If you are thinking about detransitioning you might benefit from support from a psychological therapist during this process. If so, it’s important to think carefully about what you need from psychological therapy in order to choose a therapist who is most likely to meet those needs.

A person’s thoughts about detransition can emerge quite suddenly, seemingly out of the blue or following a significant event e.g. surgery. This is likely to feel quite scary and destabilising, particularly if you are part of a peer group where it doesn’t feel like you are allowed to express doubts or anxieties about being transgender or making a detransition. A psychological therapist can provide a private, neutral and confidential space to talk through these thoughts and help to make sense of them in order to decide what to do next.

For other people doubts and anxieties about transition might have been around for a long time. It may be that the psychological pressure of these thoughts has become too much or it may be that ways of trying to push the thoughts and feelings away have become too much to bear. Sharing these accumulated thoughts and feelings with a therapist might come as a relief and, again, having a space to think and talk them through can help to provide some clarity to the decision-making process.

Choosing between a psychologist, a psychotherapist or a counsellor

It can be really difficult for someone seeking therapy to know which kind of ‘therapist’ would be most helpful to them. Psychologists, psychotherapists and counsellors are different from one another in that they have undertaken different kinds of training programmes and had different routes to qualify and practice as a therapist. Any therapist you contact should be open to informing you of their qualifications, what professional training they have undertaken, how long they have been qualified and which professional organisations they are currently registered with. They should also be happy to explain to you which therapy models they use (e.g. Cognitive Behaviour Therapy, Psychodynamic Psychotherapy, Jungian Analysis etc.) and signpost you to further reading on that model to help you make the decision on whether you it would be a good fit for you.

Cost of therapy

If you live in the UK we recommend that as a first step you speak to your General Practitioner about the local, NHS options for psychological therapy. If there does not appear to be anything suitable locally on the NHS there might be local, third sector organisations who can offer free or low cost psychological therapy.

If neither NHS nor third sector services are available or suitable you might wish to seek out a therapist in private practice. Private therapist fees can range widely, however, there is not necessarily an association between the cost and the quality of the service but rather there are many factors that determine a therapist’s fee. Also, private therapists sometimes offer a pro-bono or low fee service; so if you are unemployed, a student or on a low income it is worth asking them if you might be eligible for this.

Payment

Different therapists each have their own payment arrangements. Some private therapists may ask for payment before the session and some may invoice at the end of the month for the sessions that have been undertaken. We have heard that there are some private therapists who are asking for large sums of money upfront and we don’t believe that this is acceptable. You should not feel bound or tied in to the therapy because you have paid upfront. You should be able to leave therapy at anytime if it is not working for you or you no longer wish to continue working with that therapist.

Online therapy v in person therapy

There are distinct pros and cons that you will need to weigh up. To undertake online therapy you will need a private and confidential space, excellent internet connection and a reliable device. Perhaps you will feel more comfortable in your own space than you would if you were attending a clinic or seeing a therapist in their home. Online therapy may give you a wider choice of therapist because you are less restricted to choosing one who is in your local area. It may also be more convenient if you are travelling regularly or planning to relocate in the foreseeable future. Online therapy sessions might also be less expensive than in person sessions. 

However, you may prefer to see your therapist in person because the aspect of physically being in the same room as the therapist and exploring the feelings that this brings up can be an important part of the therapeutic work. If you are experiencing problems with dissociation in person therapy is more likely to help you to feel grounded than online therapy. You may also prefer to talk about difficult thoughts and feelings in an external space, separate from your home. Some kinds of therapy and some kinds of difficulties are likely to be more suitable to in person therapy, most notably trauma focussed therapies.

Either way any therapist who you contact should be able to advise you and help you to weigh up whether online therapy or in person therapy would be best for you, or whether online therapy might not be advisable given your particular difficulties or circumstances.

