New City, New Therapist

[LeaP]

TS responses only, please.

After a year and a half with my therapist, having moved to a new city, I was forced into making a change. Losing her is hard. She is very experienced – nearly 30 years doing gender – and help me work through the most difficult thing I have ever dealt with in my life, and a few other issues besides.

So today's intake session with my new therapist was something I wasn't exactly looking forward to, despite the ongoing need. Fortunately, it went very well. As an intake session, there was a lot of exchanging of information. Still, we hit it off immediately and I think based on that, as well as her comments on general approach and experience, we will work together very well.

This was so unlike my first sessions with my last therapist. I was a complete wreck at those. Deeply depressed, nervous, cried for hours and hours and hours afterwards…. How far things have come! Today I was happy, confident, present and comfortable.

That last bit may leave you wondering why I still need a therapist. There's a lot of reasons for that, not the least of which is to have a transition counselor available.

My questions, though, are these:

I will eventually need a second diagnosis from a practitioner with an M.D. or PhD. My new therapist has the latter (psychologist). How did you obtain yours and what were the circumstances at the time?

The reason I ask is that my first diagnosis was (relatively) easy. Given my mindset at the time, the dysphoria part of the criteria was simple to see. Today – not so much. The new DSM diagnosis is, in fact, "Gender Dysphoria." I don't feel particularly dysphoric any longer. Oh, the inner monologue is still there. The pressure to transition has only become greater. The prospect of going back is appalling and fraught with consequences. But I don't feel particularly dysfunctional any longer.

It's an odd thing. If I stay on track moving forward, it just feels like I'm executing on the obvious. If I sidestep or delay, my anxiety spikes.

So question two is, what is this? Is this dysphoria, or something else? Because the only thing I would personally tag as dysphoria is what I call "body dysphoria," meaning issues with my (male) body.

[stefan37]

My experience as i travel this path. i reach a plateau and i fell normal but i need more. Name change and Going full time changes things. No More hiding. You are out for all to see. You know who you are. If you feel that you need to progress to surgeries, you have the requisite documented time to qualify. Mentally and emotionally you may feel comfortable and normal, but if your distressed by your body and feel a need to change it. I would say you still suffer from dysphoria.

[melissaK]

I'm no therapist, but sounds like GD to me - that if you stray you pay.

I get very much your point that after we overcome denial etc etc and are out, carrying out the long desired changes all feels ordinary. And I get that when I deviate, I can tell I have hit some unacceptable place, done something against my nature. It's incredibly clear to me.

I don't want active disphoria in my life ever again. It hurt. I was miserable.
And I think (postulate) it's that sensitivity to it returning that gives me the clarity. It allows me to know what's acceptable gender outlaw conduct for me, and what's pulling up too short for my own happiness. I was really worried because no one has much guidance about living 1/2 way between MTF, but it's been pretty clear to me when my variance from M toward F is too little.

Glad you like your new therapist - one less anxiety. :)

[Angela Campbell]

Question one

The therapist I see will provide one letter (already done for HRT) and the partner he works with will provide the second one. I am sure she will want a session first, but I have been assured the 2 letters will be no problem. I would think your new therapist will have someone who can do this, as a referral thing if no partnership is in place.

Question 2

For me the dysphoria peaked during my first month or so of therapy. Once I made the decision to transition it immediately lessened and became manageable. As long as I am making progress Since the hormones started I do not feel it much anymore with the exception of the stress of the time involved and wanting to get it all done right now. I understand this is quite common and to be expected. In truth the dysphoria has been replaced with something else that is quite pleasurable since about a month or two on hormones, I think it has been replaced with more of an urgency, and a feeling of being "right" rather than the hopelessness of the dysphoria. Either way the thought of going back is both repulsive and almost incomprehensible. I actually feel like a different person.

At this point my therapist tells me I do not need therapy at all so he is more working as a counselor to assist me in transition. I do not go very often anymore. I will see him this week for the first time in about 2 months.

One of the questions I was asked was ....if the negative feelings of the dysphoria were gone completely and you could be assured they would never return, would you still want to transition?

For me it was an easy one. Yes, I am still a woman even without the bad feelings.

[LeaP]

...you stray you pay.



That's pretty much it in a nutshell. I feel corralled, prodded, channelled. Step to the left, whack! Stop and get a prod. Don't look back and don't look down - or else ...

Angela, the concept of being a different person is complicated. I often say I'm the same person. My wife questions how I can possibly think that. I don't know - maybe I'm not. Just because I feel a sense of continuity as well as a return to my "self" doesn't mean I haven't changed, maybe radically. I had a conversation last night about what it means to let yourself free after so many years. One thing it's not is turning into someone different overnight. The attitudes, mannerisms, and behaviors that might have developed never did. But the potential is still there unchanged. So maybe it's more a process of change.

Right now I'm still struck by the change from where I was to where I am between the two intake sessions. (God, nearly two years ago.) Yesterday's session was worth it for that alone. Nothing could have made the point more strongly.

[arbon]

So question two is, what is this? Is this dysphoria, or something else? Because the only thing I would personally tag as dysphoria is what I call "body dysphoria," meaning issues with my (male) body.

Its you going in the right direction.

I relate to the differences you describe between your first sessions and now. I have not seen my therapist since right after I legally changed my name over a year ago because I have not felt much need for it. I have ups and downs still but the dysphoria is nothing like it used to be. Sometimes it still comes but its more situational and not chronic like before. Then I wonder when I go to see a new professional with the right credentials for the appropriate letters for surgery will they give them to me if I am not suffering enough?

[LeaP]

Then I wonder when I go to see a new professional with the right credentials for the appropriate letters for surgery will they give them to me if I am not suffering enough?

EXACTLY. That's exactly what I was thinking and didn't (want to) say. It is also what was behind my reference to the DSM5 GD diagnosis.

[Angela Campbell]

Any therapist experienced and trained in gender issues will have no issue if you are living full time and have no more dysphoria or gender issues. In fact it will verify that the treatment is working and the proper thing is to continue. If not find another therapist. At least a year on hormones, a year of RLE and there should be no problem at all in getting the letter. If both of those have been done and the dysphoria is not better it may be a sign that this is the wrong treatment and maybe the problem is something else.

You already have the diagnosis from the first therapist so the new one should only see the progress.

[LeaP]

You're right, I think. Also, It was pointed out to me yesterday that I was conflating several things with SRS recommendation letters. Although they have considerable overlap in content (hence my confusion), they are completely separate from diagnoses and HRT letters. They all reference DSM criteria and usually reference SOC items, but are separate activities and documents.

[arbon]

There was the movie trans america with the evil shrink that withheld the letter until the ts met her expectations. Hated that part of the movie, but its always stuck in my head that some could really be like that.

[Angela Campbell]

That would be a fear for sure but there are more therapists to choose from. There are some here who will work with you from across the country using skype and are very experienced. As I have said before Florida is eat up with trannies.

[LeaP]

... Florida is eat up with trannies.

The things you learn on the web!