Quote from: stavraki on December 24, 2013, 05:36:19 PM
They probably have some diagnostic issue that they are concerned about, either of Axis I or Axis II pathology, (and our diagnostic system is deeply flawed, don't get me wrong here).  Alternatively, they are the hyper-vigilant anxious therapist, afraid of post-surgery litigation in a world gone completely mental about legal consequences.

Did they explain what the blockade was?

I don't think they had any concern about a psych diagnosis, or if they did, they didn't share it with me. I am a well-adjusted, happy, professional person who has successfully parented two children into their teen years. I've given no one any reason to question my competence.

The evaluating psychologist told me two things. First, that it was premature to write the letter. I was only four months into RLE, (though my surgery is scheduled for the week my first year completes). He told me it was possible I would change my mind. I asked him if he was insisting that I wait until the RLE is over and then write the letter during those hectic few days before surgery. He said no, he would write a letter ahead of time, just not THIS far ahead of time. I asked him what the difference was, and he couldn't give a straight answer.

His other concern was that my wife might take me to court for "alienation". I told him that was a risk I was willing to take, but I could tell by his body language that whatever I said in response to this ridiculous statement was a waste of breath.

After my regular therapist also said she too wouldn't write a letter, I spent 40 minutes on the phone with her. She said she didn't think it would help writing the letter when I was not far enough in to my RLE (this directly contradicts an email from the surgeon, who said she would take letters whenever they come.) By the end of the phone call, I had convinced her to write me the letter (which she did), but I'm still $190 poorer for paying the second guy with no second letter.

Quote from: suzifrommd on December 25, 2013, 07:30:53 AM
I don't think they had any concern about a psych diagnosis, or if they did, they didn't share it with me. I am a well-adjusted, happy, professional person who has successfully parented two children into their teen years. I've given no one any reason to question my competence.

Right, so it's not like you haven't been thinking about this for like a thousand aeons and not like you haven't given your life decision some extremely long consideration of your innate 'wyrd' (it's a good old fashioned word.  One's Wyrd is their innate reason or expression of their 'is-ness' or 'Am-ness').

QuoteThe evaluating psychologist told me two things. First, that it was premature to write the letter.

Right--pretty patronising towards you. I'd be cross/angry here if I were in your shoes.  Given what I assume is your Wyrd of being (see above).  He's/She's (its/they) are using the word 'premature' rather disingenuously.  What I see is what I sometimes see in my therapist colleagues: the word 'premature' is actually about something about the doc that he's throwing at 'you'.  And that is about our society that the doc's trying to be obedient to--the authorities of law governing his practice.  But, right there is how the ethical principle of 'client autonomy' is being invaded by a Code of Ethics.  That is, morality and ethics are in contradiction here.

If I imagine myself in your shoes, some part of me is experiencing the contradiction and that's triggering my inner fighter.  Which, hurled at the therapeutic community, will be interpreted by a psychiatrist through professionalised language as 'your transference--you're adolescent rebellion against me, and so dear client, of course, we know better and you're giving us exactly what we need to justify--delaying your letter.  So in our care-team meetings, we're discussing you as the impulsive adolescent, whose judgment is occluded because you are rebelling and while you are rebelling, we need to contain you until things take their appropriate course.  You will do what we say: you will wait'.

I will add some suggestions at the end about how to tackle this, as a client.

QuoteI was only four months into RLE, (though my surgery is scheduled for the week my first year completes). He told me it was possible I would change my mind. I asked him if he was insisting that I wait until the RLE is over and then write the letter during those hectic few days before surgery. He said no, he would write a letter ahead of time, just not THIS far ahead of time. I asked him what the difference was, and he couldn't give a straight answer.

Okay.  Then, the 'hyper-vigilant professional psychotherapist, who is self-focussed upon his/her (the professional's) anxiety about consequences caused by litigious client who changes their mind, post surgery, for premature rubber stamping of access to surgery.

QuoteHis other concern was that my wife might take me to court for "alienation". I told him that was a risk I was willing to take, but I could tell by his body language that whatever I said in response to this ridiculous statement was a waste of breath.

I wasn't there to hear the other side of the conversation.  My first point.

