Welcome!

By registering with us, you'll be able to discuss, share and private message with other members of our community.

SignUp Now!

Do you think therapy is neccesary or just more gatekeeping?

LADY SARAH

Celebrating 30th transiversery
Joined
Dec 26, 2019
Messages
493
Gender Pronouns
She, Her, Hers, Herself
Gender Identity
Female
Linde said:
OK my dear, I have the same Medicare deal you have.  Until last year I had that rolled into a medicare advantage plan, which did cost not a single extra penny, but covered most of my medications for free, and copay only for estrogen and progesterone.
But the copay for doctors were higher than I wanted to have them.  This year I went with the medicare plan plus an extra plan to cover the copays and the medication, because I was expecting (and still hope for it) that my surgery would be this year.  his new plan leaves me with very minimal copay for all doctor visits and procedures.
If surgeons see that you have good insurance coverage over and above Medicare they are willing to accept you, because they would know that they are not sitting there not getting their money.

Check around what Medicare Advantage Plans are available for you (I have Humana)for time being, they should be without cost for you.  After that you can check for surgeons and therapists, etc.; and once you are settled with a surgeon (to find one took me week, cause I contacted every institution), you can do for next year (or the year of the surgery) a Medicare Supplemental Insurance Plan, (they cost some monthly money, I also have Humana for that one), which would cover most of the copays over Medicare.
I had a broker finding my plans, they are free of charge for medicare members.  Look for Medicare Insurance Broker, or I can connect you with the office I use.



Hugs
Linde

The plan I have is with United. Unfortunately,  they are infamous for not covering certain procedures.

There is a multitude of plans I can go with that won't cost me any additional money. The bad part is that I cannot check and see what types of therapists and or surgeries they will pay for until after I sign up and try to use the insurance for that.

Phillip even talked to his HR department about having me on his insurance for that purpose. His insurance will not cover the surgery either.
 

OzGirl

Global Moderator
Staff member
Joined
Dec 24, 2019
Messages
1,694
Gender Pronouns
She, Her, Hers, Herself
Gender Identity
Female
Sarah, I was able to send my surgeon’s itemised quote to the insurance companies here, so they could go through it and confirm they would cover everything not covered under our national heath scheme. And this was before I signed up with them! They all had a 12 month qualifying period , and know I would need to maintain the policy for at least a couple of years after surgery in case of revisions, so I guess they figure they will get their money back!

Allie
 

Emma

Well-known member
Joined
May 8, 2020
Messages
405
Gender Pronouns
She, Her, Hers, Herself
Gender Identity
Female
When I started, I needed a letter from a therapist just to get on hormones back in the day lol. I’m sure it’s still filed away in some dusty office. Then years later, had my therapist and doc write letter for SRS and BA. While I resent the hoops we have to go through just to get medical care for our medical condition, I never felt like my therapist have been gatekeepers.

I’ve had several therapist over the last 25-ish years. A psychiatrist in Minneapolis was my first. A great lady who was the first to officially diagnose me. Transsexualism was my only mental condition. Obviously there was depression, anxiety, and dysphoria that went along with that. She once told me I was the strongest of her Minneapolis trans women which was odd because when I came to her I was at the point of transition or die and a hot mess lol. Then there was a gal in Milwaukee at pathways for single and group therapy. Me and a great trans woman (Dawn) who was a friend of mine used to drive over together. The group I always saw as a waste of time tbh. But it was worth it just to chill at Denny’s afterward with Dawn. Then I had a trans man as a therapist and he was awesome. I only stopped seeing him because i had to switch insurance to have my awesome GP. It was really nice because he just instinctively understood it. My last and current therapist I’ve had for years and she’s awesome. If anyone is in Madison, I’d highly recommend her. I would say she is probably the one person who knows me better than my husband. Well my “sis” knows me pretty darn well too. But I still go to my therapist even though the letter writing is all long done.

