Here I am with Patty in Birmingham, Alabama. We left for vacation on Wednesday morning and had a really nice drive down. Alabama is probably my most favorite place to be and I really do miss living in Tuscaloosa, where I went to graduate school at the University of Alabama School of Social Work, even after all these years. I haven't been to Alabama in about 5 years, I think.
The occasion of this trip is mixing business with pleasure. I am here with Patty to attend a workshop given by Thomas Moore, who writes of all things spiritual and is giving a workshop on finding spirituality in a secular world. It is an occasion to continue my education for maintaining my licensure as a Licensed Clinical Social Worker as well as visiting well loved places and enjoying things that I miss.
We are in Birmingham until Saturday and then move on to Tuscaloosa. Today we dined at a restaurant in downtown Birmingham called the MIX and enjoyed that. Then we went to the Birmingham Museum of Art where we were treated to some very fine collections of ancient Chinese, Japanese and Korean art from the times of antiquity. They also have a wonderful collection of Wedgewood china and porcelain.
After that, we returned to the room to rest a bit and then went on to Bessemer for dinner at the Bright Star. Anyone who is travelling through the area and is looking for a fine dining experience with down home hospitality should make it a point to visit the Bright Star for dinner.
Their specialty is southern cuisine with a Greek spin to it. We enjoyed fried green tomatoes with shrimp and salsa and a hollandaise sauce, shrimp and crab gumbo for appetizers and I had red snapper prepared in a greek style, a greek salad, shrimp and crab au gratin and eggplant.
One of the owners came by to visit and I told him that it had been a much overdue visit since the last time we had been to the Bright Star, about 10 years and that we had made it a point to come on our vacation. He was so touched that after we were done with our meal and had paid our tab, our waiter asked us to wait because the owner had something for us. He said that the owner had said that our comments touched him and had made his evening! We were served with coconut cream pie and their special peanut butter pie. It's the small kindnesses such as this which makes me miss it here so much. What a wonderful way to end our day!
Tomorrow, we plan to go visit the 16th Street Baptist Church, which was bombed in 1963, killing three little African American girls during the darkest time of racial hatred against African Americans in our country. It is my intention to go and pray for them and for bigotry and hatred to be driven from our society in what ever form it may take. We have come a long way, but we have so far to go as it takes so many forms against so many people for too many reasons, none of which can be tolerated.
After, that I hope we can have time to visit the Birmingham Zoo as they have a wonderful elephant exhibit and are one of the leaders in helping to find ways of preserving wild elephants in their natural habitat. We also hope to have time to go see the statue of Vulcan, the Roman god of Fire, who symbolizes Birmingham's history of manufacturing iron and steel.
Saturday afternoon, after the second half of the workshop, we head on to Tuscaloosa, where we plan to see a University of Alabama baseball game.
On Monday, I have an interview with the Dean of the School of Social Work to explore the possibility to return to teach there.
Of course there are some favorite places to see and places to eat, especially the Waysider for breakfast, Buffalo Phils for Buffalo Wings, and then the other two dining highlights, Dreamland who have the best BBQ ribs anywhere and the Cyprus Inn overlooking the Black Warrior River.
It should be a delightful time for us both!
Showing posts with label Social Work. Show all posts
Showing posts with label Social Work. Show all posts
Thursday, May 1, 2014
Friday, August 31, 2012
The Dialectic of the Gender Continuum
One of the hotly debated topics among people
categorized under the encompassing term transgender and some academics is
whether gender identity exists on a continuum. I am not convinced that gender
identity does exist as a continuum, but I’m open, as in most matters, to the
power of persuasion and am willing to reconsider that position.
My belief is that if a gender continuum existed,
then some of the identities would be fractional representations of others and I
posit that this is not possible. My position is that the various gender
identities are discrete and have no relation to each other than that they are
alternate gender identities. There are some gender identities that are synonyms
for others. Some of them do not fit neatly into a binary, the prevailing
organization of gender identities in western culture. If you ask the
individuals who identify as being gender variant, one will find that the binary
of gender identification is valid for most people. If one asks a person with a
variant gender identity what their gender is, the vast majority of these
individuals will say that are male or that they are female. If I am asked this
question, I answer that I am a woman. The concept of the gender binary does not
give me pause or create a sense of conflict with the prevailing dominant culture
for me.
