Recently, I asked a friend who has worked as a therapist with the LGBTQ community for the past fifteen years to imagine he was meeting with a transgendered client for the first time and to imagine that he had never worked with one before. I suggested further that this MtF individual was just beginning to transition and wanted this clinician’s support. I wanted his emotional & cognitive responses before they were censored by good clinical practice or political correctness.
My friend reminded me that despite his gay identity he came from a small town in the Midwest. He acknowledged he is a bit older (in his 60’s). He was not in regular contact with this population.
His first response was to paraphrase a Susan Sontag quote that what the individual might be seeking was “cutting off” his/her “feet to make the shoes fit.” He said it might also remind him of his first heroin or meth addict. He worried he might get seduced by the unique path the individual was on and miss important clinical issues. He recalled a time when he saw a man who was in a long standing polyamorus relationship with two other individuals. The man he saw wanted help with grief issues around the recent death of his mother. My friend said he really wanted to explore the relationship and detoured down that path for several sessions before realizing his error. He apologized and did more appropriate grief and loss therapy with his client.
I appreciate his candor. I do not think he is unique.
About five years ago I presented a shortened and more medically oriented version of a Trans training to a group of primary practice providers at Tucson’s VA hospital. (Tucson’s VA provides pretty good health care to a fairly significant number of Tucson's trans community . . . mostly but not exclusively MtF) The session went very well. We got to the inevitable questions. I was well prepared with stats and links to clinical protocols. I even had some stories to illustrate how well post–transition trans women and men do. Part way through these interchanges a man the back of the room (later identified to me as a new doc in their system) raised his hand. He did not have a question. He said, “Excuse me but I think this is all delusional”. There was an audible gasp from the other attendees.
We have, among well educated and caring professionals thoughts like we are "delusional, like addicts, or mutilating ourselves."
I started with these two stories to suggest the most important piece of your work with transgendered people may well be the recognition of and working through your own feelings and biases.