I've been seeing my current therapist for about two years. At the start, I made it clear that I was looking for both emotional and - ah, what would you call it? - I guess support-support in the form of letters for T and surgery as I continued with her. She was okay with this and said that although she wasn't a specialist on gender identity, she'd help me out. I thought, hey cool, maybe I'll have a good chance of success with her.

As time went by, I found that I could get T through informed consent and have been hunting for it through my own means, but still needed(and need) a letter for top surgery. I've been saving for almost four years, and working on my social transition. I've had my name legally changed, to top things off, too.

Just before the new year, I was informed that I could no longer be her patient as soon as I turned 18. I was taken aback, as I had not been told this up front, but apparently her practice only works with people who are still in high school. Great. I would have appreciated knowing that before, but it's a bit late for that now.

I'm about to turn 18, and decided that since I have a good portion of my top surgery costs saved, I'd like my letter now so I can reserve a surgery date. I printed off an example of a supportive letter, and brought it with me to last week's session with her so I could ask for one. She said sure and I left feeling like I was going to have no problems.

Today I went in, and she handed me the letter. It was...neutral. Upon asking her about it, she told me that she could not write me a supportive letter because she's not a specialist.

What.

WHAT?

I've spent two years of my time and money(MY money, from MY SAVINGS AND WORK) working with her, and this is just one big slap to the face. I tried to find a way to persuade her to write a supportive letter, but to no avail.

I've been betrayed and I'm angry as hell. HOW is this fair? I've done everything I can, and this is just messed up.

How am I supposed to get this stupid letter now? I'm not going to waste months or years of my time and money trying to get what I need from another therapist only to be let down again.

I hate gatekeepers. This is MY body, not theirs. I will sign any documents waiving her liability, but she still won't give me a supportive letter.  I hate this.

I work so hard to make ends meet and work on my transition. I live with my mom, but don't receive financial support beyond having a roof over my head due to our own financial situation. I've practiced self control in my spending and have been responsible all this time, so how dare my therapist pull the rug out from under me?! How DARE she?!

I want this to stop. This is messed up.

I'm sorry. I just can't take it.

That really sucks.  I'm sure if you search a little you can find a therapist in your area or one who will do online meetings that will give you a letter after one or two sessions.  I personally got my surgery and T letter after one session.  The hormone letter is not even a requirement anymore according to WPATH standards of care but some docs do want one.  Either that or go to a surgeon who doesn't require a letter for surgery, there are ones out there.

As far as her not being a "specialist" I do believe that is BS and you should try to report her for leading you on.

The majority of the therapists in my area are transphobic or out of my cost range, though the trans* friendly clinic I'm going to get T from says they can do the whole letter spiel, among other things. I might schedule an appointment with their therapist and ask about this, 'cause I'm not interested in playing games over this anymore.

I say report that fragger. That's totaly not kosher in the medical field and she should be flagged for it.

As for another therapist, i say try to find one but make sure they state what they'll do out front and even have it in writing/documented so they can't go against it and get it certified. That may be the best way to make sure this doesn't happen again.

Quote from: Zerro on April 25, 2012, 12:26:19 AM
The majority of the therapists in my area are transphobic or out of my cost range, though the trans* friendly clinic I'm going to get T from says they can do the whole letter spiel, among other things. I might schedule an appointment with their therapist and ask about this, 'cause I'm not interested in playing games over this anymore.

There are online therapists so you don't have to stay strictly local.

Have you tried going to her superiors, or to whatever organizations she is a member of (AMA, APA, whatever)?

I had a very similar experience and I did some arguing and dropped some loaded words and questions about legalities, and things turned around.

I know this is none of my business, but before people start demonising this therapist, I would like to ask: with regard to the letter, did you make it clear at the start what kind of letter would be involved? Like what the tone of the letter would need to be, for example?

As you stated, she said herself she isn't an expert in the field of gender identity, so maybe she's never had to write one before. I don't think it is BS to make the point of not being specialised in gender identity, when liaising with someone dealing with such issues. I am currently thinking of training to become a therapist myself, and in all the courses I've looked at, gender issues are a distinctly separate, and involved area within the broader curriculum.  It has distinct fields, such as bereavement, gender identity, sexual etc. It's not a catch-all field of expertise. To not have specialised in gender and gender identity is, I think, a valid point to make. Otherwise it would be like expecting your local GP to be able to perform neurosurgery because "hey, they're a doctor, right?"

I understand why you feel the way you do, and you have every right to feel angry and hurt because you feel that someone you trusted has let you down and like you've wasted a huge amount of time and money. But I would also ask: is there any possibility that it was a simple breakdown in communication between the two of you at the outset, and a failure to establish, and agree upon, a mutually satisfactory outcome before taking up her services, rather than any deliberately malicious act of betrayal?

