I'm 32 years old. I have lived my life, regrettably, as a male for all of my years so far - believing inside that what I really am is a woman. About a year ago, I sought counseling with a therapist my insurance company referred me to and I feel like I am no closer to transitioning today than I was a year ago. Can you advise me?
Trapped in Southern Indiana
For a person struggling with gender issues counseling can be a very overwhelming, and in some cases, a very ineffective experience. If you have been seeing a gender therapist, or perhaps just a therapist, for over a year, and you find yourself writing an online advice column for answers about why you haven't moved toward your goals, it might be time for a change! If nothing else, it is imperative after a year of counseling that you understand where you are headed and how you are working together to get there!
Unfortunately, most therapists, psychiatrists, counselors and other mental health providers are not adequately trained through formal education to address the needs of gender-variant clients. To become prepared, a clinician, like myself, must pursue ongoing education through workshop attendance, staying current with relevant reading and research, membership in professional organizations such as WPATH, and gaining real experience working with this population. Most therapists will naively accept clients who are dealing with gender conflicts, assuming that by attempting to apply basic counseling techniques, they will benefit the client. Unfortunately, this is often not true and can inadvertently cause delay in getting the assistance needed.
Ideally, a gender therapist should...
1) Clarify the issues through a quick diagnosis (which should take no more than a few sessions at best) to distinguish between transgender and a mental disorder that appears to be transgender, but is actually not.
2) Assist the transgender person in considering the implication of a gender transition - neither encouraging, nor discouraging, the person as they make their decision. Provide accurate information about the requirements of a transition, the common pitfalls and challenges. The counselor must also be comfortable assisting individuals with complicated, and at times, disturbing, life decisions.
3) Assist the individual in finding other resources that will assist in whatever transition process the client has chosen. This includes common issues involved in a transition such as name-change process, hair removal option, physician referrals, and all other resources related to a gender transition.
4) Assist individuals in exploring realistic alternatives to gender transition. The best decision for dealing with a gender conflict is different for each client. A skilled gender therapist will offer creativity, flexibility, and the capacity to envision resolution when there seems to be none.
5) Provide marital and family counseling services or connect them to a friendly provider through professional associates to help spouse, parents, children and other family members deal with the changes that are occurring or will occur.
6) Be of help with workplace and professional issues, offering guidance to clients about how to decide if and how to transition on their current job.
7) Offer gender-specific therapy and support groups (not mixed-groups with multiple issues - such as sexual orientation as that is a different focus all together) that are effective resources in helping individuals refine their social skills and become comfortable in their new gender expression.
8) Have a deep sense of appreciation, not pity, for transgender people.
9) Be familiar with and able to apply the Standards of Care (SOC's) of the Harry Benjamin International Gender Dysphoria Association. These standards should be applied with fairness and integrity.
10) Outline the specific requirements that the therapist will expect of the client in order to fulfill the SOC's . This should be done in a way that both client and therapist will be able to agree when these requirements are met. Clients should always ask and expect an answer to the question, “What will I need to accomplish before you will write a letter of recommendation for hormone (or surgical) treatment?”
11) Have experience writing hormone and surgery letters.. It is okay to ask the therapist "How many HRT letters have you written, and how many SRS letters have you written?"
12) Provide a helpful and even pleasant experience.
I hope this helps you on your journey to your truest self.
Michele O'Mara, LCSW