How to politely question your therapist?

[FTMax]

If you've read any of my previous threads, you likely know what this is in reference to. I've been feeling frustrated with my therapist, though she has tons of trans experience and is generally well regarded. Ultimately I'm not looking for validation or better understanding of myself - I'd just like a referral for top surgery and maybe bottom surgery later down the road. She's known this from the start. Summer is my busy season at work, so I am hoping to have surgery in early spring so that I can be all healed up and ready to go. I'd like to schedule two consults here soon and book shortly after. But I need that letter.

I've started T by informed consent. I have more than enough money to pay for surgery. This therapist is literally the only roadblock to moving on with my life.

Has anyone ever put their therapist on the spot and asked how long it would be until you hit a certain milestone in therapy (a diagnosis, a letter for HRT, a letter for surgery, etc.) and gotten a firm answer? How did you address it? I have spoken with a second therapist who is willing to give me a letter in 6 weekly discounted sessions, but if I'm less than 6 sessions away with my current therapist, it doesn't make sense to switch.

I just don't know what's considered impolite or overstepping, and I don't believe in "it'll take as long as it takes" as an answer, which is what I'm afraid I'll get.

[Julia-Madrid]

Hi FtMax

Oh yes!  I was very clear with my therapist about my goals, both short- and long-term.  In fact, I did this with my private therapist and with my gender clinic therapist.

It wasn't a case of being pushy, but I made it quite clear that I knew what I wanted, and I also presented her (in both cases) with a roadmap, complete with a timeline.  I know it sounds geeky, but it certainly helped.

I think that something additional which was useful is that I focused the sessions precisely on the surgeries I wanted so that she could see that I was evaluating their value and risks quite clearly.

Truly, I believe it would be perfectly valid to state your concerns, propose the dates for the surgeries you want, and ask how you could work together to meet these dates.

Julia

[Bimmer Guy]

Truly, I believe it would be perfectly valid to state your concerns, propose the dates for the surgeries you want, and ask how you could work together to meet these dates.

Julia

This.  This is great advice max.  You are being direct and respectful at the same time.

[FTMax]

Thanks guys. This really helped me figure out how to pop the question so to speak 

Unfortunately she still refused to give me any kind of solid answer, so I fired her. I've already switched to someone new, who I hit from the get go with dates and such, and he is super on board to get me taken care of as quickly as possible.

[suzifrommd]

Sorry to get my hackles up but I'm running on low sleep, so I'm not in the mood for sugarcoating stuff. Please forgive me:

Your therapist has NO BUSINESS withholding a surgery letter from you. Therapy is NOT required for surgery under the WPATH guidelines. She needs to evaluate you for mental health concerns. If any exist she should help treat you. Otherwise, once she has completed her evaluation, she needs to give you the results and if there are no concerns, write the letter.

You have the right to ask how long the evaluation will take. If she hedges or refuses to answer, that is, IMO, unethical.
You have the right to ask what her concerns are. If she hedges or refuses to answer, that is WAY, WAY, WAY unethical.

From the WPATH standards of care page 106, 2nd to last paragraph "Although not an explicit criterion, it is recommended that these [surgery] patients also have regular visits with a mental health or other medical professional. "

http://admin.associationsonline.com/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf

[adrian]

I'm very glad you found a new therapist and will be able to meet the schedule that works best for you!

I think I'm running into a similar roadblock with my therapist. I'm planning to address the issue in session this Thursday. My case is a little less straightforward because I initially saw him for different problems. My impression is he is uncomfortable with the whole gender issue and I have an inkling he doesn't think my identity is valid. Right now it feels like Thursday will be my last session with him.

[FTMax]

Sorry to get my hackles up but I'm running on low sleep, so I'm not in the mood for sugarcoating stuff. Please forgive me:

Your therapist has NO BUSINESS withholding a surgery letter from you. Therapy is NOT required for surgery under the WPATH guidelines. She needs to evaluate you for mental health concerns. If any exist she should help treat you. Otherwise, once she has completed her evaluation, she needs to give you the results and if there are no concerns, write the letter.

You have the right to ask how long the evaluation will take. If she hedges or refuses to answer, that is, IMO, unethical.
You have the right to ask what her concerns are. If she hedges or refuses to answer, that is WAY, WAY, WAY unethical.

From the WPATH standards of care page 106, 2nd to last paragraph "Although not an explicit criterion, it is recommended that these [surgery] patients also have regular visits with a mental health or other medical professional. "

http://admin.associationsonline.com/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf

Suzi, thank you so much for this! I didn't want to flat out say things were unethical, but reading this it definitely looks that way. In addition to that, there was a lot of "I've written XXX number of letters in my career, you just started transitioning X number of months ago" - to the point where she said my situation/the reason I'd like a date for the letter was untrue.

I had emailed the receptionist for the surgeon I'd like to go to and asked when we could do a consult and when they'd need a letter for top surgery. Turns out they need it 3 weeks in advance and they are already booked through February, so if I want to get in this March, I need to get on that calendar ASAP. My therapist said that no one requires a letter 3 weeks in advance of surgery and that she could write my letter and email it to the surgeon the day before and I'd be fine 

Very, very glad to have dropped her and moved on to someone else.

Adrian, I really love what Julia suggested above. Even if its less straightforward in your case, maybe see if between now and your session you could draft up some kind of plan for a transition and ask him where he thinks he would fit into it. If he can't help you, I'd say find someone else. The whole transition process is already convoluted enough without being treated poorly by mental health professionals.

[awilliams1701]

I asked my therapist that question a few times and she said that because I was so early in even coming out to myself that it was only fair for me to give her a chance before rushing into it. Ultimately she gave me the ok for HRT a lot earlier than I expected. While she may not have made a huge difference in my life, she did help me overcome some obstacles in my transition (like coming out) before even starting HRT.