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

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:

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.

THIS JUST IN: Therapists Nationwide Control Clients’ Genitalia in Practices Sanctioned and Required by DSM

TRIGGER WARNING: bad therapy, gatekeeping model of trans care, gatekeeping apologism, staying closeted, cis entitlement

To the “trans ally” who said that it is good for everyone to talk to a therapist, just a few times, just to make sure… To all the “trans allies” and others who seem to think that gatekeeping is a good idea.

Even more, to the trans people who have to put up with this BS in therapy, and who start to believe it, too.

To my younger self, who believed that a therapist knew more about who I was than I did—keeping me away from myself for six more years because of a “gender specialist.”

To all the people who stay away from their true selves longer because a therapist “knew best.”

Gatekeepers are not here by our own consent or for our own good. The only person who needs to make sure that we fully understand medical decisions we make about our bodies is our doctor. And they simply are there to tell us what effects this might have on our body.

We then make the decision about what’s best for us.

In no way is it benign or helpful for us to be FORCED to go to therapy about it. Not only are we forced to go to therapy, but the decision is taken entirely out of our own hands. In a space where therapists aren’t even supposed to give us a hug, they are supposed to decide what we are able to do with our bodies. That is horrible therapeutic practice.

In a space where physical touch is forbidden, therapists still reach into our genitalia and into our chests and force them to stay a certain way. In no universe is that therapeutic. In all universes is that traumatizing.

And cis people, in general, you have no fucking clue what you’re talking about when it comes to being trans. I don’t care how many trans friends or lovers you have. You still have no fucking clue BECAUSE YOU AREN’T TRANS.

And because you have no fucking clue, you have NO RIGHT TO AN OPINION on this subject, or any subject when it comes to trans people. Fine, think your thoughts in your mind. But your opinion can never trump the opinions of THE PEOPLE WHO HAVE TO LIVE WITH IT.

You have no right to tell me what you think about a therapist being able to tell me what secondary sex characteristics I should have.

The only person who gets to decide what to do with my body is me. Every. Single. Time.

You are a rotten feminist if you think otherwise.

The gatekeeper model of trans “care” has traumatized trans people since its inception. We have been given access to medical transition based on curiosity, based on research, based on paternalism, based on saneism, based on how well we wear a dress, how well we wear our cuff links, how well we walk with a swagger or a swish.

Only in the past few years have non-binary people even made the list on standards of care. It’s certainly not only in the past few years that we’ve existed.

Only in the past year has our trans-ness been designated “dysphoria” and not a disorder. Only this year have we been told that we aren’t crazy simply because we are trans.

How do you think that a system that produces so much suffering for trans people is BENEVOLENT? How could that be? The only way you would think that is if you didn’t experience this sort of trauma at the hands of providers. Clearly, you haven’t.

Providers in general, as a system and as most individuals, enact these power trips every single time. It’s enough to send you to….

Oh. Therapy. Womp wooomp.

Doctors do not have our best interests at heart. Therapists do not have our best interests at heart. They are on power trips, large or small—at least on the trip of authority. They are not here to help us. They simply stand in the way of us and the care we need.

Yes, there are individual exceptions. But if you are attempting to get something you need from a provider for any period of time (for more reasons than medical transition—but that’s a story for another time), you will quickly come to this conclusion.

So why is it again that my THERAPIST gets to decide whether I cut off my boobs or not??? Why do YOU, cis person, think it is acceptable that a therapist can decide this for a trans person?

Could it be that society dictates that cis people always have a right to trans bodies—to gawk at, to experiment on, to decide what gender we are, to decide what’s appropriate for our “freakish” selves? Could it be, perhaps, that SOME CIS ENTITLEMENT has gotten in your way?

Consider that it is a possibility… and then get your hands off of my crotch. I like to keep it to myself, thank you very much.

Letter to Former Therapist #1

TRIGGER WARNING: Cissexism/transphobia in therapy, saneism, suicidal ideation

This letter is pretty self-explanatory, but I want to give a brief introduction. I had been seeing this therapist on and off for six years, and it was only after we stopped seeing each other, mostly for reasons unrelated to the content of this letter, that I realized the full extent of what had happened in that office in terms of my gender. This is something that is still very painful for me to process, but I am sharing this (slightly edited) letter with you all because I hope that sharing my story will help other people in similar situations, or other people who are considering therapy. If any providers are reading this post, take this post to heart and consider if any of it applies to you. If it does, make changes to your practice now.

Written: 5/1/14

Sent: 5/17/14

Dear [Former Therapist #1],

I have realized in the past few weeks that there is something more I need to say to you. Feeling both anger and loss, caring about and valuing much of our therapeutic time together while realizing how you hurt and utterly failed me in this way–it isn’t an easy combination of feelings. When someone has both given so much and also deprived me of something so important, the emotions are not easy to navigate. I know that you have always had good intentions for me, but good intentions and positive effects are, as you must know, not the same, often. I am going to give you some feedback here that I hope you will take to heart, so that you can have a positive impact and a practice where all clients are treated equally. Although I am angry about this, and I wanted to show you that impact in this letter, I also wish you the best in implementing these changes. Please get in touch with me if you need further input, or if you otherwise want to respond.