The best advice I can give is to not tell your therapist what they want to hear. Keep it real and open up. They’re duty bound to never disclose your secrets so you can rest assured. There’s generally very little you could possibly say that would surprise them and it’s their job to help you work through things. But they can help best when your completely honest. Mostly these days it’s various family members shutting me out and other things rather than trans issues.

But tbh transition can be complex and there are things your going to want professional advice on. I know there’s a cost to them and that can be prohibitive but I do encourage people to take advantage of their expertise.

As a side note, it’s also a good idea for your significant other to see a therapist as well. My husband sees one and we see a psychiatrist together. It’s often as complex for them as it is for us. I could go on and on ... and on about having a partner through all this, but that’s a large topic for another time. I’ve been with my partner and husband for 20 years and there have been A LOT of changes over that time.
 

Moni

Fight for self love!
Joined
Feb 1, 2020
Messages
1,574
Being a long thread, I'll admit to coming here late and skimming a bit. I went for the required therapy, but I really struggled many times to think of what to talk about. I pretty much had figured out my relationship to being trans. If it isn't a tangent from the thread, I would be curious if anyone has been to a sex therapist. I really think that is something I could use. I don't know if they could really help. This is where the rubber meets the road for me.
 

Emma

Well-known member
Joined
May 8, 2020
Messages
405
Gender Pronouns
She, Her, Hers, Herself
Gender Identity
Female
Being a long thread, I'll admit to coming here late and skimming a bit. I went for the required therapy, but I really struggled many times to think of what to talk about. I pretty much had figured out my relationship to being trans. If it isn't a tangent from the thread, I would be curious if anyone has been to a sex therapist. I really think that is something I could use. I don't know if they could really help. This is where the rubber meets the road for me.
I haven’t been to a sex therapist, but my regular therapist handles that. Same with my spouses therapist. I had a long thing typed out but what I just typed is the gist. Most therapist especially one versed in trans issues can help with sex related things. Mine has helped with everything from my genital dysphoria and what I enjoy as well as how orgasms change throughout transition. To romance and intimacy topics. You have to feel pretty comfortable talking openly about things with the therapist but imho most can help in that regard. Best imho if they have trans experience.
 

Lexxi

Moderator
Staff member
Joined
Dec 17, 2019
Messages
748
Gender Pronouns
She, Her, Hers, Herself
Gender Identity
Female
I went to see a therapist so I could get my letter to start HRT. I would have loved to keep going to see her, but sadly my insurance doesn't cover therapy, or they make it extremely hard to get reimbursed for it I should say. I don't know how I did it, because I'm really shy, but I totally opened up to my therapist about my feelings. I discussed stuff with her that I'd never told another soul in my life. Because I was able to do that it only took her about 35 or 40 minutes to realize that I really am trans. I mean I knew I was...but I expected that I'd have a much harder time making her see that.

I was so relieved when she stopped me and said that she wanted to show me something. She pulled out the DSM-V and told me that there were 6 markers for gender dysphoria. To get a diagnosis of gender dysphoria I would have to have 2 of the 6. Then she told me that I had all of them to one degree or another. She said, without a doubt at all, that I had gender dysphoria and that she would write a letter for me...but she wanted to see me a few more times so it didn't appear that she was rushing anything. Even though I've known since I was 5 years old that I was stuck in the wrong body, it sure was a huge relief to have that confirmed by a real medical professional.

It was also a relief to be able to get so many things off my chest about my life. Things that I had kept totally secret from every other living being. As I sit here writing this I just now realized something. May 20th marks my one year coming out anniversary!! I'm so happy with how my life is going now.
 

TonyaJanelle

Ubiquitous Moderator she/her/hers
Staff member
Joined
Dec 23, 2019
Messages
1,612
Gender Pronouns
She, Her, Hers, Herself
Gender Identity
Female
As a side note, it’s also a good idea for your significant other to see a therapist as well. My husband sees one and we see a psychiatrist together. It’s often as complex for them as it is for us. I could go on and on ... and on about having a partner through all this, but that’s a large topic for another time. I’ve been with my partner and husband for 20 years and there have been A LOT of changes over that time.

