TRANSGENDER AND COUNSELING


For a person struggling with gender issues counseling can be a bewildering experience. While educated and sensitive counseling can be supportive and valuable, many transgendered individuals have been misunderstood, manipulated, and abused by counselors. Some counseling continues to promise a “cure” for transgender tendencies, unethically exploiting the vulnerability of people desperate to find peace in a complex and disturbing predicament. Some counselors assure a prospective transgendered client that they have experience in working with these issues when they have actually had little or none—in a misguided belief that transgender issues are like any other existential life questions. There are even a few counselors—under the aegis of religion—that promise help but actually provide mind controlling and even abusive techniques in an attempt to fulfill religious dictum. Some counselors with massive credentials seem to work poorly with transgender folk even though they may have been providing this care for some time, while other counselors with few credentials seem to be highly effective. And then there is the new question to face, to talk to a counselor who transgendered her/himself or to one who is not transgendered?

Qualities of an Effective Counselor

about diagnosis…
There are many benefits that effective counseling can offer. An experienced counselor should be able to fairly quickly help you distinguish between transgender and a mental disorder that appears to be transgender but is actually not. This should not take six months or three months or even (usually) one month to do. An experienced therapist should be able to provide an evaluation (with or without supportive testing) in from one to six hours of work. Additional time needed for evaluation should be provided only with a clear explanation of why the additional time is required. Therapists who string transgender clients along for months and even years in an endless quest to discover the “correct” diagnosis are at best practicing unethically and at worst being greedy and opportunistic. They would not even consider treating a non-transgender client in this manner.

about considering challenges…
An effective counselor should be able to assist a transgendered person in considering the implications of gender transition, neither encouraging nor discouraging the person as they make life changing decisions. For this the counselor must have adequate experience with the requirements, pitfalls, challenges, and questions the individual is likely to face in a transition process. The counselor must also be comfortable with assisting individuals with potentially disturbing life decisions.

and finding competent resources…
An effective gender counselor should be able to assist the individual in finding other resources—medical, paramedical, legal, deportment, speech, wardrobe, financial, etc.—that will assist in whatever transition process the client has chosen. While the counselor should and would not provide information related to costs of these services (and should not benefit financially by referring you), relative costs and requirements should be available. For instance, a gender counselor should be able to help a client in making the decision between the various types of permanent facial and body hair removal (electrolysis, thermolysis or blend, waxing, epilite, laser, etc.).

and deciding on alternatives…
A gender counselor should also be able to assist individuals in exploring realistic alternatives to gender transition. This requires creativity, flexibility, and the capacity to envision resolution when there seems to be no good answer. This can also result in the need for ongoing supportive counseling for lengthy periods of time, perhaps the remainder of the lifespan. Counselors who can only focus on short-term solution oriented therapies are not good candidates. Unfortunately this is precisely the current trend in counseling.

for families…
Some counselors are equipped to provide marital and family counseling services, either themselves or through professional associates to help spouse, parents, children and other family members deal with the changes that are occurring or will occur. An increasing number of couples in married or committed relationships are electing to stay together during and even after a gender transition. A gender therapist should be able to provide support to the couple and the family system. In cases where the couple are separating the therapist should also be able to be supportive and assist in locating legal and financial advice.

and employers…
The effective gender counselor should also be of help with workplace and professional issues. Another increasing trend is in the number of individuals who are electing to make gender transitions on the job. An increasing number of employers are open to this possibility. Often this can be a wonderful “win-win” situation. The employer retains a valued employee, and the individual retains the stability and income of a good job. Some companies are even finding that employee morale increases following the transition of one of its employees. An effective counselor will be able to not only help the individual, but should be prepared to offer assistance to the workplace in the form of consultation, education, and sensitivity training for peers, supervisors, and supervisees of the transitioning individual.

society…
For many individuals undergoing a gender transition the need for socialization is important. Therapy and support groups are effective resources in helping individuals refine their social skills and become comfortable in their new gender expression. These resources should be available to you through your counselor.

and spirituality…
Spirituality and transgender have a history going back to before history. Shamans, the spiritual leaders of primitive and native peoples, were very frequently differently gendered. Today many transgendered people continue to be spiritually sensitive. Some have been abused at the hands of traditional religious institutions and decided to give up on their spirituality altogether. Others have elected to find more comfortable non-traditional spiritual outlets, such as wiccan, druidism, native American and other naturalistic religions. A few are deciding to confront traditional religious institutions and remain within their religious communities during and after transition. While a gender counselor need not be a minister or rabbi, it is also important that she/he be comfortable in helping clients in a meaningful exploration of the spiritual dimensions of their lives. Many gender transitions that have been otherwise well planned and executed have been failures because spiritual realities were ignored or minimized.

the special quality of the gender therapist…
Making changes in gender can be a lonely road for anyone. I believe that it is imperative that a counselor working within the gender community be ready and able to be a friend as well. Many styles and protocols for psychotherapy call (appropriately) for therapeutic distance between therapist and client. While this may be important, particularly in the earlier stages of gender therapy, as the individual progresses there is increasing need for genuine friendship within the therapeutic context. Counselors who have an inherent dislike of transgendered people, or who pity transgendered individuals as unfortunate misfits have no capacity for providing this necessary kind of friendship. To feign friendship as a therapeutic devise destroys the foundation of the therapeutic relationship—trust, and must always be avoided.

Finally, about medical standards, letters, and counseling…
Some will note that I have not mentioned the coveted and dreaded Standards of Care. To many individuals these are the only reason for transgender counseling—getting the coveted clearance letter for hormones or surgery. My wish would be that surgeons and endocrinologists could trust the good intentions of their patients to request helpful treatment. Unfortunately we don’t live in that kind of world, and medical professionals will continue to insist on medical standards as long as patients are willing and able to sue for malpractice. A gender therapist should be familiar with and able to apply the Standards of Care of the Harry Benjamin International Gender Dysphoria Association. These standards should be applied with fairness and integrity. Clients should be made aware at the beginning of the specific requirements that the therapist will expect of the client in order to fulfill these standards. This should be done in a away that both client and therapist will be able to agree when these requirements are met. To hold unspecified requirements over the head of a transgendered client who is spending time and money to gain clearance for medical treatment is unethical in the extreme. It is therapeutic abuse and should not be tolerated. Therapists who practice in this abusive way should be reported to their respective licensing boards and professional ethics committees. Clients should always ask and expect an answer to the question, “What will I need to accomplish before you will write a letter of recommendation for hormone (or surgical) treatment?” It’s also not a bad idea to ask the therapist how many hormone and surgery letters they have written. If the therapist claims to be experienced in transgender treatment but also has never written a letter—BEWARE!

Counseling for the transgender client should be a helpful and even joyful experience. There is much pain to endure in the predicament that is transgender. But there is also much opportunity for growth, enduring relationships, and personal fulfillment. I consider it a wonderful opportunity to be able to meet and work with the transgendered people who come to talk with me.

Erin K. Swenson, Ph.D.
1998