WHAT TO EXPECT: THERAPY DURING TRANSITION

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Hi! My name is Kim Kunze and I am a clinical psychologist in Grand Rapids, MI. If you have never interacted with a psychologist, don’t worry, my hope is to give you a bit of an inside look at what it might look like to work with someone in my profession while (before, during, after) you are going through a gender transition. There are a lot of different terms for people who do the work I do: therapist, counselor, social worker, psychiatrist, gender therapist, shrink and etc.

Why should I try therapy?

There are a lot of reasons that my clients come to see me (client is the word I use to talk about the people who I treat; some therapists say ‘patients’, some say ‘patrons’). Maybe your doctor told you that you need to see a therapist before you can start to medically transition (starting hormone blockers, hormone replacement therapy, or surgical interventions). Maybe you have a friend who recommended that you go to therapy. Maybe you just want some help with exploring your identity.

Proving yourself

Some of my clients (many, in fact) are brought in by well-meaning and loving family members, guardians, partners, or friends to ‘make sure’ that the client is really transgender. That is a tough situation for my clients to be in. As a cis-person, I often try to imagine what it would have been like if I needed to prove to my parents that I am a woman. What if I had to work really hard to convince my parents to let me shop the ‘pink aisle’ at the store, or to buy and wear feminine clothing? Then I try to imagine what it would be like to engage in this process over and over again in many other situations with many other people. When a client is brought in by family or guardians in order for the client to address matters related to gender diversity, I often recommend that the family engage in their own therapy so they can learn how to best support their loved one. It is extremely important for a client’s living environment to be safe and affirming. Sometimes, lack of support, rejection, or even violence creates huge problems for my clients.

Gender identity is complex, beautiful, and ever-evolving (yes! Even for cis-people!). And not all transitions require an observable change.

Finding a therapist and making the first appointment

I recommend doing a bit of research to seek out specific providers. A lot of community LGBTQ centers have lists of providers who are known to be knowledgeable and supportive of LGBTQ needs. When you call the provider, be specific about what you need.  For some people, this is intimidating and stressful. It can be a lot easier to make this first call if you know that the provider you are seeking to meet with is transgender/gender nonconforming affirming.

The intake coordinator, receptionist, or therapist will ask you for your demographic information. Unfortunately, a lot of billing and medical record programs require that medical providers use the ‘legal’ name of a client. For a lot of TGNC folks, this is their dead-name. You can always tell the intake coordinator your ‘legal’ AND ask that they make a note to refer to you by the name and gender you actually use.

The intake coordinator will either schedule an appointment for you, or take your phone number so they can coordinate with the provider you are seeking to see. You will often have some preliminary paperwork to complete at or before your first session, which is usually about an hour long. It does help if you come early or complete the paperwork before your appointment, because an hour may feel like a lot, but it goes quickly.

First session

Your therapist will greet you and bring you to their* office. The therapist will ask you questions about why you are there and follow up with questions about your life history. If the therapist asks you something that you don’t want to talk about, tell them that you would rather not address that issue or you want to come back to that later.

Therapy? Letter? Both?

If I know you are here to see me because of a TGNC-related matter, I usually start out by trying to get a clear picture of whether you need to see me for a letter of recommendation for medical transition, if you have a mental health/emotional/relationship matter you need to resolve, or a combination of both. Some TGNC-affirming therapists have a policy to only write letters for people with whom they have a therapeutic relationship (i.e. they don’t do evaluation-only sessions). It’s important to address this right away so you can quickly move on toward someone who can provide what you need.

How many sessions will it take?

Speaking of quickness, it is perfectly okay to ask your therapist about the typical duration of the treatment you are seeking. If you are seeking a letter, don’t hesitate to ask the therapist what they need to know about you in order to support your desire to have a medical intervention. Every client is unique, but I usually will have a time range in mind by your second or third session. I always hope that my clients know how much I want to collaborate with them and, if timing is feeling off (too fast or too slow), tell me. I think most therapists feel the same way.