I did a review of the literature on pubmed.gov, a
database of world wide medical journals sponsored by the National Institutes of
Health. It leads me to wonder if this is a theory only found in scholarly disciplines
such as sociology. I could not find any articles in NIH database supporting a
theory of a gender continuum. Similarly, a search of the Social Welfare
Institute yielded one article solely devoted to people with gender identities
other than their assigned birth gender and any other references were termed in
the context of “LGBT”. The paucity of
scholarly research is more than a little alarming to me. The only books or
articles mentioning the concept of a continuum or spectrum were those with a
feminist philosophical perspective. I used the University of Ohio library
database to research the gender continuum theory. (I could have used my Alma Mater’s library at
the University of Alabama, but in the interest of objectivity….) When I read
feminist theory applied to academic subjects I keep in mind that “third wave”
feminist theory is a sociopolitical theory that in many instances incorporates
the ideals of Marxist political theory. Marxist theory lends itself well to the
blurring of identities. This is quite a contrast from other theories in my own
profession. Other schools of thought in the field of mental health, such as
Behaviorism for example, are notably apolitical. The notion of a gender
continuum is far from a universally accepted concept in academia, yet
proponents of the concept of gender identity continuum would represent their
model as being universally accepted. There is no scientific basis for feminist
ideology being any more valid than capitalism or socialism. It is simply a
strategy for organizing a society, just as socialism and capitalism are
strategies for organizing societies.
It is such
a sensitive issue that one would think I had also declared that the world is
flat and the earth is the center of the universe. It’s almost heretical to hold
the view that gender does not exist on a continuum. To suggest it does not will
certainly invite or at least open myself to quite a bit of invective, as it has
in the past when I have voiced an opposing view on such matters. Arguments for
the existence of the gender continuum mix biological realities with social
constructs and arrive at conclusions that do not stand up to the rigors of
scientific inquiry.
Consider the Hierarchy of Sciences. At the top is
Physics, followed by Chemistry, Biology, Psychology, Sociology, Economics and
Political Science. The further down the rank we go, the less precise the
science becomes and there is less certainty in the results of each discipline’s
research. The areas of my expertise lie in the application of the disciplines
of Psychology, Sociology and to a lesser extent Political Science and
Economics.
To the end that I might be persuaded of the
existence of the concept of gender being a continuum, the best approach is to
engage in dialectic. I had avoided the philosophy courses in the department of
religion and philosophy (to my detriment) as an undergraduate, but I did take a
course in the philosophy of behavioral sciences my senior year and in graduate
school when I selected a course on the philosophy and ethics of social work in
the doctoral program I attended.
First, we need a common language in order to
discuss this topic. Words mean things. They have specific and generally fixed
definitions over the course of time. Among the criticisms I raise about
feminist theory is their assertion of the relativity of the meanings of words.
They insist that language can be bent to serve the present need to meet an
ends. Thus we have the “reclamation” of words that are considered to be
pejoratives.
What is
dialectic? Dialectic is a term used to
describe how people who have different views try to persuade each other to
their side. It is through dialogue that hopefully the truth will emerge. In classical philosophy, dialectic (Greek:
διαλεκτική) is controversy, that is, the exchange of arguments and
counter-arguments respectively advocating propositions (theses) and
counter-propositions (antitheses). It is the practice of arriving at a
conclusion by the exchange of logical arguments, usually in the form of
questions and answers.
A continuum is defined as a
continuous extent, series, or whole. It is a set of elements such that between
them there is a third element. It is any compact set containing two elements,
though critics of the gender binary do not recognize this fact. A continuum has an order. Here lies the
problem for me. What is the order of the various identities under the umbrella
term transgender? What is the relation of each element to another and their
distance from each other? One Quarter? Three Eighths? Is a gender queer half of
a transsexual? This is a meaningless concept.
