Gatekeeping and feeling conflicted about being honest vs being "good"

[captains]

Hi all. Just wanted to solicit some opinions. I'm currently a few months into gender therapy stuff with a very nice woman who, despite being The Gender Therapist in my area, is not particularly trans-fluent. She is, however, absolutely my best option -- which I say now to ward off the otherwise-reasonable suggestion of "go to someone else!" haha. It's kind of an old fashioned set-up, and it's clear to me that my therapist sees her role as determining whether I am a "full transsexual" (and therefore deserving of letters ands stuff) or something else (and therefore not). Note: I'm probably "something else" by these very strict definitions. I'm a little on the non-binary side of things, although I definitely see myself as male and as trans. I feel like I have to tread carefully.

Recently, some stuff about my childhood came up. Until now, I've been sort of selectively editing any unsavory bits because a) I can only take so much share-and-care, and b) I wanted my story to stay nice and shiny until I had my top surgery letter in hand, which I presume would read something like: "Cameron is a handsome, stable young man without any trauma whatsoever, definitely chop his tits off."

But, well. I dunno. I want to be honest. I do have fears that my gender identity is tied to said childhood stuff, and I'd like to talk about it. I want to express my concerns openly, and I want this therapy to be useful and productive. If you've read some of my posts on this board, and god help you if you have, you probably know that I can be a sadsack with a lot of dumb baby feelings tied up in my transition. It would be really nice to actually make some progress with that.

I feel like any hesitance on my part, though, will be amplified ten times over by therapist's own. It'd be really disappointing if I shot myself in the foot with this. I have to jump through a lot of hoops just to get to where I am, and I can't really afford to do it all over again in a year or whatever.

Has anyone been in this position before? What did you do? Any advice?

[Cindy Stephens]

So, I assume that you are paying all this expense, both $ and psychic, and you are what? Worried that the therapist might cure you of some childhood trauma that is driving your desire to transition?  Show you that maybe you were wrong?  I haven't read your other posts so am basing my questions on this posting only.  But what If you show them they are wrong, transition, then find out that maybe you would have been happier in some non-binary state? 

[captains]

So, I assume that you are paying all this expense, both $ and psychic, and you are what? Worried that the therapist might cure you of some childhood trauma that is driving your desire to transition?  Show you that maybe you were wrong?  I haven't read your other posts so am basing my questions on this posting only.  But what If you show them they are wrong, transition, then find out that maybe you would have been happier in some non-binary state?

Oh no, sorry, I haven't made myself clear. I'm concerned that if I'm open about my questions, concern, and vulnerabilities -- basically, if I express any sentiment other than "I am a 100% binary trans man and I've known since I was 4. I have no doubts and nothing other than this going on in my life." -- she will not sign off on my transition related things because she has limited experience dealing with trans issues and is working off a really rigid and somewhat outdated model.

She said pretty plainly that she doesn't like the idea of transition for anyone who isn't an "extreme case of transsexualism." I am, perhaps, not an extreme case, but I really do want to transition and I have confidence at this stage in my life that top surgery is the right call. Maybe it's not, and if I felt more secure about this, I would absolutely be open to discussing alternatives and exploring every avenue. In fact, I've been moving at a snail's pace because I really do want to be "sure." But I worry that that if I deviate from the narrative, I will not be allowed to move forward, despite being "trans enough" for a therapist in a slightly more liberal location.

[FreyasRedemption]

In my homeland, therapists, psychologists, surgeons, EVERYONE INVOLVED IN TRANS MATTERS is more or less a gatekeeper. And it's pretty much officially in the law that they have to be that way, and with the current government and economical situation, that law is not going to change any time soon.
I have had to lie to people about how severe my need to be a woman is. But not much, since every time I have doubted it and thought about it, my confidence in me being female and needing treatment-all possible treatment-has just increased.
One of the very first things my gender therapist said to me was that very few actually qualify for treatment. If I didn't have my mother's support, a plan to move abroad, and a just-in-case treatment fund, I would be incredibly scared of them deciding that I'm not "trans enough" or that I have some kind of mental disorder that makes me think that I'm trans. It is still my number one nightmare, despite that I know that I'm not suffering from anything else than having the wrong kind of genitals, and that I absolutely need transition to prevent myself from falling into depression and eventually killing or mutilating myself out of dysphoria.
I know that all trans people are not as......extreme in their cases as I am, and that lying isn't really a good way for dealing with transition-related matters. But what advice I can give.....
Your transition is ultimately about you, your body, and your happiness. If you have to lie about how much you feel that you need to transition, lie to the medical personnel. Not yourself.
Ask yourself: "Do I need to transition?" Don't think about your gender therapist or her opinions. It is not for her to decide whether you are "trans enough". You are the only person who can define where you stand on the matters of gender, and if you are unsure, think about it until you figure out the answer. And be honest with yourself.

