6 appointments with gender therapist- gate keeping?

[christinemiller75]

I have attended 6 sessions with a therapist who specializes in gender issues. I meet the diagnostic criteria of gender dysphoria, I have no underlying mental health issues, I have a strong support system, and I am economically secure.

We have been "stuck" on the social psych evaluation for 5 weeks! Now, there is a gender social psych evaluation?

Is gate keeping occurring? Should I be more aggressive and request an official diagnosis, or should I continue to follow the lead of the therapist and simply let the process occur?

[Devlyn]

It's tough to know if someone needs, or has had enough therapy. I got none, my PCP asked me to explain how I came to be sitting in her office asking for female hormones. I told her the truth of my travels and landing on a genderfluid identity with a female presentation. She was satisfied, and a week later after a blood test I started HRT.

Depending on where you are, you might be able to use an informed consent protocol. https://www.susans.org/wiki/Informed_consent

Hugs, Devlyn

[Emileeeee]

From my own experience, the therapist will just keep leading you until you come out with it and say what you know is true and what your plan for the future is. If you do that and they're still dragging their heels, then I would consider a change.

Keep in mind, their name has to be on that letter, so their own reputation is also at stake. If you leave them with any doubt, they're going to be reluctant to provide it.

[staciM]

After my first couple appointments I felt the same way.  The therapist seemed to be putting up road blocks to what I wanted.  He wanted me to attend support group meetings, he wanted me to present in public to get a feel for reactions and how I handled them, and he just wanted to give me time to see if this was a phase....because I had been able to manage my GD reasonably well for many years.  However, after "check marking" all his "recommendations" I think they made some sense in the process and I believe they were all healthy and helpful.  As a result I've made some wonderful friends at group therapy, presenting has become more comfortable and time has helped me come to a firm realization of what my future needs are.   To be honest, after this experience, I'm quite concerned about the informed consent route because although the therapist approach didn't change my mind, it certainly helped in many areas that I didn't consider.  I'm jealous of those of you that walk into a Dr and walk out with a HRT prescription, but I can also see how dangerous that is...only my opinion. 

Also, as someone else mentioned, the psychologist is putting their name on the referral so it's important that they are comfortable with your mind set, expectations and support structure.

[FTMax]

If you feel like that, I think it is worth mentioning to your therapist. Any professional should be willing to explain to you why they are doing what they're doing.

And if you don't like it, you can fire them and find someone new. But keep in mind that you'd be starting all over from scratch. I fired my first therapist, but based on the rate of speed I was going with her, I was confident that someone new who understood what sort of timeline I was looking for would be able to catch up and quickly surpass where we were at. I was right.

[Devlyn]

After my first couple appointments I felt the same way.  The therapist seemed to be putting up road blocks to what I wanted.  He wanted me to attend support group meetings, he wanted me to present in public to get a feel for reactions and how I handled them, and he just wanted to give me time to see if this was a phase....because I had been able to manage my GD reasonably well for many years.  However, after "check marking" all his "recommendations" I think they made some sense in the process and I believe they were all healthy and helpful.  As a result I've made some wonderful friends at group therapy, presenting has become more comfortable and time has helped me come to a firm realization of what my future needs are.   To be honest, after this experience, I'm quite concerned about the informed consent route because although the therapist approach didn't change my mind, it certainly helped in many areas that I didn't consider.  I'm jealous of those of you that walk into a Dr and walk out with a HRT prescription, but I can also see how dangerous that is...only my opinion. 

Also, as someone else mentioned, the psychologist is putting their name on the referral so it's important that they are comfortable with your mind set, expectations and support structure.

I think you have to know who you are, but I don't believe a therapist is always necessary to get you to that point. I already present as a woman full-time, and that's what my doctor saw. Perhaps the outcome would be different for someone who is unsure of themselves?

Informed consent isn't hormones on demand. The doctor has the responsibility of determining if you're healthy enough and ready for treatment.

Hugs, Devlyn

[SadieBlake]

OP, it's not clear what you're seeking diagnosis for at this point? For HRT all I had to do was tell my PCP I'm trans and wanted to begin transition.

For my GCS referral letters, I worked with my psychiatrist who I also see for dealing with depression. I have never felt any step was gatekeeping per se, and if it's taken time to get a diagnosis and a letter, that's been because she's not an expert in gender issues and also she's a working mother who's only in a part time practice.