In discussing whether a
gender continuum does indeed exist, my position is the null hypothesis. A null
hypothesis is defined as a statistical term meaning that the proposed
hypothesis cannot be proven. In this case, the null hypothesis that is held
forth is that a gender continuum does not exist.
The alternative hypothesis I
propose is that set theory explains the existence of various gender identities
in a meaningful way. It does not make the presumption that all gender
identities are either related or interrelated. Set theory is the branch of mathematics that
studies sets, which are collections of objects that may or may not have
properties in common. For instance: At the extremes of our political system you
have extreme liberals and extreme conservatives. The only thing they have in
common is belonging to the set “political orientation”.
The word “transgender” was
first used by John F. Oliven M.D. in his second edition of Sexual Hygiene
and Pathology. His rationale was
that sexuality was only tangential to the person who identifies as transsexual.
Virginia Prince also began to use this word in the December 1969 issue of the magazine
Transvestia. By the mid 1970’s transgender became an umbrella term. At
the same time, the term “transgenderist” (TG) became popular in the vernacular
to specifically describe people who were living in a cross gender role who did
not intend to have genital reassignment surgery. In 1979 Christine Jorgensen
rejected the term transsexual, as she stated that her issue was gender identity
not her sexuality. She referred to herself as a “trans-gender”.
The term “transsexual”
originated in the medical and psychiatric communities. Virginia Prince drew a
sharp distinction between transgenderists and transsexuals. She did not
consider these two entities to be related.
So with these parameters for
our discussion, I would like to begin by asking, what are the poles in the
continuum of the umbrella term “transgender” and who are considered to be the
elements of this continuum? Or are we really speaking of a broader gender
continuum where the poles of the continuum are women who identify as female and
body sex is female and males who identify as males and body sex is male (if
this continuum does indeed exist)?
The elements of this
continuum include as I have been informed by various people (and please forgive
me if I leave some identities out) in no particular order: transvestite;
transsexual; cross dresser; transgender; drag king/ queen; sissy; gender queer;
intersex; eunuch; third gender; fourth gender; fifth gender; agender;
genderless; two spirit; androgyne; trigender; transgenderist; and no doubt
other identities that I have overlooked. I have purposely left out culturally
specific gender identities as they are not universal. For my purposes,
including them in this discussion is more confusing than it is helpful. If I
can be persuaded that the continuum in gender identities exists, then we can
discuss where they belong on a continuum or if some of them don’t belong at
all. Do adult babies who identify as cross gender enter into the category of
transgender as members of the proposed continuum?
How are these identities arranged
in a continuum that has validity and reliability? Validity is the quality of being valid and rigorous; the
quality of having legal force or effectiveness; the property of being strong and
healthy in constitution. It means that there is no change in definition and
that it describes accurately properties of a concept or theory. Reliability
means whether or not you get the same result under the same circumstances each
time the phenomenon is observed. In order to be useful, a continuum of transgender
identities must be accurate in describing the placement of the elements and has
universal agreement. Another way of describing the meaning of the continuum is
that it must define each element’s relation to the rest of the elements on the
defined continuum.
If
one is to construct this continuum, one cannot use social constructs in my
opinion, as they shift rapidly. As a result, they will not meet the criteria of
reliability and its validity will be fleeting as society evolves (or devolves).
Since for the moment until
someone responds to these ideas, I will also put forth the idea that one cannot
argue the existence of a gender continuum using sociopolitical arguments of
gender identities in establishing the continuum. That serves to narrow down the
basis of these identities existing on a continuum.
