OK, so it's easy enough to poke holes in my dichotomous thread title (I blame the Internet's insidious 24-hour, attention-grabbing news cycle), but it's not far from the truth (my truth), as I've never really found therapists¹ to be very helpful.

It's not that I think therapists have anything but my best interests and wellbeing at heart (and let's face it, I have to believe that), or that they don't have a genuine interest in the subject matter. It's just that I don't know what I'm supposed to be getting out of the sessions that I've had with psychologists and psychiatrists specialising in gender issues. Perhaps I'm not very bright.

What I got out of therapy with two psychologists was conformation that I was transgendered, probably transsexual. Subsequent sessions I had with a psychiatrist revealed little more, though he did green light my hormone program. In fact, he told me that there was never any issue with HRT clearance (I think denying HRT is the exception rather than the rule). As with the psychologists, however, I didn't gain any insight into why I thought I should take hormones in the first place. In other words, my psychiatrist cleared me for take-off for what is, really, a leap of faith (was that a mixed metaphor? I hate mixed metaphors. Anyway I'm sure you get the point). I don't know, but I would have thought a psychiatrist's role would go beyond the facilitation of a hormone program.

So basically, I just wanted to know what kind of help or insight you may have gained in therapy. Or, like me, did you find that a trip to the psychiatrists is just one more hoop to jump through in order to start hormone therapy?





¹ I'm an Australian MtF referring to Australian therapists

There are some people who genuinely need to work out stuff before they want to transition. They may want to be absolutely sure they are trans, or they may have only recently started to have trans feelings and are confused. They might have to come out to people that it will be difficult to deal with, so they need to prepare themselves mentally with the help of a therapist.  Or  - they could have a hard time coming to terms with what being trans means. Also, transitioning is pretty stressful and anxiety inducing. Just being trans makes people more prone to depression. 

But trans people are just like the rest of the population. Some of us need therapy - others don't.  Sounds you like you don't/didn't - so for you, you were just paying the time toll at the hormone gateway.  If you don't need help from a mental health professional, there is no reason you would have gotten more out of the psychiatrist or the psychologist.

The therapy requirement for hormones is slipping away in a lot of places, thankfully.

Hi SpaceRace.

Oh, I have issues - plenty, in fact, which is sort of why I created this thread.

Whenever I raised a problem with the therapists I saw, they tended not to enter into any discussion about them. Or the responses that I received in turn sounded incongruous to what I had put forward. I just felt like there was no transparency, no rhyme or reason as to how these health professionals (they were all experienced, accredited practitioners) were helping me to address some quite serious issues that I was harbouring. It seemed ad hoc and without method.

I mean, like I've said on other threads, I don't really know if I'm transsexual. I might be; the psychs seem to think so. But there are some real, untested doubts there. Think of it this way: If such sessions are about the psychiatrist facilitating a kind of self-reporting on the client's part, and the client is left none-the-wiser, isn't it kind of odd that the psychiatrist then assumes to know more about the client than the client does by permitting hormone therapy?

There is no reliable test to confirm whether one is transsexual or not, and any therapist selling one is probably best avoided. (Not that I know of any therapist who makes any such claims).  We are still largely self-diagnosed at this point, though maybe at some point that will change, given some of the recent research on physical brain differences associated with gender identity.

Also, therapy approaches are pretty haphazard here in the States, at least, and I imagine the same is reflected elsewhere. Therapists tend to choose an approach that fits them, and it hardly seems very systematic at this point.  I don't know how easy or not it is to "shop" for a therapist in Australia, compared to the States, but I'd definitely suggest digging into the details and asking some blunt questions about any therapist's approach and discipline before even tentatively committing to work with them over any length of time.

Most will not tend to offer directive advice, but will engage in talk therapy over time to eventually arrive as some sense of which issues to address first.  Sometimes, trying to fix one thing directly can have unfortunate echoes somewhere else, so there is at least some logic to avoiding a fast "fix it" mentality, when the other issues you're facing could turn out to be complicated, and they may be waiting for you to reveal issues they sense you are not prepared yet to address or acknowledge directly.  The "process" tends to feel like trying to hang Jell-O to the the wall, at least it did for me.

Despite some serious problems with my therapist, like ignoring my concerns that I might be bipolar, and encouraging (after over a year with him) a course of SSRIs that triggered the mania that confirmed I was in fact bipolar albeit with a very atypical presentation that at least my ex (an MD) considered odd enough that she felt he was not completely incompetent.... anyway, the benefits were:

• Developing Cognitive Behavioral Therapy skills for coping with depression;
• Problem solving during the period when I was not ready to commit to transition (partly due to the sense that it would mean the end of my marriage -- granted, my refusal to make a promise never to transition did lead to divorce anyway;
• EMDR work to deal with particular memories and incidents that may have been sources of the stresses behind my PTSD diagnosis;
• Ultimately, in a roundabout way, lengthy therapy did confirm to me much about the nature of my gender identity, details that can be useful for reflection, and that I hope, at least, will serve to help me maintain equilibrium when I finally do manage to put together all that is needed to proceed with transition.

