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Gianna Israel Gender Library

Are Therapists Trustable?

One of my most favorite questions I hear circulating among people in groups throughout the gender community goes as follows. Should I lie to my therapist? The preceding question is then typically accompanied by a variety of statements or reasons why a person might feel a need to lie. Some of those statements can be frightening. My therapist will deny me hormone or surgery recommendations if he or she doesn't approve of something about me. My therapist won't understand my problem. My therapist really could care less about gender issues. Or, my therapist is cold, calculating and has no human emotions.

After hearing various questions or situations regarding therapist-client trust issues, typically another person within a group will immediately launch into tirades about the horrors of therapists and gatekeepers in general. What gets lost in the process of looking at the issue is some old fashioned common sense. For instance, when trust issues arise people frequently tend to overlook other crucial dynamics within therapist-client relationships. Whether someone is receiving services from another therapist, or me, I encourage all persons to review their motivations for seeing a therapist. Doing so sets the groundwork for an empowered client or consumer.

In most circumstances if you are seeing a therapist, I would assume it is because your are hoping to change something in your life. You may be looking to improve upon your quality of life or hoping to learn new coping skills. If you are in the process of transition, you may rely upon your therapist to provide you accurate information about gender issues. In many cases new clients seek an assessment or evaluation, and then want to receive professional recommendations that help improve their situation. Finally, as is often the case in the gender community, people see therapists because they want to receive a letter of recommendation for hormones or surgery.

The most important point that you need to realize about therapy relationships is that you the client are seeking a commercial service. Consequently, it is a duty to yourself to define what you wish to accomplish within that relationship. You can best get your needs filled in a therapy relationship by stating what interests you. You can also set aside discussing an issue, particularly if you believe doing so would not benefit you. If a therapist is unwilling to discuss your goals, or repeatedly pressures you to conform to a plan that doesn't make sense to you, then that therapist is probably not worth your time. You have the right to find a therapy relationship that works for you. Even institutionalized persons or those within gender clinics or mental health programs have a right to discuss grievances with supervisors or ask for a different therapist.

Sometimes people feel uncomfortable telling their therapist about new or deeply personal issues. This may happen because the client-therapist relationship is new, and a client has not yet had enough time to feel that trust is established. Within four to eight initial sessions, a client should be able to discuss issues of trust with the new therapist. This can include the client discussing why he or she feels uncomfortable talking about a subject. Another reason a person may have difficulty focusing on a new issue within therapy is because the client-therapist relationship has deteriorated. This typically happens when a client or therapist fails to keep sessions goal-oriented or structured. Either party stating an observation that the relationship has deteriorated can be the start of regaining structure. Then, after structure has been regained, it is important to establish why the client feels uncomfortable discussing a new subject.

Another reason a client may feel motivated to lie to his or her therapist, is because a person feels that the professional is locked into stereotypes of what constitutes a transgender person, transsexual or crossdresser. Concerns along the same vein also include fears that the therapist may not respect a client's wish for a particular type of treatment. This can be particularly so when the treatment greatly differs from what the therapist considers appropriate. Nobody enjoys being forced to conform to another person's stereotypes or even suggested treatment regimens. If you are not happy or distrust your therapist's response to your requests or his or her suggested treatment regimens, do not sit by and allow the relationship to deteriorate. Instead, ask your therapist to provide you an easy-to-understand explanation of their reasoning for a decision or treatment. If you continue to dislike their approach, ask to see clinical documentation supporting his or her position. Be polite at all times. Being disrespectful will not improve your chances of being heard by your therapist.

If you engage in the preceding steps, keep in mind that an alternative approach to introducing a new treatment idea to your therapist would be for you to provide him or her clinical information that you have gathered. Clinical information is typically found books, magazines, journals and other publications. The preceding materials should be written by someone with actual experience in the subject area of interest. An article which demonstrates a point based upon a therapist's having experience working with 50 transgender persons is certainly going to be more respected than that of the therapist who only saw one or two clients. When presenting new information to your therapist, keep in mind that doing so is often easier than searching for a new therapy provider. When conflicts, distrust or treatment issues arise between clients and therapists, I typically advise that these persons try to work it out. Otherwise, the client is left with the burden of searching for a new therapist, and reinitiating the whole process of building trust. Unless a clear case of wrongdoing or abuse exists, there often is no reason to leave a pre-existing therapist.

More often than not, I also do not recommend that a client abandon a therapy relationship simply because the therapist is not a gender-specialist. In cases where a client needs gender-specialized services, he or she might ask the therapist to seek brief professional consultation on the gender issue. The client may also do so him or herself on a short-term basis, such as for an evaluation of the issues at hand. This is often why I will provide a gender specialized evaluation for an individual, then provide recommendations and goal-planning based upon the evaluation. After doing the preceding, I will then typically consult with the client on a monthly basis while he or she continue seeing the original therapist weekly. With the preceding plan, clients can allow a pre-existing therapy relationship to grow and mature, while either party can take advantage of a gender specialist's expertise in order to enhance a good relationship.

As a therapist I have always hoped my clients would not lie to me. The reasons are pretty easy to understand. When people lie, they are wasting their time and money. Eventually, a person that lies will have to go back and deal with the truth if he or she wants to improve upon a situation. On the balance, therapists are typically accustomed to hearing a variety of stories from clients, and therapists understand that they are only hearing one side of the story--the client's. A progressive therapist is going to be interested in hearing about your needs and even new treatment approaches. Thus, there is no reason to lie. Moreover, if you tell your therapist you wish to focus on a sensitive subject for a short period of time, and then wish the subject set aside , in all likelihood the therapist will conform to your wishes. This after all characterizes client-therapy relationships. Therapy relationships should serve you, the client. You will get out of it what ever you are willing to ask for, and invest in.


GENDER ARTICLES. This educational column authored by Gianna E. Israel is regularly featured on the 3rd Monday of each month in Tg-Forum, the Internet's most up-to-date, weekly Transgender Magazine <http://www.tgforum.com/>. Several weeks later each article is forwarded to Usenet and AOL <Keyword TCF>. Each column has been written to inspire contemplation and dialogue. Columns may be reprinted in any medium insofar as each article, its introduction, and the author's contact information remains unaltered.

GIANNA E. ISRAEL provides nationwide telephone consultation, individual & relationship counseling, evaluations and referrals. She is principal author of the Transgender Care (Temple University / in press 1997). She also writes Transgender Tapestry's "Ask Gianna" column; is an AEGIS board member and HBIGDA member.She can be contacted at (415) 558-8058, at P.O. Box 424447 San Francisco, CA 94142, or via e-mail at Gianna@counselsuite.com.


Copyright © 2001 by Diane Wilson. All rights reserved.