Therapy advice...

[JohnAlex]

So as I said here in a topic a little while back, I had my first therapist appointment and I felt like a failure because I didn't say anything about me being transgender, I couldn't really
talk at all, I was just nervous or shy or something.
So, with some of the advice of those here, I decided to email my therapist and tell him what I couldn't tell him in person.

I basically told him that I was transgender and that I was seeking therapy because I wanted to medically transition.
Here's where I'm confused...
He replied back saying that he can only "address problems that are the result of a mental illness of some type. It is unclear that is the case in terms of your situation."
So I'm really unsure what he meant.  Is he basically saying that just being transgender is not a mental illness, or that it is a mental illness but he is unclear if I really am transgender?

He ended his email to me saying "It is possible that what you are wanting is beyond the scope of my practice."

To my disappointment, he's not an actual "gender" therapist, although he has worked with transgendered people before.  I think my town might be just too small to have an actual
gender therapist.


I really only wanted to see a therapist so that I could get on T and eventually get surgery.  Does it sound like this guy is not the one who's going to help me do that?

[MaxAloysius]

Here's something that I got screwed around with. Everyone, and I mean everyone, told me that I specifically needed to see a gender therapist. That isn't always true. What you need is a qualified psychiatrist, or psychotherapist (sometimes even these titles aren't necessary) who will work with you until they understand that your gender identity isn't the result of some mental illness or other. Any qualified therapist should have enough knowledge to make this decision. Then they write you a letter atesting to such.

It shouldn't matter whether this therapist is specifically a gender therapist, if he can determine that your 'GID' is real, then that's good enough for most doctors (you may get a dick or two who say it's not, but they're the minority).

I'd say meet with him again and discuss what it is you need from him. It may be that he's just uncomfortable working with someone in your possition, in which case it's a bit of a lost cause. But best to give it one last try before you completely write him off.

[Jigsaw]

Does your town have a licensed clinical social worker who does therapy?  All my therapy is done with one and I get the same results.  She is really awesome to talk to and within 3 months I had my letter of referral to the endo she recommended.  Luckily, this endo was in my same health care network and is one of the best where I live.

Just wanted to throw out that bit of info in case it could help.

[JohnAlex]

Hm. Well, my therapist is great, worked with a lot of trans people but he said something along those lines. That he needed to rule out any other mental illnesses that may mimic GID. In the end I got the referral. If you can afford it, it may not hurt to see him and find out what happens. If he gives you the roundabout then just find someone else who will be able to help you.

It shouldn't matter whether this therapist is specifically a gender therapist, if he can determine that your 'GID' is real, then that's good enough for most doctors (you may get a dick or two who say it's not, but they're the minority).

I'd say meet with him again and discuss what it is you need from him. It may be that he's just uncomfortable working with someone in your possition, in which case it's a bit of a lost cause. But best to give it one last try before you completely write him off.

Thank you.  This was helpful for me.

Now I am wondering exactly how does he determine that I have GID? how does it determine that it's not some other illness that may mimic that?
Like what kind of questions would be ask me to figure that out?

I'm already nervous about going to therapy because I don't know what he's going to do or ask.

[JohnAlex]

They asked me questions like "Why not be a butch lesbian?" "Do you feel there is something essential that makes someone male or female?" "Do you get aroused sexually by wearing men's clothes?" Basically they ask you to explain why you feel that FTM is your identity, how you rule out the others.

I was nervous too, but really, just go in and be yourself. You'll find the answers will come from the heart. I had things all planned out and it all went down the toilet when we actually started talking, I just felt like I wasted time by thinking everything through and worrying so much beforehand.

:O  they really ask you those kinds of questions?  Oh boy, I don't know if I'd been ready to answer them to my therapist who is still a stranger to me.

What other kinds of questions did they ask?  I'm really nervous now, lol, so I need to know more.  for me, planning things out makes me less nervous, even if my plans end up in the garbage, they still served their purpose of relaxing me.

[kelly_aus]

Sorry to butt in guys, I'm only doing it because it's therapy-related..

If you can think of a question you don't want asked, or you know is going to make you uncomfortable, then it's almost a certain bet your therapist will ask it.. And don't bother trying to plan everything out in your head before you go, like Caseyy said, it will all go down the toilet..

[MaxAloysius]

None of my four therapists really asked me any of those kind of questions, what they did ask me was things like when I first started feeling like I was male, and if I could explain why it's so important to me. I think every therapist is different, and like other's have said, it's best not to think about it too much, because you'll just get yourself all worked up and tied in knots.

The real thing is far less scary than it sounds, just answer the questions truthfully and you'll be fine.

[wheat thins are delicious]

Different therapists are different.  Some ask lots of questions, some take your word for it, etc.  You don't always need a therapist's letter if you can get a GP or other doc who can prescribe you T who does it on informed consent. 

[JohnAlex]

From what you put, it sounds like he's recognizing that transsexuality isn't in itself a mental illness, and so he isn't sure whether therapy is appropriate for you. My guess is that he's not aware that trans people usually need a letter of referral from a therapist in order to be eligible for hormones and surgery. You might point this out to him. If you feel that you're otherwise mentally healthy, point this out too, but you can also potentially benefit from talking through your expectations and goals and having some support in doing so.

What I find a little concerning is that he's saying he can only help with mental illnesses. Unless he is a psychiatrist, that's a very unusual thing to say. It's increasingly being acknowledged that many people can benefit from therapy even if they have no mental illness.

Are there other therapists in your area who you can contact if this one doesn't work out?
My therapist didn't ask questions like that, but she was from a trans-positive and experienced clinic. The questions were more along the lines of, "When did you begin identifying as male?", "How do you see testosterone improving your life?", "Do you have people in your life that you can talk to about being trans?"

Oh yeah, if he doesn't work out, there are plenty of therapist I could choose from.  however, I have no "gender therapists" in my area, only general therapists or social workers, really.


I'm still trying to decide when I should give up on him.  I don't really like him, but maybe it's just because how nervous I am even talking about trans issues. 
Honestly, right now, I can't answer those kinds of questions.  I've never told have to explain to someone in person before, so I think i would just be too nervous too.

So now I'm trying to decide if I should just put on a hold on therapy (and therefore transition) or find a new therapist and hope I feel better about it. 
but I also don't want to be a flake, and give up on him too soon.  maybe the next therapist isn't any better.

[EthanD]

Don't be afraid to write a letter to your therapist. When I went to therapy years ago (for something non-trans related) that I had a lot of trouble talking about I wrote it all down and handed it to my therapist on our first visit. I think it helped us open a dialogue and he had all the background information already so we could start on helping me work through things instead of trying to pry information out of me.