The Process of Acceptance in Transsexuals
By the time a transsexual finds her way into your office she has usually done a lot of work on her own trying to reconcile herself to her situation. Some people, including some counselors, see the transsexual as being pleased with being transsexual. Some psychologists will say that transsexualism is Ego-sintonic in nature. There is some truth in this but only in a tangential manner. Being a member of the opposite sex is ego-syntonic because it will bring about a match between the person's gender identity and her physical identity. But to say that an individual wants to have such a conflict in the first place is not true.
I remember an interchange between two transsexuals in a computer conference over Genderline, a service of Compuserve Information Services for transgendered people. One person said, "I think I want to be transsexual." This surprised and shocked everyone not realizing that the person defined transsexual as having had sex reassignment surgery. The other person replied, "Nobody wants to be transsexual, it's just something you're stuck with." Given the fact that most transsexuals have difficulty dealing with the truth of their transsexualism, by the time they make it into counseling they have usually made some progress in coping. However, it's important to understand something of the process the person goes through to reach that point. There are really stages in this process of acceptance: Innocent Acceptance, Concealment, Denial, Resistance, Exploration of Possibilities, Acceptance and Commitment to Action. Many of these stages overlap and there is a good deal of drifting back and forth between them. One person may jump ahead to exploring possibilities for instance, then something will happen to thrust them back into denial. But each transsexual usually goes through all stages in this process. Most will be near the end of the process when they see you. Let's look at each of these stages in depth.
This stage usually doesn't last long. This occurs in early childhood when the child is first discovering his or her gender identity. At this stage the child may shock parents by playing "dress-up" in the clothes of the parent of the opposite sex or insisting that one day he or she will be a member of the opposite sex. At this stage, many transsexuals report a type of innocent feeling that it is perfectly normal to want to change sex and that such an occurance will happen spontaneously at some point in future life. This child is secure in her gender identity, however that gender identity is incongruent with her physical sex. The child having had little socialization in such matters is usually baffled when she finds out that everyone doesn't feel the same way. She usually can't understand what the big deal is dressing up in Mommie's clothes after all don't all little girls do that. These children innocently accept their condition as natural. However, the swift and somtimes severe adverse reaction of their elders usally extinguishes this innocence at an early age.
At this stage the individual, usually still in childhood or early adolescence, still accepts her transgendered condition, but she has learned that there are serious social consequences of expressing this acceptance. While still accepting the fact of being different, the transsexual begins hiding the fact from others. It's simply a matter of social survival. If you don't want to be perceived as being "sick" or "bad," you must appear normal. So, the transsexual begins to take part in a greater number of gender appropriate activities, begins conciously modeling the same sex parent, begins to learn how to act in accordance with the expectations of her birth gender. These masking skills help the child to function around family and friends while still feeling at odds with her birth gender.
For most transsexuals denial starts around adolescence when she really begins to understand how significant the differences between the lives of a man and the life of a woman are. And when she realizes how poorly thought of she would be if people knew she was a transsexual. Teenagers can be cruel to anyone who deviates from the "norm." I think this is especially true of teen males. Memories of the high school locker room can bring a twinge of pain even now 20+ years later. Considering then the social consequences of being TS is it any wonder that they deny the fact in a whole variety of ways? I've noticed there are 3 ways most deny their transsexual status: Direct Denial, Diversion and Substitution. Direct denial involves simply ignoring the fact of one's inward experience. You push the feelings aside. You shove them underneath your conscious life. Whenever they pop up again, you bury them once more. They don't stay buried, though, they are usually right below the surface clawing at the dirt tunneling through the topsoil. And even when buried, the transsexualism doesn't leave the person alone. Transsexuals often feel anxious, sometimes depressed. This anxiety and depression interferes with the person's interpersonal relationships. Transsexuals may feel irritable or sad for no apparent reason. Eventually, though, the fortifications are breached and the transsexual comes face to face with what she fears most, herself. Diversion was my way of denying for years. So, I wasn't a macho male. So, I couldn't hold my own on the athletic field. I could think; I could study; I could write. I wasn't a transsexual, I was just a Nerd. (I even had the pocket protector.) As I headed for college, the nerd became the scholar. My books became my friends and my shield against the truth of my gender conflict. Intellectually, I knew what I was, but down deep, I felt if I could plunge myself deep enough into my studies, it would either go away or just not matter. Other people use work, family, church, or self-promotion to divert their attention away from their transsexualism. This may work for years, but eventually none of the diversions are strong enough to maintain the denial. Substitution refers to the transsexual accepting that something is different about herself, but interpreting it in a less threatening manner.
