Last month's column reviewed the new book, "Transgender Care: Recommended Guidelines, Practical Information & Personal Accounts." As I mentioned, this month I would write on the subject of the essay I contributed to that volume. The full title is "Ethical Implications for Psychotherapy with Individuals Seeking Gender Reassignment." However, to me it is the dilemma that won't go away.
The basic issue of concern for me is that the Harry Benjamin International Gender Dysphoria Association (HBIGDA) requires in its Standards of Care that clients seeking gender reassignment have an endorsement from a psychotherapist who has counseled the client for prescribed periods of time prior to having hormonal or surgical treatment by physicians belonging to that Association. As a psychotherapist and a Gender Specialist I am often approached by clients seeking treatment in order to fulfill these requirements.
My dilemma is how to both offer psychotherapy and play the role of a gatekeeper to desired services. The counselor is supposed to be accepting, nonjudgmental and supportive while the gatekeeper is evaluative and critical. The client also has a dilemma -- how to get help in understanding oneself better and making a wise decision without losing the option to decide on one's treatment and becoming totally disempowered.
My suggested solution is to remove the gatekeeping role from the therapist, free her to be the best kind of counselor she can, and have the decision be made by another therapist who will meet briefly with the client and have access to treatment records. This second therapist, with whom the client will not need to develop any sort of a therapeutic alliance, can bring her assessment skills to the situation and either give or withhold an endorsement of gender reassignment treatment.
I have directed this suggestion to HBIGDA's committee currently engaged in updating the Standards of Care. I received a polite acknowledgement and look forward to the committee's final report.
Dr. Anderson is located at 1537 Franklin St, Suite 104, San Francisco, CA 94109, 415-776-0139.