[Ms Grace]

I completely understand the need to selectively edit the truth, especially with people who have set themselves up as King/Queen Gate-Keeper. It's sheer arrogance on their part. My current therapist tried it and I slapped him down, but it helps if you know what you want and are prepared to stare them down over it. My release however is that I have had two therapists, one who writes the letters and the other one who is there to talk about stuff with. Fortunately the second one comes free - I talk with him about a lot of my doubts and concerns and I know what you mean, it really helps.

I don't doubt there are some childhood issues for me that are directly connected to my gender dysphoria, but whether they caused it or were caused by it are kind of immaterial. It doesn't hurt to talk about that stuff, just make sure the counsellor knows that you are raising it from a need to get into the heart of your feelings, not due to doubt on your behalf.

I'd also suggest you consider challenging her - that you have a trust issue with her methods and her intent. I've had many good therapists over the year - one that helped me greatly I saw for quite some time. I've challenged them all - called out my feelings about the relationship and my concerns about how they might be playing me. In every instance it helped improve the working relationship - it keeps them honest and you know where they stand then.

[Elis]

I was in the same boat with my therapist. I identify as mostly male with just a smidgen of nb mixed in. I was honest with her and answered her questions about how I felt being my assigned gender and how awful pubertly and school was etc. But just like you I don't like sharing unless I really know the person even though she was nice and knowledgeable. And I didn't want her to withhold T. So I didn't tell her about my wanting to be fem or feeling like I was nb. It didn't come up anyway and had nothing to do with me feeling like I have to have HRT and live as male to make myself happy. So I wouldn't feel bad for not telling the whole truth. Just be honest about how you feel having the wrong body and how happy being seen as male makes you.

[Vinyl Scratch]

Always be honest in gatekeeping although make sure you get across some sense of urgency, if you walk in and say yeah, honestly, it doesn't bother me that much, then probably wont end up getting the money

[captains]

These are all great posts with a lot of good advice. It's definitely something I have to ruminate on. Btw, I just want to clarify that I don't think I'm "too good" for my therapist or that I "know better" or anything like that. I'm actually open to moving slowly and carefully and if most therapists told me they didn't think transition was right for me, I would listen with an open mind. It's just that the definitions of transness are so strict (persistent unwavering dysphoria since early childhood, evidence that said dysphoria is purely organic, evidence one had exhausted every alternate option, evidence that not transitioning would be life threatening, binary identity...) that it's a little overwhelming, haha.

[Ms Grace]

...I don't think I'm "too good" for my therapist or that I "know better" or anything like that. I'm actually open to moving slowly and carefully...

This is always a good way to approach to have with a therapist but at the same time they shouldn't presume to think they know everything either. If there's one thing I've learned about counsellors, therapists, shrinks, psychs, whatever - they're all humans and a degree hanging on the wall in a frame doesn't make them infallible.

[Qrachel]

Hi:

I like what Grace has said a lot.

At some point you have to answer the question: Would a change to "xyz," if there was a magic pill I could take, be what I would do?  Get that settled and be sure that whatever needs that creates in your life you get met including psych, medical and social.  I wish it were different but a healthy level of self-advocacy is sometimes necessary.  Do it politely and compassionately but it's your life.

Other than that, I'll follow along here and post if I can add value - I do want you to have a life that fulfills you and that interests me a lot.

Take care,

Rachel

[FTMax]

Hey captains,

My feeling is if you're feeling like you can't be 100% honest with a mental health professional for any reason, there is a fundamental problem in the relationship. In this case, she's a jerk.

I don't normally advocate keeping things from people, but I've also never been confronted by someone clearly gatekeeping. The fact that she's told you that she doesn't like the idea of transition for someone who isn't "extremely transsexual" is a huge red flag for me. I can only see that mentality causing problems for someone who doesn't fit the typical narrative that gatekeepers have come to expect.

I know you want to make the most of therapy, but I think it's going to come down to what you want to get out of this. If the end goal is referrals for surgery, you may be better suited telling her what she wants to hear, and finding a low cost therapist to speak to about your childhood stuff on the side.

