an example of some therapeutic bullshit that trans folks encounter

By | November 29, 2016

This morning I read a book chapter by someone named Harriette Kaley, who is apparently a therapist in New York. The chapter is called “An unpublishable paper,” and it’s about a paper Kaley wrote about a transgender client. When she showed the paper to “Lee,” the client, Lee hated the paper and didn’t want it published. So instead of publishing the paper, Kaley made the perplexing decision to write a diffferent chapter about how “wrenching” it was to not be able to publish the paper. The chapter presents Lee as ignorant, emotional, and irrationally upset about what apparently feels to Kaley like a reasonable decision: To tell somebody else’s story of transition as if it’s hers to tell.

You can read the chapter yourself if you want, because I’m so mad at it that I don’t even know how to summarize it fairly. I’ll tell you some important things about it, though:

  • The chapter fails at best practices for both the conventions of pronoun use and terms for gender identity. Kaley explains that Lee began therapy presenting as a gay man but eventually came to identify as a transgender woman. Still, Kaley uses male pronouns to refer to Lee until about halfway through the chapter. This isn’t what we do. Unless you’re instructed otherwise, you should use the trans person’s current pronouns in all cases, even if it feels awkward to you. That looks like this: “When Lee first came to me, she identified as a gay man.” Additionally, we don’t fucking use the terms “transgenderism” or “transwomen” or “transmen.” We don’t use the term “transgender” as a noun.  It’s possible that Lee asked Kaley to use different gender pronouns and terminology, but I’m not inclined toward giving Kaley the benefit of the doubt on this one because of the remainder of this list of problems with the chapter.
  • The chapter includes exactly three references, two of which are to the work of Anne Fausto-Sterling. For the record, I like Fausto-Sterling’s work and think it’s valuable and useful. However, Kaley apparently doesn’t think that work is important enough to actually spell Fausto-Sterling’s name correctly. Throughout the article, Kaley refers to somebody named Fasteau-Sterling. Additionally, Kaley includes zero references that help her define gender identity or describe transgender experiences. Her expertise apparently comes from the fact that she is a woman, and that she had one transgender client–who, by the way, decided to terminate their therapeutic relationship for reasons that Kaley believes have little or nothing to do with her. In fact, Kaley takes credit for Lee’s decision to end the therapeutic relationship because “Lee began therapy with an almost crippling passivity,” but was the opposite of passive in deciding to end the relationship. Kaley sees this as evidence that “the therapy process had taken her a very long way.”
  • If you write a scholarly article about a research participant, and then you show the article to the participant and they tell you they hate it and don’t want it published, you are not allowed to pretend it’s their fault for not understanding what you’re trying to accomplish. That’s not only bad research, it’s also totally unreflective and defensive and ethically suspect. Kaley spends a lot of time explaining why all of the conflicts in the relationship with Lee are Lee’s fault. Lee is described as unable to clearly articulate her reasons for disliking the article:

As nearly as I can tell what his (sic) objections were, he (sic) had expected a theoretical piece about–about what? Being transgender? Transitioning? A critique of the society in which he (sic) was trying to live as a ‘transwoman’? What he (sic) got instead was what I had intended all along: a case study as a vehicle for considering questions of likeness and difference as they arose in working with a transgender person.”

Here you have Kaley describing how clear and consistent her intentions were, and how confused and incoherent Lee is about her expectations for the article. You also get a lovely example of Kaley’s failure to respect Lee’s pronoun choice and identity.

Kaley later explains that she tried to incorporate all of Lee’s criticisms and corrections into the final paper and writes, with implied surprise, that “the interesting thing is that the paper ended up, I am convinced, significantly better.” It’s weird how if you actually collaborate with the person whose story you’re trying to tell, the story becomes more reflective of their experiences and realities. Weird how that makes it a better paper.

  • This chapter has no discernible argument or implications. It reads as a defensive justification of a failed therapeutic relationship, and along the way, it misgenders a client, removes the client’s agency over her story and how it’s told, and apparently circulates the story without ultimately asking or obtaining Lee’s permission.

But I haven’t even gotten to the best part yet!

  • This quote, near the end of the chapter: “If there is value in this story, it is not just in its cautionary tale. It is not even in what it illuminates about the rocky arena of informed consent. It is in what became clear were the issues Lee was grappling with and that caught my paper in the line of fire.”

You have to be fucking kidding me. It must feel so terrible to have to sacrifice a Very Important Paper to the needs of a client. It must be so sad that Lee’s struggle with her identity and her relationship with her therapist had such a negative impact on Kaley’s professional goals.

Near the end of the chapter, Kaley identifies some “unanswered questions and unexplored issues” regarding Lee’s opposition to the publication and decision to terminate the relationship. “(W)as Lee expressing anger towards me in the guise of righteous indignation? Were there specifically transgender dynamics at work, as, for example, Lee’s feelings about me as a ciswoman or mine about her as a transwoman? Envy perhaps, or hostility?”

If there’s any hostility evident, it’s in Kaley’s depiction of Lee. (Kaley helpfully explains that “Lee was quite militant in her stated belief that she is as much a woman as any other.” Lee was “militant”–not “firm” or “adamant” or “decisive.” Lee was also, according to Kaley, “militant about being addressed with the proper pronouns.” Not insistent. Not consistent. Not clear. “Militant.”) And the idea that trans folks “envy” cisgender people? Come on. That’s the language of trans-exclusionary radical feminists, and it has no place in the thoughts or writing of any therapist who wants to build therapeutic relationships with transgender clients.

This chapter fails to adhere to standards of care for mental health professionals working with transgender clients. It also fails to adhere to the ethical standards of qualitative research, most evident in the author’s apparent decision to publish this paper without the consent of her client. (Maybe I’m wrong! Maybe Lee did consent! If so, I would be delighted to post a correction.) It’s therefore not only problematic, but it’s also dangerous.

This chapter was published in a book called Psychoanalytic perspectives on identity and difference: Navigating the divide. The editors, Brent Willock, Lori C. Bohm, and Rebecca Coleman Curtis, should be embarrassed and ashamed of themselves for agreeing to publish this chapter. I hope they will consider removing it in later editions, and issuing an apology for deciding to include this chapter in the first place.