Something I've been trying to tell my wife. Didn't usually go well the few times she went with me to my appointments.
 

Moni

Fight for self love!
Joined
Feb 1, 2020
Messages
1,574
I haven’t been to a sex therapist, but my regular therapist handles that. Same with my spouses therapist. I had a long thing typed out but what I just typed is the gist. Most therapist especially one versed in trans issues can help with sex related things. Mine has helped with everything from my genital dysphoria and what I enjoy as well as how orgasms change throughout transition. To romance and intimacy topics. You have to feel pretty comfortable talking openly about things with the therapist but imho most can help in that regard. Best imho if they have trans experience.
Thanks @Emma , I don't think my therapist could have helped in my case. He is a trans guy, and I don't think it would have done it for me. At best the subject would be a sideline, not a specialty for him.
 

OzGirl

Global Moderator
Staff member
Joined
Dec 24, 2019
Messages
1,694
Gender Pronouns
She, Her, Hers, Herself
Gender Identity
Female
And taking my wife to a session was embarrassing. I did tell the psychologist my wife was there to observe only, but the psych took it as a challenge to get something from my wife. No matter how many times the psych asked my wife what she felt, my wife sat there with her lips clamped shut. It is embarrassing to see an adult in a psychological session with zipped lips. It wasn't a total loss as my psych got some idea of my frustrations at home.

But even with all that, we managed to maintain our relationship as best friends living together. The science of keeping relationships together is so complex you could never write a book to suit all, or even most situations. There are a few basic principles and from there each case is vastly different.

Hugs,

Allie
 

Linde

Adminstrator
Staff member
Joined
Dec 10, 2019
Messages
3,636
Gender Pronouns
She, Her, Hers, Herself
Gender Identity
Female
I still see my therapist about every 6 to 8 weeks. My insurance does not cover ehr, but I feel seeing her is well invested money. She currently helps me with my deep sitting confusion of my sexual orientation. Without her, I would feel pretty lost with my feelings.


Hugs
Linde
 

Ryan

Member
Joined
May 31, 2020
Messages
23
Yes, I do think therapy is necessary. If the therapist is competent, no qualified therapist will deny a transgender person access to hrt, however to get proper diagnosis you have to be completely honest with them. I also don't like the idea of informed consent without taking the time to explore a person's gender identity or talking through things with a professional. Sure, it takes a lot longer to get a referral and everything else, but in my opinion it's better to be 110% sure, than to jump the gun and realize you have to detransition.
 

Moni

Fight for self love!
Joined
Feb 1, 2020
Messages
1,574
Yes, I do think therapy is necessary. If the therapist is competent, no qualified therapist will deny a transgender person access to hrt, however to get proper diagnosis you have to be completely honest with them. I also don't like the idea of informed consent without taking the time to explore a person's gender identity or talking through things with a professional. Sure, it takes a lot longer to get a referral and everything else, but in my opinion it's better to be 110% sure, than to jump the gun and realize you have to detransition.
Dylan, the people I have seen who detransition have experienced abuse in their past. I have read of some with DID. It really is best to figure out the basis of one's desire for gender changes, especially irreversible ones. I agree with you.
 

Marie62

Trying hard to speak less and say more ...
Joined
Jun 11, 2020
Messages
966
Gender Pronouns
She, Her, Hers, Herself
Gender Identity
Female
Many good answers have already been given above and as a clinical psychologist and (former) psychotherapist I am very happy that there more or less seems to be a general consensus that psychotherapy in the trans*sphere is more than just gatekeeping. Still, most answers were - hardly a surprise - personal accounts, so please don't mind me trying to add a more formal interpretation ...

Gate keeping - The term is typically used to denote some form of segregation, much in the sense that the "Gated" in "Gated Communities" refers to closed gates, not to open ones. This is neither the idea behind the requirement for PT in transgender*ness, nor is gating as such being practiced through PT. Sure, there are freaks and turds among the PTs as well and some may inwardly even be transphobic, so never say never, but the inherent idea is a different one.