The most common conditions substituted for transsexualism are homosexuality and transvestism. Some transsexuals deny their gender identity conflict by retreating into homosexual relationships. Being gay, with all it's difficulties, is preferable to the transsexual admitting that she may have to go through the grueling process of transition from one gender to the other. Besides, if everyone thinks you're "queer" or a "faggot," why not just prove them right. The transsexual can do drag within the gay community without the stigma found in straight circles. But eventually, the person discovers that the sex she might want with a man is not that of man-to-man, but of man-to-woman. The other lifestyle substituted is transvestism. Here the transsexual tries to tell herself that the only thing she wants to do is crossdress. It's not as if you really want to BE a woman; you just want to express that feminine side of yourself occasionally. This can actually work for many years until the crossdressing isn't enough, and and the transsexual finds that the "feminine side" of herself is more than a dressed up man.
Stage 2: Resistance
Linked to or following denial is an active attempt to resist the change. There are four common ways transsexuals try to resist their gender dysphoria: Will Power, Therapy, Machoism and Marriage. Will Power is one that most transsexuals try at one time or another. It takes many forms. Sometimes people make a concious effort to think in line with their birth gender. They tell themselves over and over, "I really like being male (female). I don't really want to change sex and if I keep thinking manly (womanly) thoughts, I can change myself." Another form of will power is the purge. Most transsexuals at one time or another gather up all of their clothes, makeup, wigs, high heel shoes, etc. and throw them away telling themselves that they can "cure" their transsexualism, if they simply don't have access to the clothes. Then many try a systematic approach to partial resistance (which is really close to acceptance) by limiting transgendered activities to a set period of time. For instance, a married transsexual may negotiate with the spouse to only dress two times a week then promising to reduce that to one time a week then to three times a month, etc. The hope is that strength of will can take care of this problem. It is a devastating discovery for many to find out it can't. This is especially for those raised male. The socialization which says: "Courage and strength of will are all you need to fix any situation" is challenged and failure to meet the challenge is interpreted as personal failure. When I say that therapy is a method of resistance, I don't mean that good gender counseling isn't vital to making an effective transition. I obviously believe that effective gender counseling is vital to the transsexual making an effective transition. That is why I'm writing this handbook. However, many transsexuals go into therapy so that the therapist can "get rid of these feelings." Would to God, there was such a therapy. But whatever school of psychology you study- psychoanalytic, cognitive behavioral, transactional analysis, gestalt, family systems, existential or humanistic- none have been able provide a "cure." The problem is some therapists not understanding or being familiar with the research will try to analyze the client into an appropriate gender role and just exacerbate the problem. If you find such a client in your office, your job will be to help that person reconcile herself to her condition and to work together to discover how best to deal with the fact of her transsexualism. Machoism is another popular way to avoid transsexualism in the MTF. I'm not sure a related version exists in the FTM. But many transsexuals try to avoid admitting their status by becoming overly involved in "manly" activities. They buy pick-up trucks, get jobs in male dominated fields, hunt, fish, engage in rowdy sports activities, join the military, engage in numerous affairs with women. Somehow they believe that by assuming an exaggerated version of the appropriate gender role that they can get rid of the transsexualism. The problem is that gender role and gender identity are different issues. Assuming one does not change the other. Marriage is one of the most troublesome ways people attempt to resolve their gender issues. Many transsexuals mistakenly believe that by getting married they will "get over this thing." I even had one person advise me that what I needed was a woman. The problem was I already had a woman, and she was me. Marriage leads to enormous complications for the transsexual, particularly where children are involved. What happens to a wife when she discovers her husband wants to be a woman? What happens to a heterosexual marriage when the husband discovers his wife wants to be a man? What happens to children when they discover Daddy is going to become Mommie(?)? These are difficult issues to resolve and often result from a marriage of resistance. Dealing with a transsexual couple in therapy is especially challenging. Even if the spouse expresses a compassion and support for the transsexual partner many unresolved issues are stirred up in both parties. We'll discuss this in greater depth in a future chapter.
