Therapy Session #1 - Complete!

[Kaley]

Had my first therapy session (to kick off the start of Transition 2.0) yesterday and it was awesome!  I was really nervous before the appointment started, but the Dr. was very well informed on transgender topics and issues and was very easy to talk and relate to.  Definitely looking forward to my next appointment next month!  Anyways, here is a breakdown of some of it:

- Apparently, she does not like to be deemed a "gatekeeper" and thus does NOT write letters for hormones.  Instead, she does referrals based on her evaluation which according to her falls within the guidelines of the newest version of the WPATH standards of care.  At the end of the appointment, she referred me to a clinic that provides transgender services without the need for a letter.  According to her, this is pretty standard practice in HI - which I did not know.

- She has treated (and is still treating) numerous transgender patients from around the area - including some from the same place I am currently employed at.

- She used to organize "T" parties at her house every so often where her transgender patients and friends would come over to socialize.  She told me that she hasn't done one in a while, but would like to start again after her house renovation is completed.  Sounds like a really cool idea!

- She provided me with a partial copy of the WPATH Standards of Care (7th version).  I'm guessing this is probably pretty standard.

-She gave me a free copy of a book titled "Transexuality in the late 20th Century - What it was and what it wasn't" by Sarah Seton.  Apparently, she is friends with the author (who, as you could probably tell from the title of the book is transgendered herself) who lives in the area.

- I felt no real interrogation factor and was pretty comfortable talking to her.  I did not have to do all of the talking - she had great advice and info to talk to me about.

- I was pretty scatterbrained and told her about a lot of stuff ranging from childhood to my current situation.  I hope to focus in on a few of these things more thoroughly in future sessions.

- Office space was just OK.  AC was broken, but should be fixed soon.  Privacy was slightly iffy - Her office is the first one next to the waiting area, but the door was shut and I think the level of sound isolation was OK as I could just faintly hear people talking outside.

- She doesn't take insurance and charges a flat rate of $50/hr, which I don't think is that bad at all!

- Best of all, she provided all of this NO charge for the first appointment!  Pretty amazing, especially considering the appointment lasted just about 1.5 hours!


Any thoughts from anyone?  Do you see any red flags?  I feel like she is a pretty good match and am definitely looking forward to seeing her again!!

[Jessica Merriman]

- She doesn't take insurance and charges a flat rate of $50/hr, which I don't think is that bad at all!  Do you see any red flags?

A doctor (I assume an M.D.) that doesn't take insurance is a red flag to me. As a Paramedic the only M.D.s I personally knew of who did not take insurance assignment were on restriction or had limitations levied by the Medical Board for violations or disciplinary actions. I am not saying this is true in your doctors case, but I would check with your State Board for any violations and reported issue's. I do this with any doctor I use as a matter of fact and feel better when I see their license in good standing and positive patient replies. 

One other is a Doctor should not in my opinion socialize with patients. They should keep a professional demeanor and patient/doctor relationship. Some states do not allow this to happen at all. It is really an ethics question though. It is hard to provide unbiased care when the patient is a friend.

[Kaley]

A doctor (I assume an M.D.) that doesn't take insurance is a red flag to me. As a Paramedic the only M.D.s I personally knew of who did not take insurance assignment were on restriction or had limitations levied by the Medical Board for violations or disciplinary actions. I am not saying this is true in your doctors case, but I would check with your State Board for any violations and reported issue's. I do this with any doctor I use as a matter of fact and feel better when I see their license in good standing and positive patient replies. 

One other is a Doctor should not in my opinion socialize with patients. They should keep a professional demeanor and patient/doctor relationship. Some states do not allow this to happen at all. It is really an ethics question though. It is hard to provide unbiased care when the patient is a friend.

Jessica, thanks for the input.  Maybe I should have specified a little better, but she is not an M.D.  Here is a little background that I found listed for her:

Constance ("Connie") Brinton-Diamond, Ph.D. is a private-practice psychotherapist and clinical sexologist who provides TG-affirming counseling and referral services to individuals, couples, friends, and families wishing to explore various gender identity issues. These may include gender identity or sexual orientation concerns, transitioning (according to the WPATH Standards of Care), cross-dressing, and post-transition issues. Her professional credentials (i.e., education, specialized training, and 25-years of experience) are in the fields of clinical and forensic psychology (specializing in human sexuality, including gender issues).

As for the professionalism aspect, I can definitely see where you are coming from and maybe that's another reason she hasn't held one of those in a while.  I couldn't find her being rated by any doctor rating websites and am unsure of how I would check with the state board...do they have a website with this info or would I need to call their office or something?  Does it make any difference because she is not an M.D.??

[Kaley]

Very good point.

Kaley, what are the letters that come after this therapists name?

Candice, you can see my previous reply, but on her card, she is listed as having a Ph. D. in Psychotherapy.  Hopefully that clears things up haha.

[Jessica Merriman]

PhDs should be licensed (at least in my state) and inquires should be able to be made at the State Health Department in your State. It could be online so check it out. One thing that concerns me though is she will not issue letters for HRT. That is very strange to me. If she can't help you all the way find another one soon. Though we do go through therapy for mental health HRT letters are part of the treatment for Gender Dysphoria. I am wondering now if she has had her prescribing status revoked or letters refused by HRT providers. Not trying to be a downer, just helping. 

[Kaley]

PhDs should be licensed (at least in my state) and inquires should be able to be made at the State Health Department in your State. It could be online so check it out. One thing that concerns me though is she will not issue letters for HRT. That is very strange to me. If she can't help you all the way find another one soon. Though we do go through therapy for mental health HRT letters are part of the treatment for Gender Dysphoria. I am wondering now if she has had her prescribing status revoked or letters refused by HRT providers. Not trying to be a downer, just helping. 

I see, alright, I will try to look into this issue more.  I'm wondering though...when you say she may have had her prescribing status revoked...If she is a Psychologist and not a Psychiatrist, then she would not be able to prescribe medications anyways right?  As for the hormone letter issue, she made it sound like it was common practice here which kind of surprised me because during my first transition, I did get a letter for hormones from an online therapist and searched around the area for a knowledgeable endocrinologist who was willing to treat me and it all worked out.

However, this time around, it seems that only a referral, rather than a full blown letter was all that was required.  The place she referred me to try first is called "Planned Parenthood" which offers transgender friendly services.  She also said she has connections with a few transgender friendly endocrinologists, but said I should give Planned Parenthood a shot first.  Its also kind of interesting that this Planned Parenthood place is located in the same building as her office, but that's probably just coincidence right?
Anyways, planned parenthood seems like a legitimate nationally established organization and I have made an appointment there for this coming Monday for a consult/general physical exam/bloodwork.  Apparently, after the bloodwork comes back, they will be the clinic that prescribes the meds and periodically monitors progress and bloodwork.  They DO take my insurance provider, but told me because it pertains to transgender services, it may or may not be covered.

I will try to email Connie about the whole letter issue and try to clear the air about it, but please let me know if you have any additional thoughts on taking this route to hormones.

[Jessica Merriman]

Is she wanting to counsel you anymore or just have you go to PP and not see you again? Therapy is very important in my opinion to success in transitioning.

[Kaley]

Yea, she does.  I feel like we have so much more to talk about and I for sure want to see her again! 

I definitely understand the importance of therapy...I feel a lot more confident about transitioning just from the 1 session.  Unlike my first attempt at transition, where I used an online therapist, being able to actually talk face to face with someone has a much greater impact.