First therapy session – What to say? – what not to say?

[K8]

Hi Galantha,

It sounds like a good start.  You don't have to stay with the same therapist all through the process.  (I'm on my third.)  It sounds like you can get started figuring things out with this one for free.

Regardless of what you are doing it can be hard to get started.  Starting therapy (counseling) can be a bit scary, but if you click with the therapist even a little will find it very worthwhile.

Good luck.

- Kate

[Renate]

If you go to a therapist with all your issues resolved, with a sober sense of purpose, completely open to the therapist but without hysterics or use of Kleenex, you will get all the recommendation letters that you need but with snotty comments that "male socialization" has left you without the ability to express your emotions.

[Galantha]

Well, I had my first session with the intern and her superviser.

1. I did look at the floor to much
2. I was very open
3. They do have reason to believe I am a nutcase
4. I do not believe they are inclinded to deny my HRT request in three months

They are looking to meet with me weekly and have scheduled there of.  I was under the impression that this was normally done monthly.  I am not sure wether to be alarmed, or to suspect they are just trying to get the intern her hours in.

-- Galantha

[Ms Jessica]

Looking at the floor is okay
Being open is good
Nutcase?  Would you elaborate?
Good!  An HRT letter is a good thing. 

I saw my therapist weekly for the first month or two, and decreased to a monthly frequency after that.  I wouldn't be worried, it's just a good way to take care of a lot of the past history and details that they want to get out of the way. 

[Galantha]

Looking at the floor is okay
Being open is good
Nutcase?  Would you elaborate?
Good!  An HRT letter is a good thing. 

I saw my therapist weekly for the first month or two, and decreased to a monthly frequency after that.  I wouldn't be worried, it's just a good way to take care of a lot of the past history and details that they want to get out of the way.

1. I admitted to having suicidal thoughts in the past
2. I admitted to having been depressed (a red flag to deny HRT in my research)

-- Galantha
Post Merge: July 13, 2009, 02:06:38 PM
On the flip side, I realized today I had mislead the therapists (intern + senior supervisor) on the standards of care internationaly vs the US.  Specifically I had indicated you do not have to live 1 year in role with the international standard, where as with the US you do.  It turns how you do with both on further research. 

I sent an email of apology to them, but I wonder how this will effect future sessions.  I was very positive and adminate on this item, and I suspect this turn of events will not make me look good for one thing.

-- Galantha

[Ms Jessica]

1. I admitted to having suicidal thoughts in the past
2. I admitted to having been depressed (a red flag to deny HRT in my research)

I admitted both of those to my therapist, too.  It's not necessarily an automatic block to HRT.  It depends on the therapist. 

On the flip side, I realized today I had mislead the therapists (intern + senior supervisor) on the standards of care internationaly vs the US.  Specifically I had indicated you do not have to live 1 year in role with the international standard, where as with the US you do.  It turns how you do with both on further research. 

I'm not sure what you mean about living 1 year in role, but I thought you were talking about HRT.  SOC according to wpath.org states 3 months in RLE, or a recommended period of psychotherapy of 3 months, prior to being started on HRT.  Or were you talking about SRS (1 year according to wpath.org).  If you're going through an insurance company, or public health service for SRS, they can make you wait longer, but that's not an international standard or guideline. 

Or am I just totally misunderstanding you?

[Galantha]

I admitted both of those to my therapist, too.  It's not necessarily an automatic block to HRT.  It depends on the therapist. 

I'm not sure what you mean about living 1 year in role, but I thought you were talking about HRT.  SOC according to wpath.org states 3 months in RLE, or a recommended period of psychotherapy of 3 months, prior to being started on HRT.  Or were you talking about SRS (1 year according to wpath.org).  If you're going through an insurance company, or public health service for SRS, they can make you wait longer, but that's not an international standard or guideline. 

Or am I just totally misunderstanding you?

I did not provide proper context for my post.  I have been working myself up with foolish thoughts of them not trusting me now. 

I was refering to 1 year in role for SRS.  Specifically, if I remember right 1 year of in role time + 1 year of HRT + 2 letters are required for SRS?  (I plan to go to Thailand as I have no expectation my insurance would ever cover it, but that is a long ways down the road).  I had specifically and strongly indicated to them the international rules did not require 1 year of real life experance for SRS.

I am under the impression you do not have to live at all in role for HRT, just three months of therapy. 

[Ms Jessica]

I wouldn't stress too much about them not trusting you.  You've only been (presumably) one or two times, yes?  That's hardly enough time to develop much rapport with your therapist, so give it a chance to work out. 

IIRC, it's one year RLE for SRS.  The year of HRT can be concurrent, AFAICT.  2 letters also sounds right.  If you plan to go to Thailand, I'm not sure if all surgeons there require the letters/1 year RLE, though I suppose that's different than saying the standard doesn't apply.  It would probably be more correct to say that not everyone follows the wpath SOC. 

You may not have made a statement of absolute or complete fact, but as I said, there are people that don't follow the SOC.  Couple that with the fact that everyone makes a mistake at sometime, and it's maybe not so bad.  Your willingness to own up to your mistake is probably a good thing in the long run, and not a bad one. 

I hope it all works out.  Let us know!

[NicholeW.]

...  I have been working myself up with foolish thoughts of them not trusting me now. 

Yes, worrying unnecessarily and "working yourself up" is always contra-indicated no matter what the situation is: therapy, police stop, bad fish at a restaurant, hernia repair or mowing the lawn.

Emotion is fine, but "working myself up" should be re-trained to something like "working with what's there and what I actually know."

I was refering to 1 year in role for SRS.  Specifically, if I remember right 1 year of in role time + 1 year of HRT + 2 letters are required for SRS?  (I plan to go to Thailand as I have no expectation my insurance would ever cover it, but that is a long ways down the road).  I had specifically and strongly indicated to them the international rules did not require 1 year of real life experance for SRS.

TBH, it's not your job to give them such info and it would certainly be poor of them to not do their own research. So, you made a mistake. Ever drop a book while walking to class or arrived late for a party? About the same thing. They won't "dock" you for that.

As for your earlier worry about depression. It's not a worry. most TSes are depressed to some extent for a lot of our lives prior to being post-transition. Par for the course.

A clinical depression, quite different, would be a reason to withhold both hrt and delay srs. In fact, you may well need to be in a psych-unit with that as SI usually becomes acute in such states.

Delaying hrt because there does appear to be some evidence that estrogen-rich humans are more likely to be depressed than are T-rich humans. But once the depression relents and you're normally depressed or not depressed hrt would be able to resume or start.

It's also not a good idea to go into surgery while in a clinical depression. Most people get post-op depressions anyhow. And your surgery will work better if you feel good overall when having it and afterwards.

I am under the impression you do not have to live at all in role for HRT, just three months of therapy.

Thst impression is correct.

Nichole