The need to have "therapeutic contact" stems from the concept of what is and what is not worthy or in need of treatment in a medical sense, as it is embedded in ICD and DSM. Before DSM-II the idea prevailed that society defines what is sick and what is not and that this distinction then defines the need to treat/cure or not. This particularly pertained to psychosexual disorders such as homosexuality and the various paraphilias such as fetishes, all of which were considered illnesses per se - and requiring (!) treatment. This changed in the mid 70s and especially the psychosexual "illnesses" were redefined as "disturbances" and as requiring the qualification (among others) that they only warranted treatment if the condition was posing a threat to the emotional or physical wellbeing of the person - or if there was a danger of the person harming him-/herself or others.

The "need to treat" in TransGender/TransSexualism therefore is something that is dependent on whether or not the person seeking treatment actually qualifies as suffering and needing help or treatment to avoid the development of grave psychological and/or physical illnesses. This is why Gender Dysphoria is such an important aspect of things and this makes psychotherapeutic contact to obtain indication still an evaluatory process, but not one in the sense of gate keeping and rather one of establishing "eligibility" or "belongingness".

So, what the psychotherapist is charged with doing is to establish whether you/we plausible belong to a group of individuals qualifying as gender dysphoric (among other things) and thus as suffering (sic!) from the disturbance/~illness (sic!) Transsexualism and thus are in need (sic!) of treatment.

The secondary criteria that the client has to be free from other psychopathological conditions is plausible, since someone who is e.g. psychotic can not be trusted in their self-view or self-report, nor in their actions being in line with either. Transitioning may sometimes make one feel psychotic, but *being* psychotic a priori simply does not help. Some affective disorders are also exclusion criteria, mainly since transitioning take a real toll on anyone and someone compromised by e.g. bipolar disorder will simply not be able to cope or at least not at all times.

However, what this does NOT mean is that someone with chronic psychopathologies such as schizophrenia or bipolar disorder cannot receive the diagnosis Transsexualism or be given the indication required to inititate medical transition. The idea rather is that such other psychopathologies have to be "dealt with" before one can go on, but it does not mean they have to be "cured" before one can go on. Essentially, once you know how a schizophrenic transgender person "ticks", you can better see and discuss the transgender aspects within the schizophrenic symptoms and can draw up plans for transition also with bipolar disorder patients.

Above, Allie wrote that her psychotherapist initially told her that it would take a minimum of 2-3 hrs to make the diagnosis @ $210 (Robbery!, 1/4th of that here in Germany), but then came to a firm conclusion after only 40 minutes and some of you might have taken that as a sign of lack of professionalism in the PT, but it is not.

First of all, it normally DOES take a *minimum* of 3 hours to establish a therapeutic relationship, do anamnesis, let the client open up to the situation and to then get on with the actual topics. Here in Germany, we call the first 5 hours "probatory" and they are reserved for exactly those purposes. It is therefore only fair to up front let the client know that this will not be a one-meeting "thing".

However, if a case is such that the client is a "very analytical" person, as Allie calls herself, and perhaps has a long established and stable transgender history and "condition", then it is equally professional for the psychotherapist to say "Ok, done!" at the very moment when the PT sees that the criteria of ICD and DSM are met beyond any reasonable doubt. Any going on beyond that would be a waste of - your money!

And one more thing, which is an often seen misconcetption regarding what pychotherapy is and what it is not: The therapist is not there to "tell us something we didn't already know." - Well, surely not within the first 40 minutes, but even throughout the entire therapy is it is neither the job of the PT, nor is it in any way advisable for the PT to solve our problems for us.

A good PT will listen very intently and will listen mostly between the lines and will patiently wait for those little cracks to appear and will then make one comment or ask one seemingly unrelated question that is meant to prompt us to reflect and then to come up with ideas - ourselves! The PT can support us in this and he/she can be active in this as well, but mostly PTs are meant to take a position of being "passively active" by merely enabling us to help ourselves - and believe me, some are masters at just that!

