Benefits of Psychotherapy for the Transgender Client

The following is a more subjective exposition about psychotherapy, (thoughts from the writers’ more than 30 years clinical experience) written for the person contemplating psychotherapy and for the therapist working with or contemplating working with transgender people.

Psychotherapy is not a prerequisite for referrals for medical interventions and in many ways, is independent of the assessment and evaluation requirements of the SOC. Psychotherapy involves a deeply interpersonal and subjective relationship between two people, the client and the therapist, focused on the needs and goals of the client during a usually transitional (in the broadest sense of the word) period of their life. This involves a process of (Pfafflin, 2007) listening closely: acknowledging the distress, fears, and hopes of the client and together exploring the direction to take. This may, under some circumstances, include assessment and referral, but does not do so in a substantive way.

The transgendered person seeks therapy for the same reason as does anyone else, to sort out difficulties within a compassionate, safe, nonjudgmental and neutral environment. Yet, the transgender path involves a unique journey, one with quite specific potential obstacles. The transgender specialist knows a good deal about this particular path and can help the client negotiate the difficulties and along the way.

Specific challenges include finding and hearing one’s authentic voice, and learning to express an identity and negotiate relationships independent of external pressures, both from the wider community and even from within the transgender community. With more available choices and individual variation along the transgender path, the importance of the safety within the therapy relationship to sort out myriad options cannot be overestimated.

A major aspect of healthy identity development involves being seen and mirrored authentically, and for the transgender person, this may occur for the first time in psychotherapy. An identity does not develop in a vacuum, yet for many transgender people, their sense of self in a gendered way has developed internally and in secret and hasn’t had the opportunity to be in relationship. The therapy environment provides:

  • a space to develop the client’s authentic narrative
  • a space to be seen, heard and mirrored, without stigma, with compassion
  • a space to retrieve the lost soul
  • the instillation of hope, one of the foremost tasks of psychotherapy


Depending upon the situation and the needs of the client, a good therapist is a mirror , a guide, an ally, an advocate, a steadying hand and a stable consistent image that can be internalized during the therapy and beyond. The benefits can last indefinitely.

Lin Fraser EdD- from paper on Psychotherapy in the Standards of Care

Filed under: Benefits of Psychotherapy, Transgender on September 19th, 2008 | 1 Comment »

Challenges and Rewards for the Psychotherapist

The following is a more subjective exposition about psychotherapy, (thoughts from the writers’ more than 30 years clinical experience) written for the therapist working with or contemplating working with transgender people.

For the clinician.

This evolving field offers unique challenges, and when working in the spirit of the standards and under the canons of ethical practice, it offers extraordinary rewards that are:

  • pioneering
  • interdisciplinary
  • challenging
  • creative
  • operate on the frontiers of the human endeavor

Gender is central to human identity.  Working with people who are examining their gender identities offers the therapist the opportunity to bear witness to some of the most profound and ultimately satisfying transformations extant in the mystery.

As Ettner (2007) has suggested, providers working with trans clients need to forswear nearly every timeworn sacred canon of allopathic Western medicine” (p. xxiii), since there is no observable disease, diagnostic test, or organ deficiency. She suggests the metaphor of “soul retrieval”, where the clinician, during the therapy, helps retrieve and return the lost essence of the person. Consistent with this spirit, is Lev’s (2004) earlier description of the therapist as midwife or Pfafflin’s (2007) advice on the importance of individualized treatment, listening, challenging established models, recognizing the basic human need of wanting to be understood.

The therapist is called to examine his or her own preconceived ideas about sex and gender to be able to do this deeply personal work. In terms of general knowledge, the therapist must have both general and specific knowledge, the general including knowledge of general psychotherapy and assessment as well as knowledge of co-morbidity issues.

Specifically, the therapist needs to understand:

  • general sexual identity development
  • transgender identity development
  • challenge conventional theory

The work demands a comfort with the frontiers of gender theory as well as a certain creativity and imagination. What is seen in the consulting room is rarely consistent with established non-specialist literature. The work challenges the clinician to develop new models or frame conventional models in trans-positive ways to mirror and bear witness to the real human beings seen in practice.

An open minded, flexible therapeutic approach is implicit and explicit in the Standards.  Much is unknown, gender identity is at bottom-line a mystery, etiology of transgender identity is unknown (Pfafflin, 2007), gender and transgender has multiple meanings contingent on culture and individual circumstance. Gender operates on a spectrum and trans clients can have multiple outcomes.  The importance of an open minded therapist stance cannot be overestimated.

Moreover, the field requires more than a little interdisciplinary knowledge of other fields, not just psychotherapy.  Gender is a multidisciplinary construct central to biology, medicine, law, sociology, political science, and anthropology, among others.   The therapist works with multiple disciplines and providers; with surgeons, endocrinologists, family practice physicians, lawyers, speech therapists and electrologists, among others, following best practices of overall care. Moreover, the therapist is also called upon to do human rights work, advocacy, training, teaching and consultation, all consistent with the vision of the association. The work takes one across national and international borders. It is creative, pioneering and multidisciplinary.

Whether going outward to do social justice, teaching or advocacy, or inward to do theory-building, or writing, the clinician ultimately goes back to the heart of psychotherapy, bearing witness in the encounter with another human being in the liminal space of the consulting room.

It is this relationship that is the center of clinical work.  Ultimately, it is this transformative relationship at the heart of therapy that provides the greatest rewards for both the client and the clinician. For therapists interested in pioneering and creative endeavors and wanting to work with remarkable people, the field offers extraordinary challenges and rewards.

Lin Fraser EdD- from paper on Psychotherapy in the Standards of Care

References:

Ettner (2007) Transgender Medicine and Surgery

Filed under: Benefits of Psychotherapy, Transgender on September 19th, 2008 | No Comments »