A reader writes: “I have two related questions about psychotherapists and trans clients when the trans client is not specifically seeking transition-related medical approval stamps, but simply seeking psychotherapy for any number of things that may include trans and transition-related stresses.
“For psychotherapists who are not very familiar with gender variation and trans issues, and who may have clients who are trans and who seek therapy: What would you put on your top three to five things such therapists should know or be aware of?
“For trans people: What would you put on your top three to five things a person should be aware of when pursuing therapy with a therapist who is not very familiar with trans issues?
“The other factor is that I’m sometimes pulled into playing the role of educator and I’m really torn about it because 1) I know nothing about therapeutic worlds and am not trained to be a trainer, 2) I am a client, not a teacher, and 3) I don’t know where else they should be looking. How do therapists train themselves or learn about these things?”
These are interesting questions, and very timely, because the Gender Identity Center of Colorado is having its annual Colorado Gold Rush Conference on March 22-25, and the conference has a two-day clinical track for therapists and other professionals who are working or want to work with trans people (this includes students in an MSW or other counseling program). This is one way that therapists can learn about trans issues.
Since I’m answering your last question first, I will say this – it’s unfortunate that most university MSW and doctorate programs don’t have specific training or classes on trans issues. This should actually be an entire semester-long class in and of itself. What most higher-education programs (and most therapists) don’t understand is that therapists will run into clients with gender issues regardless of what area of counseling they are entering – family counseling, marital counseling, drug and alcohol treatment, child therapy, and pretty much any other area.
Whether or not these therapists choose to treat clients with gender issues or refer them on to someone else, they will see them in their practice. And even if they do refer them to someone else for work with gender issues, they should at least know what to do and how to handle the initial contacts and referrals.
The positive thing is that an increasing number of instructors are taking matters into their own hands and bringing trans people into their classes to speak. Every year, I speak to several master- and doctorate-level social work and psychology classes in the Denver metro area alone. While I am only able to scratch the surface of what these future therapists need to know, they at least get some exposure to trans issues and are able to start thinking about what they might want to explore further.
Most therapists have to take on in-depth training themselves. The Gender Identity Center of Colorado has an internship program where future therapists can learn under the supervision of a doctorate-level therapist. Other gender centers might have similar programs.
But new and seasoned therapists are usually on their own, and they need to seek out conferences, read books, and find mentors within their community who can help them. They can also join the World Professional Association for Transgender Health (WPATH) and get information, contacts, and resources. Readers might also have other suggestions with regard to organizations, conferences, and other programs.
What I think any therapist should understand is that the client should not have to teach the therapist. I know many trans people who have trained their therapist, because the therapist had no prior knowledge of trans issues, and the client had nowhere else to go. Sometimes this works very well, and a strong therapeutic relationship is formed. Other times, it can be very problematic, because the client is already dealing with a lot of very stressful stuff, and having to train a therapist along with everything else can be overwhelming and exhausting.
If university boards, licensing boards, and professional organizations would listen to me, I would say that a Trans Issues or Transgender 101 class should be a required course for all therapeutic professionals. But I am rarely (actually, never) consulted when universities are setting up their curriculum and state licensing and oversight boards are setting up their requirements. So, given that, we have to make do with the enlightened professors across the country who are bringing in trans speakers and trainers for their own classes.
Now, to your other questions:
“What would you put on your top three to five things such therapists should know or be aware of?”
1. Have a working definition of the terms “transgender,” “transsexual,” and other associated terms, while realizing that these definitions vary from community to community, and from individual to individual within certain communities. When your client comes out to you as transgender, transsexual, genderqueer, or uses any other self-definition, say, “I know what that means to me. Tell me what that means to you.” If, as a therapist, you aren’t able to say this because you don’t know what those words mean to you, find out.
2. If you are working with, or want to work with, trans clients on trans issues specifically, be aware of WPATH, the Standards of Care (SOC), and the various opinions within the community regarding the SOC, the DSM-IV, and the upcoming DSM-V, along with other issues that are central to transitioning clients. Along these lines, do not use the DSM as your sole diagnostic tool. Use it, if you must, as one of many. With regard to the Standards of Care, remember that they are guidelines.
