"When we ignore the calling, when we ignore the truth, when we ignore our experience of ourselves of somehow mysteriously transcending the binary gender system, a deep psychological and spiritual wound is inflicted." ------St.Claire
“Like dogs chasing our own tails, We are bedeviled by the ‘why’ question, which conjures up its twin, the devilish ‘how’, how to change. The pursuit of happiness becomes the pursuit of answers to the wrong questions.”
--—James Hillman
Psychotherapy, Hormones, and Genital Surgery
Clients who consult with me about transgender issues represent a diversity of gender and sexuality, and each client experiences a personal and unique set of issues. Most clients are seeking a resolution to conflicts and confusion with gender identity, gender roles, sexual orientation, and sexed body. Gender identity concerns are just dawning for some; others have resolved to seek guidance to help resolve their gender issues after years of being afraid to talk to a psychotherapist about it; and others only seem to need help to access medical care, such as cross-sex hormones and genital surgery.
When clients first come to consult with me, I recommend that we first reach a shared understanding of the gender and/or sexual concerns. I suggest that we discuss how gender and sexual issues emerged throughout your life from childhood to the present, so we can understand the path that your life has taken thus far. Then, we can agree on the goals for our work together. Clients often have specific goals, such as deciding whether to consider gender transition, learning how to develop a healthy and balanced self-concept as a transgender person, or obtaining referrals for hormones and genital surgery.
I also want to understand whether there are psychological issues that might also be causing problems in your life. Sometimes clients are also having problems with depression, anxiety, suicidal thoughts, shame, and guilt. Internalized negative beliefs about non-traditional gender and sexual expression, (internalized transphobia) can cause intense life long psychological suffering. Gender diversity, no matter what we may call it (e.g., transgender, transsexual, cross-dressing, androgyny, etc) is not a perversion, a psychological disorder nor a pathology.
I believe that the reason transgender persons struggle with gender and sexuality is because of the heterosexist beliefs in our culture which stigmatize gender diversity. As children, we are raised in a heterosexual culture with rigid beliefs about what is acceptable and normal for men and women. We learn at a young age what are acceptable gender roles and behaviors for our sex, and we internalize feelings of guilt and shame when we know we want to be and act like the other gender.
The suppression of gender and sexual expression can cause prolonged depression and anxiety that can be resolved through psychotherapy.My experience has been that transgender persons are more susceptible to depression and anxiety than non-transgender persons. Transgender persons often experience multiple stressors that can increase the vulnerability to depression and anxiety. Depression and anxiety can be effectively resolved through transgender sensitive psychotherapy, but sometimes medications are needed. However, many transgender persons do not have a psychological problems of this sort, such as depression, and do not need psychotherapy. I do not believe that people with transgender issues necessarily need psychotherapy.
People who are transitioning and who would benefit from sex hormones and surgery do not necessarily want or need psychotherapy. However, I do believe that psychotherapy is an effective method to resolve the gender and sexual issues discussed above and as a tool for self-understanding that can improve the quality of life.. When a client wants sex hormones and/or genital surgery, and we conclude that there are no relevant psychotherapy goals, I do follow the Harry Benjamin International Gender Dysphoria Association Standards of Care (SOC) in making referrals to physicians and surgeons.
Many non-transgender providers of psychological and medical care assume that the desire to be the opposite sex is a psychological disorder. Unfortunately, the Harry Benjamin International Gender Dysphoria Association as a professional body also equates such gender diversity with a psychological disorder. Nevertheless, the SOC are a specific set of medical standards that psychologists, psychotherapists, physicians, and surgeons are expected to follow in administering sex hormones and making decisions about genital surgery. I believe that the only disturbance is the gender dysphoria that many of us feel, and need help to resolve.
I am committed to honesty, clarity, and collaboration in psychotherapy and consultation with clients. I clearly explain my understanding of the issues and my recommendations for counseling goals, and collaborate on a making an agreement for services that makes sense to both of us. I believe in equalizing the power in psychotherapy and consultation through educating clients, carefully listening to and understanding clients, and collaborating in making decisions. I believe that these qualities are essential in working with transgender issues because of the history of the abuse of power by gate-keeping professionals. In order to work together productively, my clients and I must have a consensus on our treatment goals, the frequency of sessions, and the methods of psychotherapy. When I am held to specific professional behaviors by legal regulations, medical standards, and professional ethics, I inform clients ahead of time whenever possible.
Many clients are worried and anxious about how their gender issues may affect their relationships, the people they care about and love, their family, spouses, and children. There can be fears of rejection, abandonment, and anger. There can be fears about stigmatization for self and the family within important social contexts, like school, church and the neighborhood. I can help clients transition with their family members, and also help family members, through couples and family counseling, understand and resolve their own concerns about their transgender family member.
Clients who are transitioning from one gender to another often are unsure about what if anything to tell their employer and co-workers. There can be fears of discrimination and job loss. I have experience helping clients manage transitions within the workplace, and consulting with supervisors and human resources professionals. I am available to consult with attorneys in legal proceedings, and provide expert psychological testimony in court.