I have a confusing situation regarding my new therapist. The therapist specializes in LBGT and is a transman in his twenties. He is licensed but is an intern under supervision of a clinical psychologist. The program is specifically for LBGT individuals and is a new program funded by the state of California. I saw him three times and on the third session we had to go over my diagnosis and a set of goals so that he could get approval for a further 25 sessions. I am his first TG client. The issue is that on the form my diagnosis was an adjustment disorder but not GID. The rest of the document details evidence of the diagnosis but they are all gender identity issues and are said in that way. According to my reading of the HBSOC, there is overwhelming evidence that GID is my primary issue. I asked him why GID was not there and he wouldn't say exactly except that it was a controversial diagnosis and he didn't want to saddle me with it. It was that he didn't believe that GID was a proper diagnosis for anyone.

I have asked him to give me a referral letter to a local endo who specializes in TG but he not only does not know her, he says that he has to call her to see what she needs to have in the letter before he can write one. (A bit of background, I am on DIY Estradiol gel and spiro  and trying to get to see an endo to get proper care. ) I was of the understanding that the letters like this are generic and I could take it to any endo of my choice. He has never written one of these letters. I have asked him three times and he agreed to do it but it is clear that he hasn't even looked into what is supposed to be in such a letter.

The third issue is my SO. She is having problems adjusting to my transition and wanted to help me and so she found this therapist and called him for me. I then met with him and began therapy. The past week, she felt she needed to discuss the issues with him as he had offered to do couples counseling initially. I asked him to call her at work. He said he could not do that legally. I could have her call him. So I did, she called and he pretended not to know her. He further said he could not discuss me or our case unless I signed a "release form" The entire call was so cold and matter of fact that she was completely put off. Now she says she cannot see how she would take any counseling from such a person and won't see him.

This all brings up a decision point for me. It seems like the therapist is unable to understand Transgender treatment issues, unresponsive to my questions, and unnecessarily cool to my SO when I asked him to speak with her. I am thinking that this is strike two in my attempts to go to therapy. I have lost confidence in his ability to treat me.

Any thoughts?

Well, the "disorder" part of GID *can* be a problem. I don't know where or how, but many people hear that and think "mental illness." And if you're paying for sessions through insurance, they may not cover GID issues specifically. Therapists will often call it something else, such as "depression," to get it covered.

Generic referral letters are tricky. I asked my therapist to write one, but she instead insisted that I make a list of doctors I would be contacting, and she wrote letters addressed to each. Different doctors DO have different requirements as well, although my doctor barely even looked at my letter.

As for your wife, it sounds like your therapist was doing the ethical thing in not talking about you with her. He can't, or shouldn't, be tracking HER down at all. She has to initiate contact, and your therapist probably DOES have to be given (written, not verbal) permission to discuss your case - even with your wife.

~Kate~

Just to clarify the situation of this therapist, he is not an intern.  He is a resident.  The way it works is while you are in school, you go through a year's part-time internship where you work under supervision, sometimes with patients, but you are not licensed.  After you get your license, you have to go through a one and a half year full-time residency where you are also working under supervision, but are freer in how you handle your clients.  If this person is licensed, he is a resident.

Isn't it a requirement to have a diagnosis of GID to get HRT?  We talked a lot about my transition and such but how can it proceed without following the HBSOC at some level?

Just based on what you say, it seems the therapist is following his training and protocols, and the lack of experience is driving the decisions. If you are getting insurance coverage for your issues, then it may be GID isn't covered or isn't covered as a primary condition. Most therapy programs, especially those covered by some insurance, requires a diagnosis, a treatment plan and a limited full-coverage number of sessions (often twice a month plus a few emergencies per year with a limit in years).

I am surprised if he is a transman and working in LGB"T" issuses, he doesn't know the process and work. He has his own experience to work from and likely knows other transpeople to help.

Do you have primary care physician? If so, the therapist can write the letter to them and they can, if they don't do the necessary blood work in-house, refer you to an endochronologist. Otherwise, it seems reasonable to me the therapist write a specific letter. I don't know of any who write generic "To who it may concern" letters for hrt. This doesn't stop you from finding a endochronologist and discussing your interests and asking them about the letter.

