In my session this afternoon the subject of letters for HRT and/or SRS came up.  I had been trying to work up the courage to ask for one for the past couple of weeks, although until my wife gets pregnant (no success on that front this month), it's really a bit premature, and based on everything we'd said in sessions up till now, I'd assumed that it wouldn't be a problem.  Today, though, the conversation just sort of worked its way there, and I found out that my therapist writes no letters for any clients as a matter of policy, because she feels it interferes with the therapeutic process.  She actually had me work out on my own the reasons why asking for a letter could be problematic in terms of the work we've been doing together before she gave me the news, so I understand it, and I even agree, philosophically; having the request for a letter hanging over our conversations was preventing me from speaking freely and openly, and it's galling that I should have to look to her for any sort of "permission slip" for my own body.  Still, it's a setback, even if it's probably only a minor one, practically, and I feel let down and a little humiliated.  It feels like I just asked someone I really like out on a date, and they rejected me.  Even if the reasons are good, even if it's nothing specific about me or my situation, she still told me no.

I'm trying to hold onto the fact that she did make clear that I don't need to ask for permission, and that her goal and desire is to support me and help me become a fuller, happier, more whole person regardless of what decisions I make vis-a-vis transition (or anything else), to help me find and express my more authentic self, &c., and that she will work with me on me as I move through the process; that she's not telling me she doesn't agree with me or think it's a good idea.  As I reflect on it, I think there's a possibility that she's trying to push me toward taking firmer, more assertive action on my own, and not relying on others to hold my hand or "do my transition for me."  Or maybe I'm reading too much into her, though even I am, that's not a bad outcome to reach for.

It all happened toward the end of the session, but I want to believe that there was a release of tension after she told me and I'd had a moment to absorb the news.  Like, knowing that no letter is coming, even if disappointing, means I could let some barriers down, not have to be so careful in what I said, not be putting on a performance.  Wishful thinking?  Who knows, but I hope not.  I really do value the work we've done together so far, and I really do like her a lot.  I think there's enormous potential in the work we can do together, and having this matter put to rest relatively early will hopefully make that work that much easier to do.  I think I used a little bit more casual speech, post-revelation, which is probably to the good.

She also said something about my talking about transition as if it were something I could succeed or fail at, rather than an experience I go through, and she has a point.  It does feel that way to me, and I wish it didn't.  Especially when I feel, right now anyway, like my chances of success are a lot slimmer than my chances of failure.  I want it to be a journey that I can appreciate the experience of the whole way through, and not just a set of goalposts, but the goalposts are what I'm seeing right now, and I'm doubting a bit my ability to reach them.  It all seems so far away.

So anyway, not sure there's a larger point or wisdom to be gained from any of this, but I wanted to share.  I'm a little shaken up, but it's not over.  We'll roll with it.  Thanks for listening.

The time and place where I transitioned, I couldn't go on HRT without a letter. If that is the case for you, I see the same problem I had at one point in my transition where I was in therapy with no hope of progressing beyond that point.

Now it is possible to use informed consent where you can go on HRT when you feel you are ready without a letter.

You need to understand what rules apply in your case and learn how to get hormones when you feel you are ready for them. If a doctors letter is required, you may be wasting your time with a doctor who refuses to write a letter. Learning the rules will help you save your money for some of the more costly things that will happen in the future.

It sounds like you're doing some good work with this therapist -- it also sounds like you have the wisdom to value that over not getting a letter from her. You deserve a lot of credit for that! Still, it's a pity she couldn't have been more upfront with you about that, especially if HRT and SRS are things you've discussed with her before.

If it turns out you do need letters, perhaps she can refer you to someone who will write them, and "put in a good word" so that person doesn't eat up too much of your time and money. That sorta seems like the least she can do...

It would be good, too, to be direct with her about your feelings about this -- in my experience (more than I wish I'd needed!), letting therapists know how you feel when they do something you don't like can lead to good things.

But anyway, it sounds like you're dealing with this like a champ!

Thanks; I definitely plan to continue working with her; it's like no experience I've had in therapy before, and I think there's an enormous amount of potential there.  But, it's also very abstract, and I can in retrospect why she wouldn't write letters.

It's a bump in the road, but not a brick wall.  I have options; I just need to figure out what the best ones are.  I haven't actually contacted the endocrinologist I plan to see, because it's premature for that given the pregnancy situation, but maybe it would be worth calling and finding out what her requirements are.  Se has a lot of experience with trans people, and she's affiliated with the same hospital as my primary doctor, so those are good things.