I would also like to challenge the notion that
this continuum is based on brain sex. Though there have been studies that
establish differences in brain sex between men and women, and there have been
some studies that have found cross gender structures and neuron density
patterns in transsexual men and women, there are not enough studies with large
enough samples to say with validity and reliability that the brains of
transsexuals are more like the gender to which they identify. We can, at this
point say that there is a great deal of evidence (an association) that supports
that finding and we are closer to understanding the biological underpinnings of
gender identity now more than ever. In the area of anatomy and physiology, I
can clearly see that we will be able to identify a continuum, as one appears to
indeed be emerging, but to date this continuum appears to only include
biological males who identify as male, male to female transsexuals, female to
male transsexuals, and biological women who identify as women. There is no
evidence to support these other identities existing on a biological continuum
to my knowledge. The studies I refer to are all quantitative studies. In other
words, these studies are based on statistical analysis. To the extent they are
proof of a hypothesis they are limited to confidence levels of probability. In
other words, we need to know whether we are speaking of a study that is wrong
once in a hundred times, once in a thousand times or however the author of the
study sets the burden of proof so that the results of the study are accurate
and able to successfully predict that a random individual instance will bear
out to be the same as the results of the study.
The notion of a transgender
spectrum or continuum can only be positively established with the use of
qualitative research methods. Qualitative methods of research are not as
powerful as quantitative research methods, particularly in proving the
reliability of the hypothesis. But they are very important and useful in
identifying phenomenon for evaluation using quantitative research techniques.
Methods included in qualitative research include participant observation,
ethnographies, case studies, surveys, historical reviews, and document surveys.
They lead to a rich descriptive understanding of the phenomenon being studied.
My opinion is that if a continuum of “transgender” does indeed exist, these are
the research techniques that might offer proof of the existence of such a
model. They will offer the hypothesis of whether a continuum of transgender
identity exists and pave the path to begin quantitative research strategies to
prove or disprove the existence of such a continuum. Until that day, I must
remain convinced of the null hypothesis, that there is no proof of a
transgender continuum and that identities under the rubric of transgender are
grouped as a matter of convenience for sociopolitical purposes.
I would propose that perhaps a
better way of envisioning all of these identities and recognizing their
independence and/ or interdependence with each other would be better served
using the Venn diagram. Borrowing from another mathematical representation, Set
Theory, a Venn diagram recognizes that there is a universal set of these gender
identities. Yet elements of the set may
or may not share properties with each other member of the universal set, while
others do share some but not all properties of a member of the set. They do not
describe a continuum. An example of this would be the overlap of identities
such as gender queer, agender, eunuch, and other similar identities. Other
identities such as transsexual and transvestic fetishists share nothing in
common but can be recognized members of a set under the umbrella term “transgender”.
Wednesday, May 9, 2012
Further Along the Long and Winding Road
Recently, I have had a few unfortunate personal circumstances and these have been needing my full attention. As a result, I have not posted as frequently in the last few months. I have two other articles I have been working on for this blog. I also have not been working on a text for clinicians that I am writing. It's about providing care for transgender patients from the perspective of a transsexual who is also a well seasoned psychotherapist.
That is ok, it will get done in the future and it won't disappear. I have too many things happening to worry about things that will take care of themselves. I do have a strong desire to continue these projects.
I spoke to my own therapist today and we mainly spoke about the present unhappy circumstance. That's an external issue. I also have had my desire to speak to my supervisor put on the back burner because of the last three months of what has been going on. Today I had a very unusual conversation with two of my female coworkers who included me as another woman and not as a male. It could not have been as a female teasing a male. It was a simple female to female conversation about a subject of feminine interest. I simply answered honestly and felt quite comfortable.
However, this does seem to make informing my supervisor imperative considering another development. I had a second encounter with another professional in my field who knows my male presentation professionally. I reintroduced myself (for the very first time) as my female true self. It was evident that he recognized me. Turns out he calls my supervisor from time to time as they are friends. I would rather be able to present this information to her first.
In any event, I'm feeling close to being ready and when I feel the time is right I will set up that appointment. I do want to process it a bit with my therapist and have wanted to for about 8 weeks, these things keep getting in the way darn it!
Hopefully I will get a chance to talk to my therapist to fine tune my game plan next week and the nest couple sessions and then go forward with speaking with my supervisor. She is a fair minded person and has always been my best supporter of transgender care at the hospital. I'm very proud of my front office staff coworkers (two of who were having that conversation with me today). They are always especially kind to my transgender patients, NEVER make mistakes with names and NEVER mix up the pronouns. How cool is that?!
In any event, I am close to the tipping point with my employer and feel ready. Just please please please let me get through the external tough things going on, so I can get this accomplished
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.