In the end, though, much of what you accomplish in therapy is your own accomplishment, the therapist is often only there to serve as a sounding board, or a reality check, depending on what you need and how you see yourself working towards your goals.

If you are looking for something other than transition and HRT, best to ask about that as directly as you can.  While therapists are not quite as manipulative and gate-keeperish as they were a decade or two ago, they are not likely to push you somewhere you don't want to go, but they may be tending more at this point to assume that most people presenting to them with gender identity issues are probably looking to begin HRT.

P.S.: One thing about HRT, if you start it and it feels really, really wrong to you, that could in itself serve to rule out identifying as transsexual... concerns and doubts are common, whatever one's issues might be. The risk of hormones for a short period, in lower doses, is not really that great, so, if they see no obvious signs that your issues are something else, it may simply be the most practical thing at this point to confirm or rule out things by starting hormones.

My therapist pretty much said flat out, that it was not his job to stand in the way of getting T or getting top surgery or anything else. I never went in to "get a letter" (although I might need one). I really went in due to the stress of figuring out I was trans but not knowing what to do with it. I didn't know that I was not strictly non-binary.

To me, the idea of a gatekeeper on these things is weird and some doctors have apparently taken this to extremes of trying to mind trick their clients into giving up the idea or proving themselves one way or the other. Things I have seen here include misgendering, using given names, and that sort of thing or play other kinds of games. I don't understand this at all. I think actually some of this come from doctors who may not believe in the concept of transgender who are out to prove trans people are frauds or troubled in some other way. I don't know if there is any benefit in the whole concept as it is a big thing, and it seems like people should think about it. But not sure it is anyone's right to force the person to do this.
And there is not any reason (to me) for some doctor to prove to their female (trans or bio), you can see the misogenistic strain, that they are misguided.


--Jay

I went and saw the therapist, initially, to exclude other issues that might exhibit similar 'symptoms'. I thought I must be nuts. But I'm not, I'm just a trans woman. Actually, just a woman.

I've been seeing mine for about 18 months now, and now not all that regularly..  And in that time, we've not really spent a lot of time talking about anything trans-specific. What I have done is offload a whole pile of baggage from my past, stuff I just didn't want to have to carry around any more. Yeah, it took me about 4 months to start hormones, but that was my own choice. He had been waiting for me to ask - and that's when I was ready.. Overall, I've found my therapist to be useful.

Quote from: aleon515 on March 01, 2013, 10:23:23 PM
To me, the idea of a gatekeeper on these things is weird and some doctors have apparently taken this to extremes of trying to mind trick their clients into giving up the idea or proving themselves one way or the other.

Just my opinion, but I have to think that John Money's spectacular crash-and-burn from his assertion that one could alter any child's gender as long as it was done in the first 24 months postpartum must have had a profound effect on the thinking of many professionals who had been trying to play God until a few years ago.  The field has undergone a long overdue humbling that (hopefully) will mean that horror stories that were common as recently as 10 or 15 years ago are unlikely to be repeated frequently, at least by anyone who is actually doing their homework, and staying current with what little reliable research there is available. Even back 15 years ago, practitioners were aware how spotty the existing research and especially long-term follow-up was.  But the case of David Reimer was really a major wake-up call that's still echoing for them.  BBC summary here.

I have to agree with Servalan.

Therapists do come out with some pretty clever mental manipulations for dealing with some issues. But these are little more than that. Designed earlier and pulled off the shelf, like a replacement part, to suit an instance.

It may well help some, even many people to talk things over with a therapist. But the realities are that everyone's life is crap. Everyone had bad memories. The problems isn't the memories or what happened, it's how we choose to deal with things. Therapists work because we believe they will. In much the same way that some believe in faith healers, or witch doctors. It's just smoke and mirrors, snappy come backs and manipulations of reality that border on self deception.

Whether these people have the full monty of university degrees, or just a 6 week correspondence course to be a councilor, they are all motivated by the same thing, their own egos. They seek to justify their own neuroses and inadequacies by imposing their moral judgements onto those seen as vulnerable.

Mistakes are unfortunate. Successes are hailed. But what works is what the individual is prepared to accept, whether they buy it form an overly qualified therapist or pick it up on the web.

Life is crap. It's crap because we make it so. We each revel in our own sense of misery and no sooner have we found someone with a more tragic tale than we find a way to integrate that into our own.

There are kids out there, sleeping on pavements. People dying of hunger. People living in constant insecurity of eviction or arrest and torture. Therapy is rich indulgence. A means for us to flatter our own egos, salve our own guilt, justify our own self pity.

What therapy never does teach is learning. It teaches us to look at our own tragedy, but never to learn not to do the same to others. The therapist is just the school bully, grown up.

It is one of those expenses which we need to have to achieve almost anything. Like the cost of the airfare to the SRS clinic. It's a necessary step and nothing more.

(Cool name by the way Servalan. Do I detect a fellow Blakes 7 fan?)