Why Therapy?

[Cindi Johnson]

Please, I don't intend to offend anyone, so take this comment at face value.

Therapists. Do we all really need them? Or is this whole paper chase just an obscene byproduct of Dr. Benjamin's "standards of care"? And who, by the way, appointed Dr. Benjamin as God to all transgendered?

I am well past the age of majority. I have supported myself since I left home at age 18, and have also supported my family. I am a responsible citizen, pay my taxes, don't scream at people I pass on the sidewalk, don't kick my dog, etc., etc., You probably get the picture.

I've been under the knife before: once as a GI in 1971; once to have my knee fixed; and more recently to have cosmetic surgery. And never, for any of these operations, have I needed the blessing of a therapist.

I do not understand why (other than to support an often corrupt profession) I need a therapist's blessing to get hormones or SRS. It's my life. My body.

Just who do these yahoos think they are??? Who else in society, other than those forcibly committed to gov't mental institutions and prisons, are FORCED into therapy? Are we transgendered really that sick??? Are we helpless??? Do each and every one of us need a therapist to lead us through life's problems?

I have a college degree in a more demanding field than psychology. I'm not retarded, ignorant,or uneducated. I don't want their help. Nor do I need it.

And I suspect most SRS surgeons would gladly transform me without a therapist's blessing, were it not for Benjamin's "standards".

All I can say is, thank god for the internet, where hormones can be acquired when I deem I need them. And should the time come for surgery, I'll consider Thailand as a viable, if unfortunate, alternative.

Cindi Johnson

[GypsyKaren]

It's always amazed me that you can get any surgery you want, you can have an extra head put on your shoulder, and all it takes is money while we have to jump through flaming hoops.

However, don't make a mistake by thinking that Thailand is an "unfortunate alternative", I had my surgery there and I can tell you that the quality and care is first rate and their medical system puts ours to shame. Another thing to remember is that the top tier surgeons there do follow the standards to some but lesser extant, but it is a lot easier to get it done there.

Karen :g1:

[Hope]

To be honest, the content of this post makes me think you maybe need to see a therapist. But then I am just one of those corrupt, ignorant, mean-spirited people with a lowly degree in psychology and a masters in a vaguely related field, so my views probably don't have a lot of value in your opinion. I will try to rise above my feebleness if you will be so kind as to lower yourself so that we might exchange information.

The purpose behind almost any SOC is to provide a minimum level of care, and to protect medical practitioners from unfounded litigation when they provide that level of care, or better. I don't think that this one came into existence for any other spooky and subversive reason. All medical professionals and procedures have a SOC associated with them, from cardiologists to dentists, to general practitioners. This is not some attempt to prevent people from getting the care they need, rather it is an attempt to get people the care they need, and to protect the professionals who provide that care. Sure, you can get some shrapnel cut out of your arm, or you can get a hip replaced without any sort of questions being raised because "normal" "healthy" people want jagged bits of metal removed from their bodies and they want hips that work. But try to get a doctor to replace a perfectly functioning hand with a hook because you think it would be fun to be a pirate. It's not going to happen. Most folks (lucky them) don't want a surgeon going anywhere near their genitalia with a knife either. When someone DOES want a surgeon to have at their junk, it raises reasonable red flags.

When a new procedure or a new area of medicine is developed, there are always times when the SOC is being formed, generally by the pioneers of the procedure in question. But that SOC does not get left sealed in amber, never to be changed or updated as holy writ. A SOC is constantly being updated and amended, usually by the most well regarded professionals in the field in question and based on their experience and training. Some folks think that updates come to slowly, which is a reasonable critique; personally I like to err on the side of caution when dealing with life altering irreversible things, call me crazy if you must. The fact that the professionals in question have sustained the wisdom of therapy in our case itself makes a strong case for therapy. Most M.D.s have no love for therapists, if they did not see value in requiring therapy for folks with gender issues - therapy would not still be a part of the SOC.

But your larger question is "Why Therapy?" The answer is relatively simple. Because this is a complex decision, because this is a decision that is fraught with extraordinary consequences, and because this is a decision that is absolutely and positively irreversible. EVERyBODY involved NEEDS to know that we know what we are getting into, and that we actually understand and want the consequences that will be brought about by this decision. It is helpful to have the guidance and help of a professional to help a person sort through all of the variables, and all of the possible consequences, all of the motivations behind what they are actually feeling. Because if you get this decision wrong, you are FU(%3).

