Questions on Therapy

[Russ Fenrisson]

For the longest time, I thought I could go it alone, but once I had a sudden thought, "I need help," coming to my brain back in April or May, I decided the best course for me to take- to help figure out my problems and eventually work towards acquiring T- is to take up therapy. I didn't do so before because I thought I could cope on my own and I didn't think it would be acceptable to take that route. After talking to some of my family, it seems like it'll be okay to take up if I want to pursue it.

 

On regards to taking up therapy, what are things I can say and probably shouldn't bring up? I've been told time and again not to bring up depression and how I've been dealing with that because if it gets put on my medical record, it might hurt certain opportunities I would want to take up in the future. Also, when is the best time to inform the therapist I'm trans/non-bibary and have gender dysphoria? I know gender dysphoria is one of the key factors behind my depression, but how do I bring it up to let the therapist know my gender dysphoria is the problem I want fixed, especially to start HRT? I know all my problems won't be solved in the chance I am able to start T, but I want to start that route so I can stop the misery that encompasses me much of the time. If nothing at all, even if the therapist cannot help my with my GD, I hope they can point me in the right direction towards better security and mental health.

 

I thank everyone putting in the time to help me out with this issue.

 

-Russ

[Colleen Henderson]

This is just one person's experience, so don't take it as gospel.

 

I had encounters with psychiatrists and psychologists beginning in the 1980s. The first two were in private practice, and then there were three others within the VA medical system. All were initiated by me, and only the last one did not involve the subject of gender dysphoria.

 

The subject of depression came up repeatedly, but whatever reference to that subject might appear in my medical records has had no effect whatsoever upon anything I've tried to do.

[VickySGV]

Call your nearest LGBTQ Community Center and ask if they can give you the name of a therapist who works with the Trans Gender Community.  Sometimes they get the title of Gender Therapist, but all of them have been garden variety Marriage & Family Therapists, MSW's and the like before they gained experience in Gender Counseling, so things like Depression and Family Stress will not phase them in the least.  They are going to want to know how long you have had the thoughts of being Gender Variant, the intensity of the thoughts and how they are making your life difficult. The difficult part often leads to depression if it lasts long enough and thus helps your progress rather than taking you off on side issue.  It is true that Therapists who are not familiar with the Trans experience will grasp at things like depression which they know and maybe overwork it , but experienced Gender Therapists know the parts to go for and will help you explore those issues.   

[Russ Fenrisson]

Thanks. I think I understand the process a little better now.

 

That's very reassuring @Colleen Henderson. When talking to medical professionals, they encourage their patients to tell them the truth in regards to their condition so they can better help them. When the question "Have you ever felt depressed or had suicidal thoughts?" comes up, I immediately become nervous. I just don't know what to expect. When that question pops up again, I feel a little bit better knowing it won't be counted against me.

 

I didn't know about that @VickySGV. I just assumed that only a gender therapist or any therapist specializing in LGBT issues would be helpful. It's comforting to know there's other avenues to seek help. I'll see what I can find and go from there.

[Colleen Henderson]

3 minutes ago, Russ Fenrisson said:

When the question "Have you ever felt depressed or had suicidal thoughts?" comes up, I immediately become nervous.

In the VA medical system, that question is asked in the present tense ("Are you" rather than "Have you") asked on every visit - no matter how routine.

[Russ Fenrisson]

Oh. Is it perhaps to make the patient feel more comfortable about their position? When it comes to certain conditions, especially those of the mind, I heard that speaking of things in the past tense isn't always the best. It's like a way of distancing the self from the past so it has no adherence to the person in the present.

[KathyLauren]

On 9/25/2022 at 3:25 PM, Russ Fenrisson said:

how do I bring it up to let the therapist know my gender dysphoria is the problem I want fixed, especially to start HRT?

 

I would just tell them.  I told my therapist, "I am pretty sure I am transgender.  I am looking for a hormone readiness letter."  That pretty much set the tone for the sessions.

[Russ Fenrisson]

I did see you mention that in a different post, @KathyLauren. I thought it was pretty cool how you were able to do that. Lots of courage and determination as well. I'm still pretty nervous about getting started but I hope to get to that level where I can tell someone about what I want.

[KathyLauren]

3 hours ago, Russ Fenrisson said:

I thought it was pretty cool how you were able to do that. Lots of courage and determination as well. I'm still pretty nervous about getting started but I hope to get to that level where I can tell someone about what I want.

