Working with transgender clients has provided me with rich experiences, and I gain new insight into the lives of my clients with each session. Within my caseload, five clients identify as transgender, and each is in a different stage of transition. I now understand that while similarities among my transgender clients exist, each is unique, and I have been given the opportunity to get to know their uniqueness while they teach me about themselves, and their world.
Before I met my first transgender client, I believed a full transition was not a quension of if, but when. However, I’ve since learned not every person who identifies as transgender aspires to surgery. One of my clients who was born male has decided to never have surgery, yet still desires to live full time, and pass as female. It is an incredibly personal decision I would have never considered had I not been taught. As my caseload grew, I became more aware of the extent to which life as a transgender person has a profound impact not only on the physical form, but on emotions, cognitions, and family dynamics as well.
With regards to family dynamics, one of my more powerful experiences was helping a middle-aged mother through the grief process. What made the therapy unique was the absence of death. There existed no deceased loved one, nor was a person close to her experiencing terminal illness. On the contrary, the child she mourned sat beside her in my room, and was in good health. The mother’s grief stemmed from inability to struggled reconcile the loss of the daughter once born to her while she processed a new relationship with a son she never had. The pain experienced by the mother was the same as if her daughter had died. Concurrently, the son who was still navigating changes to his physical, emotional, and cognitive self, struggled with guilt and shame caused by the pain it was implied he inflicted upon his mother. I had never experienced family therapy in such a way, and it opened my eyes.
When I am not working with clients whose family dynamics have changed as a result of their coming out, I am assisting clients struggling with internal changes. Such as is the case with a client who has completed a great deal of physical transformation from female to male, save for phalloplasty. Although surgery is well behind him, and he has been in testosterone therapy for a significant period of time, he is still adapting to changes in interests, emotional expression, and mood. For example, where once lived passion for movies on the Lifetime channel, now exists interest in mixed martial arts and football, and to a great extent, my client feels as if he has lost part of his old self with which he was not ready to part.
He has also become more aware of gender expression; often hyperfocusing on posture, gait, and the way he holds his cigarette. This attention to what a cisgender person might consider minutiae relates back to passing. Within my transgender clients lives fear that if adequate passing is not accomplished, discrimination will result, not only from cisgender people, but from transgender people as well.
Emotional responses are also effected by changes in hormone levels ascribed to testosterone therapy. My female to male clients have experienced diminished ability to access primary process emotions like fear and sadness, and subsequent increased reliance on secondary process emotions like anger and irritability. When I speak about these issues with my clients, it is obvious they too are getting to know a new person, and there is some grief involved in loss of personality traits, and interests.
I work with a couple in which the husband is trans-male, but was physically female when the relationship began. Although he identified as male in the beginning stages of their romance, his preponderance of estrogen was conducive to cuddling, playfulness, and empathy. Since testosterone therapy began, those behaviors have been replaced with opposite male behaviors. The subsequent reduction in physcal attention has left my client’s wife questioning her attractiveness to her husband, which has become a presenting problem for them in therapy. The diversity of experiences seems to be endless.
It would be irresponsible to assume the experience of every transgender person is the same. I intend only to underscore similarities among the few with whom I have worked in psychotherapy because it is they who have raised my awareness to changes that transcend physical appearance, and who have taught me so much about what happens beneat their skin. I hope my education never ends, and that this piece serves to provide a deeper understanding of the depth of transformation experienced by members of the transgender community.
Changes Experienced By Members of the Trans Community Transcend Physical Appearance