And it's not because you are crazy (though honestly I think we can all agree that it is good if those who are clinically incompetent are prevented from having hormones or SRS provided for them - we do not need that sort of press). It is not because you are incompetent to make a decision on your own. It is not because you are sick. It is because this is a REALLY big issue, and people bring all sorts of baggage to the table, and those who think this is a walk in the park and are doing it on a lark should not have hormones and SRS made available to them. I haven't been in this forum that long, but even I have noticed the trend - once a week or so someone will post a question asking about hormones who clearly has no interest in transitioning, who really hasn't considered the life altering consequences of hormones. I personally almost think that if you are not serious enough about hormones to endure a few visits with a therapist, you probably are not serious enough about hormones to need them, but that is a peripheral issue.

And lets talk about the elephant in the room. GID messes with people's minds. Hormones mess with people's minds. To say nothing of the process involved in learning an entirely new gender role. It was hard enough the first time around when all of my peers were going through the same thing and a certain amount of awkwardness and confusion was expected. Going through puberty a second time, and learning to interact with the world as the opposite gender will likely be more difficult the second time. And MOST folks doing this have to put up with all sorts of reactions from society, and employers, and family. That is the sort of thing it is REALLY helpful to have a professional to help out with. We are talking about the sorts of pressures that can make a "normal" person "loose it." People CAN do this sort of work on their own, but those who do generally take a lot longer to do it than those who make use of a guide, and honestly, the vast majority of folks who don't make use of a guide - don't ever get the work done.

Most folks get help from a professional doing their taxes, or changing the oil in the car, or buying a house... why anyone would not shun the help of a professional in this situation is beyond me.

Recently one of the girls here suggested that after transitioning, if someone were to put a gun to her head she would not be even vaguely frightened. The implication is that the trauma of transition is so much worse than the trauma associated with having one's life threatened, that after having experienced the former, the latter is laughable in contrast. And you wonder why professionals think that making use of a competent therapist while undergoing this sort of Earth shaking experience should not be optional?

[GypsyKaren]

I would like to add something because Hope makes some valid points. While I may disagree with the SOC, I do believe that therapy is helpful for many and necessary for some. I've benefited greatly from it over the years for various issues, and I think it's a mistake to label the profession as corrupt. While it may be inconvenient to follow the SOC, I don't know of any true TS'ers who had a problem doing it.

Karen :g2:

[Cindi Johnson]

A couple of comments.

When I indicated it is unfortunate that someone like me might choose Thailand, I didn't mean to imply that their medical care was lacking. What is unfortunate is that my options are being limited. I've had a small surgery performed by Dr. Bowers in Trinidad; she is super and would be my first choice.

Nor did I mean to denegrate all therapy nor all standards. Of course I agree there is a need for standards -- in all professions. But this doesn't mean I must agree with all standards a profession adopts.

Look, if I, an older white male, go to a plastic surgeon and tell him to make me look like, say, Michael Jackson or Brad Pitt, chances are he'll send me home. Surgeons generally don't need a therapist to make this decision for them. They know when someone is obviously crazy.

And remember, when we talk of visiting a therapist, this is not a simple or cheap procedure; for SRS, you'll be strung along for a year or years before the therapist issues you this magic piece of paper. At what..., $100 per hour?? And many of us do not have health insurance which will cover it.

Sure, I may make a mistake and regret it. But please..., I've been transgendered for 50+ years already. Are you saying I don't yet know myself?? What gives you (i.e., the therapy community) the right to pass this judgement upon me?

True freedom includes the right to make mistakes. Even mistakes that might f#&k one up irrevocably.

Bottom line: let me, a transgendered person, decide whether I will benefit from therapy, and whether I can afford it. But please, don't patronize me by suggesting that your therapy community is forcing me into a long and very costly process in order to save me from myself.

Cindi

[~Kelly~]

the entire post.....if you really need to see it all again.....scroll up 2 posts....it is far too long to quote again

^what she said!^

[stacie]

Hope said it best, and I agree with her. Transitioning is something a person needs guidance with. A person who follows the standards have a very high rate of succes with their transition. I met many people during my transition who tried to do it on their own and all had many regrets and ended up stopping there tranistion.

