Transgender psychotherapy

You will make some important choices of service providers in your transition:

  • Therapists (and possibly a second therapist if required by a surgeon)
  • Hair removal practitioners (see my page on choosing a practitioner)
  • Physicians (general, and possibly another one for hormones)
  • Plastic surgeons (top, bottom, or facial surgery)
  • Financial advisers (recommended, often not required)
  • Legal advisers (recommended, often not required)

All of these people are being paid to provide you with a service. If you are not satisfied with the service, say something. If that doesn’t help, find another provider.

Choosing a therapist

Self-acceptance

  • Self-acceptance and coming to terms with your feelings are the first order of business in transition. For that, it can be very useful to see a therapist, even if you know how you feel and know what you want to do. The key is getting first-hand experiences and personal recommendations. To find people for this advice:

Ask local community members

  • This is the best way to get candid information. If you don’t know any, try the methods below to get in contact with someone.

Ask local providers of trans services 

  • Trans-friendly hair removal practitioners, doctors, etc. might be able to point you in the right direction or put you in contact with patients for first-hand information.

Look online

What to ask clients

Ask about rates, hours, schooling, etc., but the main thing is to ask about the therapist’s style, opinions, and policies. Some therapists require more than others before they’ll recommend hormones or surgery. Some feel they are gatekeepers who must keep people from making mistakes, and require a lot of sessions. Others are much more open or easy-going.

What to ask therapists

  • How many trans and gender patients do you have?
  • How many of those clients have you recommended for medical options?
  • How long have you been working with our community?
  • What is your educational background?
    • Remember, if your healthcare provider follows the WPATH Standards of Care, your approval needs to be from a doctorate-level clinical professional: “If the first letter is from a person with a master’s degree (M.A.), the second letter should be from a psychiatrist (M.D.) or a clinical psychologist (Ph.D.). If the first letter is from the patient’s psychotherapist, the second letter should be from a person who has only played an evaluative role for the patient.”
  • What books on gender identity and expression most influenced you?
  • Have you written any books or articles on the subject?
  • What got you interested in working with our community?
  • What is your basic philosophy about trans healthcare?
  • What is your opinion of the WPATH Standards of Care?
  • What is your hourly rate?
  • What length of session do you usually prefer?
  • Is it possible to do longer or shorter sessions?
  • How long do you usually see patients before you might OK them for hormones? How long for surgeries?
  • Are you affiliated with any endocrinologists or plastic surgeons?
  • Are you part of my insurance network?
  • Would you be willing to classify our sessions as depression in order to meet insurance requirements or keep my gender identity private?
  • What are your hours?
  • Do you have weekend or evening appointments?
  • Do you work from your home or from an office?

Don’t be afraid to switch to another if necessary

Too often I hear people say their therapist isn’t being responsive to their requests. If you feel that’s the case, you should speak with them candidly about that, and listen to their reason why. Keep an open mind, because they may be right. However, if you are not satisfied with their reasons, don’t get depressed or angry. Go elsewhere.

Continuing in a frustrating therapy relationship can be counterproductive and even dangerous. It can lead to a point where unresolved issues boil over.

Think of your transition-related professional relationships like romantic relationships: if you’re unhappy, you need to talk about it. If you feel the relationship is worth keeping, you should try to work through the issue at hand. If it seems hopeless, you should move on. Simple as that. I had several service providers give me answers I didn’t like, so I left. Don’t settle. It’s your money. If no is their final answer, move on.

People say, “But I’ve made an investment in this therapist of this many sessions and this much money.” Well, you may need to write that off. Yeah, that sucks. If you want to avoid wasting time or money, talk to others before choosing a therapist.

My general opinions on therapy

If there’s a specific thing you seek (such as hormones), adults may be able to get those directly from a physician without therapy via informed consent.

However, I feel seeing a therapist can help. I learned a lot in therapy, about myself and about the best way to transition. I believe self-acceptance is the key to transition, and therapy can help with this. An experienced therapist can also be very useful for helping shape a realistic transition plan based on your specific needs.

In gatekeeping therapeutic relationships, clients are prone to hold back information that might jeopardize their chance to get required approvals. This can make therapy lees about helping you adjust and more of an adversarial relationship. It’s best to find a therapist you trust.

I continued therapy after completing my legal and medical steps and found it very helpful. Often, emotions and problems that were not adequately dealt with during transition can catch up with you upon completion. I opted to go to a different therapist who had no experience with gender issues following transition.