How to Choose a Therapist

So I’ve found a therapist to support me through my transition. Even better, she suggested that she might be willing to write me a note next time I see her. I’ve learned to be cautious so I’m trying not to get my hopes up on that score, but it’s difficult to keep them down. If she doesn’t write it for me next week, then hopefully she’ll do it soon after.

Here is what I learned about finding a therapist from my experiences so far with navigating bullshit gatekeeper drama.

1. Get a list of names from some place other than Google. Google will tell you were every single therapist they know of works, and in a dense city like San Francisco, it’ll be in the hundreds or thousands. Such a list is simply too long to sort through. I suggest calling up your health insurance, if you have any, and asking them to provide you with a list of therapists that they cover and who have experience or interest in gender identity issues. Some therapists inform the insurance companies what their specialties are so that the clients that get referred to them by the insurer will better match their practice. If you don’t have insurance, go to your local queer center, if there is one, and ask around. If that fails, then find a hospital and ask their psych ward for referrals. The point is to get a list of prospective therapists that is short enough to be manageable, and that have been referred to you by a reputable source. If you simply pick 5 random names off of Google, you have no idea what kind of quality you’re getting. Yelp! and other such services can help, as well.

2. If possible, talk to the therapists over the phone before you commit to an appointment. Get a feel for them, ask them any questions you have. You’re not making hard decisions here, you’re just looking for obvious red flags, things that if they came up in an appointment would make you walk out of the room. Remember that someone’s phone manner and their office manner may be different, so give them a chase even if you don’t click over the phone, but conversely don’t assume that because you like them during a brief phone chat that they will be right for you. If you get the feeling that something is deeply wrong with them, or that they are worryingly ignorant on the subject of gender identities, trust that feeling.

3. Make several appointments at once. Rather than making an appointment for next week, going to it, realizing you don’t like the doctor, making another appointment, waiting another week, and so on and so on, it’s best to make several appointments within the space of a week or two. Tell each therapist that you will be seeing others; it’s the polite thing to do.

4. Be honest with your therapists. Yes, they are gatekeepers. Yes, gatekeepers are often the enemy. But remember they’re pretty good at telling if someone is lying to them, and if you seem deceptive they probably won’t help you. If you do feel you must lie, about your thoughts on black market hormones for example, then try to use half-truths. Especially do not lie about anything they could check up on and confirm for themselves.

5. Be prepared to answer Trans 101 questions, and to stick up for your identity. Even therapists who claim (or are reputed to have claimed) to have an interest or specialty in the area often don’t know what the standards of care are, or the currently accepted nomenclature, or even basic facts about the trans experience. It helps to be able to clearly articulate why having a penis doesn’t automatically mean you’re a man, or having a vagina doesn’t automatically make you a woman. If you don’t think you can make this case forcefully (but tactfully!) under pressure, type it up ahead of time and bring it with you. It’s even okay to quote someone else and say that they can describe your feelings better than you can. One way or another, it is essential that you be able to explain what being trans means to you, and why you need to transition. Make it clear that you are seeking a letter of recommendation for hormone treatment, and that you want it now. It might help convince them to write a note sooner if you agree to remain in therapy for the duration of your transition (which is a good idea on its own merits, as well).

6. Do not make a decision until you’ve seen all the therapists you have made appointments with. I’ve seen three, out of four that I originally called. I’m pretty sure I’ve made my decision, hell I was pretty sure before I left the last therapist’s office, but I’m going to sit on it for at least the rest of the day and think about it before I call them back and ask for another appointment. A few hours deliberation now can save you weeks of cleanup on a bad decision later.

7. Most importantly,  trust your gut. A therapist is useless if you’re not comfortable talking to her, and even if the reason you’re uncomfortable isn’t rational or even anything you can put your finger on, the discomfort and unease will still hinder your ability to work with her. This might convince her that you’re not “ready” for hormones, and cause even further delays while you decide if you want to try and convince her or move on to another. If you have several appointments, then trusting your gut becomes easier because you don’t lose any time when you decide to go look for another.

Wrestling With Jafar

I had a therapist’s appointment today. I had the appointment because at my last endocrinologist appointment, I was told that my bloodwork was fine, that there’s really no medical reason not to begin treatment immediately, but that I need a permission slip from a therapist. I was disappointed and deflated when I heard the news, and the rage only hit a few hours later.

So now I’ve got three therapist appointments with three different therapists in one week. I’m going to take the pick of the litter, and hopefully get a note quickly. If I don’t get one, I’m going to try to convince my doctor that I’ve been living full time for 3 months (I consider this to be true) and so meet the standards of care requirement for the begining of HRT.

The therapist appointment today was intensely frustrating. I was recommended to her by my insurance company as a gender specialist, but she was nothing of the sort. Severely ignorant questions, invasive probing of an unnecessary sort, so on and so on. Very frustrating. I’ve got two other shrinks lined up. I hope one of them will be okay.

If this post is more scattershot than normal, that’s because my depression has returned and I find it difficult to focus or maintain interest. In anything.

The Size of It

I had an endocrinologist appointment this passed Wednesday. She was amazing, didn’t ask for proof that I was trans, didn’t freak out when I eventually fessed up to having been suicidal in the past, encouraged me to find a therapist but didn’t make treatment contingent upon that, helped me figure out a way to deal with two other doctor’s offices that appeared to be giving me trouble because I was trans, and so on and so forth. A couple hours later my blood and urine samples had been taken, and now I’ve got another appointment with her this coming Wednesday.

And now it’s hit me how big this is. How drastic. Transitioning is real now. It’s big and it’s scary. The part of me that is always afraid of change is louder now, shouting that I don’t have to do this after all, that maybe I can just change my name and live half way.

I know it’s not an option. I know it’s just insecurity. I’m afraid of change. I’m afraid of getting what I want. I’m afraid of trusting myself with this kind of decision. Transitioning is the right thing to do.

But the size of it!