Since my transition I can't believe how my life has changed plus I am very happy now but it's not easy being a female compared to be a male. By seeing a therapist and going to a support group, I have learned what to expect and was prepared for what was to come. I received my letter for Hrt 3 months after I started seeing my therapist and cost wise it wasn't a lot of money. A year after that I recieved my letter for Grs and I only went to see her twice a month for 30 mins and it was worth every penny because I had someone to help me during my one year test of living as a female. Many people give up their transition during the one year test because they find out they don't want to live as a female. I do have to ask you, Does your family and friends know about your dressing and wanting to be a female? Are you already living as a female and if so is it 24/7 and for how long have you been living as a female? Its a lot more then going out and getting a vigina and good luck finding a SRS surgeon who will do the surgery for you. If you find one it will probably be some back alley butcher shop.

Truth is it is sad that our goverment considers us mentally ill, but the HBS has proven we are born with a birth defect and not some mental illness.
I understand the anger you have because I felt the same at one time. I didn't like the games I had to play to get my letters at that time, but I learned it was for a purpose and it was worth it.

[Kaitlyn Michele]

Cindi - if you are in a unique and strong position, where you don't need anyone's help to achieve your goals...then by all means do it...most of us are not in that position at the beginning of our transitions

we live in the real world...there are rules and many folks break those rules..if you break the rules and things don't go right, there are consequences and many in our community have suffered those consequences...

looking at your posts, it's obvious you don't like the profession so if you are really asking a question (as opposed to ranting about therapists---which is fine btw), then the answer to why therapy is that it's actually very helpful and productive if handled by a good therapist...this is a big deal and if it's not a big deal to you, then i agree..just do it..

There is a HUGE difference between saying you are ts or tg versus going down a path to transition..if you havent done it, then you really don't have any idea what you are in for, and we all benefit from having professional experienced for guidance..

unless you are well into a transition, and you don't give a flying fuxx about your family or your friends, and you don't care whether you have a job, and you easily fit into a female role with no guidance or support, and you already know that there will be no unexpected events, and you never need advice from people that have been through this before..

[Heatherx75]

It's my understanding that transsexualism is to be removed from the DSM-V in 2012, so I guess that's a sign that the majority of the mental health profession no longer views us as insane. Also, as far as hormones go, I go to a clinic here in New York called Callen-Lourde, which specializes in treating the gay and transgendered communities, and they only required me to go to ONE session with one of their therapists in order to get on hormones. All they basically cared about was that I knew what I was getting into and that I wasn't hearing voices. Of course I am in therapy already and at that time I had been for a few months, and my therapist had said he was willing to write the letter, but it wasn't required. So at least in some places progress is being made. However, I would say that transitioning is a tremendous life change and not something anyone should try to go it alone on. The proper therapist and your willingness to open up and listen to people helps. I understand that can be hard for those of us who've had experiences with gatekeeper type shrinks, or worse, the ones who want to 'cure' your gender dysphoria. When I was 16 I had a shrink who seemed to think that I was just a gay male and needed to accept the facts. The guy I go to now is more focused on helping me adjust to my new life, which is as it should be.

[Melissa A.]

I do find the HBSOC potentially cumbersome, unfair, and loaded with inconsistencies. I also have a problem with the apparrant assumption that first and foremost, I may be mentally ill, incompetent, or trying to get away with something, and am in need supervision. I get it, Cindi. But here's the thing: I was in therapy for about a year and a half, and not because it was necessary for that long, to get what I wanted. My therapist told me I was definitely transsexual after about 3 months and I had my endo referal soon after. I continued to see her because I found it helpful. Like most of us, I had issues with family, friends, work and the world in general that I needed to sort out. And I did. After a while, our sessions were less like therapy and more like two people hanging out and exchanging ideas about stuff. I found it really enjoyable, and I know it was alot of help. Ok, you might say, you found a friend to talk to.....for $100 an hour. Yeah, that's true. But it was someone who was always there, without fail, every 3 weeks. The structure of the whole thing was amazingly helpful to me. If you've spent the better part of your life pretending to be something you are not, then attempt to change that in the space of a few years, while doing something that makes alot of other people uncomfortable and confused, and may result in the loss of employment, friends, family and other really big changes...well, it takes a pretty special person to negotiate all of that without some assistance. Maybe you are that person. But is the assumption that the rest of us may need a helping hand really that awful? Here's another thing: My therapist AGREES with you in many ways, and is one of the people out there trying to change the SOC standards. So it's not some scam being perpetrated on the unsuspecting TS community. Most of these people do this because they believe us. Most aren't there to primarally seperate us from our money, or to make things more difficult. Not the good, experienced ones, anyway. Google Arlene Istar Lev(my therapist). You will find some of her writing interesting, I think. Speaking of said standards, they aren't near what they used to be, rigidity-wise. Find the right therapist, and you should have no real problems. The whole thing was pretty painless for me. I didn't feel like I was jumping through hoops, or anything.