And I know you don't want to see another therapist, but I've had some really positive outcomes from online therapy (as someone who is 100% skeptical of the profession and mildly antagonistic about the process). It was very cost effective as well. I'd be happy to send you the name of the therapist if it's something you'd like to look into. I told him I was time crunched, he got me a referral in 3 sessions. It freed up a ton of cash that I had set aside to pay for therapy.

[Peep]

I feel this. I spoke with a pysch as a step on the way to GIC referral and I feel like because I said I'm able to sleep with my boyfriend, that I started feeling dysphoria at 12 instead of 2, and that I backed out of exploring transition five years ago, that I'm already being doubted... she gave examples of things 'girls' were interested in when she was growing up, which was horses and boys, and I was like... I'm still into those things but I guess I can't say that or I'm a girl... *coughjockeysarestillpredominantlymalecough* And I said I had DD cup breasts before I lost some weight, and when I said I found them a struggle, she said that's the size she is, as if it shouldn't be an issue for me because it isn't for her...

I'm also worried about the fact that it's an intermediary step, and so it's really to check that I have no mental illnesses that could cause my dysphoria or conflict with treatment, I can't tell her about my depression/self harm history (actually already lied about that one because she asked it at the end of the session as part of like a check list and I didn't want to make the session longer because it had already overran... ) but at the same time if I don't I won't be considered in enough distress to need treatment. And now I've already lied I'm scared to tell the truth in case it seems like she can't believe anything I say. :/

[stephaniec]

I wish I could help. I've been through one heck of a lot of therapy in my life. All the therapist I've had were good except for one moron .I've told them everything I was possibly conscious of because I was hurt deep inside and knew it and I couldn't take life anymore so I spilt the entire bucket. Everything came out except probably the root cause of everything I was dealing with and that was my being trans. I was too afraid to tell any  one. I've had a hell of a lot of other issues to clear up , but that was probably numeral uno and I wasn't giving that up to no one. It took me 40 years and endless misery to spill the beans.

[AnonyMs]

I favor Grace's idea of having 2 therapists.

I needed to talk to a psych about my issues, and I was caught between being honest and getting the help I needed, and the possibility of getting  of SRS in the future. I wasn't after SRS, but it occurred to me that being honest might affect my chances if I ever wanted it; I was in a bit of a panic for a few days.

I eventually realized there's other ways of getting SRS signed off, and I can work around the psych no matter what he thinks. In the spirit of being totally honest I told him so. It all worked out well fortunately, but I'm definitely all for having backup plans, for peace of mind of nothing else.

Perhaps you could try one of those Internet based therapists you talk to via Skype? I expect they have plenty of experience.

I assume you don't have the money for travel and surgery? You could probably work around it easily if you did.

[Valwen]

Early on in my therapy I was afraid of gatekeeping like this myself, I was super careful what I said because I know I don't 100% fit the perfect transsexual model. I dont hate my genitals enough to attack them with a knife just because, I am attracted to women not men I like things that are considered non feminine like sci fi, fantasy and video games. these things scared the heck out of me, I dont think I mentioned my sexuality at all for the first half dozen sessions, luckly I soon learned that my therapist is actually there to help me, he may not be a expert on MtF trans issues but he trusts me to know how I feel, rather than questioning every aspect of my life, it was not till he was writing my letter for hormones that he even asked about my early life and similar issues, to him my over all mental health was what was important.

This is the big issue with the old model full of gatekeeping it dose not really work, all it dose is stop someone who has legitmate issues that they could be working on from telling the truth and getting real help, instead everything is filtered helping no one. By constantly questioning ever decision a trans person makes it just reinforces that there is something wrong with us that we cant be trusted to make a decision about our own lives, that we are somehow incapable of knowing how we feel. It criminalizes the transgender experiance and in general makes transision more dangerous, first because of holding things back but also because when backed into a corner many people choose to dodge the legal method and take dangerous unregulated drugs or choose to leave a stable home and move to somewhere else where they have no job, no friends, and no family just for a chance to get it done.

Gatekeeping alone likely indirectly leads many trans people to drugs and sex work either alone with no legal emplyment or forced to cope with our condition without help or even the hope of help that often leads to addiction.

in short I am not allowed to use strong enough language to describe how I feel about gatekeeping therapists and doctors.