Therefore, don't wait to be given anything such as strategies or advice. This may happen, but it is not normally a good sign if this is necessary, since it only points to the fact that there might just not be enough progress generated out of the client him-/herself reflecting and being "helped along".

Thus, and this is my closing remark, personal accounts of others are nice to read, but everyone of us IS different and our sufferings are as diverse as we are and thus the only relevant question is one that we have to ask ourselves:

Am I stable and well equipped enough to handle this transgender avalanche myself or should I better get help to deal with it?

This question should be asked over again with every new step of the transition process and if the answer always is "yes", then all the better. But if it is "no" at any point, then consider getting help. - If you know you need it and you know why and what for, then even those unbelievable $210/session might be a good investment, since chances of you later saying "waste of time" are truly minimal if it is you who calls the shots and does the work.
 
Last edited:

Linde

Adminstrator
Staff member
Joined
Dec 10, 2019
Messages
3,636
Gender Pronouns
She, Her, Hers, Herself
Gender Identity
Female
Thank you for your explanations Marie. Not all therapist charge $210 a session. My therapist, who is a member here, too, charges $100 an hour, and he is great and was and still is a great help for me. I still se her every 8 weeks or so, just to talk with her about stuff that bothers me. She is my sounding board, and makes me think.
As many here may know, I struggle a lot with my sexuality, and she helps me to work through this struggle.
I like my therapist, and if we would not have the patient provider barrier between us, we would be very good friends.

Hugs
Linde
 

Confused

Well-known member
Joined
Jul 4, 2020
Messages
251
Gender Pronouns
He, Him, His, Himself
Gender Identity
Nonbinary
I think therapy is a necessary evil. Insurance companies won't pay if you don't have the letters. If you live in certain parts of the country what you need might be counter to the culture there. It helps to have someone safe you can actually talk to in person that helps you sort it out.

The suicide rate is higher for transgenders and many are afraid to talk to friends or family because of horrible reactions. Sometimes there is more than dysphoria involved and it can be addressed by a professional.

Some of us just live in locations where it doesn’t seem as if there any other transgenders around. I just found one on TR a few days ago that lives very near me, but I had no idea!

My therapist has turned out to be a good sounding board as well as a great resource. I have had 4 sessions with her so far and no letter. I believe it might happen on my next visit. She set me up with a therapist about 50 miles away and one visit there got me one of the two required letters just this week.

I am glad for Allie she got hers quick, because she needed it quick. It should be that way for everyone, but I know it isn’t. We each have different lives with different problems to work through and obviously every therapist is unique as well.


The plan I have is with United. Unfortunately, they are infamous for not covering certain procedures.

There is a multitude of plans I can go with that won't cost me any additional money. The bad part is that I cannot check and see what types of therapists and or surgeries they will pay for until after I sign up and try to use the insurance for that.

Phillip even talked to his HR department about having me on his insurance for that purpose. His insurance will not cover the surgery either.


Sarah,

I have Medicare with BCBS, with the G Medipak and I have had PET scan, Lupron injection, CT scan, Radiation, and numerous Dr visits this year including PHD therapist. So far I have not paid one penny other than the premium.

Medicare will not pay my local Masters level therapist, but she gave me a huge discount because of it. You might find a BCBS office close to you and go talk to them.

When I got to your post about not having anyone near you, I was going to suggest Daniel J Freet, but then I saw that Terri already had. You might also try to contact his office and ask what they suggest. They usually know which insurance works. I considered Freet myself, but he is really far away from me (Arkansas)

I found no one in my state that would do it for Medicare. I have to drive out of state to Kansas City for my GRS. Just like you, Kansas City is a long drive for me, but necessary.

I was told by Medicare that decisions and payment are at a Federal level and not by my state. From what I understand any insurance in a Medpac plan should pay at least something if Medicare pays for it. I might be misinformed.

Mike
 
En Femme 728 x 90
Top Bottom