This is a great resource that I may refer to if I have to end up moving away from Indiana at some point in the future (preferably Illinois as that's still close enough to visit my supportive family on holidays). Although it'll be made harder by the fact that I've been having an insurance predicament (simply put: neither informed consent HRT location is covering the insurance provider I switched to in November--even though the insurance marketplace said THAT insurance plan would cover THAT specific location; and that insurance company is not even listed on the Psychology website listed in this article) that means I may have to go back on DIY HRT until I have a job that can pay for HRT out-of-pocket.
So I got a lot of things terrifying me right now. Particularly insurance, anti-trans legislature, and not feeling sure if I can handle living alone in a new environment.
Not the southwestern part of Indiana where I'm at. Where Illinois is just one town west and Carbondale (which is a place where a lot of trans refugees from Florida went) is about 2 hours away.
But yes, I am probably going to have to find/get in contact with a support group for autistic adults to guide me through living alone once I'm there. It's the uncertainty of it all that terrifies me the most--but I also realize that I'm probably making a mountain-out-of-a-molehill with anxiety about that.
Very, very fair. Just keep in mind that southern Illinois is pretty similar to Indiana, in terms of politics and such. The legal protections are wayyyy better, though.
I have a cousin who is another Illinois refugee from southwestern Indiana (for very different reasons), and it's made a HUGE difference in her life. Her parents (my aunt and uncle) are still within driving distance to babysit, but she has legal protections that are unimaginable in a red state.
Thanks, Doc! I discovered your column towards the end of last year when my CPTSD was horrific - as in, crying on the way to work, and (after reading about a high-profile murder) crying for hours at work. Nonetheless, I went full-time as me at the start of this year, having been out as trans-NB to all staff and students last year, and on HRT since 2022, partly because I'd realized how CPTSD and its related behaviours fit into the puzzle (and why approaching my trauma as PTSD wasn't right). Themes aside, I always enjoy your writing regardless of the content and feel it holds me to a high standard as a fellow PhD, part of whose job is teaching academic writing. Best wishes, Kay
Update: been looking for a therapist AND a psychiatrist (which is needed for my ADHD meds) using this guide since my current one is moving elsewhere at the start of 2025.
I may have to look at online ones in nearby cities because my hometown is a deadzone for ones that fit the criteria. Just can't go too far away--until I get my driver's license soon (or until I eventually move). I'm thinking Indianapolis and Bloomington are good bets.
Great article, I've got a huge amount from reading your writing here and I really appreciate you taking the time to address this one. I'm a therapist myself and have been on the receiving end of a lot of bad and mediocre and a small amount of very good therapy.
Unfortunately you're right about the complexity of psychological issues which means that even a very good therapist might take some time to find the right place to work with a client or the right angle to take, and similarly even the most committed client might find it difficult to find the right way to articulate and explore the right topics. When all goes well this becomes an effective and collaborative process between both parties, but damn it can be hard to get there.
It's further complicated by the fact that you can have a very good rapport with a therapist but still not make any progress if their approach or way of working just doesn't reach the areas that need to be addressed. I unfortunately wasted quite a bit of time with therapists who were genuinely doing their best and who I felt understood and supported by, but were not pushing me into the areas of myself that actually needed work.
I desperately wish that therapy was more readily available and that more therapists better understood their blind spots and endeavoured to address them.
To be fair to Steve the Therapist, even if he missed the target, he still hit the tree, which is a whole lot better than most therapists would have done at the time.
In my experience, trans kids usually have much, much deeper closets than gay kids, especially in that time period between the 1970s and the 2000s where gay people were move visible and gaining acceptance and trans people were very much not. Trans people who are exclusively attracted to their own (post-transition) gender have it even harder.
A trans woman who is attracted to men will probably identify as gay early on, and that can force some introspection and can often be a step on the way to understanding herself. A trans woman who is attracted to women is a whole lot more able to hide her fascination with all things femme as just being attracted to girls. She'll probably even hide it from herself. I know I did as a teenager. I was not entirely successful at that, but I worked really hard at it. I wondered if I maybe I was gay for about five minutes before realizing I didn't like boys but *really* liked girls, probably a little too much. I knew even then that I wanted to be a girl, and I also knew that was impossible at the time, and I buried it down deep.
