Blahs re: the therapist system

30Aug10

New Second Awakening blogger Dr. Morbius recently posted about one sticking point with her therapist:

It occurred to me this week, and not for the first time, that my therapist might raise an eyebrow toward my reading habits. Shortly after I began transition in earnest, she started suggesting women’s lit to me, as a way of starting the process of socialization. The first book she recommended was The Red Tent by Anita Diamant, which I had already read and enjoyed, though maybe not as much as she would have liked. She smiled approvingly and further recommended a book by Kris Radish, who I had not read. [. . .] After about twenty pages, I decided that it just wasn’t for me. This happened again with the next writer she recommended, and eventually I realized that she and I were not going to see eye to eye on literary matters. I started heading her off at the pass by having a book with me every time I showed up at her office, usually something daunting and intellectual like Hannah Arendt’s Eichmann in Jerusalem or Mikhail Bulgakov’s The Master and Margarita. It’s not that I don’t like women’s literature, or books by and about women, however you want to define it. [. . .] my favorite writer of horror fiction is not H. P. Lovecraft or Stephen King, but Shirley Jackson. What seems to butt against my therapist’s suggestions is the fact that I do have fairly well-developed literary appetites, and some of those appetites are decidedly un-feminine.

My beach reading is usually crime fiction. The more hard-boiled, the better. Right now, I’m reading one of Richard Stark’s Parker novels, which are farther away from what we normally think of as women’s literature as anything I can imagine. These are brutal, anti-social, testosterone fueled novels. And I love them. In contrast to my therapist’s gentle recommendations, these are not going to help socialize me in my chosen gender role, but, you know? I don’t care. The irony of this is that I was introduced to the Parker novels through the owner of one of the local used book stores, who is a woman of rare taste and discernment. [. . .] I don’t care if those novels pass the Bechdel test [Q: this] or not. It’s nice if they do. Mostly they don’t.

As the story itself points out, actual women in the actual real world have a bewildering variety of preferences in literature, and in every other area from fashion to general attitude about life. Post-transition, transwomen are just the same; while they are perhaps a little more concerned about being treated as male than the average cis women, they don’t sublimate their own identities trying to compensate. But transition is a dangerous process for the identity. For one thing, it takes a strong sense of self to see it through, and those who don’t have one may tend to pull from the culture more than they should.

But the role of the therapist is also an issue. While the term “gatekeeper” is often reserved for only those therapists who work excessively to delay or prevent transitions, the word really applies to all therapists. They facilitate access to safe and affordable hormonal medication. By simply writing a letter, they can raise your legal standing and help legitimize you to an employer.

Unless a transperson is lucky, geographically and financially — and I’m not so lucky — even their “gender specialist” therapist does many other things for a living and has not seen thousands of trans patients. And even experienced specialists can have crackpot, incorrect or generalized theories about how a transgender person should behave. Unless Dr. Morbius lives in Castalia, unfamiliarity with highbrow literature by women is unlikely to impede her socialization. She appears to be well-read and has plenty of such literature to talk about, anyhow; this is almost certainly not her biggest problem.

That therapist should know better than to be wasting her time; but who’s going to tell her? I have made the mistake of telling my therapist that I did not see the point of some of his suggestions; absolutely nothing changed. Why should it? Will a therapist make more money by genuinely trying his or her hardest to listen to a transperson’s concerns, or to string the person out as long as possible to make money, knowing that an alternative may be impossible to find? Will a patient, even if thoroughly frustrated and in possession of another recommendation, start all over with another therapist who may be just as bad? And if the therapist is the only game in town, would word-of-mouth recommendations make any difference, when the trans patients don’t want to talk about transition and the cis patients don’t want to know it occurs?

The entire system is broken, at least outside of big cities (and I don’t know if it’s even better there, although this at least seems possible — if you can just see trans patients the incentives aren’t the same.) Most of the therapists are good people — mine certainly is — and yet they have every reason to be selfish and waste time. With the advent of the Internet, more and more transpeople, including myself, are walking into the office knowing what we want to do and how it’s going to work, and impatient for approval. This increased information and increased confidence can only be a good thing, but it makes the kind of therapist I’m describing outmoded. I’m beginning to look at my sessions like a prison sentence that I have to serve before I can receive my freedom rather than as anything constructive. I resent this, and I resent the inordinate power that the psychologizing of an essentially physical disorder has given to these time-wasters.

And that is why I’m not giving my therapist the link to my blog. Yet.

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