Trust in Uncertainty: The Therapeutic Structure of Possibility, Turning Points,​ and the Future of Psychotherapy with Transgender, Nonbinary, and Gender-diverse Individuals

ABSTRACT

Therapists are conduits of possibility as we hold a vision of what is possible for people who come to us seeking support and change. Gender specialists help transgender, nonbinary, and gender-diverse (TGNB) people to increase the possibilities in their lives. Therapists facilitate positive change—on an individual level, through therapeutic practice, and on a macrolevel, by being involved in the community of psychotherapists and in the field of transgender health. As we approach our work, we reflect upon the limitations of our knowledge and vision to be realistic and to allow for possibility. We respect uncertainty on an individual level because people are complex and change over time as the world around them changes, and we respect uncertainty on a cultural level because the language and concepts of gender change and evolve across time and place. Cases are presented to illustrate the use of psychotherapy to address uncertainty and create possibility for TGNB people.

Acknowledgment

My sincere thanks to the leadership of the Institute for Contemporary Psychotherapy, the executive committee of the Psychotherapy Center for Gender and Sexuality, and the organizing committee of the Trans Formations, for inviting me to speak.

Disclosure statement

I have no conflicts of interest or financial relationships to disclose.

Notes

¹ I began the live presentation by playing a video of Sydney Lucas performing “Key Song” at the Tony Awards in 2015.

² Based upon actual cases, the details have been changed here to protect privacy.

³ At this time the SOC 8 is a long way from completion and it remains unclear exactly how the needs of eunuch-identifiedindividuals’ will be included in the final document.

⁴ I refer you to the home page of The Eunuch Archive, founded in 1996. “A friendly support site for the eunuch community.” Also see Vale et al. (2010).

⁵ “Male-to-eunuch gender dysphoria can manifest itself in different ways. The common thread is that individuals do not want fully functioning male genitalia and embrace the identity label eunuch. Some individuals are indifferent to having male external genitalia, so long as they are only physically present and do not function to produce testosterone and male sexuality.” From a draft of an unpublished paper by the Eunuch Taskforce of the SOC8 (Johnson et al., 2019).

Additional information

Notes on contributors

Katherine Rachlin

Katherine Rachlin, Ph.D. is a clinical psychologist and gender specialist in private practice in New York City. For almost 30 years she has worked to support transgender individuals and their families and partners and to increase TGNB individuals’ visibility and access to care. She is a past member of the Board of Directors of the World Professional Association for Transgender Health (WPATH) and the Board of Directors of FTM International. She was co-chair of the steering committee to launch USPATH and is one of the authors of Standards of Care for the Health of Transgender, Transsexual, and Gender Nonconforming People, V. 7 (2011). Her many published papers include “Flexible Use of the Standards of Care,” “An Intake Template for Genderqueer College Students,” “Transgender Individuals’ Experiences of Psychotherapy,” “Factors That Influence Transmasculine Individuals’ Surgical Decisions,” “Medical Transition Without Social Transition,” and “The Experiences of Parents of Individuals Who Transition in Adulthood.”