What is the basic dynamic of therapy?

[Ella~]

There's something that I've been wondering about...

As you go through the therapy process, is the goal of the therapist to "diagnose" you. Are they trying to judge and analize you until they can finally say "Aha - this person is ____ and can or should do _______ (fill in the blanks)".

Or, are they simply there as a guide for you and it's ultimately up to you to fill in the blanks yourself? It seems like a person's sense of gender is so personal, internal and subjective - so un-provable - that you'd almost have to make the diagnoses yourself. Maybe the power to fill in the blanks works the same the power to go home worked for Dorothy in the Wizard of Oz... All she ever had to do was to click the heals of her ruby slippers three times and she could go home. There were people who had been with her on her journey to help her out (her friends, the good witch etc.), but ultimately the power to fix her problem was inside her and her alone.

Now that I re-read it, my Dorothy analogy probably isn't very good. But...I'll leave it.

Maybe it's not that black and white and I'm missing something about the whole therapy process. 

- Ella

[NicholeW.]

As you go through the therapy process, is the goal of the therapist to "diagnose" you. Are they trying to judge and analyze you until they can finally say "Aha - this person is ____ and can or should do _______ (fill in the blanks)".

Not exactly, Ella. Imo, (I practice) the "goal" is never a diagnosis. The goal is to have a client discover something about herself that assists her to a better functioning in her life. Often the diagnosing gets in the way of actually working with a person. Often that's true of therapists trying to work with some of the "more difficult" Personality Disorders: Narcissistic, Borderline & Anti-Social. There's a listing of a "menu" of symptoms and a therapist will often choose x of Y number of traits and so come to a diagnosis.

Problem with the traits is that all traits are, to a greater or lesser extent, all regular features of human beings in daily life. Of human beings we'd never think had any sort of disorder, and don't. So the process, if it's gonna work needs a little more nuance and skill than car mechanics might take where  a manual might be fine. "If x,y,z & f then MNP is the problem."

Treatment may also vary according to person. Some depressed patients, for instance, do well with an approach called cognitive-behavioral, others do better with dialectical-behavioral, and a lot of patients do well with relational-cultural as well. Normally there is no hard and fast approach that works equally well for all people over all ranges of mental-illness or all ranges of adjustment disorders.

Research has shown time and time again that the absolute largest variable involved in a patient's success in therapy is the relationship between the practitioner and the patient, regardless of the methods and problems and courses of treatment.

Hope this helps.

Nichole

[Ella~]

See - I knew it wasn't as simple as I was making it out to be. 

[MaggieB]

I have found therapy to be incredibly useful. I have seen several and liked them all. I had to change because of my wife, but that is another story. What I discovered was that they would confirm my self diagnosis that I was trans. I too thought they could "diagnose" my condition for a while but that was only in my thoughts for the first session or two. The value has turned out to be that I have a person knowledgeable about trans issues who really is pulling for me to be happy. I don't know what I would have done if I didn't go. For years, I resisted going and totally dismissed what therapy could do. I was ashamed of my problem too and didn't want to admit it to anyone. Going to a gender therapist kinda made it obvious to me that things were serious. Now, I can't wait for my next session.

I stopped seeing my therapist, at the request of my wife, as soon as I got the letter for SRS. Stupid move, she changed her behavior towards me when she knew I had no one to confide in. I basically got put through the wringer. So I am now going back. The therapist says that I have suffered a setback in my adjustment. She is so right. She will help me to heal and regain my footing.

This is what therapy means to me.

Maggie

[sneakersjay]

Good for you and your therapist! 

Glad to hear you're taking positive steps again.  {{{{{hugs}}}}}

Jay

[Ella~]

Thanks for the reply Maggie. It sounds like therapy has been a very positive thing for you. I'm glad you are going back and I wish you the best of luck.

