Choosing a therapist

You will make some important choices of service providers in your transition:

  • Therapists (primary, and a second opinion for surgery letters)
  • Hair removal practitioner (see my page on choosing an electrologist or laser practitioner)
  • Physician(s) (general, and possibly another one for hormones)
  • Plastic surgeon(s) (SRS and/or other feminizing procedures)
  • Financial adviser (recommended, not required)
  • Legal adviser (recommended, not required)

Key point: all of these people are being paid to provide you with a service. If you are not satisfied with the service, say something. If that doesn't help, find another provider.

Finding a therapist

Self-acceptance and coming to terms with your feelings are the first order of business in transition. For that, it's very useful to see a therapist. Even if you know how you feel and know what you want to do.

Ask TG people and organizations in your area for recommendations. The key is getting first-hand experiences and personal recommendations. To find people for this advice:

Ask local TS women
 
This is the best way to get candid information. If you don't know any, try the methods below to get in contact with someone.
Ask local providers of TS services
 
TG-friendly electrologists, doctors, etc. might be able to point you in the right direction or put you in contact with patients for first-hand information.
Look through a national TG group
 
I recommend gender.org's resources by state, or the IFGE's site.You can order Transgender Tapestry Magazine, which also lists therapists and TG groups by state.
Look through a local TG group
 
You can also use the TGForum's website to search for local TG groups who can help you. Local groups are an excellent source of information. Most have a newsletter you can get, and some even have hotlines. You might also consider attending a meeting-- many people find the group support very important in their transition, and the people there can help you find local resources.
Look online

A List of Therapists Experienced in the Treatment of Transgender Persons by Becky Allison

You might try GLITSE (Gay Lesbian International Therapist Search Engine).

Catharsisonline.net offers anonymous counseling online.

Look through newsgroup posts via Google:
 
Go to Google Groups advanced search.
 
1. Search for your city name in the top field
 
2. Type in newsgroup names in the newsgroup field: "alt.support.srs" then repeat with "soc.support.transgender"

3. Copy the email addresses of anyone from your area who has posted something smart-sounding.

4. Write to them privately, asking for a therapist recommendation.

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What to ask clients

Ask about rates, hours, schooling, etc., but the main thing is to ask about the therapist's style, opinions, and policies. Some therapists require more than others before they'll recommend hormones or surgery. Some use a kind of weeding-out policy, trying to test your conviction. Some feel they are gatekeepers who must keep people from making mistakes, and require a lot of sessions. Others are much more open or easy-going.

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What to ask therapists

  • How many TS patients do you have?
  • How many women have you recommended for surgery?
  • How long have you been working with TSs?
  • What is your educational background?
    • Remember, one of your SRS letter writers must, according to the Standards of Care, be from a doctorate-level clinical professional: "If the first letter is from a person with a master's degree (M.A.), the second letter should be from a psychiatrist (M.D.) or a clinical psychologist (Ph.D.). If the first letter is from the patient's psychotherapist, the second letter should be from a person who has only played an evaluative role for the patient."
  • What books on TS issues most influenced you?
  • Have you written any books or articles on the subject?
  • What got you interested in working with transsexuals?
  • What is your basic philosophy about how to treat this condition?
  • What is your opinion of the Harry Benjamin Standards of Care?
  • What is your hourly rate?
  • What length of session do you usually prefer?
  • Is it possible to do longer or shorter sessions?
  • How long do you usually see patients before you might OK them for hormonal therapy? SRS?
  • Are you affiliated with any endocrinologists or plastic surgeons?
  • Are you part of my insurance network?
  • Would you be willing to classify our sessions as depression in order to meet insurance requirements?
  • What are your hours?
  • Do you have weekend or evening appointments?
  • Do you work from your home or from an office?

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Don't be afraid to switch to another if necessary

I say this because too often I hear people say their therapist isn't being responsive to their requests. If you feel that's the case, you should speak with them candidly about that, and listen to their reason why. Keep an open mind, because they may be right. However, if you are not satisfied with their reasons, don't get depressed or angry. Go elsewhere.

Continuing in a frustrating therapy relationship can be counterproductive and even dangerous. It can lead to a point where unresolved issues boil over.

It doesn't have to. If you look around, you can always find a way to get things done.

Example: I have a friend who went to a gender therapist who said, "You're not TS... you're just a swishy little faggot." No lie. While most people won't run into that extreme an example, if it looks like your therapeutic relationship is not going to lead to the outcome you desire, you should go elsewhere. My friend had her SRS this year, and got letters from other therapists. Don't stay with a therapist if the outcome you desire looks hopeless.

Think of your TG professional relationships like romantic relationships: if you're unhappy, you need to talk about it. If you feel the relationship is worth keeping, you should try to work through the issue at hand. If it seems hopeless, you should move on. Simple as that. I had several service providers give me answers I didn't like, so I left. Don't settle. It's your money. If no is their final answer, move on.

People say, "But I've made an investment in this therapist of this many sessions and this much money." Well, you may need to write that off. Yeah, that sucks. If you want to avoid wasting time or money, talk to others before choosing a therapist.

The best way to avoid getting in an unproductive therapeutic relationship is to read the information below.

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My general opinions on therapy

Keep in mind that if there's a specific thing you seek (such as hormones), you may be able to get those directly from a physician without therapy.

However, I feel seeing a therapist is very important. I learned a lot in therapy, about myself and about the best way to transition. I believe self-acceptance is the key to transition, and therapy can help with this. The other important thing is realistic planning and expectations, and again, a therapist can be very useful for helping shape your plan based on your specific needs.

The biggest problem with therapeutic relationships involving a gatekeeper mentality is that clients are prone to hold back information that might jeopardize their chance to get the approval letters they seek. This can make therapy lees about helping you adjust and more of an adversarial relationship. It's best to find a therapist you trust.

I have continued therapy after SRS and have found it very helpful. Often, emotions and problems that were not adequately dealt with during transition can catch up with you upon completion. I opted to go to a different therapist who has no experience with gender issues following transition.