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.
Sunday, November 6, 2011
She Gave Me Hope a Long Time Ago
As I had mentioned previously, When I was 12, I went to the library and started reading about people like me. That started a life long search in the literature to learn more about myself. I'd go to the library quite often and read the books about Transsexualism. I'd re-read the books that I had read before and read the new ones when they came in. I was too afraid to check them out so I could only read them for an hour or so at a time. This went on all through junior high and then high school. I was very fortunate that the Charlottesville Public Library had these books. In high school, I worked at U.Va. Hospital and then had access to the medical school library. Jackpot!! That gave me access to medical and other allied health care journals as well. The thing that struck me most (aside from THIS IS WHO I AM!!) was that there were so few of us that I felt so alone and so different in the world. I also thought that this is such a shameful thing that no matter what, I must let NO ONE know the truth about who I was. It continued into college, after college and then through grad school at the University of Alabama. Every time I went to the library, I'd almost inevitably get side tracked and go read the books about people like me. Even today, if I go to Barnes & Noble or online to look at books I still get sidetracked by looking for books on transgender themes and I have quite an extensive library that even includes all those old books long out of print that I read at the beginning when I was 12 and up.
A year after I graduated from the School of Social Work, I got married for the first time. The only thing I will always hold myself accountable for in the failure of my marriage was I didn't tell her the truth about myself before we married. No matter what her transgressions were, that is something that I was totally responsible for. She didn't deserve that. In my defense, I, like many of us who marry, thought it would go away. It didn't take long, maybe 6 months or so, to figure out that being transsexual wasn't nor will it ever go away. It wasn't until after my ex left that I came to the conclusion that I better make friends with this or it was going to kill me. Literally.
About a year after I was married, I made a decision that seemed inconsequential, but really gave me that first hope, just a glimmer of hope, that maybe there was a way for me to become the person I truly as I continue in the process of self-actualization today.
I had been working at the state hospital as director of the forensic unit, a unit whose mission is to care for those who were adjudicated Not Guilty By Reason of Insanity, or had not been able to be restored to competency to stand trial. This is a particularly political position for a mental health professional, and my assessments potentially had a controversial impact on communities and courts across the state of Alabama, as well as United States Federal Court in some instances as Bryce Hospital was still under Federal receivership due to the Wyatt vs Stickney landmark legal decision. That case resulted in nationally set standards for the care of institutionalized mentally ill people and is considered the "Bill of Rights" for institutionalized mentally ill people. While it was a very good job with the potential for rapid professional growth, it was also very stressful, and here is where I made a decision that changed the course of my life a bit. I decided that I needed to have a mental health day ( I called in sick). I really didn't do much of anything, I just really wanted to have a day to myself alone.
Early in the afternoon, after playing Ms Pacman for the 100th time or some of the other computer game I had (we're talking 1989 and the IBM XT. I was 32 years old), and talking to people on Compuserve, I decided to watch some TV. During those years, Geraldo Rivera had a day time talk show. That particular day, Geraldo has a guest whose name was Marsha Botzer. I didn't know who she was, but it turned out that she was a transsexual woman who had founded the Ingersoll Center in Seattle, Washington in 1977 (To put it into historical perspective, in 1977 I was finishing up my Freshman year at Bridgewater College).
I was rivited; never before had I ever seen or heard another person who was like me. I remember how nice and respectful he was in that interview towards her. I wanted to talk to her badly, but I knew I couldn't call her from home because my wife would question the phone call. I had no idea how to tell her about my most carefully guarded secret. Until this television show, I never talked to or heard another person like myself. I had thought that people like me were so rare that it would be nearly impossible to find or even to talk to someone like myself who could understand the depth of the emotional pain with that I lived.
The next day, back at work, I knew I had to take a risk. I used the work phone to call directory assistance in Seattle, got the number for the Ingersoll Center and after a few minutes of anxiety, called the Ingersoll Center and asked to speak to Marsha. I remember being really shy and telling her how I had seen her on TV the day before the day before. I told her about myself and that I had never known anyone else like me and it meant a lot to me that she would take a few minutes to spend on the phone talking with me. I told her that I was a clinical social worker and about my life growing up. She asked me if I would like some information about the Ingersoll Center and sent me a couple of brochures that I still have to this day. I've always remembered this experience and from time to time have shared that story with others.
