Susan's Place Transgender Resources

Today in a conversation about transition, my spouse said that a gender therapist told her that all people claiming to be trans are given letters unless the person is psychotic. This was not just in this particular practice but ALL therapists do this. I found this to be odd since it hasn't been discussed in all my reading here and elsewhere.

My spouse claimed she was told that the reason orchi's are so easy to get is because mental health professionals know that the patient will self castrate if they are denied so they just write the letters. The only caveat is when the person is demonstrably psychotic. If that is the case, only a serious mental illness i.e. one that requires the person to be committed will stop the gender counselor from writing the letter.

If this is true, then why do we wait for RLE to get letters?

Does any of this ring true to people here?

Maggie

I think she was referring to a carry letter and not a letter of recommendation. I feel that carry letters are outdated these days although many areas may still use them. I think the idea behind them was when you were in public situations and not presenting as your birth gender but not far enough along to get legal name changes and gender markers modified. in some situations, like being asked for an ID and having a photo that isn't congruent with your appearance to explain your situation in a professional manner rather than being just some kook.

as for the orchi, I haven't heard that. in fact I've mostly heard just the opposite.

Quote from: beth~chella on December 29, 2009, 07:15:15 PM
I think she was referring to a carry letter and not a letter of recommendation. I feel that carry letters are outdated these days although many areas may still use them. I think the idea behind them was when you were in public situations and not presenting as your birth gender but not far enough along to get legal name changes and gender markers modified. in some situations, like being asked for an ID and having a photo that isn't congruent with your appearance to explain your situation in a professional manner rather than being just some kook.

as for the orchi, I haven't heard that. in fact I've mostly heard just the opposite.

I'm quite sure that she was talking about SRS letters because she specifically mentioned that. She was discussing the issue with the gender therapist because she wanted to know what the SRS letter was for and specifically the orchi. BTW, I had one.

Maggie

odd, in that case I'm not sure I have any further input. most of that seemed to describe a carry letter rather than a letter of recommendation in my opinion. perhaps the therapist had their signals crossed or something? Regarding orchi's, I was kind of citing you as one of those "I've heard the opposite" examples based on your previous posts. :)

I think therapists do give out carry letters for the asking, as a means of some kind of explanation to authority personnel.

But letters of recommendations are based on the SOC.  And those are not given out willy nilly.  For those you have to prove that you fully understand the risks and expectations of the requested surgery.

Orchidectomies are not done just because a patient asks for it.  There has to be a reason, and most health care carriers only cover it for prostate or testicular cancer.  A few surgeons will do it for transsexual patients because it is a step some take towards SRS.


JMHO,
Janet

Maggie,
When I called Dr Bowers office and asked what had to be in the SRS letters, they said the letters must state that the patient has followed the SOC and WPATH guidelines (plus a couple of other things).  My understanding is that the letters are to let the surgeon know that the patient has been evaluated and is ready for surgery. 

Patients can ask for surgery for any number of reasons that have nothing to do with being transsexual and for conditions that will not be "cured" through SRS.  The letters are to weed those people out and hopefully get them the kind of help they do need.

- Kate

i got a carry letter for work before they blessedly fired me---and told me to wipe my arse with it--politely of course--not!!!

OK,
I think that the issue isn't clear here. She was told that in spite of the SOC, they all give letters to everyone for SRS who ask for it. I wasn't talking about the standards of care or what surgeon's require. It was all about the fact that therapists just don't turn away anybody. It was an inside bit of information. Just for the record. I do have my two letters and did have to show them to my surgeon for the orchi.

BTW, the therapist that my spouse went to isn't the one that I went to but she wass highly recommended by mine.

Maggie

As did I, Maggie.  I think she has been mislead.  Therapists, to my knowledge, will only write for those who demonstrate a true desire to become their true gender.

She sounds like she is picking and choosing the information she wants to use as a means to justify her view.  Selective reasoning is what my ex use to call it.



Janet

I know a person who went to a therapist for the first time and had a recommendation for HRT when she left after the first visit, had FFS a couple of months later and had SRS scheduled within half a year.  And yes, she went to a very well known and reputable person (as reputable as any psychologist is).  I think it depends a lot on who you are, what you bring in - in this case she was a highly successful business person, no immediate family ties or anything messy, and is - like most good business people, one hell of a salesperson. The SoC are guidelines, not gospel.

Quote from: tekla on December 29, 2009, 11:40:32 PM
(as reputable as any psychologist is)

hmm, I'm only a baby psychologist but I'm sensing some sarcasm here, perhaps rooted in your relationship with your mother.

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fwww.all-about-psychology.com%2Fimages%2Fpsychology-joke-pavlov.gif&hash=f0bfb2a7beecfc5c9f6ec3ccf8b7da22a3802655)

Yeah when you call my name
I salivate like a Pavlov dog
Yeah when you lay me out
My heart is beating louder than a big bass drum, alright

Is it possible that your wife was a little unclear, Maggie? 

In a sense, yes, after RLE, and demonstrating, as Janet mentioned, that you understand the SRS procedure, adhere to the SOC, etc. etc. ad nauseum, I suppose everyone does get their letter.  And being psychotic would probably keep the therapist from writing one. 

In that sense, your wife is correct, but it's not like they have the things sitting in a stack in the waiting room-- as Janet said, they're not handing them out willy-nilly. 

