2.2 Meeting Patrick
The next activity explores how sex and gender concepts apply in counselling through a video of an early session with a trans client, Patrick. Patrick, played by a trans actor, is in therapy with Jake, an experienced psychotherapist and trans man.
For this and other training videos, Patrick received a client case history, and both he and Jake were given key themes to guide their interaction. Patrick was asked to improvise in response to these cues and Jake was asked to respond as he would to a real client (with one exception). Most of the videos are intended to be extracts from the very first counselling session. The videos in Activities 3.4, 4.3 and 5.3 depict parts of the 12th session after the therapeutic relationship has been established.
Activity 2.2: Patrick meets Jake – session one
Timing: Allow 30 minutes
As you watch the video, focus on trying to get a sense of what is going on for Patrick; also notice what Jake is doing to be supportive of Patrick. Then, answer the questions that follow.
Download this video clip.Video player: therapy_session_1_clip_1.mp4
Transcript
JAKE:
Hi there, Patrick. Nice to meet you.
PATRICK:
Hi, there. Nice to meet you.
JAKE:
And finally, we meet, after all our email exchanges.
PATRICK:
Yes.
JAKE:
So, I just want to check in with you. It's always a question I ask everybody that comes, is just to check that I know how to refer to you in the right way and how you'd like me to refer to you by. So, would you like to tell me what pronouns you prefer to use?
PATRICK:
He and him, please.
JAKE:
Great.
PATRICK:
Thank you.
JAKE:
I'm also he and him, as well. So, tell me a bit about what's brought you here for counselling.
PATRICK:
Well, I've had anxiety for as long as I can remember, to be honest. But I guess, recently, it's just gotten to the point where I actually – I just felt I needed to do something about it. I've never been to therapy before.
JAKE:
Mm.
PATRICK:
And I just feel like I'm not really getting much enjoyment out of my days. And I guess the situation that I'm in, with the gender clinic and everything, I just feel like I – there's nothing I can do to change that.
JAKE:
Mm.
PATRICK:
Maybe I could change a bit how I'm feeling in the meantime.
JAKE:
Do you want to tell me a bit about that? What is the situation with the gender clinics?
PATRICK:
Well, I've got my referral now –
JAKE:
OK.
PATRICK:
– to the gender clinic, which took a long time because my GP-- with my anxiety, and depression, and stuff, my GP felt like I wasn't ready to transition.
JAKE:
Mm.
PATRICK:
But, obviously, me needing to transition is one of the big reasons for the anxiety and depression. So, I just think he doesn't understand that. I've been self-medicating for quite a while now. And the wait to the gender clinic is really long, so I've got to not only deal with the wait of that, but, also, I've heard that they don't really take well to people that have been self-medicating.
So, I'm a bit worried that by the time I get there, they won't want to give me an NHS prescription. And I'm not going to be able to progress onto any-- my chest surgery, my lower surgery, these things that I need. And I'm 32 now, and I know that's still young. But I feel like, by the time I've actually completed everything, I'm going to have lived most of my life in a body that's not right.
JAKE:
Mm. I imagine it must be really frustrating, all these delays, and it is a real problem. I believe there's about 9,000 people, this year, that are waiting to get seen for the London gender clinics.
PATRICK:
Yes.
JAKE:
They've got about 350 referrals a month, so it's a real problem. I mean, I wondered about the GP. I mean, how supported do you feel the GP is?
PATRICK:
Not very supportive, at all, to be honest. I feel like, well, they've never knowingly met a trans person before. The town I'm from, I don't think there's – I don't know of any trans people there. He called it a lifestyle choice, when I first went there, and said that it was – it'll take a long time to do this because everybody else needs to go before you, that are in – as though it's not a real condition. People with real conditions go before you.
Because of my anxiety and stuff, he's, yes, I think, seeing that as the – he's almost like, you need to get that sorted first. But in my head, I'm like, no, I need to get my transition sorted first because that's the fundamental to who I am. I mean, he has now referred me to the clinic. But I think that's only because I've been self-medicating and he can see, maybe visually, OK, he's serious about this. There's no going back.
But it's not like I've been able to arrange blood tests with them and things like that. They just don't want to know. They don't know how to handle it, at all.
JAKE:
Right. Yes. So, I think what you're talking about, It's a real common problem, this lack of knowledge. And maybe it feels, I don't know, frustrating to have to educate the GPs on something that we'd hoped that they would know more about.
PATRICK:
Yes. Well, that's why I went there in the first place. I thought, because I'm feeling this way, I need to go to the – like you would with an illness, you think, oh, I need to go to the doctor to-- yes. I thought he would actually be the one to tell me more about it.
JAKE:
Mm. So, tell me a bit about how this is impacting you. And you talked about anxiety, as well. What is going on with that?
PATRICK:
Well, my anxiety affects me, really, quite physically. So, I feel physically sick a lot of the time. I just feel like it really impacts my day-to-day life. I haven't really been able to keep a proper job down and things like that. I just feel like everything in my day is a bit of a struggle.
I mean, yes, I don't know. It's just I think it's always been there because I've always, obviously, been trans, so I've always known that my body isn't right. And it's like, now, I finally know what the reason behind that is, but then there's all these other hoops to jump through. And it's like, will I ever get there?
And, I guess, just even being out and about in the town, I mean, the – when I used to live as female and was seen as a gay female I'd get abuse in the streets just from – it's like I feel like I have to hide being trans which is another reason that rushing the hormones – I just wanted to just pass as male, blend in. So, I think there's a bit of a constant anxiety there, of are people going to clock that I'm different. I bind my chest. It's like I wouldn't dare go out the house without my chest being bound, and that is uncomfortable. Just, there's so many things that, I don't know, every day – yes.
JAKE:
And do you think that that would change? I mean, I'm wondering how it would feel if you didn't have to do those things. What would change?
PATRICK:
I think that it would just change massively, to be honest. For me to be able to have surgeries, which is a long time off-- but for me to have my chest surgery, that would be a massive thing. It's not even just how people look at you. It's how I look at myself know because it's like people can't tell when I'm binding. People can't see anything there.
But when I get home and take my clothes off, I can see it in the mirror. So, I think, actually, it's almost the biggest change is that, isn't it? It's me seeing my own – looking in the mirror and seeing a body that's right. And that's a feeling I've never had my whole life, so to actually have that one day is, I just feel like it will change my life. Yes.
JAKE:
That's so important, isn't it, to feel comfortable in one's own body? And then the point is you're making these changes for you. That's primarily the important person. You're not just doing it because of other people.
I mean, yes, there is an impact in how you're perceived, but the key person – as you say, it affects you. You have to be with yourself, in your body, all day, all the time. So, of course, it's going to make a huge difference for you in that way.
PATRICK:
Yes. Yes. I just don't know what to do in the meantime, really.
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2.1 Unpicking sex and gender