Therapists working in the gender community are often viewed as this gatekeeper was - a powerful figure that can determine entry, and must be convinced, cajoled, bribed or tackled into allowing admission. Clients often come prepared to their first session, armed with more clinical reading material than any other client population. They are either terrified of me because I have the power to diagnosis them, or furious at me because they need me to diagnosis them in order to receive the medical care they desire. Developing a healing and trusting relationship that starts from the premise of power and exclusion is a challenge.
Clients are right to be wary.
Most therapists are ignorant of issues of transgenderism, and have had virtually no training on these issues. The trans political community denies any model that diagnoses disease, and insists on access to available medical treatments on demand from a system that inherently infers an illness model. The politics of a liberation movement, however liberating, do not often bear witness to the intensity of very personal human pain in the face of gender confusion. I am a therapist. What this means to me is that I am a professional with experience and expertise in understanding something about human pain, and assisting people to live healthier, more productive lives.