In the St. Louis area, there are only a handful of therapists with significant experience in dealing with the transgendered. What follows is a brief Q&A with the five that I know. Contact information will be listed at the bottom of this article for each participant.

In Alphabetical order, the participants are:

PB    Patricia Berne, PhD
LB    Lee Borrine, PhD
HF    Helen Friedman, PhD
DR    Dean Rosen, PhD
LW    Linda Weiner, MSW

What special training do you have with transgendered individuals
PB - Seminars, reading, experience

LB - Member HBIGDA, Independent Reading in area of TS/TG, Professional and Personal Experience with TS/TG individuals

HF - Attendance at Fall Harvest 1995 & 2000. Attendance at Harry Benjamin Internation Symposium on Gender Dysphoria, Fall 2000

DR - Have worked with Transgendered clients since 1978

LW - Through American Association of Sex Educators, Counselors & Therapists (AASECT)

Approx. number of previous (or current) transgendered clients
PB - 50

LB - 2 previous clients, 5 current clients

HF - 67

DR - 2 current clients- 20 previously treated, evaluated

LW - 25

What compels you to work with the transgendered community?
PB - Care and concern that this community recieve respect and quality care.

LB - My experience is that there is a lack of qualified therapists that work with this community in St. Louis. The fact that many therapists still try to "cure" TS/TG issues. Most importantly, I find TS/TG individuals to be very motivated, bright and fun to work with.

HF - The need in the transgendered community. The belief that to thrive, people need to own all of who they are.

DR - I have always felt comfortable with these clients - and recognize their need for validation and support.

LW - This population is severely misunderstood and poorly served by most therapists who lack comfort with sexuality and information about transgender issues.
 

Do you have a particular philosophy you follow in working with transgendered clients?
PB - Respect for the person as he or she is on the journey to personal freedom.

LB - No particular philosophy except to meet the individual where he or she is and aid them in achieving their goals.  If we must classify it, a Humanistic approach where the goal is self-actualization.

HF - Yes. As a psychologist, I address the whole person - not just their gender identity. I encourage my clients to find thoughtful and wise ways to mesh their gender identity with the rest of their lives, in order to foster relationships and minimize losses.

DR - I want my clients to accept themselves, control their self destructive behavior and develop positive relationships, and use community resources.

LW - Same as with other clients - a journey we embark on together.

Are there any particular differences between transgendered clients and other clients?
PB - Some, with regard to feelings they've had to live with and keep secret.

LB - TG/TS individuals tend to be highly intelligent and more well informed about TS/TG issues than other clients are about their issues. A larger percentage of TS/TG clients tend to have had at least one failed therapy (probably due to a lack of information on the part of the prior therapist). Some TS/TG individuals come to therapy because they MUST (HGIBDA guidelines)...I try to get them to identify goals that will benefit them beyond just getting a letter for surgery.

HF - Many of the psychological issues that other clients come in with can be 'cured.' However, One's gender identity cannot be talked away or medicated away.

DR - There is usually less family support.

LW - I believe there is less support available to transgendered clients - there may be more depression, drug/alcohol abuse, employment issues, relationship concerns, etc.

How closely do you adhere to the Harry Benjamin Standards of Care in working with transgendered clients?
PB - Very Closely - although a year of real life experience can vary.

LB - The most recent version (# 6) clearly spells out that there are individual differences in readiness timeframes for each person.  I follow the guidelines as they are intended....as guidelines.

HF - I follow these standards.

DR - They appear reasonable in most instances and have been used by me except when the resources are not available for the level of care suggested as ideal.

LW - Reasonably close - some individual exceptions.

Do you feel Gender Identity Disorder belongs in the DSM?
PB - To recieve 3rd party payment from insurance, it must.

LB - That is a mixed bag.  A positive for having inclusion in DSM is that it may allow the TS/TG community to be able to eventually litigate against insurance companies for reimbursement for psychotherapy and/or surgery. Inclusion may also eventually provide job protection under the Americans with Disabilities Act.  On the down side, inclusion in DSM may stigmatize the individual as "mentally ill" and possibly reinforce the outdated belief that TS/TG is an illness that can be "cured" (eliminated through the use of psychotropics, therapy, etc).

HF - I don't believe that it is a mental disorder. On the positive side, inclusion in the DSM enables insurance coverage for some individuals.

DR - It can be useful to justify third party payment but can also overly pathologize what is a variant in nature.

LW - Yes, as long as the client is in the process of identifying and dealing with the issues of transition/adjustment.
 

Transsexuals in transition often feel that there is a 'gatekeeper' role to their therapists. How do you feel about this subject?
PB - It depends on who performs the gatekeeper function. Therapists already have a strict code of ethics.

LB - Initially, many therapists did adopt the role of "gatekeeper" (probably due to fear on the therapists' part of lawsuits, etc.) but as this field has evolved and continues to do so, there appears to be more of a collaborative relationship between therapist and client, with the object being to aid the client in achieving his/her goals in a way that is nondetrimental to self or others.

HF - It is unfortunate that adherence to the Harry Benjmin Standards of care can put therapists into that position.

DR - The standards of care have put therapists in this role for good or bad.

LW - Not a comfortable role for most therapists, but one that is necessary as a safeguard for some clients.

How much of transgenderism do you feel is biological, and how much is social?
PB - Yet to be determined.

LB - It has been my experience that TS/TG individuals feel that there is something VERY biological about their feelings about gender.  Unfortunately, we do not yet have a solid research base to reinforce this innate feeling...although one appears to be coming.  Studies involving individuals who learned they were born one sex and then surgically and socially assigned to the other do seem to support that gender is in one's biological makeup not social upbringing.  Similarly, we do have animal models as a research base that support that events in utero do substantially impact the expression of stereotypical gender behaviors.

HF - I believe it is largely biological in cause and has a huge effect socially on the individual's life

DR - I believe the phenomenon is biological, but the social response to the individual shapes how it is expressed, accepted, etc.

LW - I believe most is biological

In dealing with gender issues, is there a minimum age limit to clients you would work with? Adults only, teen, prepubescent?
PB - All ages.

LB -  While I have had training in child and adolescent psychology, I see mainly adults and older adolescents in my overall practice.

HF - I work with transgendered individuals of any age

DR - I have not worked with pre-teens but would work with their families to understand this phenomenon.

LW - Any age.

Are there any closing comments you would like to make?
PB - I believe the transition process should address all the individual's issues so that SRS is seen as an evolution not just the goal. Often the individual isn't well prepared for post surgery life.

LB - I am glad that you are doing this survey...it seems that the trans community is St. Louis is becoming much more organized and proactive.

HF - I have great respect for my transgenderd clients for having the courage to explore and become their true selves.

DR - Trans people need to accept that it can be a long and costly journey toward outer physical change but the internal changes within one's concept of self and relationship to others is really more important.

LW - (None)

Contact information:
PB
Patricia Berne
7710 Carondelet Ave.
St. Louis, MO 63105
314 725-0550

LB
M. Lee Borrine, Ph.D
8147 Delmar Blvd., Suite 219
St. Louis, MO 63130
314 960-6713

HF
Helen R. Friedman, PhD
7750 Clayton Rd., Suite 210
St. Louis MO, 63117
314 781-4500

DR
Dean Rosen
763 S. New Ballas
St. Louis MO 63141
314 872-0288

LW
Linda Weiner
7396 Pershing Avenue
St. Louis MO, 63130
314 588-8924