Therapist Questions

[Mattie Anne]

Ok, going to jump right in with the questions. I have been seeing a therapist since June. My therapist is not a "gender therapist", and has not worked with a transgender person before, but I like her, and I've made a lot of progress with her, accepting and becoming my true self. I have been open about my gender identity since day one. The only down side is that neither one of us really understands the transition process. My question is, does this raise any red flags for anyone? Specifically, my understanding is that two letters have to be written by therapists prior to surgery. Do the therapists need specific qualifications? Do they have to be "gender therapists"? Should I be looking for someone else? Should I start looking for a second therapist now for the second letter? I am interested in HRT and I have an appointment on the 21st with an endocrinologist. Will the doctor need to talk to my therapist or require a letter from her?

[Saoirse 2]

I'm no expert and have similar concerns, having been working with a fairly new and inexperienced therapist. But I will say that while qualifications and licensing are important, and experience invaluable, the most important elements are your rapport wand comfort working with your therapist.

 

If they aren't a good fit for you, all the degrees and experience in the world won't help.

 

As far as letters are concerned, the current WPATH SOC is less restrictive. But what really matters for insurance, are the rules your insurance have in place. Best to check directly with your insurer to find out the specific requirements for the letters and the qualifications required of the doctor or therapist writing each. 

 

[VickySGV]

Good news for both you and your therapist.  The is NO SPECIFIC licensing for Gender Therapists ANYWHERE.  Every Gender Therapist begins life as an MSW or MFT, or garden variety Psychologist according to the rules of their state or country.  The difference is that GT's have taken an interest in people with Gender Dysphoria, and learn from and for their patients.  Since coming out, while I have not sought a license, I have put my general behavioral science background to good use and have gotten into (Ok, I paid good money) conferences where the participants are in the Behavior Health fields including therapy for Trans adults and children.  The big thing they are looking for is that you understand yourself and do not have underlying mental health issues.  If you have depression (I have it cyclically) they want you to be aware of what it plays in your life and might make you make an unwise and regrettable decision.  Such things as DID, Bi Polar Disorder and Borderline Personality Disorder do not keep you from being Trans, but you need to know how they will affect your life generally, and then when controlled, if the GD is still Consistent, Persistent and Insistent in your life,  you will better make the correct decision for YOU.  A more experienced therapist will have developed the skills to help you deal with the specific changes in your life based on their other prior patient's experiences, but dealing with your spouse's feelings is still couple's therapy of the garden variety for the most part.   Hopefully in a few months Trans Health Conferences will get back in swing, and maybe you could convince your therapist to attend one as part of their Continuing Professional Education program.  They might have a great time learning. 

 

That said, some things may also be done on the Informed Consent Model which can get you to HRT, but in that case an endocrinologist will scare you to death about the dangers of HRT (I do have a DVT) and ask if you still want the stuff and need it, and go ahead with a protocol of medication and lab tests on a regular basis if you say yes. 

 

As my surgeon put it to me, it is not really them that needs the Therapy Letters, it is a checklist thing for the hospital's malpractice insurance carrier because the need is still on their checklists.  Be honest with your therapist who can simply put a license number after their name and life will be good.

 

[SheenaT]

My first experience with therapy was with someone who had little to no knowledge about transgender issues or how to address them. Early on after many sessions she had me see a colleague who put me on anti depressants.  That did not go well for me. They turned me into a zombie. I discontinued them and soon after stopped seeing that therapist. I think because she didn't understand she figured it was just severe depression.