--EDIT--
But maybe some therapists don't take their job very seriously, and do exactly that. 

Quote from: Jessica L. on December 30, 2009, 02:29:53 AM
But maybe some therapists don't take their job very seriously, and do exactly that.

And that's probably why you need two letters.

- Kate

A little background, my spouse is highly critical of the entire process and is still in the belief that it is a mental illness with highly sexual overtones bordering on perversion. The therapist she went to only reinforced this notion.

She was very clear in her conversation because she was declaring that one of my friends was not trans but a male with a sexual perversion and that HE got the letters for surgery because it doesn't matter to therapists why you ask, they just write them. Her point seemed to point the finger at me in that my letters are not certificates of validation either. My friend and I went to the same therapist but not to hers. In fact her therapist asked for a consent form to be signed by me so she and my therapist could compare notes. From what I heard, her therapist diagnosed me as mentally ill not trans. I never met her. I did discuss this with my therapist who said that in her opinion,I was not mentally ill.

Maggie

Of course, her therapist is of the same opinion.  Just some Transpeople do, she sought out a 'professional' who would back up her claim.

I did it trying to 'fix' me, but everyone of them only tried what they believed would work.  But it was all just their own personal BS.  It wasn't till I went to a gender therapist, who had me look at why I felt this way, that I finally realized that I am a woman on the inside and I need to fix the outside.

I am truly sorry that you are going through such a hard time, Maggie.  But I understand the reason behind remaining.  I just wish there was a way that we could get our brothers and sisters out of bad situations and get them into a positive atmosphere.


Huggles,
Janet

The therapist that she saw was highly recommended by my therapist as a very good gender therapist who I could also see for my transition. My spouse prefers to look at sources in the mental illness support group sites where trans issues are discussed as mental illnesses. She is firmly of the opinion that I cannot take care of myself. She wants me to stay out of the commitment that we made when we got married but she does not believe we are married now. Confusing.

Maggie

Quote from: Janet Lynn on December 29, 2009, 07:32:24 PM
I think therapists do give out carry letters for the asking, as a means of some kind of explanation to authority personnel.

But letters of recommendations are based on the SOC.  And those are not given out willy nilly.  For those you have to prove that you fully understand the risks and expectations of the requested surgery.

Orchidectomies are not done just because a patient asks for it.  There has to be a reason, and most health care carriers only cover it for prostate or testicular cancer.  A few surgeons will do it for transsexual patients because it is a step some take towards SRS.


JMHO,
Janet

You are absolutely right Janet and over here in the U.K we have to work to very strict HBSOC guidelines before we are allowed written letters of confirmation by qualified psychiatrists that we have completely complied with the HBSOC. If this criteria is not met or implimented we are not allowed to approach a SRS surgeon private or NHS.

Yeah, but in the US you can buy the results you require.  So long as the doctor feels they are doing what they can to avoid a lawsuit.  And the informed consent model is gaining adherents.

Maggie:

We've discussed issues with your spouse before and she has appeared to believe what she wants to believe and discount any opposite opinion.

Additionally, I think that her therapist making a judgement call about you without seeing you is unethical.  Her therapist may have had an idea or opinion about you based on what your spouse told her.  And your spouse may have relayed that to you as a judgment.  That hearsay is filtered through your spouses opinion of your condition and may have emphasized the negative aspects of your relationship and not conveyed the distress you have experienced as a trans person.

This therapist may be highly recommended as a gender therapist, but no one can make a judgement of condition without first hand information.

As others have stated, yes, if a person truly wants an SRS recommendation letter, it can be *bought*.

SRS referral letters do two things.  One is to state to a surgeon that the candidate is truly trans and that the surgery will have a positive impact on the persons life.

The second is the legal due diligence that will hold all parties harmless if the candidate turns around and sues the surgeon, hospital, and therapist because the candidate regrets their irreversible decision.

So if you buy a letter and have the surgery and then later regret that you are forever a setter not a pointer you have no one to blame but yourself and you will not get a dime from the people you fooled.

In any case, Maggie, this is kind of a moot point, isn't it?  You *know* you are trans and have had two therapists agree with you.  As you know being trans cannot be objectively diagnosed.  So you are because you say you are and that is all that really matters, isn't it?

-Sandy

Sandy,
Her comments really didn't affect my self identity but it did make me think about the system in general. I knew I was female and didn't need a therapist to validate me. That is why I self medicated for seven years before I saw a therapist. My spouse didn't like that one and begged me to see another. I did but she eventually made it clear that unless he diagnosed me as schizophrenic, I couldn't see him anymore. He wouldn't so I saw another therapist under the agreement with my spouse that I would ask for anti-psychotic drugs. The new therapist said that there was no way she could recommend that I take drugs of any kind because I wasn't mentally ill. My spouse didn't want me to see her either but I insisted at this point and finished with this one a few months later.

I hoped that seeing a therapist and getting the SRS letters would help convince her that I was really trans but I know now that she will never see it that way.

I too was very concerned that my mental state was being discussed and that this therapist saw fit to remotely diagnose me. EVEN with my therapist comparing notes with her, I was really put off by it. My therapist said that she saw me as depressed and angry because of being a battered woman. Yes, that was her opinion of my situation. At least that is what it was almost two years ago. Things are better now, only rarely do I have to deal with abuse. My spouse admits that she did behave badly.

Maggie