GenderArticles #30
Are Therapists Trust-able?
By Gianna E. Israel
©1998 Gianna E. Israel
GENDERARTICLES is a syndicated column featured monthly in TG-FORUM,
the Internet's most respected weekly transgender magazine.
American-Online's Transgender Community Forum (Keyword "TCF") posts this
column and other gender resources for our community. An entire
compilation of GenderArticles and other features by the author can be
found at the Gianna E. Israel Gender Library hosted by Ms. Diane Wilson.
Link to that site at http://www.counselsuite.com.
One of my most favorite questions I hear circulating among people in
groups throughout the gender community goes as follows. Should I lie to
my therapist? The preceding question is then typically accompanied by a
variety of statements or reasons why a person might feel a need to lie.
Some of those statements can be frightening. My therapist will deny me
hormone or surgery recommendations if he or she doesn’t approve of
something about me. My therapist won’t understand my problem. My
therapist really could care less about gender issues. Or, my therapist is
cold, calculating and has no human emotions.
After hearing various questions or situations regarding therapist-client
trust issues, typically another person within a group will immediately
launch into tirades about the horrors of therapists and gatekeepers in
general. What gets lost in the process of looking at the issue is some
old fashioned common sense. For instance, when trust issues arise people
frequently tend to overlook other crucial dynamics within therapist-client
relationships. Whether someone is receiving services from another
therapist, or me, I encourage all persons to review their motivations for
seeing a therapist. Doing so sets the groundwork for an empowered client
or consumer.
In most circumstances if you are seeing a therapist, I would assume it is
because your are hoping to change something in your life. You may be
looking to improve upon your quality of life or hoping to learn new coping
skills. If you are in the process of transition, you may rely upon your
therapist to provide you accurate information about gender issues. In
many cases new clients seek an assessment or evaluation, and then want to
receive professional recommendations that help improve their situation.
Finally, as is often the case in the gender community, people see
therapists because they want to receive a letter of recommendation for
hormones or surgery.
The most important point that you need to realize about therapy
relationships is that you the client are seeking a commercial service.
Consequently, it is a duty to yourself to define what you wish to
accomplish within that relationship. You can best get your needs filled
in a therapy relationship by stating what interests you. You can also set
aside discussing an issue, particularly if you believe doing so would not
benefit you. If a therapist is unwilling to discuss your goals, or
repeatedly pressures you to conform to a plan that doesn’t make sense to
you, then that therapist is probably not worth your time. You have the
right to find a therapy relationship that works for you. Even
institutionalized persons or those within gender clinics or mental health
programs have a right to discuss grievances with supervisors or ask for a
different therapist.
Sometimes people feel uncomfortable telling their therapist about new or
deeply personal issues. This may happen because the client-therapist
relationship is new, and a client has not yet had enough time to feel that
trust is established. Within four to eight initial sessions, a client
should be able to discuss issues of trust with the new therapist. This
can include the client discussing why he or she feels uncomfortable
talking about a subject. Another reason a person may have difficulty
focusing on a new issue within therapy is because the client-therapist
relationship has deteriorated. This typically happens when a client or
therapist fails to keep sessions goal-oriented or structured. Either
party stating an observation that the relationship has deteriorated can be
the start of regaining structure. Then, after structure has been
regained, it is important to establish why the client feels uncomfortable
discussing a new subject.
Another reason a client may feel motivated to lie to his or her therapist,
is because a person feels that the professional is locked into stereotypes
of what constitutes a transgender person, transsexual or crossdresser.
Concerns along the same vein also include fears that the therapist may not
respect a client’s wish for a particular type of treatment. This can be
particularly so when the treatment greatly differs from what the therapist
considers appropriate. Nobody enjoys being forced to conform to another
person’s stereotypes or even suggested treatment regimens. If you are not
happy or distrust your therapist’s response to your requests or his or her
suggested treatment regimens, do not sit by and allow the relationship to
deteriorate. Instead, ask your therapist to provide you an
easy-to-understand explanation of their reasoning for a decision or
treatment. If you continue to dislike their approach, ask to see clinical
documentation supporting his or her position. Be polite at all times.
Being disrespectful will not improve your chances of being heard by your
therapist.
If you engage in the preceding steps, keep in mind that an alternative
approach to introducing a new treatment idea to your therapist would be
for you to provide him or her clinical information that you have gathered.
Clinical information is typically found books, magazines, journals and
other publications. The preceding materials should be written by someone
with actual experience in the subject area of interest. An article which
demonstrates a point based upon a therapist’s having experience working
with 50 transgender persons is certainly going to be more respected than
that of the therapist who only saw one or two clients. When presenting
new information to your therapist, keep in mind that doing so is often
easier than searching for a new therapy provider. When conflicts,
distrust or treatment issues arise between clients and therapists, I
typically advise that these persons try to work it out. Otherwise, the
client is left with the burden of searching for a new therapist, and
reinitiating the whole process of building trust. Unless a clear case of
wrongdoing or abuse exists, there often is no reason to leave a
pre-existing therapist.
More often than not, I also do not recommend that a client abandon a
therapy relationship simply because the therapist is not a
gender-specialist. In cases where a client needs gender-specialized
services, he or she might ask the therapist to seek brief professional
consultation on the gender issue. The client may also do so him or
herself on a short-term basis, such as for an evaluation of the issues at
hand. This is often why I will provide a gender specialized evaluation
for an individual, then provide recommendations and goal-planning based
upon the evaluation. After doing the preceding, I will then typically
consult with the client on a monthly basis while he or she continue seeing
the original therapist weekly. With the preceding plan, clients can allow
a pre- existing therapy relationship to grow and mature, while either
party can take advantage of a gender specialist’s expertise in order to
enhance a good relationship.
As a therapist I have always hoped my clients would not lie to me. The
reasons are pretty easy to understand. When people lie, they are wasting
their time and money. Eventually, a person that lies will have to go back
and deal with the truth if he or she wants to improve upon a situation. On
the balance, therapists are typically accustomed to hearing a variety of
stories from clients, and therapists understand that they are only hearing
one side of the story—the client’s. A progressive therapist is going to
be interested in hearing about your needs and even new treatment
approaches. Thus, there is no reason to lie. Moreover, if you tell your
therapist you wish to focus on a sensitive subject for a short period of
time, and then wish the subject set aside , in all likelihood the
therapist will conform to your wishes. This after all characterizes
client-therapy relationships. Therapy relationships should serve you, the
client. You will get out of it what ever you are willing to ask for, and
invest in.
Gianna E. Israel has provided nationwide telephone
consultation, individual and relationship counseling, and gender
specialized evaluations and recommendations since 1988. She is a principal
author of the book, Transgender Care with Donald Tarver, M.D., (Temple
University Press/1997). She also writes Transgender Tapestry's "Ask
Gianna" column; and is a HBIGDA member.
She can be contacted at (415) 558-8058, at P.O. Box 424447 San Francisco,
CA 94142, via e-mail at gianna@counselsuite.com or
visit her Web Site
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