We have come a long way, believe it or not. If you had tried to do this in the 1960's or 70's, you would have been mandated to a "gender clinic", and if you weren't feminine looking enough, or didnt find men sexually attractive, you were doomed. So things are changing. Maybe not fast enough for you, but they are. In answer to your question, no one appointed Harry Benjamin God. But if not for him, it may have been years more before the medical and mental health community accepted that we even exist. We owe him some gratitude, fer chrissake.

Look, I have enoough huge problems with the DSM, the way many countries take care of this(the U.S. is actually pretty enlightened, compared to some other industrialized countries), the backlash from certain screechy, ignorant voices, and those who think I'm some kind of pervert, and should know better. The mental health community, at least that part that works with us regularly, is the least of my worries. Could the process be improved? Sure it could. And it has. It will continue to. I understand and agree with much of what you are saying, but my suggestion to you, if you're as ready and as mentally tough as you claim to be, is to put on your big girl panties and get over it. And get on with it. It could be alot worse.

Hugs,


Melissa:)

[joanlynn28]

For me the standards of care are there to protect the health care professonials from malpractice suits, and also to protect the patients from themselves. To weed out the I think that I am transgendeder from those that truely are. For me it just seemed too easy, there are those that tell of stories of how they can't get on HRT or some other obsticle in their way of becoming who they really are. Like my first visit to my endocriniologist was like okay your ready for hormones get dressed and see me in my office for your letter. And then I was seeing my therapist so that I could get my letter of recommendation for SRS, it's like I told her that I didn't want to go back to who I was and she told me don't worry that is not going to happen to you.

Must of come down that everyone I went to saw something in me that they knew that I needed to go through all the way. My goal was always to go the whole way, anything shorter than that was just not an option for me.

So when the day finally came for me I too, went to Thailand for my surgery. And I would do it again if I had to, the care and skill of my surgeon in my opinion is far better than your going to find in the United States. Everything there was World Class medically. Just depends on who you see, my sister and I researched a lot of other surgeons before we choose that our doctor was going to be the one who would perform surgery on either one of us.

I mean my sister's letter for surgery was about ten pages long and I felt that mine was inadaquate because mine was just a page and a half. Whatever the results were the same, we both were able to have our procedure done, so it is just that all of our experiences are different, but dispite that we all are still the same inside and are seeking the same result.:2c:

[Linda Z]

:thumbsup:Good post, Cindi

Linda Z

[Karen564]

1st, I would like to thank Hope for a excellent explanation, Very Well Done!!:)

My take on it is, for starters, it's because of Dr Harry Benjamin's lifelong work in the field that brought down the barriers for all of US today that suffer with GID, & so we could finally pursue our wishes & get help in a more organized & professional way, instead of being shoved aside as some kind of insane mental case, as was previously thought by his peers.
And it's because of him, had enlightened & educated the medical community & others about what Transsexualism is and how to treat it in a more humane & compassionate way, so he had to come up with the Standards of Care in order for the medical community & others to take this seriously..
Without protocols in professions there is no order, without order, there's kayos...So is that what you want?? I certainly dont..

I can understand your views on it, because I had once thought the same, and I do not entirely believe all the requirements are all fare, because part of it does seem cruel to me, BUT,,,, that's the way it is, and I also believe that every single requirement was put into place for a very good reason..even though YOU may not see it that way, regardless of your 50+ years living on this Earth, it still doesn't make it all wrong.

Once you do start to engage in this process of jumping though hoops, you will find out many things about yourself that you had previously thought would be easy can actually be very hard, and many things that you thought would be hard or incomprehensible to do can be easy.(like seeing a therapist)

Once you start seeing a Therapist, you will then wonder why you didn't go sooner, because they really do become your guiding light & your friend during this process, not your enemy..

Many therapists use a sliding scale for their fees & services based on your income, so for those of us without insurance or the means to pay $100+ per session, dont get turned away from care, so that shows you their not in it just for the money, there in it for YOU..!!
(my therapist normally charges $120 per session, but she only charges me $55. per, if I can ever afford to pay her more, I will gladly do so,
if not, she will still see me regardless of the money..