My second letter came from the gender therapist we found for my pshrink consult with (so we were killing two birds with one stone there) and she saw me for only 3 visits to determine that she concurred I need GCS and write a letter. She had never before written a letter in a purely evaluative role.

Of the two experiences, the second certainly felt more like gatekeeping but I'd hardly fault her for not attempting to develop a therapeutic relationship in that context.

As a result I've made some wonderful friends at group therapy, presenting has become more comfortable and time has helped me come to a firm realization of what my future needs are.   To be honest, after this experience, I'm quite concerned about the informed consent route because although the therapist approach didn't change my mind, it certainly helped in many areas that I didn't consider.  I'm jealous of those of you that walk into a Dr and walk out with a HRT prescription, but I can also see how dangerous that is...only my opinion. 

Also, as someone else mentioned, the psychologist is putting their name on the referral so it's important that they are comfortable with your mind set, expectations and support structure.

This is close to my experience and feelings. It's fair to say my pshrink is akin to a very close friend, albeit with appropriate boundaries. I know without a doubt that she genuinely cares for me and I fully believe she brings the same level of commitment to her other patients.

[LizK]

I have attended 6 sessions with a therapist who specializes in gender issues. I meet the diagnostic criteria of gender dysphoria, I have no underlying mental health issues, I have a strong support system, and I am economically secure.

We have been "stuck" on the social psych evaluation for 5 weeks! Now, there is a gender social psych evaluation?

Is gate keeping occurring? Should I be more aggressive and request an official diagnosis, or should I continue to follow the lead of the therapist and simply let the process occur?

Hi Christinemiller

Welcome and I hope you enjoy your time here at Susan's.

I was totally up front with mine and told him on the first visit that I had Psychological support, money, family support, and that I wanted HRT and had needed him to write a reffereal , so could he please write me the letter I needed. That was in the first session. The second session he wanted to have a "chat" and I asked him again about the letter and he was already writing it. I still see him every 4 months and he claims to want to see me in case I need help with anything. I won't be going for much longer though...

I would be asking him for whatever referral or letter you require to move on. There is no good reason to be having therapy for the sake of it.

Regards

Liz


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[kelly_aus]

Hi Christinemiller

Welcome and I hope you enjoy your time here at Susan's.

I was totally up front with mine and told him on the first visit that I had Psychological support, money, family support, and that I wanted HRT and had needed him to write a reffereal , so could he please write me the letter I needed. That was in the first session. The second session he wanted to have a "chat" and I asked him again about the letter and he was already writing it. I still see him every 4 months and he claims to want to see me in case I need help with anything. I won't be going for much longer though...

I would be asking him for whatever referral or letter you require to move on. There is no good reason to be having therapy for the sake of it.

Regards

Liz

Be thankful you went through the new system, I had to wait 3 months for my letter - and many visits. In the end though, Rob told me to go away and not come back until I had issues..

[Drexy/Drex]

Hi I can relate  to how you  may feel I felt the same. way after 3 sessions  every  session  my masculinity  was hammered  home and the last straw was the suggestion that I forgo Hrt  and all the crap that goes  with it and  and cross dress to satisfy  my female  side..... That was because  I had indicated  I was non binary no doubt
I guess  she thought  she was doing  me a favour anyway  ended up with me getting  very depressed and dysphoric
when I realised  with dismay that she is right.... I think my doc will put me  on Hrt  once I have made the lifestyle  changes to her satisfaction  anyway as for therapy  I enjoyed  most of it I don't mind talking  and having learnt  so much from this site I got straight  into it the first session  ...which surprised  her 😂

[LizK]

Be thankful you went through the new system, I had to wait 3 months for my letter - and many visits. In the end though, Rob told me to go away and not come back until I had issues..

I had a Psychiatrists report from one that had seen me as part of a multidisciplinary team  looking after me for other stuff. He was the first to diagnose me, it was just after this that I got a Psychologist. By the time I waited 7 months to get an appointment with Dr Jennings I already had 7 months in therapy and an independent Psychiatrist saying I had GD. I see Dr Jennings about once every 4 months now....not really sure why other than he feels he can help me navigate name change etc...nice enough bloke.

