Getting it Half Right: What to Do (and Not to Do) When Your Client Says You’re a Transphobic Therapist

agender, cicssexism, cis entitlement, cisgender, fatphobia, gatekeeping, gender specialist, genderfluid, genderqueer, mental illness, saneism, therapist, transgender, transphobia

Trigger Warning: discussion of bad therapy, transphobia in clinical practice, fatphobia, saneism, suicidal ideation, homophobia

I’m continuing the story of how I called out Former Therapist #1 for his transphobic gender policing and gatekeeping. I am really pissed at him right now, because he has done so much to take away my ability to work with other providers. I’m putting our exchange here and then some of my feelings about it in footnotes.

Let this be something that other providers can learn from, so that other people don’t have to deal with this pain.

I’m not the only one dealing with or writing about this. Check out this lovely example of therapeutic invalidation (plus an intersection with fatphobia) from Rooster Tails Comic:

The lady who ran out on me then came back in with another person.... it felt like I was in a job interview. So weird.Source: http://www.roostertailscomic.com/comic/happy-mental-health-awareness-week/

Two weeks after I sent a letter to Former Therapist #1 about his mistreatment, I got this email from him:

5/30/14

Hello [Birth name],[1]

I didn’t want too much time to go by before I acknowledged your much appreciated letter I received.  I have been doing a lot of thinking and reflecting on your letter.  I’m planning to send you a response soon.  I’m consulting my colleges [sic] and other gender specialists as well.  I didn’t want you to think my delay was in any way me ignoring or rejecting your letter.  I want to acknowledge the courage and integrity you displayed in your letter with a response that is as thoughtful and respectful as I can make it.

Thank you again for the letter.  I will send my response as soon as it is ready.[2]

[Former Therapist #1], LICSW

I replied almost immediately:

5/30/14

My name is [real name]. I hoped that you would know not to call me by my birth name at this point.

Are you talking with anyone who’s actually trans*?

Also, I am now seeing [current therapist]. If you talk with any providers, I recommend talking with her. She is the only provider I have seen who has been gender affirming. If she has the time and energy, she would be a great resource.

I received no reply to this email. It was early on in my trying out new names and pronouns, and his misgendering hurt a lot. I especially was appalled that he did it in email, after such a gender-relevant letter. Four days later, I sent him another email:

6/3/14

Hi,

[Current therapist] says that she’d welcome a call from you.

[Real name]

It was at the moment of his misgendering me as his first interaction with this letter—that moment when I 100% gave up on him as a therapist. I was just done. This time, he replied on the same day:

6/3/14

[Real name],

I have placed a call to her today, left a message,  and will consult with her further.  Also my apologies for wrong naming you in my last email.  I realized the mistake right after I sent it, but still no excuse.[3]

[Former therapist #1], LICSW

I received this letter about a month after I sent my own letter to Former Therapist #1.

Dear [real name],

Thank you so much for your thoughtful and courageously honest letter. I have read and reread it multiple times, consulted with some of my fellow colleagues,[4] and done some deep personal and professional reflection before responding in order to give your letter the respect and consideration you disserve [sic].[5]

First, I feel deeply sorry for the pain and suffering you have endured during your treatment with me. One of the guiding principles of my practice as a gender specialist[6] and a therapist is the basic human right of self-identification. Upon reflection, I now realize that I did not respect or encourage that right in our work together.[7] I also feel very sorry for the lingering gender binary prejudice that you felt in our recent work.[8] Eliminating prejudice in all forms continues to be one of the primary goals in my practice. For all these things, and any other moments of pain and suffering you have experienced during our work together, I am truly sorry.

In your letter you offered advice on how I could improve my future work in the gender field. I have taken this advice to heart. I have begun a thorough review of previous and current gender work in my practice, with a focus on improving quality of care.[9] Thank you for suggesting consultation with [current therapist]. We have already exchanged messages, and, with your consent, we will be in further consultation in the coming weeks. Since gender is such an evolving field of study, ongoing education and training to keep my skills current is obviously necessary.[10] I appreciate your sincere wish for me to rise to the challenge you have initiated with your letter. My hope is that I can and will rise to the challenge in my ongoing work.[11]

I am very happy to hear that you have found a therapist whom you feel very comfortable with. I am also happy to see that your right to self-identify is not only being respected, but encouraged.[12] I hope this leads to higher levels of self-affirmation for you.[13] I wish you the best of luck and hope you continue this courageous journey you are on.[14]

With respect and appreciation,

[Former Therapist #1]

A critique by which other therapists may be advised…

  • Always gender your clients appropriately, and apologize if you do not.
  • Vehement apologies for malpractice are always welcome. They do not, of course, erase the damages of said mistreatment. But they at least are a step in the right direction.
  • They are much more sincere and effective when they come with a plan for changing or avoiding the errant behavior in the future—which this one did. At least for some of the problems here.
  • It shouldn’t have to take deep reflection to help you realize how much you wronged someone. If it does, you should note that that is evidence of a long journey ahead. (This therapist didn’t recognize that the level of reflection required for him to realize how hugely he’d messed up was evidence of the level of work he needs to do.)
  • They should be led by the injured party’s wishes—so listen carefully to what the problem is. (This one only did that halfway.)
  • Any kind of social change should be led by the people directly affected by the oppression. (This therapist only consulted with other clinicians—so that did not happen here.)
  • Be humble about your own knowledge and impact, especially if you aren’t a part of the oppressed group. (This therapist showed humility by reflecting and making changes—but he did not show humility by still claiming expertise in gender.)
  • Feel free to wish someone the best, but be careful that you maintain boundaries while doing so. (This therapist slightly crossed a few lines here.)

