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Monday, November 21, 2011

Choosing the Right Therapist For You (It's Not As Hard As You Might Think)

Finding the right therapist for someone who is transgendered is not an easy task, as most of you know already. Many trans people would prefer that their therapist not only be well versed in providing transgender care, but also be transgender themselves. As difficult as it is to find a therapist who is well experienced in this area to begin with, the therapist who is transsexual, such as myself, is an even more rare thing to find. As many of you know, my practice is in a rural health care system in the heart of the Shenandoah Valley. I am the only therapist for over a three hour's drive radius who practices transgender care and there are no other therapists who do practice in this area who are transgendered themselves to the best of my knowledge. I do know most of the therapists in Virginia who provide this type of therapy. So when I went searching for my own therapist, I had to find someone who although had no experience specifically in transgender care and wasn't transgendered, yet would be able to provide me with competent care to the best of her abilities.

I did a quick survey of the top 40 graduate programs in my own discipline of Social Work. Of the handful I surveyed, only two had practice course work that had the keyword transgender in the course title. The program I attended at the School of Social Work at the University of Alabama had no courses in this area when I attended (NO! I will NOT tell you the year I graduated!! A lady NEVER reveals her age!!!!).

A therapist who has herself as a patient is a fool. Someone asked me me why I don't do my own therapy in all seriousness and it was a fair question to ask. It's because I lack the objectivity that one would get from a therapist when it comes to myself. The decision to transition is one of the most important ones of my life and I have only one chance to do it right). This might seem like it would be impossible to find someone who could get the job done, but that isn't true. My own therapist has never worked with a transgendered person before me and she has done an excellent job. At this point I would recommend her to anyone seeking transgender care. She has some characteristics that ensured that she would be competent to do the job, and I knew this when I selected her to be my therapist at the beginning of my own care. I want to share with you how I was able to find someone to help me. It isn't that hard when you know how to go about it.

The secret in finding the right therapist for you is really simple: You are hiring someone to do a job for you and you need to do your homework up front, just as you would if you were hiring an electrician or a plumber. There are things you can do to make sure the person you hire is competent to do the job, just as hiring anyone else. Remember, the therapist works for you and you are interviewing candidates to fill the position, just like any other job. This can be an intimidating prospect for most people because they don't have the same knowlege base as the therapist and they don't feel like they can pick someone who will be competent, so they make appointments with someone and see if it works. That can get expensive, especially if you see two or three before finding THE ONE. Plan on interviewing three or four, if at all possible. It's nice to have a number of options.
If a therapist isn't willing to spend 15 to 30 minutes speaking with you on the phone about what your needs are, then he or she will not be a good candidate for you to contract with. When you are interviewing, it isn't so important that you completely understand the answers to some of the questions you ask, just write them down. You can look up some things afterward on the internet which will help you make an informed decision on who to pick for your therapist.

The first thing you will want to do is look in the yellow pages and see if anyone uses the term "gender and sexuality" in their advertisement. That one key phrase brought me tremendous numbers of trans patients when I had my private practice. The other resource was people who found information about me on the internet. A number of websites provide lists of therapists who are competent in gender therapy.

More and more insurance companies are paying for transgender therapy. The easiest way to find out if you will be covered is to call your insurance company or the mental health managed care entity who handles this for your insurance and ask them if the the  DSM IV- TR diagnostic code 302.85 is covered under you insurance policy. Almost every insurance company I am a provider for, with the notable exception of Coventry administered by Southern Health and their mental health managed care company MhNet cover this therapy and that includes Virginia Medicaid and Medicare.

When you are speaking on the phone interview you will want to ask the following questions:

1. Do you accept my insurance plan and what are your rates? If my plan doesn't cover this service, what is your fee for service? (If there are valid reasons that you can't pay the full rate) Do you have a sliding scale?

2. What is your theoretical orientation? There are many theoretical schools of psychotherapy. Some of the major ones are:  Behaviorism and it's derivitives, Cognitive Behavioral Therapy and Rational Emotive Therapy; Humanism; Gestalt; Transactional Analysis; Psychoanalysis and it's derivitive, Object Relations and Feminist Therapy.

My undergraduate education was strongly rooted in Behaviorism and I practice mostly Cognitive Behavioral therapy and Rational Emotive Therapy. I am well versed Humanistic therapy, Gestalt and Transactional Analysis and have a working knowlege of Psychoanalysis and Object Relations, though I only use them to conceptualize therapeutic issues when I find it useful and do not practice their techniques as I have not been supervised to practice in that area.

Over the years I have been concerned when I hear that a therapist describes their therapy as "eclectic". Too often that means that a therapist has not mastered any particular school of psychotherapy and just draws techniques to use in their practice because they feel right to them for the situation. They often can't articulate why the selected a particular intervention and the theory base behind it. Not all therapists who say they are "eclectic" though don't operate without a philosophical underpinning it is just important to know they understand why they select their interventions.

After you have interviewed the therapists you have selected, it's time to hit the internet and look up the information they provided you. You can then decide which therapists' theoretical orientation seem to be in tune with your own belief system and make a wiser choice in your decision.

3. If they have no transgender treatment experience, then enquire if they have worked to any extent with gay and lesbian individuals. If they have experience with them, they are more likely able to be helpful to you. While our issues are not identical to their's, they do overlap to some degree. This was the deciding factor in my choice for my own therapist.