Finding a therapist who is able to understand difficulties and issues specific to detransition

Good therapists welcome questions from potential clients about their knowledge, practice, experience and training and should answer your questions on their understanding of detransition and what approach they would take to working with you. If they don’t have any knowledge or experience of detransition or working with detransitioners but they are interested in developing their knowledge you could forward them the link to the iatdd website and they could contact a member to arrange clinical supervision from a therapist who has built up experience and knowledge in this area.

Iatdd members have a diverse range of professional training, please see their individual profile for more details. We have all arrived at a special interest in gender transition and detransition from different starting points and have been able to develop a professional network to share resources, knowledge and skills on working with young people and adults who are thinking about detransition or have already begun to detransition.

Whether to choose a male or female therapist?

It is worth thinking about what you would like to get out of therapy in order to make this decision. It may be that you prioritise the particular psychological model that your therapist practices and so whether they are male or female is less important. If you feel that a significant part of your difficulties is related to negative experiences, violence or abuse by ‘women’ or by ‘men’ you might feel more relaxed and able to talk about these experiences with a therapist of the opposite sex to the one that harmed you.

How long should therapy take?

Psychological therapy provided by the NHS or funded by health insurance is usually limited to approximately 16 to 30 sessions. A private therapist should discuss with you whether you are interested in an open-ended therapy that could potentially mean working together for a significant period of time (potentially several months or years) or whether you would prefer to work together on a specific issue within a specified number of sessions.

How do I know if therapy is working for me?

Be wary of any psychological therapist who makes grandiose claims of the effectiveness of their treatments. Randomised controlled trials of manual based psychological treatments that target circumscribed problems such as anorexia or depression show that they do not work for everyone.

Good therapists are humble about what psychological therapy can offer and how long and sometimes difficult it can be for improvements to be felt or noticed. You can use scoring charts to measure whether there is an improvement on specific issues that you want to address in therapy. Or you can use part of the therapy session to reflect on whether or not the therapy seems to be working for you and how to best evaluate this qualitatively. Either way it is a really important part of the therapeutic process to decide with your therapist how you will both know whether the therapy is benefitting you.

What should I do if I feel that therapy isn’t helping or I don’t like my therapist?

It is complicated because feeling frustrated or having angry feelings towards your therapist doesn’t necessarily mean that he or she isn’t a good therapist or that the therapy isn’t useful. Sometimes therapists remind us of someone from our past who we’ve had conflict with, most likely a parent, and therapy can be a good place to work through hostile feelings towards an authority or parental figure.

However, if your therapist has been inappropriate, has overstepped boundaries or made you feel uncomfortable then you should end the therapy and consider making a complaint to their professional body.

How do I make a complaint about my therapist?

Before you agree to start working with your therapist you should find out which professional bodies they are registered with. If you wish to make a complaint about your therapist contact their professional body and ask what the procedure is for making a complaint about one of their members.

How do I know when to end therapy?

You may have agreed with your therapist to work to a certain number of sessions and so you have a ‘planned’ ending in sight. Even so, saying goodbye to your therapist can sometimes feel rather upsetting and destabilising, particularly if your therapist has come to represent a good attachment figure. Sometimes clients can find it so hard to say goodbye to their therapist they will avoid or miss the final session. Even though it can be painful it’s really important to say goodbye to your therapist so that you are not left with unresolved feelings. If you are in open ended therapy then it’s worth discussing with your therapist how you will both know when its time to say goodbye.

Bibliography: information on different models of psychotherapy/ psychological therapy

(in alphabetical order)

Acceptance and Commitment Therapy (ACT): https://contextualconsulting.co.uk/insights/free-act-resources-from-russ-harris

Cognitive Analytic Therapy (CAT): https://www.acat.me.uk/page/about+cat

Cognitive Behaviour Therapy (CBT): https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/

Dialectical Behaviour Therapy (DBT): https://www.ot-innovations.com/psychosocial/dialectical-behavior-therapy/

Person Centred Counselling: https://www.bacp.co.uk/about-therapy/types-of-therapy/person-centred-counselling/

Psychodynamic Psychotherapy and Psychoanalytic Psychotherapy: https://www.bpc.org.uk/about-psychotherapy/what-psychotherapy