My selected therapist adheres to the ICATH model

[Karen62]

I have finally set a date and time for my first-ever appointment with a therapist to discuss my TG issues. The therapist's website clearly states that patients need to understand that the practice follows the ICATH model (Informed Consent for Access to Trans Health), described at http://www.icath.org/How-Does-it-Work-.html. Are any of you members knowledgeable about this working model for therapy? If so, what do you think and is this a departure from other counseling models? Is this a good thing?

It seems to be focused on letting the patient handle the details of interacting with medical professionals. Luckily (and unexpectedly), I've already spoken to my doctor about my situation, and we're already planning a longer appointment to talk more about this (which is great!). So I don't necessarily see this model as a disadvantage, as I already have my doctor's support. In the ICATH model, the therapist will not issue any letter in my behalf in case I decide to pursue HRT; I have to pursue this for myself using the concept of informed (self) consent. My only worry here is that by giving me, the patient, the reigns of this crazy horse I'm riding, will I be informed and prepared enough to make a good decision if there is no gatekeeper? (I know, the gatekeeper is the one blocking the way!) I may be putting the cart before the horse in this case, as I have yet to even have my first session(!), but I wanted to run this question by the members here to see if they have any experience with, thoughts on, and/or concerns about the ICATH model.

Karen

[Rianna Humble]

It is interesting how people who reject a holistic approach always seem to also reject standards of care. According to their website
ICATH is not a standard of care.

One of the examples that they twist to their own ends is that under standards of care, a patient is supposed to be recommended to see a professional to ensure that other conditions that might affect the transition can also be dealt with and they claim that this is not "informed consent". If you accept the way that they redefine it, then they are correct. To paraphrase their definition "informed consent" (according to them) is about the medical professional not taking the time to consider other factors than your ability to pay.

If you think this therapist will meet your needs, then go for it. If you want to follow that model and later can find an endo who is willing to prescribe solely on your say-so and if that is how you want to approach it, good for you.

I prefer standards of care. I don't call following a holistic approach gatekeeping, but I would point out that Charles Kane apparently took this route of saying to the professionals words to the effect of "I can pay, I want it, no questions please". From what I read on your link, ICATH professionals would love that.

[Michelle.M]

Informed consent is a very good path for those who are very mature and have no (or few) concurrent issues, not necessarily associated with Gender Dysphoria, that also need to be treated.

The problem is that many people who seem to most stridently demand an informed consent approach are those with the most issues. I have no evidence to support this, but my suspicion that the majority of those who turn out to be regretters and detransitioners probably went the informed consent route and did not deal with the real issues in their lives that gender transition would never have addressed.

If your therapist operates along the ICATH approach and everything seems to be working out, then go for it.

[LeaP]

I think it badly twists the meaning of informed consent. It is telling a partial truth. While any meaning of informed consent denotes a patient able to make decisions knowledgeably, that only speaks to one side of the equation. It is still the medical, ethical, and legal duty of the caregiver to ensure that, in fact, the patient really does understand. In practice, the ICATH version of informed consent is being postured as a way of letting patients do what they want without being questioned.

Informed consent has been standard medical practice for decades! You can refer to forms you sign before any nontrivial medical procedure. It simply means you are consenting having been fully informed by the caregiver about what is going to happen and its possible consequences. It is not carte blanche before and after and does not supplant or preclude following normal processes, standards, etc. before or after.

The ICATH posture confuses the notion of responsibility waivers with the long established doctrines of informed consent. The reality is that informed consent is a legal requirement in most jurisdictions to ensure that the caregiver has provided you with enough information to make a decision. There is a history to this. At one time, medical thinking was such that not only were patients not informed, they were not to be informed! This was thought to be harmful. It is still the practice in some countries. A combination of lawsuits, insurance concerns, and patient advocacy brought about current informed consent process. There is no scenario in which a caregiver is absolved of their responsibility to follow professional standards of care except in the narrowest of circumstances (e.g. being allowed to give experimental medications to someone who is dying) or when in their professional judgment, such deviation is medically warranted.