3. If you are working with transitioning or transitioned clients on other issues, remember that not all problems or difficulties in a trans person’s life are related to his or her transness. Like anyone else, trans people have relationship problems, work-related problems, life stressors, depression, and other mental-health and emotional struggles. Many of these have nothing to do with being trans. Transition doesn’t solve all of a person’s problems. It solves one problem. The rest remain. However …
4. Don’t dismiss gender issues as a possible factor in a problem situation, no matter how long ago someone might have transitioned. Transition can impact a person for a lifetime, so while you should not assume that all of a person’s problems are the result of being trans, you should also not assume that any particular problem is not trans related. Explore all possibilities.
“What would you put on your top three to five things a person should be aware of when pursuing therapy with a therapist who is not very familiar with trans issues?”
1. If you believe that your issue is not trans-related, then you don’t even have to come out to this person, which eliminates the issue of that therapist being unfamiliar with trans issues. However, because it is often difficult for us to see the scope and all the causes of certain problems that impact us personally, it’s possible that your transness could have something to do with your issue. By not coming out to your therapist, you are shutting down any possibility of exploring the impact that your transness might have on the presenting problem. If you decide to come out to your therapist, gauge his or her response and make your decision about whether or not to stay.
2. As a client, your comfort level takes precedence over your therapist’s comfort level. In addition, it is not your job to make your therapist comfortable. If your therapist is uncomfortable working with you, find someone else.
3. As a client, it is not your job to teach your therapist about trans issues. However, many clients are put into this role because of the lack of knowledge and training that most therapists have on trans stuff. If you want to do it, that’s fine, and there are times when you might feel as if you have no other choice, because your available options are limited, and that’s understandable. But if your therapist is not even willing to pick up a couple of books, go to a conference, or visit a few websites, I would be wary. If this is the case, he or she does not seem to be invested in your care or your best interests.
4. There are very good therapists who do not know anything about trans issues and very bad therapists who know a lot about trans issues. The relationship between the client and the therapist is the most important thing. If you feel really good about a particular therapist, see if you can work it out. If you feel uncomfortable with a particular therapist, no matter how experienced that person is with trans issues, find someone else.
That’s the tip of the iceberg, but those are some things that I consider important, and I hope that we will hear from readers with many more thoughts. With that, I’ll turn it over and find out what other people have to say.
As a psychotherapist who works frequently with clients with trans issues, I say great post with lots of excellent information!
This seems super basic, but I would also say teaching/knowing etiquette can be a very good thing. What questions to ask and not ask (although those are admittedly a little bit different for a therapist) and so on and so forth.
Possibly different steps used to treat what kinds of dysphoria and how to discuss transition with a client, if they are pre anything.
As a therapist who has trained herself about trans issues, found my own mentors, trainings and books, I agree with everything you said. Being knowledgeable about trans issues does not mean someone is a good therapist. Most importantly, I tell people to find a therapist they feel comfortable with and that may or may not be me. Conversely, a client should not have to train a therapist but sharing their own understand and educating the therapist regarding their own personal perspective on trans issues is invaluable.
I do not subscribe to therapy by an inexperienced practitioner. Would you go to a cabinet maker to get a horse shod?
Well said!
While, in an ideal world, I would agree with deena17’s comment, it is a fact of life that no therapist acquires experience out of thin air, so some are always inexperienced. In this case it is essential (I would hope for training purposes anyway) that they have a strong supervisor.
While I don’t need a therapist for trans issues any more, I do have one for some other bits, kind of fine tuning. Since I started therapy with my first ‘shrink’ I have also done a masters in psychology (though not really of the therapeutic kind) and read loads and loads around the topic. So I think my current one is less experienced than my first one (now thousands of miles away), and sometimes it does feel like a bit of remedial training (I pay a sliding scale, so feel that I don’t ‘deserve’ high experience…) In the end, it all depends, as someone else has said, who you feel comfortable with.