I talked with you in one of our sessions a few months ago about my doubts and worries about us working together again. I told you that you had shot me down years ago when I had first brought up questioning my gender to you. What I didn’t do then is remind you what you had said to me.

I don’t remember every detail of those conversations we had when I was 18, but I do remember the traumatizing parts. I remember that, back in what must have been our first or second session, you asked if I wanted a penis. Uncomfortable, and confused as to whether this was the only measure of trans* ness, I said that I didn’t think so. Shortly afterwards, I think you must have concluded that I wasn’t trans*, or I must have concluded that I didn’t want to repeat that uncomfortable conversation, because we stopped talking about it for a while.

Later, maybe months or a year later, I worked up my courage and brought it up to you again. You said that you thought I had penis envy or wanted a grab at male privilege. (At the time, I was too clueless about feminism to know what you meant, so I mentally shrugged.) You said that I wasn’t trans*. “But you’re so feminine!” you said. (This was especially hurtful, given my current gender identity. I don’t identify with the word “feminine,” but me having some characteristics that get categorized that way doesn’t mean that I am a woman.)

I didn’t talk with you about it again until five years later, this current year, when my internalized transphobia and gender dysphoria (among other things) was making me suicidal. (Partly, I had buried it for some time, but I found a journal entry that showed that even in the midst of that fog, I was aware of my dysphoria. Besides, a lot of why I’d buried it was because I hadn’t been met with affirmation from you at all.) When I brought up my gender identity as one of my concerns about working with you again, you showed that you had evolved in some ways. You told me that you had been naive then, and that you were sorry. (But I don’t think you remember what you said! At least, I hope you didn’t, with that response.) You said that one of a therapist’s most important jobs is to eliminate their prejudices, and now you have no personal investment in your clients’ genders. You said that you understand that for people who don’t fit into the binary, trying to fit them into the opposite-gender box can be just as damaging. (Here, given that I hadn’t talked about my gender with you in five years, I felt you were subtly gendering me again.) Then you said, “Given all the evidence, I think it’s time for a reevaluation.”

This final sentence shows how much further you need to go. You do not get to evaluate my gender. You do not get to tell me who I am. Not any more than you get to tell your cis clients who they are and what genders they should be. Not only had you led me away from my true self for an extra six years, invalidated my gender identity, and used pathetic tropes to degrade who I am (trans men don’t just transition for a grab at male privilege! And the words “penis envy” should never be uttered with any kind of seriousness in a gender therapist’s office)–not to mention that you seemed to think inquiring about my thoughts on my genitalia was a good way to both break the ice and determine my gender–you now were judging yourself professionally fit to make those calls again! Instead of realizing the significant damage you had wrought on me (and probably many other trans* clients), instead of working tirelessly to correct that damage, you simply said that I might be able to convince you, the ultimate authority on my gender, that I am trans*–this time around.

As a first-year in college, I specifically sought out gender specialists so I could start exploring my gender identity. I naively thought that it was a safe space to do so, and foolishly bought into the idea that I could trust my therapist over myself. While I know that your statements don’t hold complete power over me, and, of course, they don’t determine my gender, your authority played a large role in squelching my shy early feelings of my true self, feelings I’d been conscious of as trans* since high school, but had been waiting for a place to show. It is true, also, that especially in the early stages of gender formation, we tend to listen to others over ourselves. You have a huge responsibility!

Had I received nurturing and competent care when I was 18, I might be in a very different place today. Many of my mental health issues would at least be different, if not lessened or resolved. I might have been exposed to less or different trauma. I might even be a few inches taller, if I’d decided that testosterone was the way to go! I’d already be myself. Maybe I wouldn’t have gone to the point of considering suicide to get here.

I think that you still don’t understand the gravity of what you did five years ago. You still don’t understand the danger of labeling yourself an expert on others’ genders, or the absolute destructiveness of the gatekeeper model of trans* care. In many ways, you taught me how to advocate for myself in therapy, and how to break down the barriers of authority between therapist and client. Yet you still cling to authority in this way. I shouldn’t have to convince you of who I am. I am certain that you don’t ask your cisgender clients to do so. I should be able to simply be, in therapy of all places. I should be supported in all ways to become more myself!

Your discouragement took away six years of my life as myself. It likely took away many others’. Please look deeply into yourself and your practice to see what amends you might be able to make with other people you have harmed through your prejudice. You have a responsibility to your current and former clients to do so. If you fail to do this, you continue to fail the trans* community. Reach out to former clients and apologize, and ask if there is anything you could possibly do to connect them to resources or help now. Check in with current clients to be sure they feel affirmed. Never “evaluate” anyone’s gender again. Ask for accountability and feedback from the trans* community and other gender specialists (maybe them, but having met many of them, a lot of them seem as or more messed up). Please look deeply into yourself and your practice, in these ways and/or others (it is ultimately your responsibility to figure this part out) to make changes now for affirming, egalitarian care. You know the stats–lives are on the line

One more thing. I am telling you all these things, taking this time and energy, because I have seen you walk the walk of eliminating prejudice before. I hope that my trust that I have placed in you is not ill-spent. I have faith that you will take this feedback seriously and do your best to right these wrongs.

Your former client,

Still fucking known as,

[Birth name]*

*Since this letter was written, I have started trying [current name] and using they/them pronouns.