[1] I very clearly said in my letter that I am now trying a different name, and expressed profanity at the use of my birth name.

[2] The rest of this email made me feel relatively warm and glad that he was doing this work.

[3] If he realized the mistake right after he sent it, then why didn’t he send another email correcting himself and apologizing? I find it depressing to think that this person thinks that he can regularly work with trans people.

[4] I specifically said in my letter that he should consult with trans community members, and that, given the quality of “gender specialists” in the area, I wasn’t sure that they would be a good resource.

So the fact that he consulted with colleagues—I’ve met most of them, and most of them are gender tools—isn’t really that helpful. But I suppose it’s a small credit to them that they recognized he had mistreated me.

[5] I asked him to think deeply, and I’m glad that he did this. I am a little nonplussed that it took such deep thinking and consultation to realize how messed up he’d been. But at least he realized it.

[6] My current therapist says to be very wary of anyone who labels themselves a “gender specialist.” “Anyone can do it, and it shows that they’re trying to claim expertise in who you are.” The fact that he still thinks he can claim this label after me sending him a letter like that is pretty appalling. It’s kind of like claiming the word “ally” instead of having it be applied to you—except with direct clinical consequences.

Former Therapist #1, you are not a gender specialist. Not at all. You are not an expert or specialist in who I am. And you, as a white, straight, cis man, certainly do not know what gender-based oppression is like and clearly have not taken the time you need to attempt understanding from people who do have lived experience with it.

[7] For the most part, a pretty good apology! At least, he said sorry a lot and explained how he’s trying to fix it.

[8] I think he missed the point of what I had experienced in our more recent work. I had told him that his commenting on “reevaluating” my gender showed how much further he needed to go in his understanding of gender. I told him that no one except me gets to evaluate my gender. He didn’t really address this in my letter.

I had also noted that he had projected ideas about what my gender was onto me—not necessarily binary prejudice. Extra apologies aren’t a bad thing, necessarily, but I am concerned that he is still stuck to the gatekeeper model of trans care, and he didn’t address that in his letter.

[9] I am so glad that he is doing this! I asked him to look into it and he says that he is. Wow. I’m not sure many people would take this to heart like that.

[10] This feels like a veiled “you non-binary people are so new” comment. Just because the Standards of Care only recently started to recognize us doesn’t mean that we only recently “evolved.”I know that he was referencing a field of study—but we are people, not a field of study, and we’ve been around for a while.

When I first started seeing him, I needed him to have cultural competency and awareness of non-binary people then—six years ago, not just now.

[11] I was truly uncertain as to whether he would take up this challenge or not. And I don’t know if he has, really, or if he just said he did. I am glad that the therapist I knew, who was committed in ideals to eliminating prejudice, if not always in practice, is trying to put his ideals into practice now.

I only wish that he was listening more carefully to me, and to other community members, more than his fellow quack “gender specialists.”

But I am glad that he has taken this to heart and trying to make changes. That is so important and goes a little ways towards helping me feel a little less wounded by all of this. (Although I still have a lot of trauma and trust issues with providers, thanks to him and others.)

The fact that we had such a close and long therapeutic relationship I hope helped for him to reflect and take this seriously—and the fact that I could leverage that feels really important and good.

[12] I appreciated this part of his wishes.

[13] This starts to get… I don’t know—like he’s back to being my therapist again? I really can’t imagine anyone except a therapist saying that in this way.

[14] There are so many things that he could be referencing in terms of “courageous journey.” Does he mean my journey for healing mental-health wise? Does he mean my transition?

When people talk about “courageous journeys” to trans people, they often are talking about transitions. If he meant my mental health journey, it again feels a little weird-are-you-my-therapist-or-not-boundary crossing. I suppose that boundary is also crossed with referencing transition, but there’s so much more in there with transition.

If he meant my transition—well, whew! I mean, there are a few awkward things about that. One is that it’s pretty patronizing for him as a cis person to call my journey a courageous one. Even if it is, even if does require a lot of courage.

It’s especially galling given how he’s already tried to shut down that journey before. I imagine that’s why he said it—he wanted to say, “Hey, I’m trying to affirm who you are now.”

But that ship has sailed, bro. You missed that opportunity. It’s a little late now.

And saying that you hope I continue it now—it implies that I’m considering discontinuing it. The only way I’ve really considered doing that is by suicide. And I’m sure you didn’t really mean, I hope you don’t kill yourself. But maybe you did. I don’t really know, because this was so vague.