 

I understand being nervous.  I was, too.  But desperation helped.  Knowing that I had "wasted" at least 2/3 of my life in the wrong gender, I wanted to get the show on the road ASAP.  How could she have helped me if I hadn't told her what I needed?

 

You can do it!

[Vidanjali]

When medical providers ask, in the present tense, "are you now experiencing thoughts of harming yourself or others" it's not for any special therapeutic reason (asking in the present tense rather than past tense, that is) - it's because they are beholden to intervene immediately if the patient is currently having such thoughts. 

 

I'd advise you to tell your therapist everything. That will ensure the best result of your therapy - don't hold back, that's what therapy is for. Like Colleen said, there's no proverbial "permanent record" type situation when it comes to psychological medical records. What's spoken between you and your therapist is confidential. However, to reiterate, if you are deemed in danger of imminently harming yourself or others, in that case, they will take action such as pursuing in-patient hospitalization, if appropriate. That said, it's totally fine to discuss suicidal ideation with your therapist - and you absolutely should, if that's the case - but be mindful to qualify whether you actually feel you're in danger (like if it's just a thought that comes up, not that you have a plan or feel unsafe). 

 

So, without further dwelling on that extreme aspect of mental health, I hope you will find a therapist you can connect with and who can help you. 

[Russ Fenrisson]

@KathyLaurenIt's great they were understanding. I can understand feeling like one has wasted their life or has felt lost with nowhere to go. Thanks for the advice.

 

@VidanjaliYeah, I was wary about talking about that before. A long time ago, during a check-up, when the doctor asked me that, I admitted to the fact I wasn't doing well mentally and they gave me an appointment to see a counselor at the clinic. When I next visited to see the counselor, I told them the issues I had with anxiety and being uncomfortable with the way I was. I told them sometimes I feel like a guy and I wished I could become one. I even got into grittier detail about my mental health... it wasn't very pretty. At the end of the session, they asked me "What is most important to you right now: fixing your anxiety or wanting to be a boy?" I told them the latter as, at the time, that desire had been consuming me. I was hurt being told my anxiety was more important. I never went back or filed for another appointment.

 

Thinking back, they were probably right- if I worked on my anxiety, then maybe, in time, we could have discussed my desire to become a man, but what's done is done. How I felt at the time is different than how I feel now.

 

Thanks for clearing up that question a therapist might ask; I've always been wary about it. And thanks for the advice.

[Vidanjali]

@Russ Fenrisson  ugh your story is an example of why it's important to find a therapist specifically skilled in treating patients with gender issues. Such a skilled therapist would understand that anxiety and gender issues are not mutually exclusive. To assert that they are in the fashion you related is terribly invalidating. Moreover, no decent therapist would ask you to prioritize your issues like that whether a gender issue were in the mix or not. To me, it seems like a passive way to dismiss your gender issue - can you imagine a therapist asking a cis person: which shall we fix first, your depression or your dissociative disorder? So, I can completely understand why you'd be hesitant to pursue therapy having had that experience. I've had some negative experiences with therapists too, and it can be devastating because in that context, you are so vulnerable. But, I've also had the great fortune of seeing a few life-changing therapists. Keep in mind, they're just human - some of them will not be so great, and others will be outstanding, just like any other subset of humans. You are entitled to interview a therapist before you commit to treatment. If there's someone you're interested in, call them up and ask them some questions like whether they are trained and experienced treating trans people (specifically FtM), or whatever other issues you're seeking help with, what modalities they use, etc. You are in control! 

[Russ Fenrisson]

At the time I went to see the counselor, I don't think the trans condition was very well understood or thought of as important. And it really isn't right for a therapist to make that kind of 'deal' situation with their client. Often, one issue causes another and they can't be singly ignored or favored for another. 

 

I saw mentioned somewhere about interviewing a therapist before actually starting treatment. It genuinely sounds like a good idea, especially since you'll be seeing them for a time. I don't like the feeling I'm conducting an interrogation, but I'll have to get over that if I want to get better. And, maybe, the therapist won't mind either.

 

I'll remember to ask about that too. Where I live, there are few therapists available that work with transgender issues. I just hope they can help those that are FtM. My one concern is the therapist having a negative reaction towards me. It's probably in my head, but if I run into a similar situation as I related before, I might be mortified.