So it's no surprise that a therapist can have trouble digging that up.
I've been seeing my own therapist for about ten years, and it was at least five years before she had any idea that I was trans. That wasn't because she was bad at her job; she was able to help me through a whole lot of other things. It was because I was *really* good at keeping all my gender stuff inside and playing the role of a totally cisgender man.
For what it's worth, I don't actually have any hard feelings toward Steve. He tried, and it's not his fault his training in queer stuff was from the late '70's. Honestly, he was a lot better than most of his vintage and time. And you're right about the double-bind of the transbian, let alone the asexual-spectrum transbian.
But we can cause harm even when we're trying to help.
A lot of people get really resistant to getting the help they need because of people like Steve: well-meaning, but... well, too limited by their own imagination to be *able*. So what those folks take from therapy is that there's no help to be gotten at all.
And in some ways, that's worse than not seeking help in the first place.
Thank you for writing this! I'm actively searching for a new therapist and it's been pretty overwhelming. There's too few options if I search locally, and too *many* if I expand to teletherapy. This should be a big help.
I have a wonderful therapist that I've never seen in person. I would love to but for a host of reasons that's not happening right now. What is important is, do they feel present. Are they noticing your posture, your expressions, subtle changes in voice, demeanor, your smile, etc. I'd take someone who could do all these remotely over someone who can't do them consistently in person any day. Be patient and don't be afraid to be picky. This is super important. This search takes time but getting the best person for you is worth it.
This is a great resource that I may refer to if I have to end up moving away from Indiana at some point in the future (preferably Illinois as that's still close enough to visit my supportive family on holidays). Although it'll be made harder by the fact that I've been having an insurance predicament (simply put: neither informed consent HRT location is covering the insurance provider I switched to in November--even though the insurance marketplace said THAT insurance plan would cover THAT specific location; and that insurance company is not even listed on the Psychology website listed in this article) that means I may have to go back on DIY HRT until I have a job that can pay for HRT out-of-pocket.
So I got a lot of things terrifying me right now. Particularly insurance, anti-trans legislature, and not feeling sure if I can handle living alone in a new environment.
Hey, Michigan is a great place to be too, and just as close to home for you!
But yeah, American insurance is a disaster.
Not the southwestern part of Indiana where I'm at. Where Illinois is just one town west and Carbondale (which is a place where a lot of trans refugees from Florida went) is about 2 hours away.
But yes, I am probably going to have to find/get in contact with a support group for autistic adults to guide me through living alone once I'm there. It's the uncertainty of it all that terrifies me the most--but I also realize that I'm probably making a mountain-out-of-a-molehill with anxiety about that.
Very, very fair. Just keep in mind that southern Illinois is pretty similar to Indiana, in terms of politics and such. The legal protections are wayyyy better, though.
I have a cousin who is another Illinois refugee from southwestern Indiana (for very different reasons), and it's made a HUGE difference in her life. Her parents (my aunt and uncle) are still within driving distance to babysit, but she has legal protections that are unimaginable in a red state.
Thanks, Doc! I discovered your column towards the end of last year when my CPTSD was horrific - as in, crying on the way to work, and (after reading about a high-profile murder) crying for hours at work. Nonetheless, I went full-time as me at the start of this year, having been out as trans-NB to all staff and students last year, and on HRT since 2022, partly because I'd realized how CPTSD and its related behaviours fit into the puzzle (and why approaching my trauma as PTSD wasn't right). Themes aside, I always enjoy your writing regardless of the content and feel it holds me to a high standard as a fellow PhD, part of whose job is teaching academic writing. Best wishes, Kay
Thank you!!
Update: been looking for a therapist AND a psychiatrist (which is needed for my ADHD meds) using this guide since my current one is moving elsewhere at the start of 2025.
I may have to look at online ones in nearby cities because my hometown is a deadzone for ones that fit the criteria. Just can't go too far away--until I get my driver's license soon (or until I eventually move). I'm thinking Indianapolis and Bloomington are good bets.
Indy will 100% have good options.
