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Blog & T-Notes


#1.Dances With Therapists

  By Anne Vitale PhD -- Mar 28, 2022

T-Note #1
Dances With Therapists
....or hard time getting to the first appointment with a gender specialist

by Anne Vitale Ph.D.
Originally posted on February 15, 1996

Rev 1-- October 7, 2000

Rev 2 -- May 22, 2011

Asking for help in coping with crossdressing, gender dysphoria and other related issues is often difficult. Making that first call to a therapist is especially hard. Even when the call is completed and an appointment made, getting to the therapist's office is often several degrees of difficulty harder. In fact, most gender therapists expect only one out of every two people who call and make an appointment to show up. Since this "no show ratio" for potential gender clients exceeds the "no show ratio" in the general population, it probably has some significance. Let's look at some ...
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#2.The Intake Appointment

  By By Anne Vitale Ph.D. -- May 29, 2022


The Intake Appointment
March 7, 1996

In T Note #1 I wrote about the machinations, or to put it more poetically, the dance that goes on between a potential gender client and a therapist. This time I'll concentrate more on the specifics of the intake appointment.

As you may recall, I said there is a large amount of sizing up that goes on by both parties during the first appointment. This is as it should be: both parties have a lot at stake in establishing a favorable therapeutic relationship. The client is dealing with an extremely important and personal problem. The wrong therapist can set an individual back for years. Meanwhile, the therapist is deciding whether or not to commit to the clearly defined professional, legal, and ethical responsibilities that are inherent in accepting any client.

Although the routine varies from therapist to therapist, all prospective clien...
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#3.The Hormone Evaluation Period

  By Anne M. Vitale PhD -- Apr 1, 2022

The Hormone Evaluation Period

Anne M. Vitale PhD
Originally posted on Jan 1, 2009 -- Revised: August 6, 2011 and April 12, 2013

As you might expect, the first couple of meetings in any therapeutic relationship are extremely critical. This is especially true if the presenting problem is a gender identity issue. People come in at varying stages of dealing with their gender issues and the work always starts from there.

--A growing number of people have come into see me already self medicating using hormones bought over the internet. Although self medicating may not necessarily be a non-starter, it does raise serious safety issues which we will need to address immediately. Please be prepared to be open and honest about any online hormones you are currently taking or have taken in the past.

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#4.Unlived Lives

  By Anne Vitale Ph.D. -- Jun 4, 2022


Unlived Lives:
....or waiting for life to begain because of gender identity issues

August 28, 1996

When I say "unlived lives," I am speaking of the frustrations inherent in "waiting": waiting for life to begin. Yes, one is doing what everyone else is doing, but the "doing" has a hollow feel to it. Life has more of a spectator quality rather than real time, actual involvement. Life takes on the quality of being in an intolerably long line at the bank. Everyone gets to the teller window but you.

For most gender identity conflicted individuals the waiting starts very early. Little boys wait to be allowed to enter play with the girls as a girl. They wait for a pretty dress to wear or a doll to mother for their birthday. Little girls get by with tomboyish behavior but they also know they're in a serious strugg...
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#5.Guilt & Shame

  By By Anne Vitale Ph.D. -- Aug 28, 2023


Guilt & Shame:
The Unfortunate Twins of Gender Dysphoria

October 12, 1996

My handy, online edition of the American Heritage Dictionary (3rd Edition, 1992, Houghton-Mifflin, Softkey International, Inc.) defines guilt and shame as follows:

guilt n. 1. The fact of being responsible for the commission of an offense. 2. One that brings dishonor, disgrace, or condemnation. 3. A condition of disgrace or dishonor; ignominy. 4. A great disappointment.

shame n. A painful emotion caused by guilt. 1. The fact of being responsible for the commission of an offense. 2. (Law) Culpability for a crime or lesser breach of regulations that carries a legal penalty. 3. a. Remorseful awareness of having done something wrong. b. Self-reproach for supposed inadequacy or wrongdoing. 4. Guilty conduct; sin. Strong sense of guilt, embarrassment, unworthiness, or disgrace.

Guilt an...
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