German Standards for the Treatment and Diagnostic Assessment of Transsexuals

Standards for psychotherapy / psychotherapeutic guidance

• The Therapist’s Qualifications
• Length and Frequency of Psychotherapeutic Treatment
• Psychotherapy and Professional Recommendation / Diagnostic Assessment

Along with the real-life experience, psychotherapeutic guidance assumes a central importance in the treatment of transsexual patients, and must precede the introduction of somatic therapeutic measures.

Psychotherapy is neutral with respect to the transsexual desire. The goal of psychotherapeutic guidance is neither the reinforcement nor the resolution of this need (though a resolution of the transsexual desire might occur). At the same time, psychotherapy should serve to assure the accuracy of the diagnosis of transsexuality. Together with the real-life experience, psychotherapy should help the patient find an adequate, individual solution to his specific identity disorder. The therapy should bring about the treatment of the patient’s relevant psychological problems.

Before the initiation of somatic treatments, the following criteria (regarding the transsexual wish) must be fulfilled:

• the inner cohesion and stability of the gender of identification and its individual expression
• the ability to live in the desired gender-role
• the realistic assessment of the possibilities and limits of somatic treatments

The Therapist’s Qualifications

The therapist must be properly trained, showing competence in psychodiagnostic, psychopathological, and psychotherapeutic skills. A thorough knowledge of the problems involved in transsexuality and cognizance of current information about the subject is also a prerequisite.
  

Length and Frequency of Psychotherapeutic Treatment

The psychotherapy’s length and frequency should be mutually determined by the patient and therapist. In the course of the treatment, the therapist must have the possibility to get to know the patient so well that he can judge the presence or absence of the three above-mentioned criteria. If sex reassignment surgery is indicated, then the psychotherapy should be continued until the time of the operation. Further psychotherapeutic treatment after the operation is recommended.
  

Psychotherapy and Professional Recommendation / Diagnostic Assessment

The psychotherapist can participate in the diagnosis which leads to hormonal therapy and sex reassignment surgery, as well as in the diagnostic assessment within the frame of the TSG. He can also decline for reasons intrinsic to the therapy. This should be clarified with the patient at the start of treatment. If the psychotherapist refuses to undertake the diagnosis and/or diagnostic assessment, then they must be adequately (as defined by the Standards) assumed by another doctor/psychologist. In the following, the term "therapist" refers to both possibilities