Therapy during transition?

[shanetastic]

Okay so here's my one random topic for the day.

I know everyone tends to go to therapy in order to approved for HRT, but my next question is, what did you do after you were approved for HRT?  I've just been thinking a lot lately, and it's like, I don't THINK I need a therapist, yet I sorta keep going to mine.  I understand that later on you'll need letters for srs and all that stuff, but I mean like, for the time being. . . is there a reason?

I don't think I have any reason to go to therapy, like I'm not depressed, or have any real problems I need to talk to someone about.  I mean sure I have fears, but it's not like I really need a therapist for that; at least I don't think.  I have a lot of good friends I can talk with this stuff about, so I just feel sorta like lost during therapy.

I don't really see a reason in driving all the way to go see a therapist to just go like.  . . talk to him about some random stuff that I don't really think has any relevance, or that I can't work on on my own.  So really, what I'm just wondering is, for everyone out there, did you have any reason to attend therapy during transition?

To me, it sorta just seems like wasted money right now, but who knows.  I do have a specialized gender therapist and all that stuff now, but it's like I don't see how he is helping with anything when there really is no major problems that are going on or need to be discussed.  I just don't see how talking to someone can make that big of a difference for me.  I can talk to friends or family or whoever if I have any problems.  Sure, they might not understand, but they can at least lend an ear for a little while.  I don't really think therapists feedback are really any good anyways, but maybe that's because I don't really like therapy in the first place anyways. 

[SusanK]

A good therapist helps you through your transistion, not just for the letter for hrt. They can provide the discussion to address the issues, questions, changes (physical and mental) and fears about it, along with the actual stuff of life (life coach) fitting your transistion into your life. In addition some physicians follow the SOC and will strongly recommend if not require on-going therapy or they'll discontinue the hrt prescription. They want to know you're getting both sides of the treatment. And there is the issue that one day you'll need two letters from a therapist and professional psychologist/psychiatrist for srs. And while you may think you'll be ready, they'll want some time and sessions to make that determination.

Just my view and thers have their view and experience which will also help.

--Susan--

[Schala]

A good therapist helps you through your transistion, not just for the letter for hrt. They can provide the discussion to address the issues, questions, changes (physical and mental) and fears about it, along with the actual stuff of life (life coach) fitting your transistion into your life. In addition some physicians follow the SOC and will strongly recommend if not require on-going therapy or they'll discontinue the hrt prescription. They want to know you're getting both sides of the treatment. And there is the issue that one day you'll need two letters from a therapist and professional psychologist/psychiatrist for srs. And while you may think you'll be ready, they'll want some time and sessions to make that determination.

Just my view and thers have their view and experience which will also help.

--Susan--

If said visits were covered, and therapists really were that good in real life (more often anyway), then yeah I'd agree with most of what you said...otherwisely, I'd agree with shanetastic, waste of money and time. I'd get my letters and be done with it.

As for physicians requiring a follow-up, they better have a good reason to require it, besides transition, like something a therapist can work on outside of it. If they require it of all 'just for kicks' I disagree with that policy.

Do parents HAVE to take courses paying 100$ and more an hour every week or month just do they can conceive a child? I don't think so. And it certainly is life-changing.

[Ell]

some therapists are really good in real life. my therapist has helped me so much, i couldn't begin to tell you. but, i do have a lot of issues, stemming, perhaps, from a very unusual childhood.

it is expensive. if i weren't making any progress, it certainly would be a waste of time and money. but i do feel much better.

-ellie

ps.
if you're gender is male, i'd recommend a male therapist. if your gender is female, i'd recommend a female therapist.
-L

[shanetastic]

ps.
if you're gender is male, i'd recommend a male therapist. if your gender is female, i'd recommend a female therapist.
-L

Only gender therapist around my area, so I'm stuck with the male one   Although I'm just contemplating whether to keep going to him or not.  I don't really know what I should be working toward with him. . . I mean I'm taking this at my own pace and doing it how I want to.  So it's like what's the purpose of a therapist if I don't have a lot of those issues you know?

[tekla]

If you think you need therapy, then you do.

[Ell]

If you think you need therapy, then you do.

i can't parse the logic on that one. but i will say, it seems to me that a lot of folks who think they don't need it, really do.

-ellie

[natalie]

i'd say just see your therapist every few weeks or months then.

keep in touch with them, since the therapist still has to approve the SRS and
if you fall off the face of the earth, the therapist might be a bit reluctant to approve you.

for me, i got enough going on in my life that i see my therapist weekly. But i see a time soon in the future where that might be every other week, then monthly...