I only went to two therapy sessions and that was last year. But, I think I share your sense of what goes on there. My therapist didn't give me a formal diagnoses after those two sessions and I didn't spell out what I thought myself either. But, in a way, I guess I was kind of kind of diagnosing myself as we talked and I think she was guiding me along. Like you, going to see her made it seem more serious. But for me, that also made it seem too scary.

Looking back I kinda wish she might have challenged me a little more. Maybe that was coming in the third session. 

I'm slowly talking myself into going again...

[April221]

My therapist is of great benefit to me for several reasons, most importantly to help me to do things in my transition in a timely manner. She is not there to judge me, she is there as a guide. She listens to what I have to say and she'll question my thinking or reasoning whenever appropriate. She'll suggest when I should begin something, or when I should get more information prior to doing something. She offers an opinion when asked, or guidance when needed.

It isn't about a diagnosis, as I have no question, and neither does she. We both agree that SRS will be of great benefit for me, and she's fully supportive of my decision to proceed towards SRS in 2009. I have great respect for her opinion, and will not go against her advice, if after discussion we're still in disagreement. I will give the issue time, and re-evaluate at a later date. Transition is not something that I'm doing on impulse, and mistakes can be costly, both financially and emotionally. I do not like the idea of transitioning without a knowledgeable guide.

Because so much is at stake with transition, I researched and found the therapist that I felt would be the most knowledgeable and appropriate for my needs, and I've been very satisfied, and that's what it's all about. I have my requirements and reasons for them, and that's how I chose my therapist. Another person may not like her, and may prefer a totally different therapist. It all depends upon you and what you wish for in a therapist. My priorities may very well be different from many other people. You have to choose a therapist upon what your needs are.

We have a very limited personal rapport. Our relationship is entirely professional. A few times, we arrived outside her office building at the same time, rode in the elevator, just the two of us. She had a magazine that she glanced at, and there was no conversation between us at all. Two strangers until my session began. That is our relationship, cold but businesslike. I really have no feelings about her as a person. I neither like my therapist nor do I dislike her. I sit and speak with her, and I take advantage of her experience and insight. It's a cold, clinical type of relationship, which is all that I ask. I'm not interested in making friends with her. I need her to keep me out of trouble, and so far, she's done that very well.

[Carol55]

I don't know that I agree with April221 about the personal rapport with a therapist.  I've had many different therapists of one kind or another in the last thirty years.  The first three or four were for my "depression".  The last three, including my current one, were for my gender issues.  Several of these therapists maintained the cold, businesslike relationship you describe and we discussed what I was thinking like it was term paper for some college course.  No feeling, just rational discourse.  Because I could never get the feeling that they actually cared one way or another about how I developed, I found it difficult to be an open person with them.  The few who did show that they cared about me, not just a client, were the ones that I could open up to.  We're not about to go have coffee on Saturday, but I'd like to think that if I asked, she would.

But each of us reacts differently and has different needs.  No one approach is the best.  Since I'm new here, I just thought I'd throw my two cents in.

Carol

"In our sleep, pain that cannot forget falls drop by drop upon the heart, and in our own despair, against our will, comes wisdom through the awful grace of God."

[April221]

I don't know that I agree with April221 about the personal rapport with a therapist.  I've had many different therapists of one kind or another in the last thirty years.  The first three or four were for my "depression".  The last three, including my current one, were for my gender issues.  Several of these therapists maintained the cold, businesslike relationship you describe and we discussed what I was thinking like it was term paper for some college course.  No feeling, just rational discourse.  Because I could never get the feeling that they actually cared one way or another about how I developed, I found it difficult to be an open person with them.  The few who did show that they cared about me, not just a client, were the ones that I could open up to.  We're not about to go have coffee on Saturday, but I'd like to think that if I asked, she would.

But each of us reacts differently and has different needs.  No one approach is the best.  Since I'm new here, I just thought I'd throw my two cents in.

Carol

"In our sleep, pain that cannot forget falls drop by drop upon the heart, and in our own despair, against our will, comes wisdom through the awful grace of God."