Reasons why a medical transition might not be recommended for you

There are a couple of mental health conditions that worry medical providers when someone is seeking any type of medical intervention (even bariatric surgeries or organ transplants). It can be frustrating or awkward to feel like you must prove your readiness or to prove your gender identity. Sometimes clients aren’t completely forthcoming during their sessions, because they don’t want to be denied the opportunity to medically transition. I understand the motivation behind this, but, if you have  a therapist who is knowledgeable and affirming of TGNC identities, it really will only hurt you to hide important details about yourself.  It is especially important to let a therapist know if you are struggling with suicidal ideation, self-harm, hallucinations, substance abuse, or trauma. For some people, going through the medical transition helps to alleviate their mental health symptoms.

It’s very important to collaborate with your therapist. I have recommended to some clients that they get a bit stronger in management of a mental health issue before pursuing transition. These are often difficult conversations. However, if you have a therapist who is affirming of and educated about gender diversity, and they are recommending that you wait before transitioning, this is being done with your wellbeing in mind. In most cases, your therapist is saying ‘not now’ to your medical transition rather than ‘no’ or ‘never’.  

I believe you

It’s important for you to know that I tend to believe that what you say about yourself is true. My job is not to prove that your gender identity is real. Parents often want some assurance on that matter, but you could change your mind each time you come to see me, and I am likely to support you on your journey toward discovering and verbalizing your identity. When I write letters of recommendation for medical gender transition, my job is to give your doctors a bit of information about whether or not you are of sound mind (not hallucinating, not delusional, able to make decisions for yourself or with adequate guardianship support) and able to handle the changes (follow instructions from the doctors, take general care of yourself, handle increases in stress, handle related adjustments).

As a side note: having a history of psychosis, suicide attempts, substance abuse, or other mental health concerns should not eliminate you from having access to medical interventions. If something like that is part of your current experience or your past, your therapist is going to explore whether or not your symptoms are reasonably controlled so you can have a successful response to the medical intervention.

WPATH

You may have heard of WPATH, or the World Professional Association for Transgender Health. They are an important organization that works hard to develop standards of care for professionals who assist TGNC persons in their transition or identity development. WPATH currently has Version 7 of its Standards of Care. It can be helpful to look through the WPATH website to get an idea of what is recommended for different providers: www.wpath.org.

Basics of the therapy gender assessment

The purpose of a psychological assessment is for the therapist to be able to have a broad understanding of your history, your readiness for medical treatment, and to come up with a treatment plan to help you meet your goals. WPATH recommends the following factors to be covered by your sessions with a therapist.

  1. The therapist should support and empower you and your identity.

  2. The therapist often will assess you for ‘symptoms’ of Gender Dysphoria according to the psychological diagnostic manual (the DSM-V). Not all therapists and medical doctors require a diagnosis of Gender Dysphoria because there have been tons of cases in which a TGNC person has not exhibited severe discomfort with their bodies or identities- yet, they may still desire/require a medical intervention.

  3. The therapist might need to help you with referrals for other psychiatric, medical and/or surgical needs.

  4. The therapist will explore whether there are any other concerns, specifically mental health concerns that might interfere with your ability to engage in treatment. If you have possible concerns, the therapist will help you to figure out how to control those issues so you can proceed with a medical intervention.

  5. The therapist will assess whether or not you seem to be able to make reasonable decisions about your own care.

Specifically, your therapist may want to know about your childhood development, gender identity, sexual orientation, trauma history, prior mental health treatment, prior hormone treatment, social support, finances, substance abuse history and your understanding of the medical interventions as part of the transition process (if you are seeking a medical intervention).

Questions for the therapist

Here are some questions that might help you to get to know your therapist and to know whether or not the therapist can help you. It’s always okay to get a second opinion; especially if your providers do not seem to know much about TGNC identities and medical interventions.

  1. Are you LGBTQ affirming?

  2. How many transgender or gender nonconforming clients have you worked with?

  3. How do you support and advocate for your transgender or gender nonconforming clients?

  4. Do you write letters of recommendation for medical transition?

  5. Are you affiliated with WPATH (the World Professional Association for Transgender Health)?

  6. Do you write letters of recommendation for people who do not want therapy?

Questions for people who need a letter of recommendation to support a medical gender transition:

  1. Ask the therapist what they need to do in order to feel comfortable with writing a letter supporting medical gender transition.