My simple minded question to you is, since you had many years to start on this transition before, whats in big deal of waiting just a little longer??

I know we all want it now, & for me I wanted it yesterday, but I can still wait if that's what it takes..because I know it will happen sooner or later regardless..

So now you want to be the other gender now because you know what you want, that's just Great!!! but out of the blue, you find it imperative to do so immediately??, just like flipping a switch & without the need of any professional advise??, but sorry to say, these are the issues & concerns that raise flags in the medical profession, and are why the HBSOC (standards of care) are in place..

Peace..
:hugs:

[Veronica_Jean]

Cindi,

I personally knew someone that was into therapy for a very short period of time before SRS was recommended and provided. It does not always involve years and years of therapy as in the case I cite it was less than a year start to finish.

This person in fact gained a lot by going to a therapist as it opened up the possibility of moving forward so quickly and helped her resolve issues that she needed to figure out before she could move ahead.

All of us are different, but having standards does not imply that we are herded like cattle toward a fashioned end based on therapists forcing us to do as they wish.

It seems to me that you have allowed yourself to generalize too much and simply want to rant about things you have not investigated sufficiently yourself.

Veronica

[sherri52]

The psychologists need to feel needed. Even if it means unnessary sessions. When a person wants to change, they want to change. What the government doesn't realize is the old cliche. You can bring a horse to water, but you can't make him drink.

[luvSophia]

There seems to be some serious misconceptions in the original posting.

First off, the Standards of Care are not Doctor Benjamin's, nor have they been for quite a long time as he passed away in 1986. They are the product of the World Professional Assocation for Transgender Health. And half of the people that currently make up the Standards of Care Revision Committee are MD's, not therapists.

A therapist's blessing is not required to get a valid prescription for hormones. I didn't have one. My GP is educated in gender issues and had no problem at all giving me prescriptions for Estradiol, Spironolactone and Finasteride. We had a discussion to be sure that I was aware of the affects of the drugs, how to take them responsibly and the possible negative affects. No letter or discussion with a therapist. However, those are all being prescribed "off label", meaning that they are not being taken for the conditions the manufacturer or the FDA intended and approved them for. To expect an MD to prescribe off label with no background knowledge of the effects, just because you asked them to, is pretty unreasonable in my opinion.

The Standards of Care also do not state that you must be “strung along for years and years” by a therapist for SRS. Or even words to that effect. They state that you need a letter from a Mental Health Professional stating that you are eligible and ready for the surgery. All you need to do is prove to that individual the validity of your gender issues and that SRS is medically warranted. But do not expect them to put their professional reputation on the line too easily. They may recommend that you have continuing therapy, but that is their decision, it's not written into the SOC.

The MD prescribing the hormones and the surgeon perfoming the SRS have a legal and ethical responsibility to not cause you harm, either physically or mentally. SRS is MAJOR surgery. I may be wrong, but I doubt that you would be able to schedule surgery to have your appendix removed just because you wanted it gone. I strongly suspect that most competent surgeons would also not perform SRS without a process similar to the SOC. There is simply too much liability involved.

Having SRS is a pretty much irreversible, life changing event. The SOC provide an established, tested path leading up to that. Under the SOC the latest numbers I have seen show a less than 2% regret ratio. Compare that number to only 89% of women who rate their breast implants as at least "mostly" meeting their expectations.

No the SOC is not perfect and its "one size fits all" nature does not fit everyone. But they do fit the great majority of transsexuals and for the minority that they do not work well for there are built-in exceptions. I have a strong suspicion that if the SOC did not exist then the surgeons would each have their own policy for determining who is a good match for the surgery.

[carrie-ann]

Look there is a high rate of suidcide in our comunity. Take all the help and counseling you can get. Even the best doc's that do the surgerys here recomend it and require it. It's for your best interest.

[Karen564]

I'm sorry for any misinformation, Sophia is completely correct, The SOC was not written personaly by Dr Benjamin, and only named after him for recognition of his devoted work & treatment of transsexuals..

http://www.transgenderzone.com/research/HarryBenjaminMD.htm

Therapist only follow the SOC guidelines as a rule to go by, they dont write them, and they also know there's some flexibility within those guidelines too, it's not necessarily written in stone for each & every patient..