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View Full Version : TS Reality Episode 2 - The Heartbreak of Psychiatrists



LeaP
06-13-2014, 10:05 AM
The saga of trans travails continues with a focus on a key cog in the transformation machinery – the psych*.

Is the psych your friend, enemy, gatekeeper, judge/jury/executioner, consoler-in-chief, pro-forma letter writer, diagnostician, counselor, syncophant-enabler, or perhaps just full of themselves or full of something else? Trained? Knowledgeable? Up-to-date? Have an agenda? Trans?

What a great question!

Were I to draw a great, vast Venn Diagram of the psych world, intersecting all the practitioner types, training and approaches, conflicting theories, treatments and standards, competencies, and roles, there would be a little, teensy, tiny, itsy-bitsy common intersection at the center, almost invisible, that represents what you want – the Gen-U-Wine Gender therapist. The Real Deal. The One who Actually Knows and will help you place your feet on the One True Path, whatever that is for YOU.

Good luck finding such! Maybe you tried one of the myriad referral sites, only to find that EVERYONE lists gender as a specialty! “Wow,” you think, “am I in luck!” Not so, Padawan! Psychs get to list anything they want, for any reason. Maybe they heard a lecture on the topic, “covered” it in a book chapter 10 years ago in school, or would find it just fascinating to have a gender client for the first time! You could get lucky, of course, and find the real deal straightaway. And you could win the lottery. (If you are actually trans, it’s a good indication that you’re not the lucky type, but I digress.)

“Hmmm, I know – I’ll interview them,” you think. And so you do. A depressing pattern emerges:


“Do you have any experience with transsexuals?” “Oh yes, I have had several crossdressing clients.”

“Do you belong to any gender-focused professional groups?” “I belong to the Harry Benjamin Society …”

“Are you taking new clients?” “Yes, I have an opening 7 months from now.”

“I’m calling about a gender issue I have …” “Come on in, Bunky, the letter is $50 on top of the appointment cost.”

“Do you have a close working relationship with any gender-knowledgeable physicians?” “You know, that’s probably a good idea …”

“Are you aware of, or follow any particular standard of care?” “[indignant tone] Perhaps you would be better off with another practitioner …”



So, maybe you conclude that you’ll work with what you got, travel, or (heaven help you) rely on fora like this and buy your letter when the time comes. Ummm – have you heard about the 1-2% of regretters? Maybe you like the psychs that "diagnose" on on intake appointment and have no need for a rigorous psych evaluation. No, wait ... those are the actual shamans, not psychs. Silly me.

Fate and the medicalization of transsexuality have conspired to plunk one of the most poorly understood, under-regulated, conflict-ridden, controversial, political, and obscure niche areas of modern medicine smack into a key role for transitioners. Further, the trans population has to deal with not only THAT, but tends to present with myriad co-morbid issues. What a recipe for success! Fortunately, the sense of sex/gender (let’s not get religious) is SO innate that the few actual TS navigate through like an Argonaut passing through the maelstrom. That we might get fleeced a bit along the way is just the price we pay …. And the non-TS? [shudder]

So, hope for the best but expect, well, less. Chances are that this part of the journey will be longer and more expensive than you hoped. (Sounds familiar) There is far more variability on this point than with electrolysis, though. But before you get too self-congratulatory about getting out short and cheap, consider the possible consequences! Also, hope the psych knows enough (or you make sure) not to bill for the DSM’s code for GD. That could be a serious bummer for your insurance coverage forever more. Assuming your insurance even covers the psych, that is.

Good luck!

Still want to transition in a heartbeat?


*(secret code word for anyone providing voodoo services, including psychologists, psychiatrists, social workers, nurse practitioners, clergy counselors, your PCP who seems to know everything, and for some purposes, your friend who thinks s/he does. Actual shamans are, of course, a huge plus as long as they can feminize you with magic and without drugs.)

arbon
06-13-2014, 11:18 AM
Enjoying your threads!

My counseling experience was not to bad, maybe I was just lucky? When I had the psych evaluation last fall for the surgery it was pretty straight forward despite my fears about it. The counselor I had seen previously was pretty good to, and helped me get to the point of taking ownership of my own life and facing some truths about myself.

