I abhor the notion of gatekeeping. It would seem to sour the client/therapist relationship. As long as the possibility exists that the therapist could refuse to write a letter for hormones or surgery, that will keep you from being completely honest. You feel you need to tell them what they want to hear, so that you'll get the letter when you need it.

OTOH, if you're a therapist and a patient who has wholly unrealistic ideas about surgery and who is headed for major misery if she goes through with it, and you're asked to write a letter, you'll not be comfortable writing a letter that says the opposite of what you really think.

Can someone be both a therapist and a gatekeeper? Where is the line drawn? Where does protecting a patient from a likely disaster end and substituting your judgment for the patients start?

'Gatekeeping' should only be as far as ensuring the patient/client is safe, has no other morbidities, understands the consequences and is capable of making an informed decision.

Any more is wrong, as is any less.

There should NEVER be any moral judgement and the only concern is for the clients safety.

Gatekeeping for GRS or HRT is exactly the same as for any other medical procedure.

If you are having any invasive medical procedure or prescribed any drug for any condition it is the responsibility of the provider to ensure the client understands the potential consequences and accepts them in that full understanding.

Any more than that is wrong.

I haven't had a chance to read your full thread from before but from the post I read I would be demanding why they are not willing to give the letter. As in please state what are your (the therapists) concerns so that they can be addressed.

My people will send the letter but not give it to me to send. That is purely to prevent letters being copied and sold by clients who then manipulate the letter for 'friends'. Which has sadly happened.

PM me Sis if you wish.

Cindy

I support the informed consent system, which is becoming increasingly more common (at least for everything short of genital surgery, hopefully that will be next), and is essentially modeled after how pretty much all other medical procedures currently work. A therapists opinion should only be necessary if the physician feels there is an issue of reduced capacity to give consent (age, co-morbid conditions, etc.).

That isn't to say I think therapy is a bad idea. It's a great idea. Many people undergoing transition can benefit from a little assistance. But it should be assistance. And for that to happen, you can't have your therapist act as your jury. It's a really bad match.

I felt the two therapists I worked with were useful in terms of accessing resources and moving my transition forward. And they never used their power over my life abusively. However, the simple fact that they had that power made it fundamentally impossible for me to trust them.

I think Sarah pretty much nailed what I was going to say.

For me, the line is drawn when, as a therapist, you make your decisions from the standpoint that you have power over someone's life. I would rather take the view of being there to facilitate a dialogue, a communication, and helping someone to tap into the power they have over their own life.

That involves what Cindy talks about.

To quote Morpheus: "I'm trying to free your mind, Neo. But I can only show you the door. You're the one that has to walk through it."

When someone tells you that you have to walk through it backwards, wearing bright yellow shoes, on the first Tuesday in August, accompanied by two lions and an albino squirrel, because that would make them happy... they've overstepped their bounds.

I went from my GP to a local gender psychologist who seemed to be acting as the gatekeeper for the gender clinic.  Then six months later an appointment at the clinic with the first gatekeeper psychiatrist.  Then another five months and an appointment with the "second opinion" gatekeeper psychiatrist.  In the second year I had a "review" and a meeting with the first gatekeeper for the surgical referral, and just into the third year the "second opinion" on that.  Both the surgical gatekeepers were the same shrinks I had already seen.  I may be missing their point a bit but I can't see any therapy there.  I think the main purpose of all this is to protect the clinic against being sued by someone who gets treatment then changes their mind.

Quote from: Sephirah on November 08, 2013, 01:37:19 PM
I think Sarah pretty much nailed what I was going to say.

...

When someone tells you that you have to walk through it backwards, wearing bright yellow shoes, on the first Tuesday in August, accompanied by two lions and an albino squirrel, because that would make them happy... they've overstepped their bounds.

Do you go to my therapist??

IMO, Cindy & Sarah said it perfectly. I'm making sure to have all my ducks in a row (at additional cost - I don't know if others' therapists have fees for any letters written?) for when I go see the Endo. This is so completely important to me right now that I'd be really pissed if I were gatekept at the Endo's office - even though I asked if it would be necessary. As it is, I'm incredibly fearful it's going to be a case of "we'll do this blood work now and give you the meds at your next appointment..... in 3 months."

This all just adds another level of anxiety on a group of people who generally have anxiety problems!

This is a very good question. I also think it's bizarre that SRS requires these letters but that FFS does not. It just all seems so trivial.