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Counseling Psychology News

Article by Budge examines ‘insight for how to write letters for transgender clients’

September 22, 2015

An article by UW-Madison’s Stephanie Budge was recently spotlighted by the Journals Program of the American Psychological Association.

Budge is a visiting assistant professor with the School of Educatioin's Department of Counseling Psychology. She also earned her Ph.D. from that department in 2011.

PST coverThe article that’s being highlighted is titled, “Gatekeeping as a therapist? Gaining insight for how to write letters for transgender clients.” It was published in the APA journal, “Psychotherapy.”

The APS Spotlight reports: “A large majority of transgender (trans) clients will seek therapy at some point during their lifetimes. Trans is an inclusive term that refers to any individual whose assigned sex at birth does not match their current gender identity. Despite the fact that many trans clients will arrive to therapy with the purpose of attaining medically necessary surgeries and treatments, most therapists have no idea how to write a letter as part of the patient’s evidence of readiness for these treatments. Most training programs do not teach therapists how to gain cultural competence with trans clients, thus leaving therapists to refer their trans clients to other mental health professionals to receive a letter. Because trans individuals need a letter written by at least one mental health professional in order to receive medically necessary treatments, therapists find themselves in the role of a gatekeeper—they are the ones who get to say if their client should have hormone therapy or gender reassignment surgery.”

The article continues: “To demystify the process of letter writing, in her article published in “Psychotherapy,” Budge (2015) provides a case example of her therapeutic work with a trans client. The case example provides information about Lia (pseudonym), an 18-year-old Latina-Italian trans woman who arrived to therapy with the intention of socially transitioning (e.g. changing her name, changing her pronouns, coming out to others) and medically transitioning (e.g. engaging in hormone therapy, having breast augmentation, and surgery on her genitals). Lia filled out outcome measures over a period of 8 assessments throughout a year of psychotherapy and also consented to share excerpts of a therapy session in which she discussed having a letter written for hormone therapy with the author. From the beginning to the end of therapy, Lia reported less anxiety, less depression, higher well-being, more social support, greater change attributed to psychotherapy, and an increasingly better relationship with her therapist.”

The spotlight adds: “Perhaps most important in the findings was Lia’s report during therapy that she perceived the interaction of hormones and psychotherapy as improving her mood and that she felt it was important for a therapist to discuss the psychological impact of receiving a gender dysphoria diagnosis.”
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