As some of you know, this past September, I attended the Southern Comfort Conference where for the past three years I have presented my workshop and The World Professional Association of Transgender Health International Symposium. What a once in a lifetime experience that was for me! I met so many wonderful people, many I have only read about and never dreamed I would have the opportunity to meet.
After the morning workshop on Saturday, I was walking around feeling a bit alone and shy as I often do in new situations and found myself within speaking distance with Marsha. She now sits on the WPATH Board of Directors. Now, this was one of this OMG!! experiences for me! I just had to meet her and tell her what that experience so many years ago meant to me and thank her for that!
In talking to her, I became emotional and I could see that what I had said had touched her as well, just as I had been touched by her generosity with a few minutes of her time so long time ago. Then, the highlight of the conference for me and one of the highlights of my life was that she invited me to have lunch with her! WOW! That was such a wonderful experience. I'll never forget that.
You know, life is pretty short. We never know what little act of kindness, something we wouldn't think twice about doing, will have a profound impact on someone else's life. I think it's really important to let those people who touched your life in a meaningful way know what they have meant to you when that opportunity comes. You never know if you might ever have that opportunity again. It's always gratifying to be able to make someone else aware that they are appreciated for the things they do that makes things just a little bit better for others when the opportunity presents itself.
A year after I graduated from the School of Social Work, I got married for the first time. The only thing I will always hold myself accountable for in the failure of my marriage was I didn't tell her the truth about myself before we married. No matter what her transgressions were, that is something that I was totally responsible for. She didn't deserve that. In my defense, I, like many of us who marry, thought it would go away. It didn't take long, maybe 6 months or so, to figure out that being transsexual wasn't nor will it ever go away. It wasn't until after my ex left that I came to the conclusion that I better make friends with this or it was going to kill me. Literally.
About a year after I was married, I made a decision that seemed inconsequential, but really gave me that first hope, just a glimmer of hope, that maybe there was a way for me to become the person I truly as I continue in the process of self-actualization today.
I had been working at the state hospital as director of the forensic unit, a unit whose mission is to care for those who were adjudicated Not Guilty By Reason of Insanity, or had not been able to be restored to competency to stand trial. This is a particularly political position for a mental health professional, and my assessments potentially had a controversial impact on communities and courts across the state of Alabama, as well as United States Federal Court in some instances as Bryce Hospital was still under Federal receivership due to the Wyatt vs Stickney landmark legal decision. That case resulted in nationally set standards for the care of institutionalized mentally ill people and is considered the "Bill of Rights" for institutionalized mentally ill people. While it was a very good job with the potential for rapid professional growth, it was also very stressful, and here is where I made a decision that changed the course of my life a bit. I decided that I needed to have a mental health day ( I called in sick). I really didn't do much of anything, I just really wanted to have a day to myself alone.
Early in the afternoon, after playing Ms Pacman for the 100th time or some of the other computer game I had (we're talking 1989 and the IBM XT. I was 32 years old), and talking to people on Compuserve, I decided to watch some TV. During those years, Geraldo Rivera had a day time talk show. That particular day, Geraldo has a guest whose name was Marsha Botzer. I didn't know who she was, but it turned out that she was a transsexual woman who had founded the Ingersoll Center in Seattle, Washington in 1977 (To put it into historical perspective, in 1977 I was finishing up my Freshman year at Bridgewater College).
I was rivited; never before had I ever seen or heard another person who was like me. I remember how nice and respectful he was in that interview towards her. I wanted to talk to her badly, but I knew I couldn't call her from home because my wife would question the phone call. I had no idea how to tell her about my most carefully guarded secret. Until this television show, I never talked to or heard another person like myself. I had thought that people like me were so rare that it would be nearly impossible to find or even to talk to someone like myself who could understand the depth of the emotional pain with that I lived.