I was lucky but would also say to anyone on a long waiting list...don't waste time see a therapist it is going to help with the psychiatrist. Speed things at the other end

Liz

[christinemiller75]

Thank you everyone for your replies. Here is some additional background information. I have a background in psychology; I will begin working on my master's degree soon. I am confident that I meet the diagnostic criteria for gender dysphoria. Additionally, I am somewhat uncomfortable with the dyadic relationship with the therapist. I am not completely comfortable such a relationship, where on party has, or may hold the perception, they have more control in the relationship than the other party. This relates to a third party ultimately having the authority to determine what another party should do with their body. Therefore, I am more than likely pursuing an informed consent model; such an approach is protected by law in my state.
However, I did reach out to the therapist, and I may continue the sessions, but with the understanding that they will not have control to make the decision; self-determination is something I hold in high esteem. Going forward, this approach allows me to be on equal footing, and now the dyadic communication is equally beneficial to both (I have a professional to consult with, and they have a paying client), and the social relationship is more likely to be maintained because no power struggle exists. In addition, under such circumstances I can be completely honest, and the fear that I may something wrong is removed. I also will no longer be concerned over a misdiagnosis, because I am only there for support, and not validation. I already know who I am; the need to be reassured by a third party is not necessary. However, if a concern arises, or a situation happens, I will have a professional to consult with.

[Drexy/Drex]

Thank you everyone for your replies. Here is some additional background information. I have a background in psychology; I will begin working on my master's degree soon. I am confident that I meet the diagnostic criteria for gender dysphoria. Additionally, I am somewhat uncomfortable with the dyadic relationship with the therapist. I am not completely comfortable such a relationship, where on party has, or may hold the perception, they have more control in the relationship than the other party. This relates to a third party ultimately having the authority to determine what another party should do with their body. Therefore, I am more than likely pursuing an informed consent model; such an approach is protected by law in my state.
However, I did reach out to the therapist, and I may continue the sessions, but with the understanding that they will not have control to make the decision; self-determination is something I hold in high esteem. Going forward, this approach allows me to be on equal footing, and now the dyadic communication is equally beneficial to both (I have a professional to consult with, and they have a paying client), and the social relationship is more likely to be maintained because no power struggle exists. In addition, under such circumstances I can be completely honest, and the fear that I may something wrong is removed. I also will no longer be concerned over a misdiagnosis, because I am only there for support, and not validation. I already know who I am; the need to be reassured by a third party is not necessary. However, if a concern arises, or a situation happens, I will have a professional to consult with.

I like  your attitude  I will incorporate  those ideals if I go back to my therapist

[AlyssaJ]

Well all I can speak from is my own experience.  I had 10 sessions with my Therapist before she was ready to recommend a doctor and provide the letter.  That said, in her words she was waiting for me to be ready. I didn't push for HRT but I also had a lot of work to do in accepting myself for who I am.  She was very upfront with me about what she was seeing in me and even at one point around visit 7 or 8 told me she wasn't ready to write me a letter just yet.  Perhaps there's something more your therapist is waiting to see from you in terms of your readiness to transition socially. 

[Drexy/Drex]

Hmm I'm  finding it hard to go back as I get somewhat  annoyed  being subject to the opinions  of whether I'm suitable or not,  but then they have my paperwork  so they can just kickback and wait
Not good business  practice  and shows a lack of care factor at 210 $ an hour I would  have thought  I would have had a message from them asking if I wanted to make another appointment  or even to ask of I'm OK.... hell even my Chiropracter sends a reminder not that it worries me,  still like  I said these people have my mental health  paperwork  which enables. me.to use the service at a. significant  discount. so it will require  me. to see my doc and  ask her to make a new mental health plan but I may be stuck with them I'll  have to see... I. wouldn't  even bother but if I want to change my gender marker etc.... I will have to go through  the official channels

In regards  to your therapist  waiting  for you to come to terms with your self... I can see from your avatar  you are femme  looking so I sort of understandwhat she meant  but with mine I'm nowhere anywhere feminine  so maybe I'd  have to wait until my therapist  comes to terms with how I look... More her problem  than mine I think maybe if had turned up in lippy and a summer  dress I would have been better off.... but when has cross dressing  been a prerequisite  to change your body for me female clothing  comes after the fact in other words I don't want to be female just to wear female clothing
Sorry rambling  on