I’ve been working with the LGBT community since 2003 when I began my Practicum experience during graduate school. As the resident transgender counselor, I was seen as a natural fit for all of the transgender clients who were seeking services. This was a good thing because I had a strong desire to give back. A lot of the work I ended up doing, as a result of transgender issues emerging as a specialization for me, was diagnosing Gender Identity Disorder. You see, trans people are required by their surgeons to have letters indicating their mental candidacy and readiness to undergo gender affirming surgeries and in some cases, hormone replacement therapies. What happens, then, is that people come to counseling solely for the purpose of procuring a letter, seeing it as a means to an end, or a hoop through which to jump on their way to living life fully. In honesty, this was certainly how I saw it when I underwent my own diagnostic process in 1993.
This presents quite a dilemma in that I don’t really believe I have a legitimate right to determine another person’s gender. Neither do you. Yet, transgender people have one way to obtain the medical services they need, and that is through the diagnostic process. For those of who specialize in transgender mental health services, no matter how radical our work in the transgender liberation struggle is, we invariably become diagnosticians because we’re the resident specialists in work that very few counselors are doing. Thus, making a firm commitment to strengths-based and resiliency-oriented counseling services for this marginalized community will invariably come with this paradoxical responsibility.
Over the years, I’ve grown to accept this fact, and have developed excellent relationships with many PCPs and surgeons who work with the trans community. I am well-respected for ethical decision-making in following the Standards of Care established by the World Professional Association of Transgender Health, and the diagnostic guidelines established by the APA for Gender Identity Disorder (which will now be called “Gender Dysphoria” in the DSM-V). Even still, I look to the day when my trans sisters and brothers can have the freedom to choose their genders and how they wish to live them without having to ask my permission or that of anyone else.
Stacee Reicherzer is a counselor, a faculty member at Walden University, and a private consultant with special interests that include: transgender issues in counseling, lateral (within-group) marginalization, and sexual abuse survival.