  2. Ask if the therapist has written such a letter before.

  3. Ask the therapist if you can read the letter before they send it to your doctor.

* I use ‘their’ instead of ‘him and her’ as a way to be respectful of all gender identities.

 

COMING OUT OF THE BLUR

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On a hot summer day in 2013 a peace came over me as I was mowing the grass.  I felt these words resonate in my soul “if you tell the truth everything will be ok”.  I knew what I needed to do but felt my world would come crashing down once I told.  

I had built my life on a lie.  

I pretended to be straight my entire life.  One week from my 37th birthday in October, I entered a campus staff meeting and told my fellow pastors that I would be resigning my staff position.  

In the next week I would be telling my wife that I’m gay.

It all seems like a blur now.  The last four years have been incredibly difficult and painful.  I lost long-time friendships and gained depression and anxiety.  I struggled to find work and figure out what it looked like for me to be a gay man.  I was an Uber driver, car salesman, windshield repairman, debt relief specialist, air bnb host and a bartender.  I spent the first year seeing a therapist every week.   I had some very dark and lonely days.  

Nevertheless, I did critical work on me.  

I had to rid myself of the shame I felt for being gay.  I wondered whether I would even look and act like the same person when I came out on the other side of the trauma.  Fortunately, I am feeling more and more ok as the months and years go by.

 I have a lot of optimism about life and do not regret a thing.

Currently, I am a bartender at the Ford airport and working on a graduate degree in counseling.  In another year and a half, I hope to have my license to do professional counseling.  I am dating an incredible guy.  We’ve been together for three years.  Without his support I would not be as far along in my journey.  He is a gift from God.  

This past summer I told my children that their dad is gay.   There was anxiety about this process as the kids are in an environment where being gay is spoken of as a sin.   My fears subsided as all three of my young children (7,7 and 11) all told me that they love me no matter what.

 The best response was from one of my girls who asked if gay people can get married.  Her immediate response was to tell me her willingness to be a flower girl in my wedding.

I always wanted to be normal.  I felt different and misunderstood.  I’m happy to say that after connecting with other gay Christians I learned that my experience is quite normal.   It is exciting to me to hear about young gay people who have the courage to be who they are.  I hope to be able to encourage a new normal to where there is no pressure to wait until you’re 37 years old to finally tell the truth about who you are.


Robb Kornoelje resides in Grand Rapids Michigan.  He is currently working on his Master’s degree at Spring Arbor University to become a Licensed Professional Counselor.  He enjoys spending time with his three children and his boyfriend Brandon.  In 2013 GIFT Chaplain, Jim Lucas,  was extremely helpful to Robb and his parents as they were processing his coming out.

THE LOVE HATE CHALLENGE

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One day, while strolling through Facebook, I found a picture of a billboard with content that stood out to me. The sign started out with a statement saying “I REFUSE TO HATE”. The billboard then continued to list out all the different ethnicities, religions, and genders of which the author refused to dislike. Though well-intentioned, I noticed that the sign’s creator left out quite a few people from the inventory. Some might say that it's impossible to include all angles of diversity in one small sign. However, by not being completely inclusive the words have lost their value to the few who are excluded. 

What if the sign read "I LOVE HATE."? 

This simple adjustment could deepen our conversations by highlighting differing variables of interpretation. This revision would not exclude creed, sexuality, or ethnicity. If "I LOVE HATE" was on this billboard it would create a platform for everyone to come together and share their personal journeys. A discussion that would provide common space to describe how experiencing hate and judgment is painful emotionally and sometimes physically. A chance to show a commonality of all humans who have experienced different forms of isolation or hostility. All stories have differing degrees of significance and severity, yes. However, the experience of hurt and pain is often indistinguishable and there are always opportunities to speak of the collective erudition that blossoms from life's hardships.

As a gay Christian, who advocates for the LGBT+ in spiritual communities, I often find myself in situations where the majority does not see my validity. During these instances, I have learned to claim an awareness of other's stories because I don't want to lose my appreciation of community or a chance to celebrate diversity. I have started listening to the journeys of people put in my path because I have learned that these stories give fantastic insight to how their minds work. Loving hate has opened me up to conversations that - on paper - I should not want to have. I may not leave these conversations with best friends but I surely have never left with any enemies. 