The next day, back at work, I knew I had to take a risk. I used the work phone to call directory assistance in Seattle, got the number for the Ingersoll Center and after a few minutes of anxiety, called the Ingersoll Center and asked to speak to Marsha. I remember being really shy and telling her how I had seen her on TV the day before the day before. I told her about myself and that I had never known anyone else like me and it meant a lot to me that she would take a few minutes to spend on the phone talking with me. I told her that I was a clinical social worker and about my life growing up. She asked me if I would like some information about the Ingersoll Center and sent me a couple of brochures that I still have to this day. I've always remembered this experience and from time to time have shared that story with others.
As some of you know, this past September, I attended the Southern Comfort Conference where for the past three years I have presented my workshop and The World Professional Association of Transgender Health International Symposium. What a once in a lifetime experience that was for me! I met so many wonderful people, many I have only read about and never dreamed I would have the opportunity to meet.
After the morning workshop on Saturday, I was walking around feeling a bit alone and shy as I often do in new situations and found myself within speaking distance with Marsha. She now sits on the WPATH Board of Directors. Now, this was one of this OMG!! experiences for me! I just had to meet her and tell her what that experience so many years ago meant to me and thank her for that!
In talking to her, I became emotional and I could see that what I had said had touched her as well, just as I had been touched by her generosity with a few minutes of her time so long time ago. Then, the highlight of the conference for me and one of the highlights of my life was that she invited me to have lunch with her! WOW! That was such a wonderful experience. I'll never forget that.
You know, life is pretty short. We never know what little act of kindness, something we wouldn't think twice about doing, will have a profound impact on someone else's life. I think it's really important to let those people who touched your life in a meaningful way know what they have meant to you when that opportunity comes. You never know if you might ever have that opportunity again. It's always gratifying to be able to make someone else aware that they are appreciated for the things they do that makes things just a little bit better for others when the opportunity presents itself.
Thursday, November 3, 2011
Little Things Make a Difference in My Life
In daily life, I, like most women like me, sometimes wonder in the back of my head if I'm really being accepted in public as any other woman, or are people reading me as a transwoman and being polite. At this point, I'm very comfortable with daily activities. I go shopping for clothes, go to the grocery store, now have a church I feel comfortable attending and am welcome to be there by congregation. That was a huge milestone for me in my comfort in public as well as in feeling accepted by others.
Over the last three weeks, I have had a couple of experiences that tell me that I am making progress in being seen as just another woman, which is what I see as my goal in the transition process. What has happened is that twice now I have been asked by another woman for assistance. The first time I was on my way into the grocery store and a woman stopped me and asked me if I could look at her receipt from the grocery store. She was concerned that she had paid too much for an item that was on a buy one get one free special. I explained that usually you only get charged half price for one item, but she had been charged a little over half, maybe three quarters. She was asking if I thought she should ask the managers about it, as if she was going to have to pay that much, she would go back and get the second item in that case.
Now being a Social Worker by profession, I just have that natural urge to help people. I guess it's like a pointer who hunts birds (No smart remarks PLEASE!!!! LOL!) So, naturally it gives me a good feeling to be able to do something, even if it is a little thing like that for someone else. But being able to do that little helpful thing gave me so much more. I felt accepted as just another woman!
The day before yesterday, I went to see my doctor for a horrible case of bronchitis I'm dealing with and then had to drop off a prescription. Now Walmart is always a mixed bag for me. On the one hand, I get all my HRT prescriptions there and they cost me a lot less because my insurance doesn't cover it. Two out of three of my prescriptions are on the $4.00 list. Ironically, because my insurance won't cover me for those, I save a dollar on two of them because it's a dollar less than my normal copay! What a little twist that turned out to be, in my favor for once!!
Otherwise, Walmart pharmacy has been a pain to deal with for some other reasons. I really don't like the long lines and the waiting. I also had one of the very few unpleasant experiences there during my transition interacting with their staff at the beginning of my relationship with that pharmacy. But, we got that straightened out and things have been ok with them since then. I can forgive and move on. Still, it's not the most convenient place to get my presciptions.
