A Therapist Struggles with the Clinical Choices He's Made

Reflections on a Marriage Therapy with a Transitioning Spouse

David Treadway

By David Treadway

Sometimes I’ve been instrumental in helping couples stay married when perhaps they’d have been happier if they’d gotten divorced. Other times, it’s been the reverse. Obviously, we all know that’s it not our job to tell our clients what’s right for them: rather, we need to create the right conditions for them to discover the answers for themselves. Frequently, however, our own reactivity shapes the messages we send and how profoundly we can influence---in unconscious and unpredictable ways---the unfolding of some couples’ lives. I feel that way about my work with Glen and Julie over a 14-year span.

An Ordinary Case

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, busy lives, and what seemed to me a pretty sweet relationship. They came to see me because they were having a painfully mediocre intimate life: she wasn’t all that interested in sex, and he felt hurt by always being in the initiating role, with little success. For her part, Julie was gently accepting of his difficulties with premature ejaculation and seemed perhaps too willing to be the problem. In their shared sense of fragility, they were usually extra careful not to hurt each other’s feelings. 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. So it’s all my fault now?”

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 and taking the blame for seeming to align too much with Glen’s sexual complaints. 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. Julie asked Glen, “Do you want to tell him or shall I?”

“Why don’t you tell him,” he said with a little blush.

“Well, after that dreadful session, we finally talked about what came up. And then all of a sudden, he 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 was looking through her drawers and came across her lingerie, and the next thing . . . .” She paused and looked over at Glen. “Is it really okay if I say all this?”

He nodded without looking up.

“Well,” she continued, “he told me that’s a private activity he’s never told anyone about his whole life, and he was so ashamed when I walked in on him. And then he started to cry, and I was holding him, and then we were suddenly starting to, you know, get aroused. And then I offered to let him wear my underwear.”

“Okay, that’s enough,” Glen whispered quickly. “We don’t need to go into the specifics. He gets the drift.”

In the weeks that followed, I tried to support their newfound intimacy. Somehow, his 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 or treat it as a psychological issue. 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, and I felt pleased about what felt like a happy ending.

Act Two

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---looking wan and much older---and Glen---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. He, now she, was planning on completing her transition with implants and genital surgery.

“We’ve tried for a long time,” Julie said. “I so wanted to keep our family together, and it seemed like each step he made was somehow going to be the last step.” She started to tear up. “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, and I was willing to try anything. 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 can’t do that. I don’t want to be married to a woman, but he says he’s just not a man anymore.”

After that, we had several sessions with many tears, but no movement. I tried challenging them to find some viable, mutually acceptable compromise, but Emily decided to complete her sex-change treatments, and Julie simply couldn’t continue down the path with her. They chose divorce.


It’s been years since I’ve seen this family. While I was writing up this case, I decided to give Julie and Emily a call to see how they were doing. Julie, her marriage having ended and her kids having grown up, seemed sad and a little stuck. She wasn’t dating or working, but she did say that she and Emily were getting along tolerably well. They could do some family events together, though she was uncomfortable with including Emily’s partner. Emily, in contrast, seemed quite content and had found a male partner with whom she’d been living for the past couple years. Sarah, their daughter, Emily said, was still standoffish, didn’t visit Emily’s home, and refused to meet her partner. But she did keep up her agreement to see Emily from time to time and occasionally talk on the phone.

Was Emily’s transgender journey inevitable? Certainly some cross-dressing men stay within marriages and don’t feel compelled to live full-time as women or become women. In our early sessions, did my delicacy about not making Glen feel ashamed about his cross-dressing inadvertently undermine the couple’s ability to find a way of working through this together? Perhaps if I’d dug into the issue more, they’d have felt more comfortable coming back to me earlier to find some kind of compromise---something that didn’t seem to be part of the gender therapist’s agenda.

In retrospect, I realize how much my own uncertainty and conflict avoidance had made me tiptoe around the central issue in this case. I was reluctant to confront Emily about the effects her decision might have not only on her marriage, but also on her 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 what I tell my students to do all the time: seek supervision. I didn’t even consult with a gender specialist or call the one they’d been seeing.

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? Perhaps it’s my hubris that makes me think that if I’d only done X, Y, or Z, then they’d have lived happily together ever after.

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.

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

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Illustration © iStock/Meriel Jane Waissman

Topic: Couples | Sex & Sexuality | Cultural, Social & Racial Issues

Tags: Couples & Family | couples conflict | Couples Therapy | couples/family | gender | gender issues | gender roles | male sexuality | Sex & Sexuality | sex life | sexual fantasies | sexuality

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Saturday, March 19, 2016 1:10:02 PM | posted by Lisa Anllo PhD
Very useful vignette, it illustrates effectively the need for consultation when practicing outside the scope of one's expertise which is a brave and educative thing for this author to disclose. I am a sex therapist and experienced in counseling mixed orientation couples such as this one. I think it certainly may have helped them had the therapist normalized and more directly confronted the inherent conflict when a couple that starts off as presumably heterosexual and cisgender becomes a couple struggling to integrate the coming out of one partner later in the marriage--not at all uncommon that they would initially seem to find a way to accommodate this and later on despite best efforts and intentions to end up separating--I don't forsee a different outcome for the marriage had this been handled differently but one hopes this is achieved more amicably fpr the couple and for the entire family with the help of therapy that is not overly focused on the person coming out as many gender therapists tend to do (who are not the ones who would not have been helpful in a consultation), but rather honoring the experiences of both parties. Amity Buxton has written about straight spouses in the context of spouses coming out as gay and bisexual where there is plenty of overlap but a better resource is V. Erhardt's "Head Over Heels: Wives who stay with Crossdressers and Transsexuals". The therapist should adapt to where the couple is at and support those who want to try to stay together but also support those who decide to separate. Another key point is to normalize the progression for some crossdressers to ultimate outcome of full transition which can be diagnostically confusing yet quite common for men who partner with women.

Saturday, March 12, 2016 4:45:00 PM | posted by Machell Bekaert
I was extremely moved by what you wrote for Psychotherapy Networker. As therapist, myself, and one who works with many couples (heterosexual, and homosexual), as well as individuals in the LGBTQ community, I just want to tell you that I believe you did a great job with this couple. It seemed to me that Glen/Emily had no idea that they were transgendered when you began treating this couple. And the way you handled Glen's cross dressing was very compassionate and appropriate. I think your treatment helped them both grow and evolve in many ways. I'm a straight female married to a straight male who likes to cross-dress occasionally. He's got great taste in clothes and shoes, and I love when he shops with me. But like Julie, I wouldn't have wanted to marry him if he had planned to transition to a female. He doesn't, and usually presents as male. But when he wants to present as female, I'm fine with it. I apply his makeup (He's not bad at it, but I'm better), and we'll go out and have fun. (Sorry--got off track there.). I just want to support you on your work with this couple. Clearly, Emily didn't know she was a female for many years. And you helped Julie accept Glen when he was struggling with his gender issues. I admire your work, and learned much from your submission. Warm regards, Machell Bekaert, LPC , Cht