[shanetastic]

If you think you need therapy, then you do.

i can't parse the logic on that one. but i will say, it seems to me that a lot of folks who think they don't need it, really do.

-ellie

Who knows, maybe I can be one of those people

Posted on: January 29, 2008, 07:53:17 PM

i'd say just see your therapist every few weeks or months then.

keep in touch with them, since the therapist still has to approve the SRS and
if you fall off the face of the earth, the therapist might be a bit reluctant to approve you.

for me, i got enough going on in my life that i see my therapist weekly. But i see a time soon in the future where that might be every other week, then monthly...

Hey natalie,

I was thinking of doing that probably, just maybe like once a month or something just to keep in contact.  I've had three therapists now so I go through them pretty easily

[SusanK]

As for physicians requiring a follow-up, they better have a good reason to require it, besides transition, like something a therapist can work on outside of it. If they require it of all 'just for kicks' I disagree with that policy.

Physicians are concerned with your physical health and fitness, and not necessarily your mental or emotional health. They can and will defer that to those professionals. And some will, under the SOC, require some type of routine therapy by the therapist who wrote the letters, so they understand their prescription is both the best for you physically and mentally. They don't have to require monthly or so vists, but sufficient they feel comfortable and satisfied you're getting full care during your transistion.

I'm not arguing they don't trust you. They simply can't cover all the bases with you, and they are the ones writing the prescriptions based on a therapist's recommendation. Granted we are the ones deciding our own life, but it doesn't hurt to have the bases covered to help you. What's wrong with that?

--Susan--

[shanetastic]

My doctor really doesn't care if I'm in therapy or not.  She sees me as a stable person and I've gone through all the hoops to get here so far.

[tinkerbell]

Well, every situation is different.  Yes, initially I went to therapy for the same reasons everyone goes to them, to get HRT, the letters, etc.  But eventually I developed this friendship with her.  We are very close friends and usually converse about many things, not just about things regarding my transsexual history. 

Even now, one year after my SRS, I still visit her every now and then.  It relaxes me to talk to her, to hear her voice, to share a few laughs.  She is a wonderful lady, and I feel very fortunate to have met her.  Besides I suffer from other things not related to transsexuality so seeing her once in a while is part of my treatment.

tink

[Steph]

I went to a gender therapist both before, during and after transition.  It didn't hurt a bit, ya we all like to think that we know what's best but sometimes we can't see the forest for the trees.  Personally, when done right, I believe that therapy is an essential part of transition it's not meant to be used solely to get letters and approval for HRT, it's there for a reason, to make sure that some poor smuck doesn't get their bits removed then live to regret it.  While giving birth and SRS are both life changing, mistakes with giving birth can be corrected.  Once SRS is done, it's done enjoy the remainder of your life cause that's what you have left.

I scoffed at therapy myself - "Who are these gatekeepers. who do they think they are knowing me better than me".  Butcha know, therapy when it's done right is well worth it.

Steph

[shanetastic]

It's not really that I think I know everything it's really just that I don't "think" were going anywhere.  Like, there's nothing to really work on in therapy, and I just seem to be going there.  Although, I've never really thought I've gotten much out of therapy, so maybe it's just myself.  Either way though, it's just sorta hard to keep the willpower up to go to therapy that once every week or two when I have so much other stuff to do most of the time.  Trying to finish my last couple of classes and I work, so at times I just feel overwhelmed.  Either way though, I'll take a deeper look into to see if it's actually doing anything before I just say I don't want to go anymore.  I just feel worn out of therapy really to say the least.   

[Schala]

Well, every situation is different.  Yes, initially I went to therapy for the same reasons everyone goes to them, to get HRT, the letters, etc.  But eventually I developed this friendship with her.  We are very close friends and usually converse about many things, not just about things regarding my transsexual history. 

Even now, one year after my SRS, I still visit her every now and then.  It relaxes me to talk to her, to hear her voice, to share a few laughs.  She is a wonderful lady, and I feel very fortunate to have met her.  Besides I suffer from other things not related to transsexuality so seeing her once in a while is part of my treatment.

tink

The issue for me is, my psychiatrist, while a bit more progressive than some in regards to it, is also kinda backwards, but I think that's more personal than professional.

I have a social worker, who also works at that place, in the same team. And I look forward to seeing her, I feel I can trust her.

