Occasionally I write a column and then, for your reading ease, run the piece past editors who also are therapists. With the vast majority of my writing, everything comes back just fine. The article will have a couple misspelled words, or a point that needs clarification. However, over time, I have also noticed a trend. Articles that criticize therapists, even when written by those within the field, get scathing reviews.

The preceding experience does not however negate a stark reality. Many transgender persons encounter therapy blunders, and based on the countless letters I receive from these individuals, the vast majority of mishaps come as a result of therapists being inexperienced at dealing with gender identity issues. It is at this point my relationships becomes contentious with other therapists and counselors who have transgender clients, because it is they who should be contacting me when questions arise.

I do not wish to dissuade transgender consumers from writing me. Therefore, it is fair to ask why I made the preceding statement. Therapists who are seeing transgender clients are obligated to seek consultation and up-to-date literature, particularly when they encounter situations reaching beyond the scope of traditional training. Transgender consumers should never be required to fulfill the role of both therapist and client, or bear the burden of augmenting a therapist's gender education.

Individuals expressing feelings of anger, betrayal and frustration at their therapists routinely contact me. This is a travesty! Many pose inquiries looking for a new therapist or are simply considering abandoning therapy altogether. When I encounter these situations, occasionally I will provide a Gender Specialized Evaluation when it is evident the therapist has rendered a client (all the more) confused about his or her gender identity. It is more common however that clients have already self-determined their gender identity when therapy blunders arise, and I redirect that individual back to therapist with instructions how to deal with the situation and better the relationship.

The most common complaint I hear of therapists imposing arbitrary or outdated expectations, standards or stereotypes on a client. More to the point, the therapist's course of treatment will contradict common sense, the HBIGDA Standards of Care and current advances in gender specialization. Failing to observe that transition goals are integral components as well as exploration tools in a self-determination process, the therapist cautions the client to wait before moving forward.

It is prudent for transgender clients to wait in some respects. Finding out how to deal with the consequences of one's intended goals, for example, helps minimize damaging him or herself and others. Determining which physical changes should come before others, for instance, helps the individual avoid unnecessary transition conflicts. I have seen numerous clients avoid "bearded woman syndrome" by having electrolysis completed or near-completion before coming out in the workplace.

The waiting that is most agonizing and deprecating to transgender persons, however, comes when only the therapist can decide as to whether a true transsexual identity exists. Or, when only the therapist can determine if the client is making the right decision by moving forward. Lost under those schemes is client autonomy or a transgender person's power to make his or her own educated decisions and learn how to deal with errors constructively. The preceding style of waiting is most often applied to first steps going out dressed, first steps telling a close friend, first steps disclosing to family members, the client's repeated request for hormones, and lastly, requests for surgery letters.

The vast majority of the preceding complaints arise when clients see a therapist who has never seen transgender persons before, or more commonly, when the therapist has seen only a handful of transgender persons over a wide span of years. Certainly, new careproviders make blunders, however to their credit they actually are more likely to seek consultation on gender issues. This is because seeking consultation on cases is common practice for people leaving the academic world and entering clinical practice. Therapists, on the other hand, with more years of clinical practice, and who have seen several transgender persons in the past, are more likely to call themselves "gender specialists.," Subsequently, often to the transgender person's detriment, these lone rangers are typically more likely to rely solely on their experience or the clinical literature stocking their bookshelves rather than seek consultation.

What many clients do not realize, is that 'practicing' in help professions, like most things in life, is a fly-by-the-seat-of-your-pants type of experience. Professionals don't like admitting just how inexperienced they are. Rather, they prefer to promote themselves and make decisions based on their prior experience. In part this is fair because any prudent careprovider will want to make a diagnosis before offering a treatment plan. In many respects this strategy works, but not always. Therapy blunders occur most often at the juncture where transgender issues differ from other conditions or situations. As an example, coming out as a gay or lesbian person can often differ significantly from the transgender experience. Sexual orientation need not always interference with employment or even non-romantic relationships, however, for the person transitioning these are often critical concerns.

The more we ponder the preceding dynamics, the more it would seem transgender folks are left in the lurch. This is not however always true. Many times positive relationships develops between transgender folk and therapists who do not routinely see transgender clients as a specialization. Reality also indicates that finding a therapist, one who actually will see transgender individuals, is no easy task in some locales. On the balance many transgender people are extremely satisfied with non-gender specialists in these situations. However, when these professionals do not take responsibility for seeking up-to-date-information or consultation on gender issues, transgender people are often left picking up the pieces. Fortunately, preventing and resolving therapy blunders of this nature need not be difficult.

For the transgender person entering a therapy or counseling process, it is important to ask how many actual transgender clients the therapist has had. If the therapist has not had much experience, this is okay as long as he or she sounds flexible, supportive of your right to make decisions, and willing to hear your about your ideas and needs. At any stage of professional relationships, clients can also reexamine the relationship. This can be done by asking questions about the therapist's beliefs about your experiences and goals, once he or she has had a chance to learn about you. For some people, it may also be helpful to ask the therapist what he or she proposes take place should a client/therapist disagreement occur with a suggestion or treatment plan.

To be fair not all therapy blunders are avoidable or are the entire fault of the therapist. Counseling and therapy relationships are working processes. These require maintenance. If your therapist is not a gender specialist, throughout the relationship it may be wise to share with him or her discoveries that you make about the process along the way. And, I feel it is perfectly acceptable to introduce books and clinical literature that address questions which are arising in the relationship. Particularly when the materials provide additional information about your requests and situation! It also can be useful for you and your therapist to discuss the contents of the material you provide, as long as the context of the conversation remains on you. Your therapy session is not Transgender 101 about other people's situations, unless they affect you, or you wish to discuss how your situation is unique when compared to others.

Standing up for yourself is an important part of survival and success in this world, and your therapy session is a great place to distinguish self-representation skills. For instance, there are occasions where a therapist will entirely disagree with your point of view. This is okay. In countless responses to letters I receive, I encourage individuals to show their therapist the Standards of Care, my book "Transgender Care," Mildred Brown's book "True Selves" and other materials. Discuss your disagreement without being disrespectful. Look to see compromises which satisfy both parties. Also, ask what research your therapist has performed in order to make decisions in your case. This may be important, because it is possible something outdated, or which didn't apply in your situation, was consulted.

Therapists sometimes don't like it when I inform their clients that it is the therapist's responsibility to learn about gender issues if they are interested in working with transgender people. Resolving one or two therapy blunders is probably on par with most professional relationships. However, if it feels as if your sessions are more for the benefit of the therapist's education, than receiving therapy, it is time to ask for a reduction in rates. A large difference exists between explaining how situations impact you, and educating someone about gender identity issues by and large so that they can understand transgender basics.

Within my practice and those of my colleagues, we place great emphasis on providing counseling and therapy to help clients improve their quality of life. If a therapist cannot present a reasonable explanation for their decisions, ones which seem to negatively impact your long-term well being, it is definitely time to secure a second opinion. During a brief consultation or evaluation, a gender specializing therapist or counselor should be able to pinpoint where the difficulties lay. Once you have received new information about your situation, take this back to your original therapist and discuss it. However, if the therapist gives you a hard time, consider moving on. Therapists who are so inflexible as to disrespect your efforts at securing a second opinion, are likely concerned that the second opinion will unveil a disparity or unfairness in the professional relationship.