Stage 3: Exploration of Possibilities
Ironically, victory in the struggle against gender dysphoria only comes after a surrender. Once the person stops denying that they are TS and stops trying to "cure" herself, she can begin to explore ways to make life-enhancing changes. For some this takes the form of finding everything in the library on transsexualism, transvestism, crossdressing, homosexuality and anything that might provide a hint as to what this condition is and how it can be handled. For others it might be visiting a gender group or signing on to a computer bulletin board service for transgendered people. It might involve little tests, like staying dressed all weekend or even developing a parttime life as a member of the opposite sex. Some seek the help of a professional gender counselor to discover more about themselves hoping that a Ph.D. or an M.A. behind someone else's name can give them the wisdom to tell them what they already know to be true. Howevever the person does it, she begins a process of exploration and self-discovery which is rarely easy. But without this exploratory phase she remains stuck in a cycle of denial and resistance, never moving forward and yet never finding rest where they are. By probing, by exploring she begins to see a future that could be possible: a future where her body and her mind are in sync, a future where she is no longer playing a role twenty-four hours a day, a future where she can become who she already is. Some may vacillate back and forth between exploration and resistance or even denial for a while. But as the person learns more, she begins to see some hope which moves her forward to acceptance.
Acceptance is not by any means the same as making transition. What it means is that the person finally accepts the reality of her situation and makes a commitment to do something about it. It was almost ten years ago, that I finally decided I was TS and that there was nothing I could do to change that fact. Given that situation, I started asking myself what I could do about it. At the time there was very little I could do other than make plans and develop my feminine persona. At times it seemed hopeless, but for some strange reason I believed that if I kept working at it I could somehow make it through. My goals sort of shifted over time. First it was just to be able to crosslive part-time while working full-time. I somehow didn't believe I could make transition and continue working in my chosen profession of teaching. But then I began to believe even that was possible. Finally a year and a half ago I made the move toward transition, believing it would be three years or more before I could go full time. Things began accelerating and now I'm biding my time waiting for a date with a surgeon.
Many of the people you see will be in this stage of the process. This is the point at which the person not only accepts her situation, but makes a committment to to move toward transition. Things start moving quickly once a committment is made. After a long period of denial and resistance, of exploration and getting used to the idea that you really are what you knew yourself to be as a child, it is hard to be patient with a process of transition which must be a slow and steady process. You will face some transferrance issues with transsexuals because of this fact. Once the committment stage is entered, the transsexual wants to move ahead quickly. Part of your job as a counselor is to restrain the transsexual from moving too recklessly out of impatience. I knew one person who went from almost full-time male to full-time living as a female in about three months. There were significant adjustment difficulties that arose. Although, the person has the gender identity of the opposite sex, she has been socialized in her birth sex. She literally has to learn a new gender role. This takes time, work and practice in a variety of situations to develop. This committment impels the transsexual to act. Knowing this will help you work with the person. If you can convince this person that your directives will help that person make the transition more comfortable or easier, then they will be likely to listen.
There is one final stage I should mention: Integration. It's hard to think about this as a separate stage, because it's simply the rest of the person's life after a successful transition. During this stage, the person really ceases to be a transsexual socially, physically and emotionally, and simply becomes a member of her new sex. Except when I'm working on something like this or doing counseling with a transsexual client, I think very little about being transsexual. This is a major contrast to just a couple of years ago when my condition dominated my thoughts. Integration is what most transsexuals strive for in life. Those that make the best psychosocial adjustments after transition are those that are able to acheive some measure of it in their lives. Part of your job after transition is to help the person become integrated into society in their new role.
Note: When I wrote this nearly four years ago, I believed that integration was the very last stage of transition. I was wrong. If the client does the work necessary to bring it about there is a stage beyond integration. That stage is transcendence. The integrated transsexual in essence becomes the woman or man she or he would have been if born that way. But for many of us, we discover that there is a place beyond that where we actually become a better person, not in spite or, but because of the gender problems which we faced and resolved. Like I tell my students, "When You've been through the fire, the sparks don't hurt so much." This stage, if clients knew about it, would be one great incentive to stay in therapy.
Like any recovery process, there are really three stages of therapy. First, the person has fallen in a hole and need help getting out. Secondly, they learn how to avoid falling into other holes. But third, they learn how to sprout wings and fly above the holes. It is a great hope for those still struggling to climb out of the hole to see the eagles flying above.This article was originally published by Carolyn Mason at [this page has expired]