What Every Trans Person Should Ask Their Mental Health Provider

For me, deciding to see a therapist about my gender dysphoria was a huge step.  It was the first time I had told another human being face to face that I thought I was transgender.  I was lucky; the psychologist in the area who is known for taking trans clients was full up and couldn’t take me.  She recommended a colleague whom I had never heard of.  I gave her a chance, and she turned out to be phenomenal. She was non-judgmental,  listened well, asked insightful questions, and in the end became someone whose insights and ideas I trusted.

Not everyone is so lucky.  Horror stories abound regarding bad therapists for trans people.  Hearing some of these stories made me ask my therapist if she thought it was fair to interview a potential therapist / psychologist / psychiatrist before you invest time, money and emotional energy with them. She was emphatic: “Oh my, yes! Absolutely you should ask them hard questions.  There’s no point in going to see someone you’re not comfortable with.”

She also agreed that it is entirely fair to ask them hard or pointed questions, including some personal ones. A bad therapist is often worse than no therapist at all. However, for a person who is just starting the process, knowing what to ask may be difficult.  The following list is what I would have asked up front if I knew then what I know now.

1. Where did you get your degree(s)?

Avoid those who got it at a strict religious institution like Liberty University, BYU, Baylor, Oral Roberts, or some staunch Catholic Schools. There is a strong chance that whatever education they received will have biases towards LGBT people, and may regard reparative therapies as a viable option.  They may also regard you as needing “fixing”.

2. Have you worked with LGB people before? Trans people? For how many years? How many trans people?

Therapists who have had very little experience with trans people are going to be very hit and miss. There is no established minimum, it comes down to you asking yourself if you are comfortable with someone who has only seen X number of trans people.

3. What is your religion?

This is a fair question.  Measures of religious intensity have been found repeatedly to be the best predictor of people’s attitudes towards LGBT people.

If it is a religion that is generally intolerant of LGBT people, ask them what their own particular religious views are regarding LGBT people.  When I found out my therapist was Catholic, I immediately asked her about her views on LGB and T, reparative therapy, whether she saw gender dysphoria as a sin, etc…  Also, not everyone in a particular religion is going to be intolerant.  I met a Evangelical Pentecostal minister at the OutServe Leadership Conference in October.  Very nice man, and he was fully aware of the reputation of his faith.

So, if someone answers that they belong to a particular faith that is usually very conservative, go ahead and ask how they feel about LGBT issues and how they relate to their religion.  The answer might surprise you.

4. Are you familiar with the changes being made to the DSM-5 with regards to GID and gender dysphoria?

If the answer is no, then they may not be keeping up with the most current thinking on gender dysphoria, or worse, holding onto discredited theories.  The fact that disorder is being taken out of the description, gender dysphoria is being moved off of all the diagnostic axes, and the American Psychiatric Association is taking a stance that gender dysphoria may be a medical rather than psychiatric condition are all significant in terms of de-stigmatization.

One example of this would be a trans man friend whose therapist said he couldn’t possibly be trans, because his life hasn’t gone completely to pieces.  Based on old diagnostic criteria, in order to be “truly trans”, your life had to become a smoking crater and a debris field.  The new criteria for dysphoria clearly state, and acknowledge, trans people can be completely, and highly functional.

Almost needless to say, my friend never went back.

5. Are you familiar with Dr. Ray Blanchard or his theory of Autogynephilic transsexuality?

If they are, immediately follow up by asking if they agree with it? If they answer yes to both of the above, run, don’t walk, away from the conversation. Indeed, if they even know of it and think it’s a possible explanation, you’re probably better off going elsewhere.

Blanchard’s theory is the scientific veneer that reparative therapists use to try and cure you. Also, the individual therapist is likely to be hostile to you and hold you in some contempt as either a dishonest homosexual, or as a self mutilating fetishist.  If you are FTM and they hold these views, they are unlikely to know much about trans men, nor particularly care to treat you as anything other than an “uber lesbian”.

6. What methods of treatment do you use for people with dysphoria?

Whatever they say, do some research on it.  If they say hypnotherapy, and you’re not a believer in it, move on.  This is very subjective, but if you don’t believe in their methods, you’re probably not going to get good results.  If they say something like “cognitive behavioral therapy”, find out what that means and decide if it is appropriate.

7. What do you consider a successful outcome?

If they say learning to live happily in your current (birth) gender, move on to someone else. This answer implies they regard deciding to transition as a failure, and that there is something inherently wrong with being transgender or having gender dysphoria.

If they say something more to the effect of helping you find personal answers to your dilemmas, that is much more appropriate.

8. Are they familiar with the WPATH SOC v7.0?

If they are not, that’s not a good sign.  It has many of the same implications as question number four, i.e. lack of currency in their field.

If they are familiar with it, ask what they think about it.  If they hate it, it’s probably not a good thing.  The changes in the SOC v 7.0 give a great deal of leeway to providers in letting the patient decide what is needed, and tries to loosen much of the gatekeeper mentality.  If your potential mental health care provider dislikes the SOC v 7.0, ask why they do.  If they dislike it because it loosens control by gatekeepers, you are probably better off finding someone else to talk to.

The most important thing to remember when interviewing a potential provider is that there is no such thing as an unfair question.  If something is important to you, it must be resolved prior to starting therapy.  Otherwise, that lack of trust will affect your ability to connect with the therapist, and vice versa, and as a result the quality of the care you receive will suffer.

Note: Brynn is not a lawyer, psychologist, psychiatrist, doctor, licensed clinical therapist, or anything else connected with the field of mental health care.  She just reads a lot, talks to people, and stayed at a Holliday Inn Express last night.   

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