The Unique Problems Trans People Face When Finding a Therapist
You should be able to talk to someone about your mental health without having your gender status blamed and scrutinised.
Photo: Konstantin Pelikh / Alamy Stock Photo
Natalie* was excited to begin seeing her therapist.
"I didn't go to see him because I was at a low ebb," she tells me. "It was the opposite. It was five years after beginning my transition, I finally had a semi-stable income and home life. I decided to invest in therapy and try to address some of my issues, which had been going back to my teens and before."
Natalie was 26 years old when she started the sessions. For more than a decade she had suffered from a debilitating eating disorder that had interrupted her school and university education. This was one of the main problems she wanted to address in therapy. Her status as a transgender woman, on the other hand, was not.
"I didn't consider it a problem," she says. "I obviously had my share of trouble with my gender growing up and when I came out. Workplaces are still a major struggle. But I'm luckier than most because my family were lovely and actually anticipating it. My friends were brilliant. Once it was all out and I could be myself, I was happy in my personal life."
But Natalie’s therapist, a private practitioner found through Google, saw things differently. Immediately, Natalie was taken aback when he asked her if she had "completed transition", meaning had she undertaken genital reconstruction surgery. Before the end of her first hour, he was suggesting that her eating disorder was connected to being transgender. He wasn't trying to be rude or hostile, she tells me, he was actually very pleasant – which made it even more difficult to object: "And, having no experience with therapy, I went in with the feeling that he was in the right and had the authority and I should listen."
That was the beginning of six months of therapy which left Natalie infinitely more vulnerable and distressed than when she began it.
Talk therapy is on the rise in Britain. A 2014 study by BACP (British Association of Counselling and Psychotherapy) showed that 28 percent of people in the UK had consulted a counsellor or psychotherapist, compared to 20 percent in 2010. Anecdotally, of my immediate social circle I would estimate at least a third are either engaged in NHS cognitive behavioural therapy (CBT) or privately-sourced therapy.
Even in the ten years since I was a teenager, the perception of who might benefit from therapy has massively shifted. I remember desperately wanting to see a therapist when my self-harm and eating problems began to spiral during my late teens, but I can recall thinking quite clearly and calmly: 'No, your problems aren't serious enough.' I had the idea – as many people did, and still do – that to need therapy you must have suffered some quantifiable and catastrophic childhood trauma. This seems to be in the process of changing. While some people I know do indeed go to therapy to work through particular life events, many others go to simply try to understand themselves better – to use that understanding of their motivations and desires and fears to live better.
For transgender people, though, finding a therapist can be a minefield. I spoke with London-based therapist Louise Futcher – who specialises in sexual, gender and relationship diverse clients – to ask her thoughts about why this is. Louise treats a wide variety of people who find it difficult to access mainstream therapy. She tells me she is aware of an increase of therapists like her, although they remain small in number and difficult to locate outside of London. A therapist like Louise might make it clear, for instance, that they are capable of sensitively working with sex workers, polyamorous people, fat people and people who are transgender or non-binary. These are all demographics who are commonly let down by mainstream therapists.
"My experience is that the understanding around gender identity is surprisingly poor," she tells me, "and the dangers of that are great. The therapeutic relationship is so intimate and vulnerable, and we show so much of ourselves as clients, that to then be invalidated within that is potentially devastating. People do report that therapists go 'fishing' around to uncover the trauma that 'led to' the dysphoria."
This is something that came up time and time again when I discussed the subject with trans friends of mine: that therapists are over-eager to find an experience to "blame" their gender identity on. Not only is this counterproductive, it has the potential to re-traumatise people who suffer from dysmorphia or simply had a difficult time coming out as transgender.
Natalie* told me that she eventually made the decision to stop going to therapy when she realised she was spending days in advance of each session filled with dread; dreading having to defend herself and who she was, dreading having her real issues brushed aside.
I spoke to George*, who is non-binary, and heard a similar story. They had gone to a therapist looking to work through feelings of shame around their gender expression, and also some distressing memories of childhood abuse. Their therapist suggested that the abuse was responsible for their discomfort with gender identity.
"I would change the way I dressed for sessions," George told me. "I would not wear jewellery, and dispensed with the little make-up that I wore. It was intimidating and reminiscent of the emotional abuse I was experiencing with my father."
I asked Louise why it's so difficult for transgender people to find therapists who are sensitive to their particular needs.
"Therapists need to understand that their way of viewing and interacting with the world is heavily influenced by cultural context and that the 'default' is oppressive," she said. "The concept of gender we in the West work with is specifically based on certain ideas which have changed throughout history, and actually aren't subscribed to in other cultures. Gender itself isn't fixed or set, so connecting with or exploring different gender expressions and identities isn't some rebellion or trauma response, but actually finding what fits us best. And, really, who is that hurting?"
I'm hopeful not only that more therapists like Louise will train to specifically serve these communities, but also that mainstream therapists will become more reflective on their own normative values. While negative experiences with therapy can be potentially devastating, everyone I spoke to – even those who had suffered a bad encounter – was insistent that it can be life-changingly positive.
George* has since found a new therapist.
"She has always been respectful of my gender, effectively treating it as a non-issue unless I raise it myself," they said. "As a result, I often do. I'm still not sure what I am, but I'm almost certain I'm not ashamed anymore. This may not sound much, but it's enormous for me."
*Names have been changed