The
Gender Therapist
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The Standards of Care provided
by the Harry Benjamin International Gender
Dysphoria Association establish guidelines pertaining to the professional
qualifications and responsibilities of therapists with transsexual clients.
Most of the experienced gender therapists working with such clients will
be aware of, and adhere to, those guidelines to one degree or another.
However, few therapists work exclusively with transsexuals, yet many of
those same guidelines are still applicable in dealing with individuals
from a wide variety of transgendered lifestyles. But aside from the professional
qualifications what are the qualities of an effective gender therapist? |
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As with just about any other profession some therapists with extensive
credentials may sometimes work poorly with transgendered clients even though
they have been providing such care for a long time, while other counselors
with fewer credentials may be highly effective with lesser experience.
In some measure this often relates to the ability of the therapist to step
beyond psychology in the purest sense and accept a larger role, or roles,
in the transgendered client's overall care. Some of the most common roles
are: |
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Psychologist/Counselor -
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Initially there is a diagnostic element involved wherein the therapist
must determine whether or not a client's transgendered behavior is related
to a specific medical or mental disorder. While specific medical causes
are extremely rare, when they do occur the condition involved can be a
very serious one. Likewise certain psychological disorders can equally
impair a persons ability to rationally consider issues such as gender.
As such it would be truly irresponsible for any professional therapist,
and certainly not in their client's best interest, to proceed with any
course of therapy before at least making some effort to rule out these
possibilities. Generally such an evaluation, with or without supportive
testing, will take approximately one to six hours to accomplish. How quickly
this is completed can be largely dependent upon the length and frequency
of your sessions with the therapist. |
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While in most instances transgenderism is not usually something that a
patient undergoing therapy may be "cured" of unless there are specific
underlying reasons for an individuals cross-grender behavior. It is not
at all unusual that a gender patient may enter therapy seeking such a cure.
But once the diagnostic element is completed there is no definitive outline
as to how therapy should proceed as the issues involved vary from case
to case, although generally a therapist will want to explore the history
of a client's past cross-gender activities, perhaps even the motivations
behind such behavior, for these are the typical avenues to understanding
and once someone can begin to find self-understanding it is often much
easier to begin dealing with the issues of how to cope in the future. |
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Someone dealing with transgender issues often faces personal decisions
that have far reaching, perhaps even life changing consequences. Whether
it be the transsexual seeking hormones, transition, and surgery or a crossdresser
who might be risking the continuity of his/her relationship with a significant
other by continued cross-gender activities. In concidering the issues faced
by the transgendered client, a therapist can neither encourage nor discourage,
but rather must guide the individual in seeking their own answers, making
their own decisions. |
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Gender varient ideas and/or lifestyles do not often fit into neatly segregated
and clearly defined categories as one might believe. A typical stereotype
is that all crossdressers content to merely to dress up and act out the
cross-gender role but are not interested in any form of further transition
such as hormone therapy, or that all transsexuals are seeking gender surgery.
Yet in reality their are always degrees between these extremes, many TS's
are quite content to transistion and not continue with surgery (non-op),
and some CD's are interested in hormones as a means to enhance their passability.
The best rule of thumb is only to do as much as you need to to be happy,
and to this end an experienced therapist can present information on the
options available, along with discussing the consequences of differing
choices, allowing the client to make informed decisions which may be for
a positive benefit in their lives. |
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Many gender therapists are equipped to provide marital and/or family counseling
services, either themselves or through associates to help the transgendered
client's spouse, parents, children, or other family members. Some who work
with transsexual individuals may even be able to provide help with transition
employment issues in the form of consultation with employers, education,
and/or sensitivity training for supervisors, and co-workers. And in many
places may be able to serve as an advocate in helping to get name or ID
changes. |
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Transgendered individuals often have need of information and resources
(medical, cosmetic, legal, deportment, speech, financial, etc.) beyond
that of therapy alone. An experienced gender therapist is generally familiar
with these needs as well as the resources available in the local community.
For many transgendered people a therapist will be their first point of
contact with anyone providing services for them, where as a professional
with experience in treating gender issues often has occasion to interact
with others in the community that work with TG's in one capacity or another. |
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A therapist of the same gender as their client seeks to become through
their cross gender activities may often themselves become a role model,
as might a therapist who is transgendered themselves. In fact a transgendered
client may even choose a particular therapist based upon these very criteria,
feeling that it would be easier to talk to someone of the same gender as
they perceive themselves to be or someone who might better understand the
issues they face having dealt with them themselves. This can a difficult
position for a therapist to be in, and when it occurs they must be careful.
Quite correctly they must maintain some therapeutic distance between themselves
and their client to avoid contaminating the treatment process with their
own ideas or issues. Yet one can still be an effective as a therapist and
provide information to their patients based on their own experiences, such
as tips on passing (i.e. observations about cosmetics, styling products,
fashions, etc. as might be appropriate). |
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It is important that a client be able to talk freely and openly. Often
a therapist may be the first person that a transgendered person has disclosed
their feelings to, the only person they feel safe enough to talk to, opening
up a part of themselves they may have keep hidden most of their lives due
to stong feelings of shame or guilt regarding their cross-gender identification
or activities. These feelings, combined with a fear of discovery, can build
a powerful emotional lock. Opening that lock and sharing what is behind
it in many ways is an element of trust, and such a trusting relationship
between a patient and therapist is generally one of the first steps towards
successful therapy. |
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A therapist that does not have a friendly manner, or who is inexperienced
in treating gender issues, may often have difficulty inspiring such trust,
and may even put their client on the defensive in these areas causing them
to lie or otherwise attempt to manipulate the therapist in order to achieve
their goals. This can be especially true with those treating transsexuals,
causing contention between the therapist and client over the therapist's
defined role as "gatekeeper" in their treatment process. |
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While many, both therapist and patient alike, often object to the term
"gatekeeper" with regard to transgendered care, to a certain degree this
characterization is technically correct. The Standards
of Care also establish guidelines which transsexuals seeking hormone
therapy, or gender surgery, should comply. The professionals that provide
these services need to have medical standards to rely on, standards that
weigh the interests of both parties. As such it is the therapist's role
to insure these guidelines are properly met by providing clearance or referral
letters for hormones or surgery, steps which are successively more serious
and perhaps irreversable. |
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In this area two individual criteria have been defined, eligibility and
readiness. Eligibility is perhaps the easiest of the two to define, since
a definative step by step standard is outlined in the SOC guidelines. A
certain length of therapy prior to receiving a referral for hormone therapy,
followed by a certain length of real life experience prior to receiving
surgery, etc. However, weighed against the eleigibility requirements is
the concept of readiness. Wherein readiness is defined as the degree to
which the individual likely to be successful in their transition. A person
with a high degree of readiness may be be able to proceed regardless of
having met the specific eligibility requirements, whereas a person with
a lower degree of readiness may need to extend the minimum for eligibility,
and since the degree of readiness is left to the judgement of the therapist
it is quite natural to perceive the therapist as the "gatekeeper". Yet
the bottom line is that the therapist and client should be working together
in such a way that both client and therapist will be able to agree when
these requirements are met and thus insure the individual's transition
is likely to be a success. |
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Forums
Contributions
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While all of our site is open to your contributions and suggestions, the
forums area in particular depends upon them. If this area is to become
the source for information and support that we know it can be, then it
is all of our transgendered sisters & brothers that will make it so.
Your input might be just what someone else needed! If you have something
to share here E-mail us: TGE@tg2tg.org |
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