Maybe she is just being difficult and a jobsworth, hiding behind the lack of expertise. That's a distinct possibility. But also maybe there's a possibility that your hopes and overwhelming need to do this led to a greater expectation of what could be achieved with her than was actually the case.

I really hope you manage to obtain the letter you need from elsewhere and get that which you've sought for so long. Whatever the reason, that is a really unfortunate and, I'm sure, a massively disheartening thing to happen. I'm really sorry it has happened, and I'm sorry for playing devil's advocate with this. But I know how instinctive emotional reactions to things sometimes are different to those thought about in the cold light of day, as it were. All I would say is don't be too hasty to assume that she did what she did out of some deliberate intent to make your life awkward, even though that's what's happened.

If the clinic you attend can do the necessary, then I'd just go with them and ignore the rest.

I had this happen to me once before. That's why I won't see one ever again.

I'm sorry that things haven't turned out the way that you wanted - the level of frustration you must have right now must be unimaginable. *hugs*

Sephirath's post is insightful.  We don't know of your exact circumstances, but what she wrote as devil's advocate may be a distinct possibility.  I personally feel though that she may have felt the need to help you initially, thinking that she'd be able to see your case through to the end, but as time went on, found that she may have actually gotten over her head so to speak when it became apparent that you are dead serious about surgical changes to your body.

She might not have had the fortitude to say to you "I've hit my limit on how far I can help you at this point, I know of someone who will be able to finish the process for you and I will forward my recommendations and that person will confirm it"

From her point of view, if she's misdiagnoses you, you have irreversible surgery and regret it, even if you sign a waiver, she may still end up liable in a court of law.  The medico-legal system is bizarre in that respect (trust me on this one - lawyers defeat logic every time!), and I suspect that this may be part of why her letter was neutral.

Given what has happened, at this point, I suspect that you would find it hard to continue in a positive working relationship with this therapist.

Dwelling on this too much will build up anger and angst, to try and move onwards, a constructive and positive way forward you might consider is:
1.  Find a therapist specialised or with expertise in gender issues first who is willing to take your case on.  If you still feel as though you are on talking terms with your current therapist, it may be worth your while to ask for a recommendation from her.
2.  When you've done so, request that your therapy records be forwarded from your current therapist - this will allow your new therapist to have a better baseline to work from and cut down the number of sessions you might need drastically.

There are some surgeons that don't require a letter, but if you had your heart set on one that requires it then there's not much choice. I was in a slightly similar situation years ago. I was in therapy for my T letter and felt like it was going nowhere so I quit. It makes matters worse to know that therapists with a gatekeeper attitude or ones that wont write letters because of lack of experience are the majority of therapists.

Woah, lots of responses. Okay so...

-JayKyle: I might report her, but I'd rather talk to both her and her boss/superior/etc. first before doing anything drastic. Same goes for any suggestions that I take legal action. Really, she hasn't -done- anything illegal, just inconsistent and a bit misleading.

-Andy & Jayr: An online therapist might work out, but I'm going to talk to the therapist at the clinic I'm getting T from first, since it's a bit cheaper and they state that they can do the whole letter thing. If it's not going to work out with them, I'll try an online therapist and see if that's better in the long run.

-Sephirah: Actually, we did get into what kind of letter was needed in the earlier sessions. I brought an example of a supportive letter and we read over it together. At the time she said that she could write it. According to the standards of care, the therapist doesn't -have- to be a specialist in gender identity issues, but they should have an established 'relationship' with their client and consistent symptoms of not identifying with their birth sex, as well as a desire to change their body/pursue changes/etc. If they've recorded these things in their patient's records for a good period of time, then they're qualified enough to write supportive letters.

But granted, had she just up and told me "I've gotten in way over my head and don't feel okay with this" before anything else went down, I would have appreciated it. It's possible there was some sort of miscommunication between us, but she won't say anything to me about it. I've tried asking her about her feelings on the matter or if there was any sort of issue we didn't address in our sessions, but she just kind of skirts around the questions with no solid answer. I have no issue with people playing devil's advocate, I just wanted to vent because I'm just overwhelmed with stress right now.

-Luna nyan: See, I can get that fear. Fine and all, but I wish she would have just up and SAID something as soon as she started thinking she wasn't cut out for the job. I could have found a different therapist and been on my merry way without investing too much of my time, money, and energy into seeing her. I'm still on talking terms with her, and have already had my records transferred to the clinic I'm going to get T from, so I'll just try shopping around for a therapist who doesn't need to hold me down for a few years and can work with me.

-Nygeel: I'm aware that there ARE some surgeons who don't need a letter, but I've been set on Garramone for his prices and results since I started saving. I also live within a reasonable distance from his practice, so it sort of works for me financially. If he needs a letter, I'm willing to get one. The letter thing isn't too big a deal for me, it's just the whole dealing with powermad/confused/whatever gatekeepers that's draining for me.

Thanks for your insight, people. I'm a bit calmer today, I just really needed to rant about it.