XVI Harry Benjamin International Gender Dysphoria Association Symposium
17 - 21 August 1999, London

Reflections on "Transsexualism and Sex Reassignment" 1969 -1999

Meeting at the Gate: A National Survey of Transgendered Individuals’ Experiences of Psychotherapy

Rachlin, Katherine, Ph.D. New York, NY U.S.A.

• Introduction
• Methods
• Results
• Discussion

INTRODUCTION: Psychosocial assessment and psychotherapy are often required, or at least suggested, in the treatment of Gender Identity Disorders. Much has been made of the combined role of gatekeeper and therapist. How do those roles color the patient’s experience of the therapeutic interaction? How do individual’s experiences in psychotherapy compare with the ideals for such treatment as set forth in the fifth version of The Standards of Care? This research attempted to look at patient experiences in psychotherapy covering a range of treatment settings?

METHOD: The sample (which continues to grow even as this research is ongoing) consists of 90 subjects (69 Female-to-Male and 21 Male-to-Female) who reported on 144 contacts with various psychotherapists. Participants represented 28 of the 50 United States. The majority of subjects were on hormones, had changed their names, and had either undergone or were actively planning some surgery.

Subjects completed a survey which asked why they had sought mental health services and what their experience of treatment had been. Each participant was allowed to describe two therapy experiences. Surveys were distributed at transgender conferences; by psychotherapists and peer counselors to their clients; by coordinators of support groups; and by coordinators of internet newsgroups.

PRELIMINARY RESULTS: More than 90% of respondents reported that positive change occurred in their lives as the result of psychotherapy. This was true even when they felt that the therapist did not have adequate training in gender issues and would not recommend him/her to a peer. However, negative experiences in therapy were more often associated with perceived lack of provider experience with gender issues. Subjects also reported that treatment was compromised when providers who had some expertise in gender were not adequately up-to-date on current queer, transgender, or FTM issues. Overall, provider experience in working with the gender issues was associated with a higher number of positive changes, higher patient satisfaction, and patient’s willingness to recommend the therapist to a peer. Individuals consistently expressed appreciation for therapists who were flexible in their treatment approach and demonstrated respect for the patient’s gender identity. Additional findings will be presented.

DISCUSSION: Discussion will focus on the practical application of this data. Results have implications for increasing the successful psychotherapeutic experiences of TS/TG individuals as well as relevance to medical practitioners and other providers of services to this population.