That does not automatically mean, in the case of trans care, that the standard is WPATH's. Some gender clinics, national healthcare organizations, and others have their own applicable SOC's, either replacing or supplementing WPATH's. The Endocrine Society, for example, has published a standard for hormones administration for transsexuals. Surgeons follow strict standards according to their boards and hospitals, etc.

I followed the WPATH SOC 6 protocol at the time I started HRT, and I signed informed consent documents with both my therapist and physician. Moreover, I am still required by my physician to come in periodically for testing. Normal standards of follow-up care are being pursued despite the original informed consent signature.

What is being advocated is like asking your car dealer's mechanic to remove your brakes when you go in for your annual inspection. After all, you have assured them you know what you are doing and that you have other plans – which you politely decline to disclose, when asked – for stopping in your vehicle. You simply need their services. Maybe you do, maybe you don't. But if the mechanic is found out, you can bet there will be consequences. There will be serious legal consequences in the case of a crash. And those can include felony charges in the case of serious injuries, damages, and or death.

Personally, I think any physician who provides hormones to someone on demand on the simple basis of a so-called, bogus "informed consent" document is out of their mind. A doctor is legally accountable for providing care without doing harm to the best of their training and knowledge. When it comes to the involvement of the courts, one of the first things that will be looked at is whether the doctor followed applicable standards … Physicians are allowed to deviate from these with good reason, but they are still on the hook for defending that reasoning.

[Michelle789]

I never heard of ICATH. I have heard of informed consent. My therapist uses it. However, she uses informed consent along with WPATH standards, not ICATH.

[arbon]

I don't think there would be anything wrong with it as long as you are educated about what you need, the risks, and understand where you are wanting to go with it all. However I did not really follow any of the rules myself so what I say is probably not worth much.

[Angela Campbell]

I wonder which surgeons will perform srs without a letter or letters?

[Eryn]

If you are getting any procedure, including a flu shot, you will be signing an "informed consent" form that pretty much absolves the person providing the service from any liability for their actions. No signature, no service, period.

Still, tort lawyers figure out ways to extract money from the medical industry and their insurers which makes Informed Consent moot.

So, this ICATH approach pretty much sounds like "you're on your own, make your own decisions." While I'm not fond of people acting as absolute "gatekeepers" in the system, there should be some due diligence on the part of the person seeking the service to make sure that they are truly getting what they want.

Even the WPATH approach seems to be a system that, in many cases, is more focused on passing the client through than it is in determining exactly what the client needs.

[DebbieL]

Many of those who have severe gender dysphoria are mislabeled by therapists as suffering from depression or other mental health problems that they claim make them unsuitable candidates for transition. Most of the time, this is a legitimate concern, for example, if someone knows they will lose their job or their family and has not addressed the preparations needed to be able to accept such changes.

On the other hand, some therapists are a bit subjective. I had 3 therapists claim that I couldn't be transgender because I was sexually attracted to women more than men. It was once a part of the WPATH protocols but was later revised. Historically, therapists tried to discourage transition and supported only the most extreme candidates. Standards have been relaxed gradually, and many of the original barriers have been reduced or removed. Even the price of SRS has gone down.

ICATH is an alternative to the more rigid protocols, for example, letting someone start hormones when they are living half-time or more as women rather than requiring them to be full time before starting any hormones.

The downside of ICATH is that there is risk of abuse. For example, someone subjected to forced feminization could claim to be consenting to please a wife or lover, but in reality are being coerced into doing something they really don't want to do. Often these clients exhibit the same issues as domestic abuse victims, low self esteem, they are sexually abused, emotionally abused, even physically abused, and subject themselves to SRS to get relief from the abuse.

The other concern with ICATH is that someone can start hormones and end up with breasts and not be prepared for the consequences, not only of friends, family, and work, but also the emotions stirred up by the hormone cocktails. For those of us who are seeing therapists, we find that it's not only OK to cry, but it's even fun to cry, for joy, because we are inspired, because we are sad, or because we are grieving for a loss. For someone who has been forced to be a "man" for many years, such crying jags can be misinterpreted as mental illness or weakness. Taking too many shortcuts can cause serious problems.

Since you've found an ICATH doctor, it can give you a "shortcut" to hormones and SRS, but you should seriously consider following the WPATH guidlines to help you achieve a smoother transition.