On the other hand, my psychiatrist is pushing me to be stubborn. Maybe she is asking questions I don't know the answers to, or making demands I can't satisfy to her liking, but the main issue is her attitude, for me. I'm sure Rachael would have a field day with her, or wouldn't stay with her more than one session, considering all I read from her about not being trans anything.

While I believe in fighting all oppressions and helping the weak and less fortunate and such, my identity is a personal thing, and I do identify as a girl (I'm still too young to think of myself as a woman, I'm only 25 emotionally I'm younger). My psychiatrist seems to have trouble grasping that, she suggested me to watch some movie "Priscilla, Queen of the Desert".

I frankly have only heard the title before and it didn't interest me. She gave me a synopsis of it and said I should watch it and would learn a lot from it. She also went on about how transgender (as umbrella, not only transsexual - she did not specify but she did see transsexuals before, where she used to work) are easily recognizeable, mannerism, some 'male traits' (she didn't mention FtMs), feminine exagerration.

She claimed she could tell about me (when of course, its listed on my file...). She almost went out of her way to say I was delusional to think I was 100% passable and said I should "accept myself as transsexual" and that I'll "never be a real woman". Yeah, I bet you can see the conflict there.

I'm not miss confidence, I'm actually very self-conscious about my appearance, and have had no issue at all with passing since well over 15 months ago, that is not a stare, not a question, no query if I use the women's room or buy and try clothes in a women's store and changing room. Not even an odd look, nothing. The only odd looks I get is when I have to use my ID and then have to out myself because of name mismatch or something like that, which rarely happens anyways (since I don't work).

The only ones who know also have my birthdate, medical history and more information, so yeah they're not guessing, or reading me, they're trying to make themselves "see through my female disguise so they can prove themselves right that I am really male in some way". This is a known effect in psychology, bias.

If I was Jew, then some people would suddenly try to find sense in my love for numbers. "Ha she's Jew, it's in her blood." Not only is it a bad joke, it illustrates that the mind doesn't want to be fooled. This is also why parents deny all feminity in feminine boys and MtFs or vice-versa, for a long time. They want to believe their son or daughter is the image they have of it, reality be damned.

The same goes for bias. Such a therapist who takes it for granted that I'm really 'a male trying to look like a female' (which is basically what she's saying, even if I was post-op) will find hints, clues, and traits, that would be normally overlooked by over 95% of people. How often do you go around checking for clues of transness in people when walking around? Sometimes it's not so obvious. And the rate of failure and false-positive, when trying to go that way on everyone, is so high as to be ridiculous.

For example, if all women who had long chins were declared to be transsexuals, or maybe all women with A cups, or maybe...you get my point. You try to prove that something is there, even if that 'something' is mostly in your mind. For me to think someone *might* be trans, I need to see a LOT of cues, and even then I don't out people.

To classify all traits as male and female (physical, mannerism etc) will result in near 100% of people not fitting either, because no one has all criterias to perfect female, or perfect male. They don't exist. Even going by average and standard deviations, there will be a lot of false-positives. There's a lot more 6 feet tall women than there are who transitioned, even if it's not common.

I know there is a lot of women who have some (though not much) facial hair, and I could go on...my point is, my therapist will never see me as a real girl, even if I was the picture of a female Hollywood actress, and that conflict of ideas sort of makes me untrustful towards her. She seems to address me with my chosen name and right pronouns as a way to humor me and show professionalism, rather than natural. At least she does...I've seen worse.

Sorry for the long post, I felt a bit ranty, and it explains psychological problems with seeing a therapist who is prejudiced.

[deviousxen]

I don't blame you. I think its rude someone would do that after you payed them for that purpose in the first place.

As for me, my therapists cool, but not all-knowing about gender issues, and the search for a specialist, continues.

I just hate WAITING. No idea you were 25 Schala. The profile pict threw me off. It kinda goes with your point of not being 100 percent of something, and therefore people don't see every tiny flaw.

[Schala]

I don't blame you. I think its rude someone would do that after you payed them for that purpose in the first place.

As for me, my therapists cool, but not all-knowing about gender issues, and the search for a specialist, continues.

I just hate WAITING. No idea you were 25 Schala. The profile pict threw me off. It kinda goes with your point of not being 100 percent of something, and therefore people don't see every tiny flaw.