Angela Campbell
06-13-2014, 11:36 AM
Too many big words for me. Can you put in some pictures and diagrams?

LeaP
06-13-2014, 12:08 PM
Sure!

227048

KellyJameson
06-13-2014, 01:24 PM
You are cursed/blessed with being a deep thinker Lea and restrained in your actions.

There is the "other world" of transitioning where gatekeepers are something to get around, hormones are bought illegally and orchiectomy is done early on.

Restraint and caution are not words I think of in the world of transsexuals I have lived in.

Everyone I have known just wanted their letter and avoided those who probed to deeply because they either cared or did not want the medical liability of making a mistake.

The system was seen as keeping you in pain and not really there to protect you.

I must admit that I have shared in these feelings and opinions.

sandra-leigh
06-13-2014, 05:11 PM
Where I am, the path I have gone through, I have not experienced any "gatekeeping". I do know a couple of local people who have felt that the same resources were gatekeeping them, but I did not experience it.

I have been with my gender therapist for several years now. This was because I took a fair while to come to terms with the situation myself, and to decide what price I was willing to pay and how quickly I wanted to go. I could have had my HRT letter much sooner if I had asked for it, but HRT was not something I wanted until (relatively quickly) it was.

Really, from the time I started asking seriously about whether I was even a candidate for HRT, all of the doctors, the psychiatrist, the therapists, and related staff I have worked with, have fairly quickly concluded that I have gender dysphoria and require appropriate treatment. Perhaps my memory is falsely reconstructing itself, but as best I cast back at the moment, it was as if within 10 minutes or so of any one of the evaluative conversations, each of the evaluators had shifted from the neutral "Does this person have gender dyshphoria?" to "Yep, they have gender dysphoria all right, now let's figure out how urgent their struggles are or what they need at this time."

StephanieC
06-13-2014, 08:42 PM
Oh Lea!
I love your posts and you are always so dead on.

Personally, I only use the professionals when I really need. But you are correct, it would so much better if people are who they say they are.

In town, I've noticed a MDs are closing their TS practices...this is getting harder

PretzelGirl
06-13-2014, 09:03 PM
I made a good selection from the beginning. He mostly abides by WPATH which I wanted for my own safety; we communicate well together; and when he bills, it is paid for on the first pass. :) I still see him and also attend group therapy he runs which is a combination of trans and LGB. It has been worthwhile. The individual sessions are great sounding boards as I navigate informing family and prepare for telling work. My biggest thing is I need some time back! But it was easy finding someone with experience. We have a group called LGBTQ Affirmative Therapists Guild of Utah and they all obviously have experience with trans patients.

But between him and my HRT provider, I have done quite well. She is an OB/GYN and dedicates certain days to HRT patients. I suspect it won't be a problem to get a letter from her to change my gender marker and intend to ask on my next visit.

celeste26
06-13-2014, 11:10 PM
Now that medicare covers some of those expenses it only means a co-pay now. Not entirely sure of it covers the SRS but the psych stuff yes just like all the other Dr appointments.

Aprilrain
06-14-2014, 06:25 AM
The only "gatekeeper" I encountered was 5 years before I transitioned. She was the only psych. who came up in an internet search for my area at the time. She told me I was a crossdresser and never to come to an appointment dressed because appointments were not the time to play dress up. I was wearing male attire at the time. Needless to say I never went back but her comments were enough to send me creeping back into the deepest darkest part of the closet I could find for 5 more years! When I finally emerged again I found a support group and they all told me she was the worst therapist around who advertised as working with trans clients. I have since found others who do not make proclamations one way or the other.

Angela Campbell
06-14-2014, 06:54 AM
Being where I am, I was lucky when it came to the medical and psychological choices. I started with a psychologist who was mainly doing family work. She helped some but referred me to a specialist who is himself a f to m. He never diagnosed anything, he asked questions and let me go where I wanted. I got my first letter in about 6 weeks, but I didn't feel like it was gatekeeping as much as educating me. He specialized in transition and I am convinced that his guidance is a large part of why my transition went so smoothly.

but the bottom line is you. You need to find the right counselor, doctors and groups. You use them for informational purposes and do research. Figure out what is best for you. No two will be able to do this the same way.