The relationship with a therapist is a very personal one, and one that needs to be clearly understood. Because of who I am, why I'm going to a therapist, and the goals that I'm considering, I'm really happpy with an exceptionally clinical and academic minded individual. While I can easily understand your feelings and I think most people would agree with you, my needs are what guided me.  In all fairness, my therapist may be a bit warmer if I were a bit different myself. I arrive at each session with written notes to ensure that I clearly express my thoughts and that all issues are covered. I do everything that I can to make the most of a very short session. I have absolutely no problem in discussing my concerns with her. I tend to be clinical and a bit cold also.

I would have more of a problem with someone with whom I've established a more personal rapport. I may be LESS likely to discuss things that I'm not very proud of. ( I was wondering how I was going to say that!) and time may be spent on things that I don't have an interest in paying to discuss. I try to get as much out of each session as possible, and a businesslike approach works well for me. I think that the only thing that's important is whether or not the relationship with the therapist is working for you. I went to my therapist hoping to find a possible alternative to HRT and transition, she allowed me to fully express myself, and to understand which direction I should pursue and why. She offered no opinions unless she felt that my decision would have been ill advised. She helped me to find well reasoned, workeable solutions. I found my own answers. As a result of our sessions, I've made the decisions that will allow me to live a longer and happier life. I'm currently enjoying my RLE, and I have part time jobs as both a receptionist and a saleswoman in New York City. I'm about halfway through electrolysis, without my therapist I may not have even started! and I have plans for my post-op life that will allow me to continue to grow as a person and as a woman. She told me where I could find an experienced and low cost medical professional to oversee my HRT.

I'm more than satisfied with the results that I've had from working with my therapist, and that's my point. As long as I'm finding the relationship to be productive and helpful, then the sessions are beneficial and are worth continuing. I'm going in the right direction, and that's why I'm there. The relationship is working.

[Aiden]

I find that I can't stand to go to one unless they are friendly and act like their there for more than just fidnoing out stuff about you and writing notes.  I've had some pretty painful experiences with therapists and some good ones.  I've had ones where I couldn't stand going to, and ones I can't see enough.

Right now the GID Therapist I see seems generally caring.  I love going to see her even though it takes me 2 hours and 2 buses to get there from home.  I feel relaxed anough to be open with her and as for what she does.  She provides a patient ear without being pushy, she lets me express and figure out things while also helping me out when I get stuck explaining how I feel.  She actually makes me feel validated without judging me.

Though recently there was an issue where my medical history and medicans I take became and issue.  Think have just set myself back for sure.  I was diagnosed as bipolar when was about 9 though have never really felt I fit that disgnoses, and find that a lot of my medicans actually make it difficult to get past my depression when I should be enjoying something.

[Elwood]

My experience has been like this... Doc = all my doctors... over time.

Doc: How you feeling, Elwood?
Elwood: Like crap, ma'am.
Doc: Mmhmm. *writes notes* Feel like you want to hurt anyone?
Elwood: No, ma'am.
Doc: Yourself?
Elwood: Sure, sometimes. I hate my--
Doc: Mmhmm... *writes notes* You have high anxiety.
Elwood: What? Wait, what about...
Doc: We're going to put you in an anxiety class.
Elwood: I came here for other... Okay.
Doc: And put you on meds.
Elwood: What? Uhhh... okay. What about my--
Doc: Now you're going to have no progress for the next 5 months.
Elwood: You serious?! What the Hell?
Doc: Yeah, we don't believe you. Or something. But yeah.
Elwood: Frack.
Doc: You're officially GID.
Elwood: Okay, now what?
Doc: I don't know. I guess we'll just sit here.
*silence*
Elwood: *fills out paperwork to get a new doctor*

And that's how I got signed up to see Demara, a REAL gender therapist who might be able to ACTUALLY help me.

[Aiden]

Yeh, unfortunately a diagnoses correct or wrong, can effect you for a long time.