Sure will. I think I'm in talks with one right about now.
Gotta get the ball rolling on the orchi. And if Medicaid will cover it, all the better!
So this afternoon, I've made some headway on a few things:
* I sent prospective emails out to a new therapist and a new psychiatrist, both covered by Medicaid.
* I set up an appointment for a new local physician + endo....one that is *very* much an ally to the local trans community.
* I emailed someone in Indianapolis (my state's capitol, about 2-3 hours away by car) to lay the groundwork for having an orchi done in 2025.
Yeah, I'm wanting these balls GONE. And I'm damn sure it's going to be covered by Medicaid.
Let's GOOOOO!!!
Great article, I've got a huge amount from reading your writing here and I really appreciate you taking the time to address this one. I'm a therapist myself and have been on the receiving end of a lot of bad and mediocre and a small amount of very good therapy.
Unfortunately you're right about the complexity of psychological issues which means that even a very good therapist might take some time to find the right place to work with a client or the right angle to take, and similarly even the most committed client might find it difficult to find the right way to articulate and explore the right topics. When all goes well this becomes an effective and collaborative process between both parties, but damn it can be hard to get there.
It's further complicated by the fact that you can have a very good rapport with a therapist but still not make any progress if their approach or way of working just doesn't reach the areas that need to be addressed. I unfortunately wasted quite a bit of time with therapists who were genuinely doing their best and who I felt understood and supported by, but were not pushing me into the areas of myself that actually needed work.
I desperately wish that therapy was more readily available and that more therapists better understood their blind spots and endeavoured to address them.
Agreed entirely! It'd be so much easier if therapists weren't people too, with all the foibles that come with that, huh?
To be fair to Steve the Therapist, even if he missed the target, he still hit the tree, which is a whole lot better than most therapists would have done at the time.
In my experience, trans kids usually have much, much deeper closets than gay kids, especially in that time period between the 1970s and the 2000s where gay people were move visible and gaining acceptance and trans people were very much not. Trans people who are exclusively attracted to their own (post-transition) gender have it even harder.
A trans woman who is attracted to men will probably identify as gay early on, and that can force some introspection and can often be a step on the way to understanding herself. A trans woman who is attracted to women is a whole lot more able to hide her fascination with all things femme as just being attracted to girls. She'll probably even hide it from herself. I know I did as a teenager. I was not entirely successful at that, but I worked really hard at it. I wondered if I maybe I was gay for about five minutes before realizing I didn't like boys but *really* liked girls, probably a little too much. I knew even then that I wanted to be a girl, and I also knew that was impossible at the time, and I buried it down deep.
So it's no surprise that a therapist can have trouble digging that up.
I've been seeing my own therapist for about ten years, and it was at least five years before she had any idea that I was trans. That wasn't because she was bad at her job; she was able to help me through a whole lot of other things. It was because I was *really* good at keeping all my gender stuff inside and playing the role of a totally cisgender man.
For what it's worth, I don't actually have any hard feelings toward Steve. He tried, and it's not his fault his training in queer stuff was from the late '70's. Honestly, he was a lot better than most of his vintage and time. And you're right about the double-bind of the transbian, let alone the asexual-spectrum transbian.
But we can cause harm even when we're trying to help.
A lot of people get really resistant to getting the help they need because of people like Steve: well-meaning, but... well, too limited by their own imagination to be *able*. So what those folks take from therapy is that there's no help to be gotten at all.
And in some ways, that's worse than not seeking help in the first place.
Thank you for writing this! I'm actively searching for a new therapist and it's been pretty overwhelming. There's too few options if I search locally, and too *many* if I expand to teletherapy. This should be a big help.
Honestly, I'm a real fan of teletherapy when needed, and my therapist and I still use it from time to time when we need to. =)
I have a wonderful therapist that I've never seen in person. I would love to but for a host of reasons that's not happening right now. What is important is, do they feel present. Are they noticing your posture, your expressions, subtle changes in voice, demeanor, your smile, etc. I'd take someone who could do all these remotely over someone who can't do them consistently in person any day. Be patient and don't be afraid to be picky. This is super important. This search takes time but getting the best person for you is worth it.