Contemporary Psychoanalysis in Action

A roundup of psychoanalytic points of view

A Man Walks into a Therapist’s Office and Says He’s a Woman

A therapist can be the difference between life and death for transgender people.

By Joy Ladin, Ph.D.

It’s hard for me to imagine how the therapist felt when my friend J, who lives as a married man with several young children in an ultra-Orthodox Jewish enclave in the U.K., showed up for her first appointment dressed, as we trans people say, as herself.

In J's case, dressing as herself meant wearing the garb of an Orthodox Jewish woman over a male torso and under a bearded face. J is literally dying to lose the beard and change her body to fit her female gender identity. If she can't transition – begin to live as a woman instead of a man – soon, she'll kill herself; she's come close many times this year.

However, the moment J begins to live as a woman she will lose her marriage, children, home, her minimal livelihood, her Orthodox Jewish world. She'll become an object of gossip, mockery, public humiliation. She fears she will lose her closeness to God; she fears she will never be loved.

It's easy for me to imagine how J felt, because, though my male life was very different from hers, my anguish, fears and prospects were much the same. Like J, when I began gender identity therapy, I didn't know who I was, because I had never lived a day as myself. But I knew what I was: a male-to-female transsexual, a person whose male body was painfully, depersonalizingly, tragically mismatched to my unshakably female gender identity.

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My life as a man was a mask, a painful, shameful way of not being the person I knew I was. Like J, I was on the verge of suicide. The technical term for this anguish is “gender dysphoria,” the gut- and psyche-wrenching sense of not being what and who everyone thinks we are.

Like me, J knows she isn't the man her wife, children and community know; the face she sees in the mirror, the body that entombs her, isn't hers. She had hoped marriage would make her feel like a man, or reconcile her to living as one. After ten years, her coping mechanisms – pretending to herself and others that she is not who she knows herself to be, and brutal self-harm – aren't working any more. Gender dysphoria has become her life, morning, noon and night.

J's therapist never worked with a transsexual before, but she understood J's tortured emails well enough to give J permission to dress as herself for their first session. “You don't look bad,” she told J, and J, who has rarely been seen outside the mirror as female, wondered what she meant. In many ways, J had a good first session: she talked, she cried, she felt heard and cared about.

But J was confused when her therapist told her she would have to dress as a man in some sessions, so they could work on healing her male self. “I don't have two selves,” J wrote to me afterward. Her male life doesn't represent a self; it's a mask that makes her sick and miserable. If the therapist can't see J in her own terms, can't accept her female gender identity as her authentic self, J won't go back. 

It's hard to imagine a therapist telling a non-trans patient that they will have to dress as someone they aren't for some sessions. But the therapist told J something that was even more devastating: because J's children are young, she said, J can't live as herself; for her children's sake, she has to live as a man.

It's hard to imagine a therapist telling anyone other than a transsexual that they are obligated to live an inauthentic life. It's particularly hard to imagine when the therapist knows that the patient is ready to kill herself to escape that inauthentic life.

Like me, J lives in a world in which very few people believe we know who we are. Like me, she is dying for confirmation, affirmation, valuing of what she knows to be her true self. Therapists encourage non-trans clients to be true to themselves, to live as fully and authentically as possible. Too often, transsexuals are told what J was told: you can't be true to yourself because it might harm others.

As gender therapist Arlene Ishtar Lev shows in her indispensable Transgender Emergence, gender identity issues are family issues; everyone in the family is affected. When transgender people begin to be true to themselves, marriages may break up, parents and children may grieve the loss of the man or woman they knew.

Our family members deserve our attention, compassion, patience, and support, but they are not entitled to demand that we sacrifice our true selves and endure decade after decade of inauthentic, anguished, existence. That's not what loving families do, and that's not how families coping with gender identity issues heal.

And yet, I encouraged J to have another session. There aren't many therapists who understand gender identity issues, and J's therapist, despite her missteps, sounds kind and well-meaning. If the therapist listens to and respects what J tells her about her gender identity, the relationship might work out – and J desperately needs it to.

Like many who seek therapy in the midst of gender crises, J is exhausted from years of fighting against herself, battered by the transphobia of her community and the verbal abuse of her wife, unable to imagine how to simultaneously lose her world and create a new, authentic life. She has few resources now, living as a man; when she begins living as a woman, she will have nothing.

The last thing J needs is to go therapist shopping. Though the boom in media coverage of trans children may make it seem otherwise, most therapists will never treat transsexuals. It is critically important that those who do remain open, curious, non-judgmental, and ultimately supportive. For those like J, and myself, whose life may hang by a thread, all the difference might be made in a 50-minute hour with a therapist who tells her she is, and can be, herself.

Joy Ladin, Ph.D., is the William Alanson White Institute LGBT Study Group Pride Lecture speaker. She will be talking on Friday, June 7th at 8pm.  Please register for this event by clicking here.

Joy Ladin, PhD, Gottesman Professor of English at Yeshiva University, is the first openly transgender employee of an Orthodox Jewish institution. Her memoir of gender transition, Through the Door of Life: A Jewish Journey Between Genders, was a finalist for a 2012 National Jewish Book Award, and a Forward Fives award winner. She is also the author of six books of poetry, including several that address gender identity and transition: Transmigration, Coming to Life, and The Definition of Joy

Contemporary Psychoanalysis in Action, edited by Susan Kolod, Ph.D., and Melissa Ritter, Ph.D, is under the auspices of Contemporary Psychoanalysis, the journal of the William Alanson White Institute.

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