5.4 When therapists are cis

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This section has focused on the diversity in the trans community but there can also be difference between client and therapist. All the way through this training we have stressed the need to examine your own assumptions and understandings in order to work ethically and effectively with trans clients. Here we revisit the question of what this kind of reflexivity might entail if you are a cis therapist working with a trans client.

Activity 5.4: Revisiting Patrick talking with Jake about transition care

Timing: Allow 15 minutes

Earlier you watched this clip of Patrick and Jake talking about his transition. Watch this excerpt one more time, but this time focus on how the interaction might be different if the therapist was cis.

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Transcript

PATRICK:
I don't know, you know? I know it sounds a bit dramatic, but like my anxiety really was getting in the way of the jobs. And being self-employed for me is the best because I get to be in charge of myself. I get to work from home. But it is unreliable in terms of when I get paid and stuff. And I already spend a lot on the self-medicating. I just couldn't afford to – I just can't afford to go privately, yeah.
JAKE:
So, you're in this situation where you're just in this limbo state, waiting for what you want basically to get it, almost legitimised in some way.
PATRICK:
Yeah.
JAKE:
Yeah, I wonder how have you felt with the hormones. Have you felt – I mean, just looking at your beard, it's wonderful. But how are you feeling around taking hormones?
PATRICK:
Well, I mean, it has been amazing. I do get to look at my face and be like, this is my face. I love that I've got a beard. Not everyone is as lucky as me to get a beard so quick as well. I do – yeah, it is – it feels amazing to be on them. But there's this constant dread in the back of my mind that I'm not on an NHS prescription. And it's like – I suppose, yeah, had just to even get people – that validation from my GP and from – just to be – by the medicals to actually be like we recognise you as male because I think it feels like I'm doing something wrong, like it's a little dirty secret type thing that I'm doing, you know.
JAKE:
Like you're going to be found out or something like that. And does that feel – yeah, how does that feel for you, though, that state of this 'dirty secret'?
PATRICK:
I think that's what – yeah, it just feels like I'm in a bit of a constant state of anxiety about it, really. Yeah, I mean obviously, my family and close friends know. But I guess I've shut myself off a bit from the world. If I bump into someone in town that knew me before I transitioned and they're going to be like, what?
That's you but – do you know what I mean? It's like I don't know everything – I think I feel like I know I shouldn't because I'm really proud of other people that have transitioned. But I feel this shame around it. I think just because everyone's treated it as something wrong. So, to actually get a medical prescription on the NHS would make me feel like, look, this is a real thing. The NHS have given me what I need.
JAKE:
So, do you think that means it gives you a sense of empowerment that I can be seen for who I am and move away from that experience of feeling shameful, that I am being acknowledged, and believed, and accepted in the identity that I am, that I say I am, because the NHS are almost affirming it for you through just that power that they have to legitimise and legitimise the hormone taking?
PATRICK:
Yeah, yeah, definitely. That's definitely – and I want to get to that point. But it just feels like a million miles away till I actually get to that point.
JAKE:
What you're up against, Patrick, is just this terrible system. And I'm sorry that we're having to be in this place.
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Discussion

The expert therapists interviewed for the ICTA project talked about how if both client and therapist are trans it is possible to explore gender and gender identity in way that may not be possible for cis counsellors. As one person said: ‘There are questions I can ask of a trans client that I don’t think a cis person could ask without that being received as a denial of that person’s gender.’ Another person said:

‘A cis friend of mine who’s a great therapist, [was] working with a non-binary client and the client wanted them to ask them lots of questions to help them explore their gender. But when she did ask those questions, it landed with the client as an interrogation because they’re so used to having to justify themselves… With a trans therapist it’s safer for the therapist to say “let’s ask all these interesting questions about your gender”. They will land with the client like interesting questions from a fellow trans person rather than interrogation through a cis gaze.’

Gender reflexivity thus potentially involves cis therapists understanding – and accepting – that they may well, for good reasons, be seen as less trustworthy, safe, competent than a trans therapist, as well as that they may not be able to support a trans client’s gender exploration in the same way that a trans therapist might.

5.3 Trauma and abuse

Summary