[Karen62]

This is all very enlightening feedback -- thank you all! After I wrote this post last night, I did some more research on the web and found a podcast about ICATH, and it featured my therapist-to-be explaining the thinking behind organizing it. The therapist recalled that when starting as a brand new therapist in a larger practice, there were patients that literally knew what they wanted, came to counseling for the mandated 90 days and said nothing of note during any of the mandated sessions, only to go through the hurdles needed to get their letter and move on. The therapist thought this circumstance wasteful of time, money, and counseling resources. That was the genesis of ICATH. The idea, as described in the podcast, is that ICATH is connected to and in line with WPATH, so it seems less rogue than I initially feared. There is even a templatized letter that can be used to give to a doctor.

Frankly, I am seeing this particular therapist because of their experience, their professional qualifications, their deep specialization in the trans* world, and ICATH was not a positive or a negative for me. I assure you, I am not just looking for my letter. At this point, I actually want to have a genuine conversation with a trained professional who understands what it means to be on (and what is not) a TS path. I don't know what I want right now other than some guidance. And I suspect I will be sharing my thoughts, my concerns, and my questions with the members of this forum as I walk down this path of my life. I don't want to live a lie on either side of the spectrum. I just want to find the truth, in as much as it can be fully revealed, and then go from there. No schedule, no destination, no preconceived notions. Just the journey to awareness. That's what I seek right now.

Each and every one of you here have far more experience than I with the path I am taking, so I trust you implicitly. But I know ultimately any decisions made about me have to come from me. Just know I am not bucking the system because I think I know better. I am here to testify I do NOT know better. I know nothing. But I am very interested in learning.

The poscast webpage: http://gendercast.libsyn.com/webpage/episode-23-icath

The podcast itself (getting the link to play was tricky for me): http://ec.libsyn.com/p/3/f/f/3ff26182dd69fe49/episode_23_ICATH_edited.mp3?d13a76d516d9dec20c3d27 6ce028ed5089ab1ce3dae902ea1d06ca873fd9c8587416&c_id=4379033

Thank you all for caring enough to give me your heartfelt advice!

Karen

[KellyJameson]

Transitioning has its own version of "Pink Fog" which is why it can be dangerous.

Imagine that you have been imprisoned and tortured for a large part of your life and you discover the key to your freedom.

If you have ever rode a horse sometimes they run the fastest when they are running back to the barn where they know food,water and relaxation await.

It is difficult to be pragmatic when you are in pain.

The problems come out of our imagination where we spin fantasies of what living as a woman will be.

There is also the desire to be sexually alluring combined with elements of narcissism.

Since my early teen years I have acted seductively and find it natural to be sexually alluring and certainly worried that I was narcissistic and this caused me great concern as to the forces that "created and were creating my female identity"

I'm also shy and modest and these two emotional states would pull me in opposite directions further adding to my confusion of "what I am and why"

In my opinion you want to be as aware as possible to the emotions and passions that drive transitioning.

You sound wonderfully practical and balanced and I do not fear for you as I have in the past for myself and others who I have known that stepped onto the path of transitioning.

There is nothing wrong with wanting to be sexually alluring or seductive and a touch of narcissism can be healthy but this is not identity and can lead to dangerous behavior and choices.

Transitioning and Identity are not about having an audience. It can not come out of being "emotionally needy" where we feed off of others, while recognizing that being an untransitioned transsexual leaves us "emotionally needy"

In my opinion it is very difficult to know if you are transitioning for healthy reasons and this is where a good therapist and your own dedication to doing some hard soul searching can protect you.

I had to confront intense transphobia and homophobia along with narcissism and a host of other repressed issues.

I feared therapy at first because I thought "What if they decide I'm not a woman, than what ?"

For me the "than what" would mean not only would I not be able to live as I felt I needed to but also that I must be mentally ill for believing that I am in actuality a woman.

It is really tempting to lie in therapy and "manipulate the therapist" because it is scary.

What actually happened was the opposite, I (she) emerged.

Try not to "force your identity" (create her) but trust that you will "find her"

Be really really honest with yourself and your therapist and you should be OK.

Everything about transitioning is WORK.