If they do have transgender experience, ask them if they are a member of the World Professional Association of Transgender Health. If they are a member of WPATH, that is the gold standard for transgender care. If they are not, ask them if they are familiar with the new seventh version of the WPATH standards of care. If they are knowlegable of them or the prior version, then you know they are at least well enough acquainted with transgender care that they are likely to be able to provide you with quality treatment.

If they don't, but have other experiences that place them into serious consideration to become your therapist, then ask them to what degree they are willing to educate themselves to be able to help you. Are they willing to dig up resources and learn on their own? If so, you will most likely find a good therapist to help you, though they might be inclined to follow the standards of care more to the letter of the law. That can be frustrating. We all want what we want when we want it in terms of our gender issues and transition and I am no different in that respect, but someone who is going to be careful before signing off on your hormones and surgery rather than just going along with what you want may just be what is best. At least you will be sure they erred on the side of caution, if they erred at all.

Too many of us have rushed into decisions they knew were right for them without consideration how they will support themselves, who will be supportive of them and who will abandon them merely because they are differently gendered. Too many times thre have been disasterous outcomes. Our community has about an 800% higher rate of attempted suicide than the general population and an astronomically higher rate of substance abuse and addiction as well.

I hope that these thoughts and strategies will help those of you who are looking for a therapist. If anyone has any other ideas that will help my viewers, please do contribute your thoughts to the discussion.


  1. i have been desperately looking for a therapist for 15 months. i live in Central Georgia and the nearest therapist to me is 7 hours round trip. My search gets more and more desperate.........sigh. i am so glad there are wonderful therapists out there in other places you give me at least some hope.

    Kimberlyann Marie

  2. Can you email me privately and I will look into helping you find someone. Sherri Lynne

  3. Hello Sherri - Thank you for the invite - Back in 1991 - I attended a support group for 2 yrs at the Clarke Institute in Toronto. / Very bennificial to listen to their stories & traumas - It helped me to come to my own conclusions in many areas in life for myself... / I became a lone ranger & did my own thing... / Not all lifes problems were just related to "Gender" ..."God" helps those who helps themselves - Luv Ya Kid !! Shirley

  4. My first question is, if you know you are transgender, why do you need a therapist and if you need to be told why you are transgender, are you really?
    I have to send this as anonymous which I am never but none of the other options make sense to me.
    Perhaps I need a therapist to sort out this confusion? hahaha.

  5. Hey Rachel, I didn't need a therapist to tell me whether I was transgender. In fact, I've only had two or three out of a couple hundred who weren't sure. One I work with now and the other wasn't he decided.

    It's navigating the pratfalls and pitfalls of transitioning where a therapist can be helpful, such as helping to preserve family relationships, negotiating the work environment, and help with finding providers for the various services a transgender person may want. Some are very depressed and need help with that, some may have developed substance abuse issues and may need help with that.

    As far as someone knowing, if they do, then all there is left to do is to help them along as they decide how that want to proceed.

  6. Navigating self-acceptance as a transgender person is a hard task. As a community, we have a horrible record of making healthy choices for ourselves (41% of those alive now report attempting suicide. How many more aren't around to report their attempts?)

    I consider myself as bright as the general population, reasonably well balanced, and I can't possibly imagine anyone dealing with being TG on their own.

    Aren't you worth investing in? Isn't finding out some of the best ways to handle telling family, friends, coworkers, and others worth something? Are the people you love worth you trying to be the best you can be through your transition?

    No transgender person would turn down makeup tips, dressing tips, and recommendations of places to shop, right? I just consider figuring out how best to interact with others a step in the right direction.

    It worked well for me during my transition and I would highly recommend therapy for anyone, not just those TG.

    And while I have never been a patient of Sherri's, I know more than enough about her to highly recommend her.

    Lastly, I am so comfortable with being TG that I have done appearances on radio, TV, been interviewed for magazine articles, been published in magazines, and have been an open advocate for gender rights in legislative sessions. Therapy helped me get out of the closet and I have kept my family members and my job during the whole process - Caroline Temmermand

  7. Hi Sherri, When reading your thoughtful blog, I began to question whether any TS women should be a mental health therapist for TG woman. You do remember the Transference and Counter-Transference of Freud. That's why so many Psychiatrists did Psychoanalysis for themselves for years. They understood their problems so well after awhile that they could separate themselves from their patients.
    So you now have a non TG therapist and she hopefully understands that you are TS. Here's my question. Do you see every TG person who walks in as a potential TS no matter how many years it takes. I think you can live full time as a TG woman without being TS. I'm going to speak to that at Keystone. Thanks Shirley for the heads up. Yes, we are all remarkable women who may not need therapy. Luv Ya, Cerise

  8. Thanks Cerise for providing an excellent thought provoking comment and question. I think that if a therapist who is transgendered has a good sense of self and has healthy ego boundries, he or she can be a highly comepetent gender therapist. They do have to do the prerequsite work on themselves whether professionally and/or personally though. I've always believed that a good therapist doesn't have to be transgendered to help someone who is, much as one does not to be of a minority to help another person who identifies as a minority.

    When I enter into a therapeutic relationship, I have no set goal as to a person necessarily must have SRS. Their life is their own journey and it is up to the individual to choose where they want to go. My role is to help them clarify what it is they want to do, assist with resources to accomplish what their individual goal is and to help preserve important relationships and careers. To impose an agenda that my patient must have SRS or even take hormones as their outcome would be just as unethical as practicing reparative therapy, don't you agree?