As for the SO, it may be the lack of exerience or interest. Finding another therapist is your choice, but it's worth exploring if you're uncomfortable with your current one to find a new one. Remember if you do, you have the responsbility to inform the old one if you want him to forward any information or records.

Just my thoughts. Good luck.

--Susan--

Quote from: SusanK on October 27, 2007, 09:38:23 AM
I am surprised if he is a transman and working in LGB"T" issuses, he doesn't know the process and work. He has his own experience to work from and likely knows other transpeople to help.

Exactly.  If he is trans, he should know the process like the back of his hand. 

Sounds like he is giving Maggie the run around.

Over the weekend,as I have let this information settle in my mind, I have become increasingly worried that I am insane. My SO feels that the reason I was not given the GID diagnosis is that this therapist's supervisor suspects that I am not TG but mentally disturbed. When I asked a direct question of the therapist, he was evasive and wouldn't look at me. It is true that I had a lot of childhood abuse and that my mother told me when I was six that I was supposed to be a girl. However, I lived most of my life in the male role, at least, I thought I was. Only in the last seven years has TG become dominant. The clinic has no experience in TG but still since they are "experts" and I am the client, I cannot dismiss what they said. I am so upset about this that I am in a near state of panic. I can't go back to the therapist because I lost confidence and my SO was treated so coldly that she won't see them either. I just don't know where to turn now. Am I supposed to find a shrink that specializes in people doing act and look TG but are not TG? Who does that? What kind of nutcase am I?

Hi Maggie,

   I'm sure you are not a nutcase.

  I agree with some of the others that sometimes the doctors and therapists avoid the GID diagnosis because of insurance reasons.  I went to a clinic and they used to use anxiety/depression as my reason for seeing them. They did, however, agree to treat me with HRT, but by then, I realized it was not how I wanted to handle myself.
  I'm surprised that they haven't worked to get you under supervised HRT, but then I don't know everything.

  Maybe it's a coincidence that these therapists are not really working for you.  One option might be to stop seeing them and begin the process over.  Maybe look into alternative therapists and doctors.  I understand the process is a little freaky in and of itself.  But you want a path that feels right to you.



Rebis

 

I'm feeling much better about my status today. The situation is still shrouded in mystery as there is no insurance component involved. The program is a state funded program to help LBG and T people get counseling services. Now if they won't fund Transgender therapy if I am diagnosed as transgender, then the program is bogus. Then again, we now have an anti-contraceptive activist running Title X, a government program for contraceptives for the poor so I guess that is how it is done nowadays. We have a program then make sure no one can actually use it...
My SO is a major part of this. She disapproved of the new therapist and I felt the pressure to stop from that.

I think the lasting damage is that now I can not wear my clothes anymore. My SO no longer considers me to have a transgender condition and am treated as fully male which really stings. She is delighted and I want to bang my head against the wall. Now if I can't even consider another TG therapist.





Posted on: October 30, 2007, 10:18:58 AM

---

The therapist called and we chatted for about a half an hour about the issues. He was affirming that he always was supportive of my gender identity as female. I asked again about the lack of GID diagnosis. He feels that GID is a pathological psychiatric description for a medical condition and it is inappropriate for use. He did acknowledge that it may need to be in the letter to the endo. What has been now established is that my SO is using the information ( that I gave her) incorrectly for her own needs and that I am out of therapy and cannot return. He did invite me back and I would if my SO would agree. However, that is not likely to ever happen since she is now convinced that I am not TG.

Hi,

   I'm sorry to hear about the SO stuff.

   As for the possibly fake clinic, that may be true about them being allowed to set up and then told to not do anything that would help patients.  Being state funded may mean being patient unfriendly because there's always some non-medical people making decisions.
   They may have an order to not encourage medical transition.  Maybe you should look for a regular place that isn't state funded.

Just a thought.


Rebis