Therapy advice.

[jackielynn]

I am wondering if anybody can give me advice about therapists. Right now I am really questioning whether or not I am transgendered. I am in a point in my life where I really need to decide the rest of it. I just turned 27, and have been seriously having these feelings for a little over 2 years. The rest of my life has been the typical trans story. Gender anxiety issues arising when I was about 6 or 7. Covered it up for years and have used crossdressing as a coping mechanism. I always felt like it would go away but it has only grown stronger over the years. Crossdressing was sufficient for a while but for the last couple of years I have been feeling an intense feeling of what I can only describe as gender dysphoria. I have always been extremely analytical especially regarding my life and I understand that the reasons for my dysphoria are rooted in several issues. I just don't know if I should see a gender therapist first or if I should see a general therapist. I would prefer to see a general therapist because I am married and my wife already questions me about being trans due to my crossdressing. Any advice I would really appreciate it.

[Zooey]

You sound eerily similar to me. One thing to keep in mind is that gender therapists aren't like brain surgeons where they do nothing else. Most gender therapists that I've found are also "general therapists", they just also have experience dealing with gender issues.

You should absolutely see somebody, and I recommend seeing somebody with experience in gender issues and transition. Go into it with an open mind, and without a conclusion you're hoping for. I went to one therapist looking to be validated when I really wanted to just be a crossdresser (because I didn't have to rip my life apart for that). These are largely self-identified diagnoses though, and so I of course got the validation I was looking for and made basically zero progress. Since coming out to myself as transexual, I've been open with my new therapist and we're working together to move forward until I find my endpoint (which may very well be full transition).

[Michaella]

I had been seeing a therapist for my stress and depression issues for some years, and I was very open with her about my crossdressing of course, as it was just too much a part of me to not address. She was very supportive, and I was able to see her a number of times presenting as female. After a while I decided I really needed to deal with my gender issues, and sought out someone with special experience in that area, with my therapist's approval, with the goal that I would return to her once I had decided whether or not I wanted to transition. And that is exactly how it worked out, and I am very satisfied with it. They are not comfortable with a client seeing two people at once, but in sequence it was fine, and seemed to work for me.

Something to think about: you are never tied permanently to a therapist. If it is working, great. If not, move on, find someone else who is meeting your needs.

I am also in Philadelphia, and if you want to private message me I can give you some contacts if you wish.

Whatever you do, best wishes to you.

Michaella

[Cheyenne Skye]

I hear the Mazzoni Center in Philly is supposed to be a good place to go for all your LGBT needs.

[Starling]

By all means go to a real gender specialist, jackielynn, because generalists don't really have enough direct, personal experience to draw upon, and are more likely to resort to platitudes and cautions. I'm having to educate my long-time psychologist as to the nature of transsexualism and gender dysphoria. Part of this process was going as myself the last time. That made a big impression on her, because I may have been the first of her patients to do so. I don't think I would have been able to do it, if I hadn't been in gender therapy for awhile.

:) Lallie

[sandra-leigh]

I saw a general therapist for years at the same time I was seeing the gender therapist. It was not a problem: we were focusing on different areas.

[Frances]

Avoid Blanchard?

[Angela Campbell]

I would have issues going to a therapist I had to educate on the subject matter I was going for.

You don't go to a dentist for heart problems.

[Starling]

Lest I be misunderstood, I have both a gender therapist and a regular shrink.

:) Lallie

[KellyJameson]

No advice on therapists other than to find one you are comfortable seeing and don't let anyone else decide for you whether you are trans or not.

I found gender dysphoria was actually easier to understand " as I transitioned" because it was by making the changes and feeling like I was freed from something or my brain was relieved of a pressure inside or finally feeling like I was living naturally and normally.

It was the contrast between what was and what is that really brought clarity to my understanding of "what I had always beeen feeling and living with " as "gender dysphoria". When you are inside GD it is very difficult to understand it.

Until I transitioned I lived in a state of deprivation without understanding what deprivation meant.

