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What I Learned From Therapy With My First Transgender Patient


Editor’s note: This story has been published with permission from the therapist’s patient. Patient’s name has been changed in this piece to protect privacy.

We therapists often find ourselves in search of a “niche.” Some specialize in family work, others work with couples and some with children. We strive to find a specialization marketable to populations in need and build our practice from there. When I began my practice two years ago, I was so thrilled just to be a therapist, I had no idea what population I might want to place emphasis on. Fortunately for me, every now and then, the niche discovers the therapist. This was the case for me when I met Tom, my first transgender client.

I had no experience working with the trans community and had little idea what to expect. Even though my daughter had recently come out as bisexual, I knew there was a big difference between discovering sexual orientation and realizing gender identity. During my preparation for Tom’s intake, I was anxious and utilized Google to discover appropriate approaches for treating transgender folks. In my fear of missteps and a resulting reputation as being insensitive, I worked myself into a frenzy. But when Tom sat in the chair across from me, I became calm because all I saw was a person and I had a wealth of experience helping people.

I had taken self-inventory to check for residual adolescent prejudice instilled in me by a more close-minded generation. If I was going to help Tom actualize as a trans male, I had to know who I was. As a teen, I heard all the theories about the gay and trans communities. When I grew up, I came to the conclusion being gay was not a mental illness, nor would any person willingly choose a life plagued by social stigma and discrimination. Then I had to reconcile the fact I belong to a Catholic faith that employs a “hate the sin, love the sinner” philosophy. This message essentially means you can be gay or trans, but any physical expression, be it sex or surgery, will bring hell fire. When I worked through this, all that remained was curiosity. It wasn’t the type of curiosity experienced when people examine carnival attractions, but was more about the impact of such an overwhelming experience on a person’s life.

During our intake appointment, I imagined us in each other’s chairs and could only guess what Tom imagined I thought about him. It occurred to me he placed himself at risk of rejection the minute he walked in my room. I appreciated that he took a chance on me. Within five minutes, I blurted out my inexperience working with trans people and Tom confessed he had never worked with a white, male, cisgender therapist either. After he taught me what cisgender meant, laughter ensued and the ice was broken. By session’s end, I had some understanding of other terms like non-binary and genderqueer, but more importantly, some understanding of the person in the other chair.

When I acknowledged mistakes would be due to inexperience and not insensitivity, Tom was understanding and appreciative. It turned out we needed to understand each other.

Every client has a narrative I get to hear unfold during the course of therapy and I discovered how daunting Tom’s story was. Being transgender created special circumstances, most noteworthy being Tom’s need to “come out” twice. He first came out as lesbian at age 16, and then in his early 20s as trans. I couldn’t imagine coming out once, let alone twice. Transitioning not only impacts individuals, but families as well, as I learned when I incorporated Tom’s mother into treatment.

As our work progressed, I helped Tom cope with the effects of testosterone injections, which he taught me is also referred to as “T.” We also worked through Tom’s fears about surgery and frustrations about acceptance and adapting to new gender roles. I know we have made progress together and I believe there was success the minute Tom and I developed an authentic relationship based on trust and acceptance.

I received some confirmation as to how Tom felt about our work when I was informed by my office staff he referred a friend to me who was also a transgender male. Referrals happen all the time, but this one felt special to me. I felt validated in my willingness to see only humanity. I count this referral among the highest honors I have received in professional practice and I am thankful to have been accepted by Tom as trustworthy. Should work with the transgender population be my therapy niche, I am beyond happy it found me and I will do what I can to build bridges and end stigma.

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Thinkstock photo via Ljupco.