What considerations arise in shopping for a gender-sensitive therapist? Competence, cost, comfort, and convenience are the crucial issues. Your primary concern will probably be how to locate a competent practitioner. You will want to be sure that the therapist you select is well-trained and experienced as a counselor as well as TG-knowledgable and friendly.
A psychotherapist qualified to treat transgender individuals must have established counseling credentials such as State licensure in psychology, social work, marriage and family counseling, psychiatry or nursing or certification in sex therapy, as well as training and experience in working with clients with gender concerns. Be aware that to obtain State licensure a therapist does not have to demonstrate any familiarity let alone competence with transgender issues. On the other hand, certification as a sex therapist does not guarantee counseling competence. Perhaps the best way to identify a TG-sensitive competent therapist is by contacting transgender organizations which distribute resource lists of "tried and true" professionals.
In assessing the competence of a therapist, you will want to inquire about the practitioner's basic credentials (education, supervision, licensure) as well as training and experience with TG issues. The best training and experience is obtained in settings specializing in the treatment of TG clients. Supervisors are usually highly trained themselves, current profesional literature on the subject is subscribed to and membership in professional associations focusing on the study and understanding of gender dysphoria is encouraged. There are however, few of these training settings.
The next choice is to locate a counselor who identifies him/herself as a "gender specialist." You will want to know about his/her familiarity with the wide range of gender concerns that people have as well as with your specific issues. You should also ask in which professional gender-oriented organizations the provider holds membership.
Or you may wish to consult with your doctor. There is an informal network of health care providers to the transgender community who know each others' work and refer to those professionals who are known to be competent. A less reliable source is the Yellow Pages. Keep in mind that this is a form of self-promotion and accuracy of claims is not guaranteed. In situations in which practitioners who are competent in their field but not experienced in transgender care are available, one who is willing to research the subject of transgenderism and/or obtain consultation or supervision should be considered.
If you seek treatment in an agency or organization where there is a hierarchy of professionals ranging from director through supervisors, clinicians and trainees, be flexible in your expectation of who will be your counselor. You can be treated competently by a trainee or intern in such a setting. The advantages are that such a provider is closely supervised, exposed to the most up-to-date counseling approaches, and has fewer patients to whom more attention can be devoted. If however, you do not feel confident in the clinician assigned you, request a meeting with a supervisor and be prepared to explain your concerns.
Cost of treatment should be presumed to be negotiable until advised otherwise. In your first contact state your financial limitations up front. It is appropriate to ask if the provider offers a sliding scale based on income, extended payment plan or a brief initial consultation at no charge. If you have any health insurance, make sure that you know what services are covered as well as which are not. This can save embarassment later on. Should your financial circumstances change once you are in treatment, don't hesitate to tell your counselor.
Once having selected a therapist and attended an initial meeting, consider your level of comfort with him/her, the office setting, and support staff (receptionists, etc). Be prepared for some sense of uncertainty, but ask yourself if you feel treated with respect, concern, and competence. Is there an air of professionalism, stability and consistency in the office? Are you addressed as you have requested? Are your questions answered to your satisfaction?
Convenience may seem like a trivial consideration, especially after you have finally found a professional who meets the above requirements. However, if the counselor is not easily accessible you may find it difficult to keep appointments. Is the office convenient to your home or workplace? Is an effort made by the counselor to accommodate appointment times to your schedule? If you have any resistance to pursuing treatment, be aware that lack of convenience may provide an excuse for missing appointments and eventually discontinuing treatment. If it is physically difficult or costly for you to keep appointments, ask if occasional telephone consultations can be substituted for face-to-face visits.
While TG individuals have the same emotional problems that beset the general population, such as addictions, depression, interpersonal difficulties, etc., the fact that these symptoms arise in the context of a transgender orientation is a major consideration in treatment. The experienced therapist knows that the remediation of these symptoms cannot be achieved without attention to gender identity issues as well.
Too often counselors inexperienced in working with the transgendered overlook serious symptoms in the gender dysphoric client because of their obsessive pursuit of a cure for TGism. Other similarly untrained therapists become seduced by a client's request to be cured. There is no evidence indicating that a cure is realistic. In fact, the current thinking is that TGism is not a disease and therefore the issue of cure is irrelevent.
In summary, the search for a counselor begins with your knowing what you are looking for in terms of competence, cost, comfort and convenience and ends with your having found someone who meets enough of your criteria to allow you to get your mental health concerns met for the present . Do not allow the pursuit of perfection to derail you and delay your getting immediate needs met.
Dr. Anderson is a therapist in the San Francisco Bay Area. She can be reached at 415-776-0139.
© 1997 by Barbara Anderson & 3-D Communications, Inc.