You suffer without understanding suffering as to its nature. I think this is what leads to mental illness for many. GD is crazy making on an existential level.

In some ways I could not see how the dysphoria was related to gender because I did not understand "gender" from never having lived or experienced it. For a transsexual until they transition they have never actually lived the experience of gender so it is "outside their understanding"

You are caught in a paradox of trying to understand something beyond your direct experience. You only experience that which you have been deprived of as " dysphoria" but "not gender".

For me I thought of it as being insane while trying to understand what sanity felt like. You always sense the paradox you are caught in and you cannot think your way out of it so intellect or being analytical can actually work against you from the limits of what you can learn as (deep to the core understanding) with the tools of intellect and analysis. Gender is a whole body experience. Gender is a whole life experience. It touches everything and this everything is to big for the conscious mind to grasp except in hindsight.

You can only know what you have known and this is the paradox. Gender is built out of the past but we have no past to refer to, only emptiness.

We seek to fill this emptiness with all sorts of things but nothing can be used as a substituent for gender because you cannot replace the self (gender) with a thing. (everything else)

For me I reached a point where transitioning was a leap of faith that was only confirmed afterwards. I had doubts all the way through and even afterwards until I had time to live not just with my gender and as my gender but "WITH GENDER" which I had never done before. I was ignorant of what everyone else knew about the experience of gender that they knew without knowing they knew (subconscious)

Gender is a largely subconscious experience that we are trying to consciously understand with the added burden for a transsexual of never having lived or known it "but only its absence"

There are many layers and subtleties to dysphoria making it very frustrating to understand if you are experiencing it "from being in actuality a woman" so "outside the experience of gender as to your gender "

Here is a link you may find interesting and possibly helpful related to GD http://anagnori.tumblr.com/post/75333093314/the-more-subtle-kind-of-gender-dysphoria

[LeaP]

Avoid Blanchard?

Funny!

Jackielynn, my advice is perhaps a bit different than what you are asking for. Your brief comment about your wife is already ringing my alarm bells. Resolve NOW to keep nothing from her, don't try to protect her, don't speculate, don't reassure. Involve her as much as she is willing. Do NOT try to game the situation by cherry picking a therapist "because." Interview several, whether gender specialists or not, and select the best you find. While I think that a gender specialist is preferable because it is a niche knowledge area, a good generalist is better than a bad gender specialist.

[Karen62]

While I think that a gender specialist is preferable because it is a niche knowledge area, a good generalist is better than a bad gender specialist.

So how you determine if a therapist is a "bad gender specialist"? Especially when, borrowing a theme from Kelly, you have no context within any of this?

[Nikkilovesdresses]

Hi Jackie,

You make a slightly cryptic reference: "rooted in several issues" and I wonder what the implication of that is. Are you suggesting that some early trauma might have caused the dysphoria? If that's the case, you could be implying that a general therapist might be able to help you work through that, and by inference, remove the dysphoria. Am I way off?

Are you concerned that by consulting a gender specialist, you might not address root causes, but just focus on how to move forward as a potential transsexual, how to assimilate that into your life?

My instinct is that some meetings with a normal therapist might help you make the decision on what form of further therapy to choose, assuming you don't find the answers you need in this forum.

The steady trajectory of your move towards femininity and the way you phrase things here does imply to me that you've reached a tipping point, where the femme is beginning to move past 50%. That must be very unsettling, not least for your relationship. Your wife's instincts may be correct.

[Starling]

...You suffer without understanding...its nature...GD is crazy making on an existential level...I could not see how the dysphoria was related to gender because I did not understand "gender" from never having lived or experienced it. For a transsexual until they transition they have never actually lived the experience of gender so it is "outside their understanding"...