Well I do look younger than 25, I've been judged to be as young as 14, and as old as 20 or 21. I still get carded (legal age is 18). I go for a youthful look, and it fits my physique more too, adult clothes don't fit all that good, and many I plain don't like (like high heels, pencil skirts, tight/revealing dresses).

and I didn't pay her, but since its the public system, waiting lists are long - nothing like NHS but still long - like 6+ months, I had 12 months wait to see her...

[cindybc]

During all 8 years of my transitioning I continued to see the same shrink I did before I started transitioning. He was not a transgender shrink, so I believe that when I left him I probably left him more well educated about transsexuals then he did ever before he knew me.

Originally I was seeing him for my bipolar disorder once per month, I saw him more often for the bipolar then I actually saw him for the trans problem. Well, actually the trans problem wasn't really much of a problem. But I must say that I was quite happy to receive his report that he had been accumulating which was also the documents I needed, or should  say one of the letters as some call it. The other letter I obtained from Clark Institute.

I am not certain but I believe if you don't have a shrink or therapist to verify your visits which are also required to show how long you have been doing real life experience full time. And I am not certain, but one could be cut off the HRT if you are not attending a therapist

Cindy

[SusanK]

It's not really that I think I know everything it's really just that I don't "think" were going anywhere.  Like, there's nothing to really work on in therapy, and I just seem to be going there. 

Ok, there is nothing left to discuss about your decision to transistion, but there is a lot to discuss in the transistion and the issues and situations you'll find in your transistion. I don't doubt you can handle or adapt to most of those, but all of them? A therapist has the experience from their work with previous transpeople to guide through the process and time and help deal with your feelings and emotions. Or not, that's your choice. But I can tell you very, very few transpeople are fully capable of going through their transistion without professional help, beyond forums and support groups. Sometimes having someone to vent, rant or cry with helps. That's why going to one, even infrequently, helps. And you will need one primary and one secondary one for your letters, court documents, drivers license changes, etc. And without some visits, it's unlikely a therapist will write them.

I take hiatuses from therapy, it's normal as I run out of issues to discuss. But I know the reality is that without the therapist I won't get the letters despite both of us knowing I'm normal and everything is fine. It's not just the SOC, but often laws and physicians' standards. And I have no doubt some transwomen are so focused and confident for their transistion that they don't need professional help, they know who they are and what to do, and it's a matter of convincing others to agree to do what you want. Ok, but turn it around and be them, would you? Not just seeing you as you from their side, but seeing you from their perspective, not knowing you and demanding you do something for them that isn't in the SOC.

In short, it doesn't hurt to go every few months if only to keep in touch and give you space to hear a different view of your transistion. What's the harm? Good luck.

--Susan--

ps. Cindy's point is a real possibility. Some physicians will require some therapy before and while on hrt. It's not unreasonable to expect that and it makes them more comfortable writing prescriptions. Just presenting as a 'stable" person without therapy requesting hrt isn't grounds for a physician to prescribe. You could of course shop for another physician, but then you run the risk of your health. That's what the physician is for, to know what to test, check, ask and so on so you don't risk your health. Wouldn't you want someone with that experience caring for you?

[Schala]

I still stand by my "Therapy is optional" idea. Letters should also not be needed. Or maybe just one, without need for a 6 months follow-up to produce it. It doesn't take 6 months to ensure someone knows what they're doing.

I'm sure when I buy a house for 200,000$ they won't make me take a battery of tests to determine if I'm ready to face the possibilities of money trouble, including personal bankrupcy and all it means. If I'm going to have a child with someone, they also won't test or question me, and it certainly is more life-changing than mere surgery. After all, SRS might be irreversible, but it's the cherry-on-top, and its treated like its all there is to transition.

Make me sign a dozen consent forms, and make a serious assessment on my knowing what I'm getting into, in a 1-2 hour session. Then I don't see why it wouldn't be performed.

Breast augmentation is on-demand, though some catholic hospitals apparently refuse to do it on MtFs (even if post-op). Rhinoplasty and other facial surgery is also on-demand, and rather common. Why is the most restricted type the one that could justify a legal change (or rather, what is changed is the element judged by a standard by which a lot of countries rely to determines someone's legal status)?

If I can't get letters, I'll just go to Thailand. I won't follow BS bureaucracy just because of bigotry, because its beyond a fear of lawsuits (you sign consent forms, therefore sign away your right to sue), and beyond a "doing the best for you" paternalistic attitude. It's an attitude destined to make SRS seem like a last recourse *paliative* treatment, rather than something that makes things right.