Quote from: Berliegh on November 25, 2007, 03:47:22 AM
Here's my question again, What do they do at therapy? what happens? and what is achieved?
I am in the US. I have seen 3 therapists on the way to getting my surgery letters and all of them were helpful.
For all therapists the first couple of sessions are spent getting to know each other and your styles of talking, telling your history and why you are there. They always ask about alcohol/drug usage, home life and situation, social life, and work situation.
My first was a psychologist with no gender identity experience. I wasn't having any luck finding one that would be able to provide me with HRT/surgery letters but I still wanted to work on the anxiety and depression that were holding up my transition and hopefully find a referral to someone who would have the training/experience to write HRT/surgery letters. At the first session he asked me why I was there, what I wanted to achieve, and how he and I would know when we were done. I wanted to get control of my anxieties and fears that triggered depression and were blocking my transition. I was too depressed to have any social life at all and too afraid of people to try presenting in public as female. He explained his style as CBT (cognitive behavioral therapy) and EMDR (eye movement desensitization and reprocessing). CBT focuses on modifying your behavioral responses. At each session we started by me bringing up any new or past events or issues in my life or whatever I wanted to talk about. He might question me further about those things and offer ideas or exercises toward improving my handling of events and my emotions. That would lead to the second part of the session where he would take something I had talked about such as some depressive trigger and have me to focus exclusively on that. He asked me to follow his hand with my eyes as he moved it from left to right. I was to try to relive the moment in my mind and to re-experience the thoughts and feelings I had at the time. After a minute or so he would stop and I would describe what I experienced and any other thoughts that it triggered. We would talk about that a bit then he would pick another event and repeat it for that. For the last one of the day he would ask me for a positive event or time when I felt especially good and do the eye movement thing for that so that I always left feeling good. We did progress to the point where I was presenting as female at our sessions and beginning to go out socially. At that time his office was able to get me a referral to someone who had GID training and experience.
My second therapist was a Masters degree social worker/therapist with gender identity experience qualified to provide letters for HRT and surgery. He provided a letter for hormone therapy after 3 months and the first letter for surgery after 1 year RLT. We started out with weekly sessions, then monthly during most of my RLT, and every two weeks toward the end of RLT and approaching surgery. Each session is begun by me talking about what is new in my life since the prior session. I talk about my progress in transition or what is happening at home, work and social life. I might talk about my attempts to improve my appearance and presentation. I describe how people are relating to me and reacting to my transition and how I would handle that. The therapist gives me ideas about how to improve if needed. I sometimes bring pictures of myself with friends in social activities. I always volunteered (without waiting to be asked) as much information and evidence as I could to show that my transition was working and making my life better. We sometimes talk about the political/legal issues relating to transsexuals or how we are treated in the medical/mental health professions. We occasionally trade information on resources for transition. The sessions are always enjoyable. I get insights to myself and suggestions on further improving my life and relationships with other people. He sometimes gives me assignments to do which we would talk about later such as:
Asking me to think about some particular idea to talk about later (for example asking me how much if any I would feel connected to my previous experiences as a male after completing transition.)
Had me make a collage using magazine/newspaper clippings on the theme of "who am I".
Suggest I write about some events immediately after they occur while they are fresh in my mind to make it easier to talk about later.
Make a list of recent things that trigger anxiety or depression.
Make a list of recent positive things or happy events in my life.
Give me some suggested reading.
Ask me to do something I was afraid of.
As the time for getting my surgery letter came near we talked about surgeons, the surgery, risks, recovery, aftercare, and how I was to finance it. We traded information and I made sure the therapist could tell that I had thoroughly researched surgery and had a realistic view of what it would do for me and what my life would be like afterward.
My third therapist was a PhD psychologist with GID experience that I went to in order to obtain a 2nd surgery letter. I asked for and signed a form with my primary therapist to allow him to share any and all information regarding my therapy with the secondary therapist in order to minimize my time needed with the 2nd and to make it clear my stories were honest and that I welcomed them to compare notes. This therapist did not really provide me with therapy since I was just getting my 2nd letter. He just needed to evaluate whether surgery was appropriate for me so he asked quite a few questions. After the first couple of sessions he told me that so far he saw nothing that would prevent him from writing the letter for surgery and he would likely be able to do that. Like the other therapists each session began with me just talking about what was new or whatever I wanted to bring up. I would talk about most of the same things I was covering with my primary therapist and would usually try to talk about some things that directly related to readiness for surgery. One difference in style with this one was that after the initial sessions if I ran out of things to say it could get very quiet with him waiting for me to bring up something else which could make me very nervous. The other therapists would always prompt me with some idea or question when that happened. All three therapists asked me at some point my opinion about treatment protocols and causes of GID. We sometimes talked about the controversial theories or efforts to stop GRS surgeries completely (Blanchard, Lawrence, Bailey, Paul McHugh, the Russell Reid lawsuits) and what I thought about those. I continued seeing him for several months and had my primary therapist sent him a copy of the first letter after which he provided the second.
If someone has already lived as their target gender for many years it should not take too long to get letters if you can provide evidence of that (name change records, employment records, proof of HRT, consistent story etc.) Even if you do not need therapy, most therapists are still going to want to see you long enough to be able to say they can see that you are consistent and persistent in your goals and presentation and have a clear understanding about surgery.
