Playing By The Rules
What a lot of people deal with in therapy is problems related to having a secret, so we have intimacy and trust issues. If your whole life Is a secret, it affects who you are and your relationship with other people, particularly with people whom you love. Who do you tell, how do you tell, what is the effect of having a secret, of feeling not completely known, feeling if you really knew me you might reject me?
Of course, there are issues of depression, isolation, loneliness, feeling different, issues of self-esteem, and a lot of guilt over who you are. One of the things we usually need to work on is overcoming feeling guilt about being who we are.
Other people are overwhelmed by obsessive-compulsive Issues around crossdressing. We have a relatively new treatment coming out of the University of Minnesota for obsessive-compulsive gender dysphoria and/or crossdressing which is Prozac and/or lithium. What that seems to do is take the edge off the feeling of overwhelming urgency. It allows you to be free from that and start to deal with your issues. Some people even give up the gender dysphoria, but not many.
What doesn't come up with this group? I don't see much psychosis at all. I very rarely see paranoia, with the exception of legitimate paranoia, in other words people who say I'm scared to go out in the world crossdressed, with people reading me and rejecting me. I see almost no clinical paranoia. I think because I'm in private practice, I don't see a lot of borderlines, or acting out, except for the people who are absolutely sure they are transsexual and they want their hormones and I don't agree with them. I see very little sociopathy; most people in this community play by the rules, so I don't see people who are breaking laws.
I don't see people who are not serious about psychotherapy. This population is extremely interested in self understanding, and that's one reason I like working with you.
I tell providers who are thinking of entering this field that there is usually a great sense of responsibility in this population. People pay their bills, and they show up for appointments, and they work hard in therapy, which is very good for the providers.
I don't see a lot of co-dependency. Occasionally I do, because it's such a common thing in this culture, but transgender people are not controllers; they are usually not controlling other people. They are focused on what's going on with them, and you can do your own thing. Live and let live.