I won't lie; the feeling of rejection still stings a little, even if it's not actually a rejection, but I think there are positives that can come of this.  I hope so, at least.

So, I've done some searching and made some inquiries, and found someone who will write a letter with a relatively small number of visits, and while not outright promising a letter did say that one was likely given the situation and history I'd outlined in my initial contact, but he is not covered by my insurance, so I would have to pay out of my own pocket.  He can also provide me with a list of other therapists who would be covered, but might not necessarily provide a letter within the same timeframe he would.

Meantime I've started and deleted several letters to my current therapist, but can't seem to figure out just what I want to say, or how.  I cycle between this development feeling like no big deal, an easily surmountable hiccup, and the death knell of our therapeutic relationship.  While I have options that will get me to the next step (even if I have to cough up a not-insignificant amount of money for what amounts to a pro forma permission slip), I have concerns about long-term planning; can I afford to invest in work with my current therapist only to have to scramble for letters when the time for SRS approaches?  Can I do meaningful work with her knowing that practical help with my plans are in her power but off the table? 

And, in a more abstract, but possibly much more important, sense, do I still believe that she's supporting me and has my best interests at heart?  I'm not so sure of that anymore.  While the work we had started together was interesting and unlike any experience I've had in therapy up to now, I'm not certain I believe in its potential as much as I did.  It just feels a lot weirder and less promising than it did before, and that's sad.  I had been looking forward to every appointment before, and now I just feel unsure and apprehensive.  I wish it could go back to feeling the way it did, but I don't know whether it can, and even if it were to, there still won't be that letter down the road that I'll need.

The whole situation stirs up old feelings around my previous gender therapist, too, and the way she kind of gatekept me/allowed me to gatekeep myself, years ago.  My current therapist knows some of that story, and about the disappointment and hurt I carry over that, and I suppose I'm going to have to tell her that she's now the source of some of those same feelings.

I don't know. 

I guess at our next appointment, I'll need to sit in the chair (we use a couch, typically, but lying on the couch would create just too weird a power dynamic for the conversation we need to have, I think), and lay some of this stuff out, and see from there whether this is a relationship that's worth continuing.  I'm beginning to suspect I know the answer to that, but it makes sense and it's only right to have that conversation with my therapist, and not just in my own head.

*sigh*

Thanks for the time and space to work through some of this.

L

Can I make a suggestion? Print out what you just wrote (don't even edit it), take it to your next session, and give it to your therapist to read. You express your feelings so well here, confusion, ambivalence and all -- I think this would be a great starting point for that conversation you need to have with her.

Thank you.  My wife said something similar.  To me, that post feels like it's leaving so many things out, but to her it makes sense.  As you said, it's a starting point to the conversation, at least.  Maybe that's all it should be.

I would look for a second therapist. Even if that means waiting a little so that you can get one that is in network  (babies are expensive).  Transitioning is a long and expensive process.  This marathon.  Not as long as raising a child but it takes a while.

Start planning it out and then implement.

Hugs

Jen

Yes, I think that's the direction I'm heading. I've gotten some names, and will make contact with them to see if we're a good fit, and unless my next session with the current therapist goes places I really don't expect it to, I think, sadly, that it's probably time to move on. I'm surprised that I'm grieving that so much after only a couple months working with her, but so it goes,I guess.

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I'm not sure where you are, but my first therapist never wrote letters either, however she would do referrals to an informed consent clinic that would do a one hour intake session and prescribe in the same day after you sign a piece of paper saying you know the risks, provided your bloodwork was already done. It may be that you've run into a similar situation. I did switch therapists and found yet another one that doesn't do letters, but I still ended up at the same clinic the first one would have referred me to because the second one did.

I'm in CT. Informed consent clinics in either NYC or Boston are within the realm of possibility, but there's a particular person in-state I'd really prefer to work with (not to mention travel, waiting lists, &c w/ the clinics), so the letter is an unfortunate necessity. Plus, thinking long-term, I want to have a solid letter from someone I have an authentic working relationship with for Dr. McGinn.

But I also feel increasingly like the relationship I was building with my current therapist has been damaged just as badly by her no-letter policy as she feels it would have been by my desire for one, just from a different angle; now instead of her not being able to fully trust me not to self-censor, I can't fully trust her to be truly supportive of my wishes & needs.  Different side, same coin.