To add to this wonderful post and insightful comments, I think as a therapist, obtaining good consultation with an “expert” in the field is imperative to understand not only the client’s psychological issues and dynamics but also to explore one’s own feelings and thoughts in working with the trans population.
“There are very good therapists who do not know anything about trans issues and very bad therapists who know a lot about trans issues. The relationship between the client and the therapist is the most important thing. If you feel really good about a particular therapist, see if you can work it out. If you feel uncomfortable with a particular therapist, no matter how experienced that person is with trans issues, find someone else.”
This is it in a nutshell. Find a therapist who doesn’t see you as mentally ill and can help you deal with how society in general will treat you.
A wonderful blog by a wonderful therapist: http://darlenetandogenderblog.wordpress.com/
p.s. I am a client of the above therapist; very happy with her work and highly recommend her blog!
Great post, Matt. I jhave to educate my therapists about BLINDNESS as well as TRANSNESS! I did have to educate them and hopefully, they stay educated for the next blind person they get. I don’t think they get educataed in school about disability issues any more than they get educated on Trans issues (sigh!). Bottom line: Educate the therapists on these things before they go out and start their own practices. Then they can be a better help to their clients who happen to be disabled or Trans and then get to the meat of the problem the client comes to them for in the first place. It has been frustrating to me to have to educate everyone all the time about trans and blindness but somebopdy’s got to do it I suppose! And it will be better for those who come after me.
I started therapy almost two years ago with a woman who had only a little experience with the trans population. At first my therapy was for trans related issues, such as body issues and dealing with all of the changes of living as a female presenting person for most of my life and now living as a perceived white male presenting person. The therapist told me in one of our first sessions that if she ever had a befuddled look on her face when I was talking about trans stuff to let her know. I’ve never seen that expression on her face. She has and continues to educate herself. ( I was willing to educate her but have never had to.)
I took a chance on a non “expert” and she’s the best therapist that I’ve ever had. I’ve been in and out of therapy since I was a young child (I’m not far from 45 now) and met quite a few bad ones.
Im a therapist who is also trans and I’ve got one of the largest caselosds of trans people in my state. For my own needs I found a therapist who had no experience, because I am it for such a large area. I have a huge caseload, I average about 130 patients a month. I see one or two trans patients a day. They come from a distance of up to 3.5 hours away.
The problem is there arent enough of us that are visible to therapeutic community, though that is beginning to change, and along with that, comes more willingness to learn about treating people who are differently gendered than their bio sex. So much of our education is self education., and in the final analysis every presenting issue we see, some have to be the first few for a therapist to learn on. However having said that, a therapist, to paraphrase Clint Eastwood as Dirty Harry Kellerman said, A therapist has to know her limitations. Meaning one needs to seek out supervision when she sees the need. All therapists are called to do that no matter how experienced. I’ve seen well over 250 trans people at this point in my career. on occasion I still seek supervision if I’m working in an area, that I feel unclear about, trans patient or not.
I’m not sure if we will see a full course devoted to Transgender treatment. Most graduate educations would not generally devote a full course to an issue that specific. My program was 60 hours and 18 hours of that program were supervised internships, leaving42 hours for the academic work or foundation and concentration courses. 21 hours for foundation courses and 21 for your specialization. Some of the specialization courses include practice models, research, developmental psych, and psychopathology. If one were to pick e.g. gender and sexuality for one of your few electives, you might get some working knowlege on trans therapy, along with other things. Most specialized training comes from the setting you work and continuing education that you select. In the past two years, I’ve picked up about 57 hours of continuing ed. 40 clock hours is a 3 credit course. As I give work shops on this subject I’m very fortunate to find myself at places where continuing ed. Is available. This isn’t true for most therapists, though we are required in my state to get 30 hours of continuing ed every two yearsWhen new therapists graduate, they have the skill set to work with a broad spectrum of issues. They are supervised for a minimum of two years before being eligible for independent practice.
Hopefully, this will shed some light on the conundrum. I do believe that graduate programs need to have Transgender content to provide an entry level knowlege of working with trans people.
From when I was a kid: “He’s just doing it for attention.” And I’m one of the younger people here. Ouch.