When I accept an engagement to speak on TG issues to a professional audience, the part of that experience I most look forward to is the Q&A at the end. I always leave half as much time for this segment as for my presentation and it is rarely enough. I usually speak on aspects of psychotherapy with transgender clients and cover why treatment is sought, what clinical issues are raised, symptoms, my philosophy and role in therapy, setting goals and measuring outcomes. Here are some of the most common queries and my responses:

How did you get into this field?

I first became exposed to the transgender community when I was a marital and sex therapist in New Jersey. I met a woman who had a wig shop and electrology practice who hosted meetings for a chapter of Tri-Ess in her home. She invited me to a meeting to speak on sexuality, relationships, and therapy. My preparation for that talk and the meeting itself was the beginning of my interest in the experience of transgenderism.

What is the cause of Transgender Behavior?

Some scientists believe in a biological root and have identified the role of the hypothalamus as crucial in its development. Others, usually social scientists believe psychological factors, especially family relationships impact on the development of gender identity. In any event, it is the distress associated with transgender issues, not the crossgender identity itself that is dealt with in therapy and therefore the cause is irrelevant in treatment.

I am treating a child who crossdresses, is a sissy/tomboy, etc. What should I do?

Kids are different. They express their gender identity across a broad range of behaviors that fall within usual limits as well as beyond. Some children express themselves in a manner that flaunts traditional standards but does not isolate them from normal childhood experiences. These children do not require special attention.

Other children's behavior may be so unusual that it elicits negative responses from peers and family. It is less a question of whether the child is TG than if his/her behavior is precluding positive feedback from peers, the forming of friendships and the development of self-esteem.

What about prospective clients who don't really want therapy, just a letter approving them for hormonal therapy or genital surgery?

I adhere to HBIGDA's (Harry Benjamin International Gender Dysphoria Association's) requirement of three months therapy for recommendation for hormones and six months for genital reassignment surgery. I tell such individuals that therapy is a broad term encompassing education, rehearsal of new behaviors, problem-solving, and identifying resources as well as the traditional experience of learning about one's needs, motivations and expectations. I encourage them to consider going along with the program but do not pressure them. They are free to seek their approval letter elsewhere.

How do transsexuals differ from transvestites?

In many ways. Their histories, sexual patterns, experience of their bodies as appropriate or not appropriate to their gender, whether or not surgery is desired, all distinguish one set of individuals from the other. In fact, their only commonality is their desire to crossdress. Beyond that, they have very different needs and goals in therapy. How do you respond to a client seeking a "cure" for transgender behavior and feelings? Because transgender behavior is not an illness but a statistically uncommon experience, it is not curable. However, the gender dysphoria or gender identity disorder that may accompany it is treatable with traditional therapeutic approaches incorporating education, self-awareness, building of self-esteem, locating a supportive community, abandoning secretiveness and guilt, and living in the most authentic manner allowed by one's lifestyle.


This is a sprinkling of the kinds of questions professionals ask. On the one hand, I think they should know these things already. On the other hand, I'm glad they are interested enough to seek the answers and humble enough to acknowledge their deficits.

Dr. Anderson is a therapist in the San Francsico Bay Area. She can be reached at 415-776-0139. This article originally appeared in Devil Woman, the newsletter of the Diablo Valley Girls.


© 1996 by Barbara Anderson & Transgender Forum



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