But--at face value, given what you are saying, this feature is only his/her concern, to the extent that he/her (your therapist's responsibility is to) bring it up in therapy.  But here's the clincher, so that you can decide whether or not and when that ('that' being 'your wife's alienation') matters.  Beyond that point, not the therapist's role--ie not right to use that (that being 'I'm your wife's defender') as justification to obstruct you.

QuoteAfter my regular therapist also said she too wouldn't write a letter, I spent 40 minutes on the phone with her. She said she didn't think it would help writing the letter when I was not far enough in to my RLE (this directly contradicts an email from the surgeon, who said she would take letters whenever they come.) By the end of the phone call, I had convinced her to write me the letter (which she did), but I'm still $190 poorer for paying the second guy with no second letter.

Smells of cat poo dressed up in cellophane paper.  I see what you mean.

I'll put the suggestions/ideas for you in my next post.

thank you for being patient with me to bring me up to speed.  It can be very frustrating to get a whole, multi-month process summarised, in text, to educate the reader.  I'm appreciative of your patience.

Here's some tools to tackle this:

1. The Analysis:  Is your therapist having a counter-transference that is contaminating their decision making.  In this case, my tool for you to use as you would, were the words 'the hyper-vigilant therapist', who is 'anxious about civil consequences' and whose 'anxiety is self-focussed, not client focussed' and so is using the word 'premature' to 'protect themselves, not you'.

2. Things to Be Wary of: 'the psychotherapist ready to pounce' on you and attribute your pressure to rush this forwards as about 'the pathological you': dear client, you're being delinquent.  You are battling your parents, coming out in this battle against me, your therapist.  Your pressure to proceed quickly is pathological and you're being impatient.  We have laws to delay this for a reason.

So, be aware of this and actually use it to your purposes:  *Another way* to put people's obstructions as the food and vehicle for your progression:

3. Self-protectively: to your therapist: therapist, I am feeling infantilised by the parental process involved in transitioning.  I have teased apart, from my transference, which part is about the teenage rebellion in me, and which part is about the invasion of my autonomy by the process of therapy, misused.  I'm wondering if the process is becoming iatrogenic for the client.  (Look up the word - it means 'the therapeutic process as causative of illness, not healing' - entre here core therapeutic principles:

Non-malfeasance.
Beneficence (see earlier post).

Stated in plain language: make the therapist self-reflective.  Get his monkey off your back, so that you can deal with and understand your own process.

4. I have some questions for you, dear therapist

• Are you having an anxiety-counter transference as my therapist, worrying about what's going to happen to you, if you release the letter and I transition and then change my mind?
• I'm wondering how my wife's potential alienation is your responsibility.  Can you clarify that please.  I can assure you, I have spent a lot of time on this one.  I may lose my wife, and I am aware of that, but how have you formed the conclusion that I am not aware of that?
  
• When a client is being directive of the process, and not a passive recipient, are you (dear therapist) experiencing that as a counter-transference.  Are you, not me being the rebelling adolescent because I am being directive?

5. Have yourself truly in a position where you will take responsibility for post-operative feelings.  All that means is - ask the question 'if I wasn't at odds with my therapeutic team, how would I truly feel at this point'.  Make this entirely about you and your Wyrd.

summed up:

Psychiatry might be 'clever' but not always 'smart'.  When you say to a psychiatrist "I am feeling infantilised by being parented" some will grin in that ghoulish way, as their eyes tell you 'got you now'.

When the rhetoric starts, ask them questions.

"are you suggesting that invading client autonomy, by imposed delays, is not potentially iatrogenic, for that group of clients, who have the sense of self to know what's best for them. (that is how to ask a psychiatrist the question 'you don't always know what's best for me, you just think you do', by making them responsible for their own profession--power has responsibilities).  And the question is also 'or are you suggesting that the therapist is always right?"

And one for your own community:

It's the two groups of trans-gendered at opposition.  On the one hand, those who are being pushed by the gatekeepers to 'wait'.  On the other, those post-op/transition attacking psychiatry because 'you got it wrong, my transition was a mistake, and you didn't realise it doc.  I'm coming to get you'.

what should we do about this?