desperately need to transition and they accept all the costs, both personal and financial, necessary to live the rest of their life as they wish.

When I went to my therapist, I knew what I was and I told my therapist exactly how I have struggled over the years with my dysphorias. I did not ask them if I was transgender or not. I told them that I needed to transition. I tried cross dressing a few times and found it unsatisfying. To me, clothes and make up are not important. For me, my sense of self  needed to match my physical body as much as current technology will allow.

The most important thing any therapist can do is to make you aware of all your options and determine if you are able to make a rational decision on how you would like to live the rest of your life.

Often times, the best way to find a good therapist is in the local trans support groups.

Whatever your eventually decide to do, remember that this is your decision. Take care.  :-*


I think you need to step back and ask yourself a few questions. Do you know your goal? is it to save your marriage and find some alternate way to feel whole? or transition? or to figure out what you want?  Its perfectly fine to use therapy to understand your own needs and what will work best for you.

On a very personal note.. I have a lot of empathy for where you are.  I am in a similar place, albeit 32 years into marriage. It isn't easy.  My therapist validates who I am while offering me alternates that might work for my wife and I. Maybe that is a good place to start-- validation and ways for you and your wife to move forward together.  Personally, I am slowly realizing that my own needs cannot co-exist with my wife's open hostility. I am coming to terms with what I need to do to get right, get whole.

good luck in your journey


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