OK, so I was initially looking for something that would give me information on how therapists diagnose transgender patients to better understand what is happening in my therapy. I ended up finding a German conference paper by Sophinette Becker titled ,,Transsexualität – Geschlechtsidentitätsstörung" (transsexuality – gender identity disorder (published in 2004). As you can already see from the title, the terminology and some of the concepts/ideas are outdated. Some of it made me cringe a little, but yeah, it's ten years old. Anyway, it has a short chapter on counter-transference and like I said that was interesting to read. I know, in theory, that counter transference exists, but somehow I never thought of the fact that it could actually also be affecting my therapist. I mean, I don't know it does, but it could be. One or two things he has said recently make me wonder in hindsight.
Anyway.
The article says that doing therapy with a trans* person can be a particular challenge for therapists. It may be very difficult for them to remain neutral throughout a trans* person's exploration of their gender identity and the process of coming to a conclusion concerning transitioning etc. For example, they have to position themselves by choosing to address someone with male or female / correct or incorrect name and pronouns.
Becker states how working with trans* clients requires therapists to deal with strong emotions and affects on their side, and requires them to be adept in dealing with counter transference. Some of the emotions that therapists experience, often in fast succession, are:
- feeling powerless and devalued
- feeling manipulated
- feelings of omnipotence ("I can heal the patient / redeem them by providing therapy or giving them access to surgery")
- the wish to reach complete consensus with clients so there are no conflicts (only grateful, idealizing clients); wish to symbiotically feel the "transsexual wish"
- distancing, hatred, sadism, invalidation (denying empathy with the transsexual wish)
- feeling paralyzed and helpless
- activism to show affirmation (,,I do whatever the client wants")
- fear, e.g. fear of castration or destruction
- feeling pressured by the client (e.g. because a client threatens suicide)
- confusion – because clients are perceived sometimes as their assigned, sometimes as their target gender; but also because working with trans* clients touches on the therapist's own history of developing their gender identity, with all its scars and ruptures
A therapist working with trans* clients can never remain ,,innocent". If they deny the ,,transsexual wish", they abandon the client thereby driving them to suicide, rash decisions pro surgery, among other things. But if therapists support trans* clients in their wish to medically transition, they are ,,guilty" of participating in the (perceived) ,,mutilation" of their clients, in their taking irreversible steps and decisions.
The article concludes by stating that it is crucial that therapists are aware of their intricate involvement when working with trans* clients, and that they are prepared to feel and cope with all those emotions.
So I'm not quite sure how "state of the art" any of this is, but as I said -- to me it provided an interesting perspective on the relationship with my therapist. I sometimes forget that there's a human being at the other end, and that the therapy relationship is _not_ a one way street.
