Wrestling with Our Clinical Choices

“Damn it, Julie!” Glen yelled. “I can’t believe you brought that up here.”

I was stunned. “So, Glen, it seems like you’re really hurt that Julie would bring this moment up in our therapy without warning,” I said. I tried to be a comfort to each of them, normalizing how embarrassing secrets can sometimes be blurted out in the supposed safety of the therapy room. Meanwhile, the couple huddled in their separate corners of the sofa without looking at each other. They endured the rest of the hour and got out of there as fast as they could—without making another appointment. In the following weeks, they didn’t return my phone messages, and I felt as if I’d blown the case. But after a month and half, I was delighted when they phoned to set up another appointment.

To my surprise, they shyly walked into my office holding hands. “Well, after that dreadful session,” Julie said, “we finally talked about what came up. Glen told me that it all started when his mom died, when he was 10. He told me that he used to go into her closet just to smell her smells because he missed her so much. One day, he came across her lingerie, and the next thing....” She paused. “Well, he told me that’s a private activity he’s never told anyone about, and then he started to cry, and I was holding him, and then we were suddenly starting to get aroused. And then I offered to let him wear my. . . .”

In the weeks that followed, I tried to support their newfound intimacy. Somehow, Glen's vulnerability around his idiosyncratic way of feeling connected to his mother, and Julie’s compassion for him had led to a rekindling of not only their sexual life, but also of their emotional connection. Careful not to rock the boat as I had before, I was reluctant to probe deeply into his feelings about his cross-dressing. After all, they seemed comfortable with his wearing her underwear as part of their sexual play, and it seemed to make them both feel more connected. I know other therapists might have more aggressively explored his attachment to wearing women’s lingerie, but I chose not to. It felt so right between them that I decided to let it be. They left therapy seemingly quite content.

Eleven years later, Julie surprised me with a phone call. “A lot has changed,” she said in a way that sounded sad but didn’t prepare me for our session. So I was surprised when two women came into my office: Julie and Glen, who was dressed fashionably as a woman with startlingly feminine features. It turned out that Glen, who was now referring to himself as Emily, had gotten electrolysis and was on female hormones, planning on completing her transition with implants and genital surgery.

“I so wanted to keep our family together,” Julie said, “but he’s been so preoccupied with feminizing himself and actually separating more from me. When I asked him to come back to see you, he said you didn’t know anything about trans issues. He insisted that we see a gender specialist who’d understand better. The therapist seemed to think this all was a natural evolution for Glen and that it didn’t mean he didn’t love me. But now Glen wants to go all the way, and I just don’t want to be married to a woman.”

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After that, we had several sessions with many tears, but no movement. I tried challenging them to try to find some viable, mutually acceptable compromise to stay together, but soon Emily decided to complete her sex-change treatments, and Julie simply couldn’t continue down the path with her. They chose divorce. Was this an inevitable outcome? Was it a successful one?

I look back on this case with awe about their journey and questions about whether I should have done something differently. Emily does seem to be confident in her journey, and the evolution of her sexual orientation implies that perhaps there never was a chance for her and Julie to stay together. But I’ve learned enough to know that complete transitions and divorce are not necessarily the only outcome for couples that face gender identity and/or orientation issues.

In retrospect, I realize I was reluctant to confront Emily about the effects her decision might have, not only on their marriage, but also on their children. And I was hesitant to push Julie to consider joining a support group of wives, or even to explore her reluctance to consider making a life with a transgender husband, as other women have done. Somehow, their choice to see a transgender specialist, rather than come back to work with me, had frozen me in more uncertainty. I didn’t know much about cross-dressers or transgender individuals. Nor did I do a thing I tell my students to do all the time—to seek supervision. Was I too embarrassed about my choices throughout the case to ask for help?

How do any of us therapists know what’s good enough in the unfolding of people’s lives? Who knows what would have happened in this family if they’d tried to stay together? I know I practice an often intuitive craft, not an exact and predictable science. I bring my therapeutic models, repertoire of techniques, previous clinical experience, and all-too-limited personality to my encounter with the clients I see. And the truth is that all too often, like most practitioners, I can never be quite sure how much difference my bit part plays in the unfolding drama of their lives.

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David Treadway, PhD, is a therapist who’s been giving workshops and trainings for 40 years. A long-time contributor to the Networker, he’s the author of Treating Couples Well and four other books.

This blog is excerpted from "Questions of Gender," by David Treadway. The full version is available in the September/October 2014 issue, There and Not There: Growing Up in an Age of Distraction.

Photo © Dragan Andrii/Dreamstime.com

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