I never thought of it that way Kelly, but yes, although I was born with male genitals I've never known what it was like to be a "boy"; and to this day have never have been fully, unconsciously present in my male body. Growing up, I would look at boys playing or fighting and see aliens whose thoughts and feelings were a total mystery to me. I envied them terribly, even as I feared their aggressiveness and carefree physicality, because they seemed to have so much fun together. But I was always afraid they were going to beat me up.

:) Lallie

[Paula_56]

Jackie-- A lot of younger girls here at these forums-- Paula

http://www.reddit.com/r/asktransgender

http://www.reddit.com/r/transtimelines

[LeaP]

So how you determine if a therapist is a "bad gender specialist"? ...

First, given some of the comments, a clarification. A gender therapist is still "just" a therapist. Not a separate animal at all. The differentiation is that gender is a practice focus area and that the therapist has specific study and training in gender. This is no different than many other areas of practice, whether child psychology, marriage and family counseling, etc. Gender, however, is less amenable to nonspecialists treating clients effectively. It is truly a niche area in many respects, with its own body of research, it's own professional organizations, it's own standards of care, unique diagnoses and history, it's own literature, etc. Nonspecialists risk ignorantly going down differential diagnosis paths that are inappropriate, not distinguishing the many differences among different types of gender manifestations and conditions (conversely, mistaking genuine gender issues as other manifestations and vice-versa), not properly triaging and sequencing the treatment of typical comorbidities, etc. A sensitive and hard-working (and both will be required) non-specialist can overcome this. To stretch the point, the same doctor who removed your appendix might get by doing your open heart surgery, too.

In any event, nothing is going to relieve you of your general responsibility to pick a good therapist. You are going to have to simply educate yourself enough to at least ask reasonable questions and then use your best judgment to select one after you have heard what they have to say.

The kinds of things you might ask include:

Do you have any specific training, mentoring, or education specifically in gender? If so, what?

How many gender clients do you have or have had in the past?

How and why did you start engaging with gender clients?

How many of your gender clients have transitioned while in your care?

Do you know what WPATH is? Do you belong?

Are you familiar with the WPATH standards of care? Do you know what the current version is?

Do you know what the contents of an approval letter for hormones consists of? Have you ever written one?

Do you know who the major theorists are in gender? Do you have any preferences among them?

Are you familiar with current research in the area of biology as it relates to gender? Can you cite any of it?

Can you cite the titles of a few books appropriate for a gender client to read?

Do you know who any of the following individuals are or their significance – Magnus Hirschfeld, Harry Benjamin, John Money, Paul McHugh, Ray Blanchard, Milton Diamond ...) (Apologies for this list becoming a bit US specific)

Have you ever attended a gender conference? When was the last time you did? Have you ever presented at one?

Do you work closely with any physicians with your gender clients?

Do you participate in or facilitate any gender support groups?

What are your credentials? (I.e., psychiatrist, psychologist, social worker, religious counselor, etc.)

If applicable, what other areas make up your practice and why?

Are you in solo practice or part of a group? If the latter, are there others to whom you can turn for support and knowledge when needed?

Do you participate in any local practitioner groups, organizations or associations? What has the focus of your last couple of years of CE credits been?

Etc.

[Patty B.]

Jackielynn, I really agree with LeaP's advice find a therapist or group you feel comfortable with and go it's important. Also keep your wife informed as much as she wants its also important, your not only talking about your life but her's as well and if there are children involved that adds another dynamic. A niece who's a therapist suggested a group for me to see, the psychologist who heads this practice has experience with tg/ts clients dating back into the 70's which is a real plus. Now back to you, find a therapist you're comfortable with and live your life. It may not be easy the decisions you'll have to make but just remember, whether male or female everybody has issues to deal with. Sure would have liked to known this back in my 20's anyway best withes Patty B.

[Inna]

You are TransGender, no PHD necessary to decipher such...

However, you may fall anywhere on the spectrum of TS or gender fluidity, for that as I presume others answered above, find therapist specializing in TG therapy. Preferably one with extensive experience.

[TessaOKC]

Kelly

Such a well thought out and brilliant response!!!! Well done!