Gatekeepers

[Ariamythe]

At the end of every therapy session, I mention to my therapist how next time, I'd like to discuss taking the step of starting hormones. And every time, at the next session, she somehow gets us talking on different topics so that, by the time I get around to wanting to broach the hormone topic again, we've run out of time.

She's a good therapist and she has a lot of trans experience, and I may be reading into things. But it really seems like she's avoiding the question, or trying to delay it for some reason. This week was no different, and I mentioned again that, NEXT TIME, I'd like to go there. We'll see ...

Anyway, just needed to vent a bit. I've seen women complain about therapists as "gatekeepers" all the time, but this is honestly the first time I've felt ... er, gatekept. Sucks that only through her can I even approach an endocrinologist. Sigh.

[Kaitlyn Michele]

I would gently say that its a bit on you ...you are avoiding the subject..
You need to start the session and talk about what you want to talk about...

do you have a desire to be "diagnosed" as a way to accept yourself??... I think that's fine...in your case I think you are well served to think about what you want to say, and to say it..or do you just want to the letter and start? if so, you just need to demand the letter and find out what she requires of you...my therapist surprised me by saying "its about time you asked" when I finally brought HRT into the conversation..

its interesting because part of therapy is putting meat on the bones of feelings that can be very squishy... people say "my life didn't turn out the way I want" but they can't say EXACTLY what they wanted their life to be...

so are you ts?? do you not know?? if your therapist is just a gatekeeper, its time to read the riot act to her.. if you are letting her drive your therapy then there must be a reason for it..she can't make you talk about stuff that isn't helping you unless you let her..

so i'd encourage you to be very specific about what you mean when you say "i'd like to discuss the step of taking hormones"...
Does that mean its time to start?

Does that mean you want to ask her when its time? does that mean you have questions about it??
see what i'm saying?? get specific...its hard to do!!! but it will be worth it..

[AllieSF]

Kaitlyn says it very well. If you tend to forget to bring up that important topic, like I do sometimes, then just put a rubber band tightly around your fingers before you go to the therapist. Then during the therapy and the pain and numbness becomes too great to ignore, you will definitely remember what you wanted to talk about, and do it then as you remove the rubber band. Good luck and take the lead in your life.

[LeaP]

I also agree with Kaitlyn on this. There's always a bit of a dance with a therapist. What gets discussed, when, and at what depth is sometimes driven by the therapist, sometimes you. So unless yours has said something pointed in response, like "we need to deal with [pick your topic] first", it's up to you to press.

I danced for MONTHS. And mine DID want to put the topic off for a while. But even when it came time, I would bring it up ... but wait until the last few minutes of the session. And she wasn't about to broach it at that point! I finally sent her a long email emphasizing a number of things as it relates to hormones as well as my strong desire to not put off the discussion any longer. Hormones were THE topic in the next session. We talked through and about hormones thoroughly and then I asked if she would support my starting and writing the letter. She smiled and said "of course"!

Sometimes you need to lead the dance. Thing is, you have to be prepared for your partner wanting to sit out for a while.

[Kathryn Martin]

Although my situation was somewhat different, I went to my psychologist and when she asked why I was there I said because I need clearance for hormones and then explained why. Three sessions later I had my letter. The time in between she asked all of the appropriate questions to clear the gates.

[Angela Campbell]

I did the same as Kathryn, I went to the first appointment and told him I want to transition. He did the initial meeting and over 6 or 7 appointments we went over everything and he gave me the letter. There was no dance, it was straight forward and honest. He had to determine if I fit the criteria, and make sure I could make an educated decision, once we were there the letter was no problem. Most of the time after the second session was educating me on transition and all the aspects of what is involved. He simply wanted me to be ready.

What they may want to do is determine if there are any other issues that need to be dealt with first and make sure you do that first. Deciding if you are TS or not usually comes pretty quick even if they do not tell you so.

[StephanieC]

I've seen two therapists and both have told me there was nothing further they could do for me. I finally took a different approach and sought out a doctor directly.

I agree....there are ways you can make it clear what you need. But for me, it took years.

-stephani

[LeaP]

...There was no dance, it was straight forward and honest. ...

Maybe I should clarify what I meant by "dance." What I meant to convey is an open give and take. I wanted the exploration and therapy. I had some pretty serious depression and other issues going. So when she led and explored, I followed. Sometimes I did. It ebbed and flowed. We touched on gender fairly lightly for the first couple of months. As time went on and as I started feeling better, gender as a discussion topic became more urgent. It was at THIS point that I could have been more assertive - and wasn't. I asserted the topic of hormones, along with identity, strongly, all at once in the email to which I referred earlier. Maybe she was waiting for the assertion. Looking back on it, it was the way it had to be for me.

None of this was in any way dishonest. It was much more reflective of my introversion and fear.

[Angela Campbell]

Lea I didn't mean by any stretch you have been dishonest, I hope you didn't think that. I only meant that our sessions together were that way. I didn't try nor did I have to prove anything to him to get the hormones. Yes it is a give and take but actually tonight I went to see mine and he told me I was different from most. Usually he is telling them to slow down or have you thought of this? etc With me I was bringing the subjects up before he could. He tells me I am going much slower but more methodical than most. I never had issues to be solved he thought other than the need to transition. He is confident that my plan is good and will be smooth and successful, in fact he said I may want to speed things up a little.

I guess I was a bit assertive. But then I wasn't really getting psychotherapy I was more getting transition counseling.

[LeaP]

Based on our exchanges, Angela, no, I didn't exactly think that. But I did wonder if you meant something ... lesser along the same lines.