Dr. Laura Jean had called in my antibiotic to Walmart since it was closest. I was feeling very poorly and knew it would be a little while, so I went grocery shopping. That took about 45 minutes and then I went to Walmart (Here in the sunny south we call it "Walmarts" or if we go to Kmart it's pronounced "Kmarts". I don't know why, it just is!). After the perfunctory long wait, I learned it would be another 45 minutes, so I left and went to Books a Million to hang out.
When I got back, on my way in I noticed a woman in a handicapped parking spot and she was on oxygen. She called out to me and I went over. She was struggling to change out an oxygen bottle. She was literally crammed in her car with all her groceries and I wondered how she would ever get all those groceries into her home without a lot of physically agony from oxygen starvation. She asked me to change out her bottle for her. I told her that I worked in the medical field and knew how to do this. It's pretty easy actually and I've done hundreds of them over the years. So I was able to help her out and she was very grateful for my help.
But it was really me who got the help! I got another affirmation that people look at me as just another woman out there taking care of her daily business. To me, these two women gave me something more than I gave them. They gave me confidence that I can lead a regular life and be seen as who I see myself; another woman leading her life in an ordinary everyday way.
Over the last three weeks, I have had a couple of experiences that tell me that I am making progress in being seen as just another woman, which is what I see as my goal in the transition process. What has happened is that twice now I have been asked by another woman for assistance. The first time I was on my way into the grocery store and a woman stopped me and asked me if I could look at her receipt from the grocery store. She was concerned that she had paid too much for an item that was on a buy one get one free special. I explained that usually you only get charged half price for one item, but she had been charged a little over half, maybe three quarters. She was asking if I thought she should ask the managers about it, as if she was going to have to pay that much, she would go back and get the second item in that case.
Now being a Social Worker by profession, I just have that natural urge to help people. I guess it's like a pointer who hunts birds (No smart remarks PLEASE!!!! LOL!) So, naturally it gives me a good feeling to be able to do something, even if it is a little thing like that for someone else. But being able to do that little helpful thing gave me so much more. I felt accepted as just another woman!
The day before yesterday, I went to see my doctor for a horrible case of bronchitis I'm dealing with and then had to drop off a prescription. Now Walmart is always a mixed bag for me. On the one hand, I get all my HRT prescriptions there and they cost me a lot less because my insurance doesn't cover it. Two out of three of my prescriptions are on the $4.00 list. Ironically, because my insurance won't cover me for those, I save a dollar on two of them because it's a dollar less than my normal copay! What a little twist that turned out to be, in my favor for once!!
Otherwise, Walmart pharmacy has been a pain to deal with for some other reasons. I really don't like the long lines and the waiting. I also had one of the very few unpleasant experiences there during my transition interacting with their staff at the beginning of my relationship with that pharmacy. But, we got that straightened out and things have been ok with them since then. I can forgive and move on. Still, it's not the most convenient place to get my presciptions.
Dr. Laura Jean had called in my antibiotic to Walmart since it was closest. I was feeling very poorly and knew it would be a little while, so I went grocery shopping. That took about 45 minutes and then I went to Walmart (Here in the sunny south we call it "Walmarts" or if we go to Kmart it's pronounced "Kmarts". I don't know why, it just is!). After the perfunctory long wait, I learned it would be another 45 minutes, so I left and went to Books a Million to hang out.
When I got back, on my way in I noticed a woman in a handicapped parking spot and she was on oxygen. She called out to me and I went over. She was struggling to change out an oxygen bottle. She was literally crammed in her car with all her groceries and I wondered how she would ever get all those groceries into her home without a lot of physically agony from oxygen starvation. She asked me to change out her bottle for her. I told her that I worked in the medical field and knew how to do this. It's pretty easy actually and I've done hundreds of them over the years. So I was able to help her out and she was very grateful for my help.
But it was really me who got the help! I got another affirmation that people look at me as just another woman out there taking care of her daily business. To me, these two women gave me something more than I gave them. They gave me confidence that I can lead a regular life and be seen as who I see myself; another woman leading her life in an ordinary everyday way.
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