Serena

[captains]

Thank you, everyone. There's a lot of wisdom in this thread, and I can't describe just how much I appreciate everyone listening and sharing and giving advice. I'll admit, I was feeling a little bit stuck between a rock and a hard place. I'm not exactly sure what I'll end up doing, but right now I'm leaning towards Max's suggestion of online therapy. My current gender therapy is actually free, which is why I was so strongly in favour of sticking with her for everything (brokeass student life!). I never really intended to get... actual therapy out of it, haha, so we'll see how things go.

Unfortunately, self-advocacy has never been my strong suit, and I have a very hard time disassociating my needs from "whatever makes the people around me the most comfortable." Usually, my desires start and stop at making other people happy, but as you all know, transition isn't exactly the top of your average cis person's list. When I encounter resistance, my first reaction is to go, "Okay, you know what, it's fine, it's fine. I don't even want it that bad. I never really wanted it. This is totally fine.  "

I have encountered a lot of resistance over the last 5 years. My capacity for self-delusion is wearing thin, haha. But still, I worry that my ease of capitulation will read as "not trans" rather than "wimp." We shall seeeeeee.

Thanks again, all!

[Kylo]

I have the exact same concern - even though my therapist is one trained specifically for dealing with trans people. I'm still concerned I won't use the correct terms and language to appropriately describe my situation and come off as someone who doesn't know what the hell they want. So I've edited down the fact that I'm not particularly interested in playing "roles" or adhering to stereotypes, that yeah, I am patient and not on the verge of suicide or something because frankly I've dealt with this my whole life and I'm not exactly holding my breath for a great deal of hope it's all going to be resolved. I am still skeptical they'll even approve me, but perhaps that's just because I know nothing about going through a medical system as a trans person.

If you want to be honest and talk about all this stuff, can you do it with a different therapist or doctor than the one that will sign you on for treatment? You could get more opinions that way without jeopardizing your treatment.

When I walked into the GP for the first time to talk about being transsexual I think I screwed up. She was like "so are you sure you would like to be a man?" and my response was "No. I AM a man. I would like to have my body corrected." So right off the bat I was probably not going with the flow and impressing my ideas about what trans is over theirs, and I suppose med professionals are always going to go with theirs. You do have to fit their narrative I guess.

[Elis]

When I walked into the GP for the first time to talk about being transsexual I think I screwed up. She was like "so are you sure you would like to be a man?" and my response was "No. I AM a man. I would like to have my body corrected." So right off the bat I was probably not going with the flow and impressing my ideas about what trans is over theirs, and I suppose med professionals are always going to go with theirs. You do have to fit their narrative I guess.

When I saw my GP for the first time she said 'so you want to be male'. I was so annoyed that a GP would say that. I admire you for sticking to your guns and correcting her, I wish I did

[AnonyMs]

When I walked into the GP for the first time to talk about being transsexual I think I screwed up. She was like "so are you sure you would like to be a man?" and my response was "No. I AM a man. I would like to have my body corrected." So right off the bat I was probably not going with the flow and impressing my ideas about what trans is over theirs, and I suppose med professionals are always going to go with theirs. You do have to fit their narrative I guess.

I think you did the right thing, just make sure you have backup plan if it goes badly.

The first thing I said when I met my psych, was I'm here about transgender issues, tell me what you know. I was trying to find out what he knew about it before he had a chance to work me out, so that I could get a truthful picture of him. It kind of went up and down for a bit, but worked out really well.

I still haven't told my actual doctor, and not going to. Doesn't need to know. My endo, I just wanted HRT and no issues fortunately.

I prefer mutual respect and I don't believe in putting up with crap from doctors; I'm paying, they work for me. But I always have backup plans. They can refuse to deal with me if they want.

[Tysilio]

This stinks to high heaven, Cap'n!

It's just that the definitions of transness are so strict (persistent unwavering dysphoria since early childhood, evidence that said dysphoria is purely organic, evidence one had exhausted every alternate option, evidence that not transitioning would be life threatening, binary identity...) that it's a little overwhelming, haha.

If this is what she believes, she is so out of touch with current practice that I'd say she's potentially dangerous -- you seem pretty well grounded, but heaven help someone who saw her and was too vulnerable to see her gatekeeping for what it is, or lacked the knowledge to see it.

It would be great if you could challenge her on this. One way to do that might be to back up expressing your discomfort with her expectations by printing out the relevant section of the current WPATH Standards of Care and asking her to read it.

If she's not willing to educate herself about the current best practices, then she's dealing from prejudice, not expertise in her field, and you may want to find someone else. You'd be way better off with someone who's not an official "gender therapist" but is willing to learn. Any qualified therapist can write those letters we all need.