[I Am Paula]

I told my therapist upfront that I would only be seeing her until I got my go ahead for HRT. At the end of the first hour, she said I had informed consent out the wazoo, and if I didn't feel I needed more therapy, I was ready to start. She faxed a letter to my endo. My only other contact was when I sent her a nice thank, and update email.
Ultimately, we are masters of our own fate, and you should demand to talk about, and get, your HRT letter.
Please also always remember- you are the client- your therapist works for you.
Good luck

[mikiSJ]

Ari

I agree with most of the girls above, with this proviso: your therapist may not be ready to give you the letter is using your hesitancy as her shield in not coming forth.

[Angela Campbell]

Based on our exchanges, Angela, no, I didn't exactly think that. But I did wonder if you meant something ... lesser along the same lines.

Absolutely not.

[Ariamythe]

Thank you all for the thoughtful perspective. It's true that a therapist's job is to listen, not lead. I should be more assertive at the beginning of the next session. Being assertive just isn't in my nature.


I danced for MONTHS. And mine DID want to put the topic off for a while. But even when it came time, I would bring it up ... but wait until the last few minutes of the session. And she wasn't about to broach it at that point! I finally sent her a long email emphasizing a number of things as it relates to hormones as well as my strong desire to not put off the discussion any longer. Hormones were THE topic in the next session..

The last few minutes -- yes, that's me too. :) You know, I have never e-mailed my therapist anything except a link to an article I thought she would enjoy reading. Maybe I should try your approach.

[LeaP]

I found it easier to pour my heart out in a focused way in email, Ali. At that point in time, my emotions were too bound up and jumbled to put it out there strongly and coherently in person. Removing the interaction - which has been an issue throughout my life - made it easier.

And thank you, Angela!

[Marleena]

My story is very much like Celeste's I went to the therapist confident in my own self discovery. I did have a long history of depression that meds did little to help with though.

I think I was accused of being a "super tranny" here for getting my letter so easily. Or maybe they meant somebody else.

[LeaP]

Thing is, there are those who are sure and are right, and those who are sure that are not.

[Marleena]

True that Lea! The gatekeepers do serve a purpose and an important one.

[Ann Louise]

Hi Ariamythe,

My therapist referred me to my endocrinologist, and they talked on the phone before I went to the endo consult. But no letter. But other girlfriends of mine had their GP refer them directly to their endo. Seems to be a variable route to HRT, depending on a particular professional's sense of potential litigation later.

Good luck hun, and stand up for yourself. Ask eye-to-eye for what you want. It's your journey, not theirs or anyone elses, Ann

[arbon]

Well if you really want it you can do like I did - on your own without waiting for her or anyone else's permission. (oh I am going to get in big trouble here for saying that I already know!) I don't like the whole gatekeeper thing.

[Chickhe]

I get this picture that you go there and wait for the therapist to tell you the answers... In my opinion, these people are a better service to you when you decide what it is you need and you ask them for help to get there. They are good at showing you tools that help you find out what you need they are not going to do the heavy lifting for you.

[Ariamythe]

I found it easier to pour my heart out in a focused way in email, Ali.
That's the second rec for e-mail. I'm sensing a trend.


I think I was accused of being a "super tranny" here for getting my letter so easily.
Ooh! With a red cape, some tights, and a stylized "T", you could really make that work. :D


Well if you really want it you can do like I did - on your own without waiting for her or anyone else's permission. (oh I am going to get in big trouble here for saying that I already know!) I don't like the whole gatekeeper thing.

I'm not fond of the gatekeeper phenomenon, but I've done a lot of reading and I'm honestly against the idea of self-dosing HRT. There's far too many possible medical risks (http://transgenderscience.tumblr.com/post/62891984704/why-transfolk-should-not-self-medicate-hrt), not to mention the question of full development (http://transgenderscience.tumblr.com/post/62716604818/does-a-specific-hormone-regimen-impact-mtf-breast). I don't begrudge anyone who chooses the route; it's just not for me.

[Leah Lynn]

I use the VA as much as possible, so that may explain my ease of getting to hrt. The VA Clinic that I regularly go to, has me assigned to a nurse practitioner for my PCP. I told her I wanted to transition, and she set me up with an Endo consult. He and I disussed what I wanted, did the lab work and set me up with the VA psychiatrist. A brief talk with her, back to endo, and got my prescriptions. I'm still looking for a therapist/counsellor that I can work with. I know it'll be required for SRS, should I live that long.

Make your demands to the therapist, get what YOU want, or get another. Maybe this one's just working you for the money.

Leah

[Marleena]

Ooh! With a red cape, some tights, and a stylized "T", you could really make that work. :D


Well, Halloween is coming up.:)

[Ariamythe]

Make your demands to the therapist, get what YOU want, or get another. Maybe this one's just working you for the money.
Actually, I'm getting the sessions for free via the local uni Gender Services program. They will work with people whom they can't pair with a trained gender therapist for some reason (such as not taking my insurance). The program does have a reputation for being a bit "gatekeepery" though. But free's free.

[dreamer_2.0]

Perhaps being free makes them an attractive option for anyone off the street meaning they have to be extra strict in their gatekeeping.

[kimberly ann487]

I've read this in a few places ( books, web-sites, etc, ), also from my therapist: Be aware of the therapist that is quick to move you on and the type that seems to drag the process out forever. The best answer is somewhere in the middle, and it's different for everyone.

[Ariamythe]

Dreamer_girl, they have strict screening ahead of admittance, so once you're in it's not so bad. They're not a fly-by-night operation, but part of a major health system.

http://www.uofmhealth.org/medical-services/transgender-services