With what I have experienced as a gay man and through my presence in the LGBT+ community, I know that people are feeling tired and hopeless. For far too long the stronger more powerful majority has beaten down on those who has been underserved or are on the fringe. The under privileged are passed the point of exhaustion. Sometimes, in these situations it can be comforting to surround ourselves with like-minded people who share the same emotions, adhere to similar interests, and are passionate about the same things we are. During these moments it's easy to lose sight of the essentialness of diversity. If we only surround ourselves with mirror images we are no better than the oppressors. It is so important to never lose the ability to process our thoughts individually in an atmosphere that encourages variation.

What I am suggesting is a renewed burst of positive energy. A vow to never forget what hate has done in our past, both monstrous and magnificent. A promise to own our personal responsibility for standing up for what is good, right, and moral. A pledge to hold on to our own stories with confidence but to never hold them higher than anyone else's. And lastly, an eagerness to continue sharing our valuable stories both inside and outside of our personal circles. 

Keep sharing the wisdom of your heart.

So, what if you loved hate? What opportunities might open up simply because you decided to answer dark with light? How can you continue sharing your story in a way that has more meaning and direction? Let's see what a #lovehate movement can do for your soul.  From there, let's dream about what the #lovehate movement can do for the world.


Jonathan Farman is the President and CEO of GIFT Grand Rapids. He is an educator, advocate, artist, and mediator, with a passion to help resolve the pain and isolation that many from the LGBT+ community experience in faith communities.

WHAT DOES IT MEAN TO CARE?

GIFT is dedicated to helping ratify LGBT+ people of faith and help their communities affirm them. This may sound like a simple idea, but doing this can take so many different forms.  We do a variety of different things that are focused on the advocacy involved in our mission. Our “Gay Christian? Yes!” campaign back in 2012, providing information to churches, and our partnerships with local GSAs are just a few ways we have supported the community. 

But another part of that advocacy work is providing care. Rev. Jim Lucas has walked with countless individuals on their journeys of self-acceptance. I know, because he did it for me. Now I am excited to be with GIFT as the Care Intern this summer. I have been both helping with programs we already had in place (like our adult support group) and I have been working to build new programs that help our outreach and ministry to be able to connect to the social media world.

As I’ve been working on these programs, it has pushed me to think about what it means to care for others. Care means walking with people through different parts of their life journeys. It could be coming out or processing a loved one coming out, or it could be dealing with the internalized hate we may be carrying. In our fight for justice and equality for LGBT+ individuals, we must remember to be taking care of each other and ourselves.

I am inspired by this work because of the care I received back when I was first coming out, from Jim and from GIFT Grand Rapids as an organization. They were there to care for me and journey with me as I sought to connect my identity as a transgender woman with my faith. GIFT was a soothing presence in my life during a challenging time. Care can take so many forms, but one of those forms is being able to journey with people through their challenges. This is a form of care especially needed for LGBT+ individuals. 

That is why we have launched our online Spiritual Care program, which provides a place that people can come to when they have worries to talk about. That is now growing more with the introduction of an online Support Group. We are making sure that if people need support and care, we can be there with them.

To me, providing care and support to individuals on their journey is intertwined with the other advocacy work we do at GIFT Grand Rapids. We work on a personal level with LGBT+ people and their allies, while also working to make their faith communities be places where they can find acceptance. We want people to live whole and healthy lives, where their faith does not bring them self-hate but rather self-acceptance and GIFT is here to be on that journey with those who need it!

Ember Kelley is the Pastoral Intern for GIFT Grand Rapids this summer.  Ember is also a past board member and has been very influential in GIFT's history.  

 

MEET OUR NEW PASTORAL INTERN!

GIFT is excited to share that this summer Ember Kelley will be joining us as a Pastoral Intern. She is a student of Chicago Theological Seminary and previously volunteered on GIFT's board. Now she is going to be joining us to help provide care to our community.

Ember will be involved in a variety of ways such as; offering online and in-person care, running groups, and tabling with us at Pride. We will be revealing more about these exciting programs in the coming weeks. Stay tuned for more details!