Wrestling with Our Clinical Choices

Do Any of Really Know What's Right?

David Treadway

Up until my eighth session with Julie and Glen, they’d seemed to be a vanilla kind of case—a middle-aged couple with two middle-school children, two careers, and what seemed to me a pretty sweet relationship. They came to see me because they were having a mediocre intimate life. Then, toward the beginning of one session, Julie dropped a bomb. “Well, I don’t think his ‘male needs,’ as you call them, Dr. Treadway, always get expressed so normally,” she announced. “A few years ago, I walked in on him dressed up in my underwear!”

“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.”

Sexuality isn't simple. If you're seeing young clients struggling to figure out what's right for them, and you need a little guidance too, this FREE printable worksheet can help.

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.


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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Topic: Couples | Children/Adolescents

Tags: counseling | divorce | EFT | emotion | intimacy | science | separating | sexual orientation | SPECT | TED | therapist | therapists

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Wednesday, December 2, 2015 2:48:59 PM | posted by wonderful
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Sunday, November 23, 2014 6:05:57 PM | posted by Nicole
I agree with the comment that this therapist was "brave." We should be able to discuss evolving in our personal lives and professional lives without the scrutiny of virtually anonymous people on the internet criticizing us. We've all been in situations that were difficult to maneuver due to our lack of understanding or knowledge but desire to help, especially when a trusting relationship already exists. Also FYI medical doctors quite frequently treat people with conditions they know nothing about. And mistreat them. And misdiagnosis them. Welcome to the medical profession of trial and error.

Wednesday, October 15, 2014 6:54:58 PM | posted by Deborah Emery-Giglio
I am a counselor who work with clients who are transgender and love my work. I have read a lot of books and been mentor by others doing this work. I would love to take some courses for CEs but can never find any. Do you have some resources? I noticed that you mentioned in your remarks that there are places to get CEs.

Wednesday, October 15, 2014 5:37:06 PM | posted by Jake
I think the title of this article is misleading. It sounds as though the therapist was transgender, which wasn't the case. I think it is a disservice to not seek out supervision or refer clients to another therapist if you feel you are way out of your skill set as a therapist. The issues that transgender people face are very difficult and a therapist can do real damage if they don't have training with transgender issues, or if the therapist isn't willing to face their own uncomfortable countertransference feelings. A medical doctor would not treat someone with a condition that they new nothing about why do therapists think they can do this and that it's ok? We as a profession really need to examine this closely. Transgender people deserve the best mental health treatment just like all of us do. We need to take a good look at our own issues as therapists. That said, I'm glad that this therapist was brave enough to reveal these doibts about his/her work.

Saturday, October 11, 2014 3:08:42 PM | posted by Claudemiro Soares
I'm so sad to hear about these things. I'm a 39, married, 2 kids. I used to be 100% gay but I've found the way out. I'm sad to hear people saying "it can´t be done", when they think about sexual orientation change. It CAN be done! I'm not telling you that it MUST be done. No way! I've got a Master in Public Health and I wish people could open their mind to ALL different points of view. I hope politic won´t defeat Science forever, as it has done up to now. Contact: clausofe@gmail.com P.S: I'm from Brazil.

Saturday, October 11, 2014 1:57:18 AM | posted by Leslie Hilburn Fabia
I am an LICSW, married for twenty years to David Fabian, MD (an orthopedic surgeon), and now to Deborah Fabian for three years. Please read my recently published book, My Husband's a Woman now: a Shared Journey of Transition and Love. I believe it can be a useful tool for therapists, as well as providing assistance to others like us. This is not my dream come true; it's my spouse's. However, our relationship remains loving, mutually supportive, and truly better than most! We have six adult children between us, all of whom have accepted their father's/stepfather's transition to female. You may read excerpts from my book at Amazon or Barnes and Noble online. It's available in paperback, as well as in ebook form. This transition was a very challenging chapter in my life and I know that it's not for every wife. Compassion and support are necessary for BOTH individuals in a transgender relationship. It behooves us, as therapists, to learn whatever we can about this phenomenon. I'm convinced that it will be showing up more and more frequently.

Saturday, October 11, 2014 12:08:42 AM | posted by Geri
You wrote, "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." I am guessing that Emily likely had already spent plenty of time considering those things, as most transgender folks do. I think that it is just as well that you didn't ask her those questions, as it might have simply been received as unnecessary guilt-tripping. A transgender person who chooses to self-actualize is acting from their deepest core, and is has their best chance at happiness when they are able to transition their body to match their self-image to whatever extent they feel led to. Ultimately the health of the individual must come before the marriage. As for the children... There are many children of transgender people who adapt to the change and thrive, just as children can continue to have a happy life after a parent comes out as gay, or becomes differently able, or any of a number of changes that can happen in a life. Please do go seek some education about how to work with trans folks - there are a lot of good books and CE courses these days.

Friday, October 10, 2014 3:44:56 PM | posted by Paula Susan
More and more our culture is slowly making room for people to be truly authentic. It is about time. there are so many people who struggle with self-esteem issues, who are heterosexual,not comfortable in their own skin,. And here are a group of people who have been forced to live invisible. Our society has long been looking at those who are different, with disdain and disrespect. How terribly sad, how terribly disrespectful to human beings who have such a brief time on this earth and have to hide their true identity. Joe Kort has wonderful information about the culture of gay, lesbian, transgendered people. We all should take the time to notice that they are human just like us. How they choose to live their time here on earth should be, needs to be their choice. What right do any of us have to make those decisions about who is okay and who is not. None of us should be looking into the bedrooms and hearts of others unless someone is physically or psychologically in danger. These people are people. They have enough challenge to survive in a hostile world. Let's make it a welcoming one.
Paula Susan