This is a serious question for many transsexuals; the Standards of Care require recommendations from therapists at key points in treatment. The fear is always that if one is honest, one may be denied treatment, that it is more important to "say the right things" than to say the truth.

But shame and guilt may cause any of us to hold back, from therapists or friends or family, no matter what the issue might be. It takes some of us a long time to learn how self-defeating it is to keep secrets.

The question of honesty with therapists really comes down to one of these issues:

• If you can not be honest with your therapist, then it is important to understand why. If you do not trust your therapist because of things the therapist has said or done, find another one!
• If you are not willing to open up to a therapist, that is a different problem. Learning to trust the process and work with it takes time, and is a prerequisite to doing any useful work in therapy.
• If you are not willing to open up to anyone, then you are not ready for therapy; you are simply wasting your time and money. It may be that your issues do not yet hurt enough that you need to do something about them.

There are valid reasons to "find another one." Certainly an "I can cure you" attitude toward transsexualism or cross-dressing shows arrogance combined with ignorance, and that's reason enough to start looking again.

Even speaking generally, "I can cure you" is a warning sign. Therapists are not gods; they cannot cure. The only person who can cure me is me; the only person who can cure you is you. The role of the therapist is to teach us how to do this, and to be a companion along the way. [1]

Even the concept of "cure" is suspect; a therapist whom I love and respect once said, "Mental health is when your symptoms don't bother you any more." Unlike physical illnesses, so many emotional issues are based on past events or relationships. The only changes we can make are in the ways that we deal with them, and in the ways that we allow the past to influence our present and future.

There's a book that's been around for a while called If You Meet the Buddha on the Road, Kill Him! by Sheldon Kopp. It deals with exactly this issue; one cannot begin to make real progress in therapy until we stop looking to the therapist--or anywhere outside ourselves--for solutions. Another strong theme of the book is to understand the limits of therapy; in therapy we can learn to change our approach to life, but the issues that bedevil us never go away. Indeed, life will always find new ways to trouble us, and we will always have new opportunities for healing ourselves.

The corollary to this is that a therapist who does not understand his or her role in this way has the potential to do additional damage to us. A friend put it this way: "You haven't been hurt until you've been hurt by a professional." Therapists are human too; this is both their greatest strength and greatest weakness. It is something that we all must take into account.

The "kill the Buddha" line comes from Zen traditions. The story is told of the Zen teacher who sets three tasks for his student:

Kill the Buddha, meaning that we must stop looking to a superior being for help;[2]

Kill your family, meaning that we must stop letting family issues and feelings block us from finding our own paths;

Kill me [the teacher], meaning that we must stop looking to others for solutions to the issues of our own lives.

It's certainly true that a lot of people become mental health professionals in search of a cure to their own problems, and that is reason to be wary also. Possibly one of the most subtle and difficult keys to finding a good therapist is to figure out to what degree they have come to peace with themselves--something that people having trouble with their own issues may find particularly difficult. But it is crucial. One therapist I know put it this way: "You can only take another person as far as you have gone yourself."

This last statement should be a caution to any transgendered person seeing a non-transgendered therapist about gender-related issues: They have not traveled on our path. It helps if they are willing to learn from us and about us. It also helps if they have had to deal with comparably difficult life-changes. I know of a gender therapist who is a former nun, a grandmother, and a lesbian. As she put it, she could write the book on denial. The magnitude of her life-changes helps her understand us by analogy.

Questions also arise about "wonder drugs": they are useful, in their place. When I started therapy, I was dealing with life-long depression, and Prozac was quite helpful. I, too, questioned the need for drugs at that point. What I have come to understand is that conditions such as long-term depression can induce biochemical changes in the brain; the drugs can reverse those changes temporarily, allowing us to work more effectively in therapy in dealing with the underlying causes of depression, anxiety, or whatever. The drugs are not alternatives to therapy, but are best used as a supplement to therapy. Therapy, not drugs, is the long range cure for some issues, while in other conditions such as bipolar disorder, drugs may play a longer-term role. The only real answer is to work with your therapist to understand the what, how, and why of the drugs they suggest.

Essentially, it all comes back to learning how to heal yourself. At that point, the question isn't really whether you can be honest with your therapist; it's whether you can be honest with yourself.

There is an additional factor that can interfere in the therapist-client relationship, and that is managed health care. Too many health care organizations are interested only in quick-fix solutions, and are not supportive of the kind of "talk therapy" that leads to real change. They may also steer people to social workers or to less-skilled therapists in the interest of cutting costs. This kind of attitude will make it difficult for people with long-term issues to find a therapist that they can work with. This is especially true for transgendered people, who frequently find only frustration with general therapists, and who may have difficulty finding a gender therapist who works within a health maintenance organization. (Never mind the question about whether a health maintenance organization wants to deal with transsexuals!) For the present, I strongly advise avoiding managed health care for mental health issues of any kind.

In this very Christian society, it may seem troubling to reject reliance on a "superior being." I'm currently reading a remarkable book, The Gospel According to Jesus by Stephen Mitchell. It attempts to strip out all external influences in our understanding of who Jesus was and what he taught. This includes early Christian influences embedded in the Bible itself; if there is doubt about the authenticity of any words or acts of Jesus, those words and acts are thrown out. What emerges is a remarkably Buddhist Jesus who teaches us to look inside ourselves for inner peace (the Kingdom of God). One gets the strong feeling that this Jesus would reject the kind of worship and dependency that the Christian establishment encourages. All in all, a fascinating book, and highly recommended--both in the context of spirituality, and also in the immediate context of inner healing.