ED: How Honest Should I Be In Therapy?

Hello,

You should be as honest as possible with your therapist. Hiding things from him/her will only complicate things for you.

Remember that therapy is based on science and psychology, and not on the personal opinions of the individual therapist (considering we are talking about a certified and competent therapist, and not a charlatain). Sure, it may be frustrating to hear you will need to wait and do X or Y before getting what you really want out of therapy. However, there are reasons why it is needed to address other things first in some cases. Remember that transitioning is a process that changes your body, and trying to force or speed things up without proper care and professional support may end up not working correctly or even harming you, which will be more frustrating.

Sometimes, we judge therapists or medics based on our personal opinions. Sure, they are humans and they make mistakes, but they have studied a lot to work on the health field, and therefore are more prepared than the average person to decide how processes that are directly related to your health should go. The person you saw on the google review may have written that out of frustration, but does that person have enough knowledge about health science to back up that review and decide things alone?

In short, remember that by going through therapy you are making progress, and that's an important thing! As much as it things may sound frustratingly slow, please be honest with your therapist. That way, you two may work together to advance everything, without unecessary risks.

 

I echo Chiroptera's viewpoint. When a client is seeking a given treatment (especially something as drastic and irreversible as hormones for transgender treatment), the therapist has a responsibility to ensure that the treatment the client is seeking will not cause further harm.

In the case of bulimia, that's a pretty deep-seated issue that often has complex roots, and can be potentially life threatening. The same is true of cutting and self-harm. It's easy to say that both of those behaviors are coping strategies for gender dysphoria, but the research and current thinking indicates that the roots are far more complicated. Adding to that, some of the root causes of bulemia can, in and of themselves, create gender dysphoria. In other words... there are a significant number of people who started to transition, figured out that transitioning was not really the solution to their discomfort and dysphoria, and had to de-transition (which has only limited success, depending on how far transition has progressed.)

Giving hormone therapy to someone who already has a pretty severe mental health concern would be incredibly irresponsible, as the way that hormones interact with brain function, thought, impulse control, and various other factors can in some cases significantly amplify the ineffective behaviors. In other words, taking hormones can actually increase bulimic or self-harming behaviors (or various other ineffective coping strategies) in some people.

So as much as you may be convinced that you know what you need, and the therapist is simply a gatekeeper standing in the way of you getting what you want, the therapist is actually there to help you make the best possible decisions for your own mental health and physical health. Lying to your therapist might get you what you want... and might well end up with you having far more severe problems than you currently have (as difficult as that may be to believe).

I also have to say, I am not a fan of the so-called "informed consent" clinics. I realize that for some people they may be the only option, but I really feel like they are basically a last resort. It can be pretty irresponsible for a physician or therapist to essentially be a prescription mill under the guise of explaining the risks and letting the patient decide, especially if the patient has other mental health issues that could influence his or her decision. I know they've definitely been lifesavers for some folks, and I also suspect that they may be the source of a lot of heartache for people who get what they want, and then realize that maybe it wasn't really what they wanted. The therapist evaluation process is intended to prevent that heartache, though I recognize that sometimes it can create heartache of its own. The field is doing its best to balance these two issues, and it's a very complex situation with few clear answers.

 

One of the really insidious things about eating disorders -- especially bulemia -- is the shame involved. Because it is such a private thing, and because it is often possible to hide it, the shame becomes that much more magnified. I can say with a pretty high degree of confidence that if you do share it, you'll feel much better getting that load off of your mind. Sharing here helps, but sharing in real life is so much more relieving for most people.

And from what you describe, I think it would be worthwhile to talk to a therapist about the dysphoria associated with your voice. If someone came to me with that sort of presenting symptom, I'd want to spend some time with them exploring that and looking at other origin possibilities before assuming it is dysphoria and that the person is trans.

I can't tell you what to do, but given the constellation of symptoms and experiences you are describing, you would do yourself a huge service by opening up completely to your therapist, and asking him or her to help you explore it.

I hope that helps!

 

It doesn't sound like you're particularly interested in exploring the origins of the bulimia, and that's certainly your choice to make. It's not a choice I would make, but I wish you the best in any case.