I chose this person initially because she included something about transgender identity in information I found about her during my research. I'm not saying I think she was dishonest about that (I don't), but I do think it was misleading.  I hope I can be brave enough to suggest to her that she clarify that information so that others aren't led to the same misunderstanding that I was when we meet.

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Without diving too deeply into the details, we met today and it went well, but not as I had expected it would.  I told her what was on my mind, and how I felt; she said that some of it was obvious in my tone and body language the previous meeting, but some of what I was saying she was just realizing, especially in terms of how betrayed I felt, and how I took her position to mean she was standing in my way.  We talked about how intellectually I understood where she was coming from, but emotionally I felt like she was telling me I was foolish for feeling this way, for wanting to pursue this path, and she reassured me that she'd intended nothing of the sort.  We talked about the notion of our relationship feeling broken to me, what that meant, and then she told me she valued working with me, and asked whether I thought that what was broken could be fixed, and whether it was worth it to try.  I said that I wanted to continue working with her, and then we spent the rest of the session brainstorming options for the letter.  I'm going to see a different therapist for that, someone in my insurance network, and kind of separate the deeper "internal self" work from the day-to-day aspects of transition, and see how that goes.

I'm so relieved that we're going to continue working together.  As angry and hurt as I was, I didn't really want to have to end things with her, and it made me feel a lot better to know and hear that she was taking my feelings about it all to heart, and genuinely wanted to work with me to find a solution that would let us continue our work.  I'm glad I didn't do something rash and destructive like fire off a break-up letter, or anything drastic.

Glad you were able to work it out, finding good therapists isn't always easy. I was going to suggest that you keep her for getting the work done on yourself, while getting someone else to get the paperwork done. They can also communicate with each other so you don't get overlap. At least I am pretty sure that they can.


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Well done, and I'm glad you're sticking with her.

It's true that good therapists are hard to find, and she sounds like a keeper.

I just wanted to thank you for posting your experience. It did not occur to me a therapist wouldnt issue a letter. I just happen to be shopping for my first therapist. So i made sure to ask if they issued letters.
   Thats what the forum is all about, sharing so we all learn. I really hope you get your letter and the your future is bright.

You're welcome; I'm glad it was useful for you to hear, and that you made sure to ask about letters up front.  On one hand I wish I'd done that and avoided the shock and hurt of finding out the way I did, but on the other hand, I would have missed out on a really positive therapy experience if I had passed on this person.  So I don't know.

The good news for me is, I had my first appointment with a second therapist, and we're both clear in our understanding that a letter is part of what I'm there for.  I'm going to see her a little less frequently, but her approach, focus. and demeanor are all so different that I really do look forward to working with her.  She's very laid-back, very affirming, very easy to talk to, very down to earth.  So it's a nice balance for me.  I think it's going to end up working really well.

I had almost the opposite experience.

I got a recommendation to a Psychiatrist who deals in gender issues from the Gender Centre and during our first session without prompting he explained the process to me and suggested he could write a letter and referral to a specialist GP for HRT right away as it was obvious I had come to this point after lots of consideration. Also that he could refer me to a therapist for ongoing support or would be happy to provide a few sessions to help deal with my anxiety issues that are mostly related to GD.

I was honestly surprised as I had read so much about gatekeeper doctors forcing people to slow down and plus I was still half hoping to be told "No the GD is a side effect of anxiety issues so take these antianxiety tablets and it will go away". Personally I slowed things down and had a few sessions to help me understand and be confident and trusting in my own feelings then had one session with a GP to talk about side effects, blood tests, possibly banking sperm and then went on HRT.

I was surprised by how easy it ending up being but maybe that is because I had built it up so much in my mind over the last 20+ years.

So I had an appointment with my second therapist today, and she's going to get started on a draft letter for the endocrinologist.  We'll take a look at it at our next session in a couple of weeks, make any adjustments as necessary, and she'll get it sent off.  I plan to start HRT post-orchiectomy in late May/early June, so it's time to start pulling things together.

It's exciting, but it also feels a little unreal, still.  Like, after so long believing I would never actually go through with any of this, the wheels are actually starting to turn, and it's, so far anyway, going OK.  Could it really have been that the biggest thing stopping me all this time was me?