Quote from: fluffyflower on May 21, 2009, 11:19:37 AM
...
His therapist has said and I have tried to explain to him that he will not and cannot be approved for hormones unless his depression is treated first as per the Harry Benjamin protocol. I can't get in his head so I can't fathom why he can't understand this.
... Have any of you heard of this problem before? I'm at my wits end...any advice will be greatly appreciated. I'd like to show him this thread so he can read some of your comments. Maybe he will listen to others who understand what he is going through with regard to ->-bleeped-<-.
Hello fluffyflower, welcome to Susan's. Normally I'll add a few other things as well, but this time just one. Please read and follow the guidelines in the
TOS.
Have I heard of this before? Well, yes, I have experienced it before. It can be a rather common side-effect for transsexuals. Side-effect in that the depression will generally come about due to increasing dysphoria.
The depression tends to get worse rather than better the longer the dysphoria remains untreated.
I work as a therapist myself and just for what it's worth disagree on a couple of points with your daughter's therapist.
1) Dual Disorders have been shown repeatedly to be best treated by simultaneous treatment for both. The conditions are symbiotic (feed one another.) For instance: alcoholism accompanied by bi-polar disorder. Very little headway can be made by the patient if they have to maintain sobriety (for say 3 months) without also treating the mania and depression as well. The alcohol often is self-treatment by the patient to help them through the manic and depressive swings.
2) The Benjamin guidelines definitely do NOT indicate that one issue must be addressed BEFORE the other can be addressed. The clinician is asked to determine as best they can that the GID is not an effect of the depression. (Given the attitudes that prevail about transsexuality in the society at-large one might see that there's a lot to be depressed about simply in the way TS/TG people are treated in the social order.)
The same problems tend to prevail in any minority group that is hounded in some fashion by society. The particular minority group isn't an issue, unless the hounding is more severely practiced against them.
Thus, if the clinician will take some time she/he will probably find that your daughter's gender disorder is unlikely to be caused by her depression, but instead that the ongoing struggle with the GID enhances the depression.
The main things the therapist should be looking for are probably schizoid disorders that could be causing the patient to have delusions: "I am Napoleon" being one of the most stereotypical.
3) Hormone treatment may well alleviate both the dysphoria and the depression (it surely was the case with me.) Simultaneous hormone treatment and psychotherapy treatment (cognitive-behavioral is perhaps the most popular) may well see a vast improvement in your daughter's state-of-being, all the way around.
4) If there is a carrot-stick approach being used: "you take the anti-depressants and I'll write a script for the hormones after 3 months", then the likelihood of the therapist enhancing patient resistance to the treatment is almost 100% assured. I'd suggest that you might wish to check-out
Miller & Rollnick, "Motivational interviewing: preparing people for change," New York, The Guildford Press, 2002 as a valuable how-to and why-to book for clinicans to at least have in their repetoire of possible tactics. (Psst, ask the therapist if she/he is familiar, has read and studied, that book.) The approach is being more and more designated a "best-practice" throughout the USA and Western Europe.
I hope for the best for both your daughter and yourself and family.
But, whatever the clinican is currently doing from the sound of your post it doesn't seem to be working. Perhaps a new approach might be better for both patient and clinician.
Best to you,
Nichole
