Q: Do you take insurance?

A: I am in-network with Regence Blue Cross/Blue Shield of Oregon.

I expect to be in-network with several other forms of insurance by 2020. In the meantime, my fees are extremely reasonable.

In some cases, my services might be covered if you have “out-of-network” insurance benefits. Check your insurance card–it will usually say whether or not you have out-of-network benefits. If you do, how’s how it works: you’ll pay me for each session at the time of our appointment. Then, I’ll send you an invoice to send to your insurance company. If your insurance company accepts the bill, they will reimburse you for all, or a portion of, the cost of our session.

If you have an insurance deductible, you might be able to count the cost of our sessions toward the deductible. Again, in this case, you would pay me upfront, I would send you an invoice, and you would submit the invoice to the insurance company.

Q: Do I have to come for counseling the same time every week?

A: Not at all. I have a flexible schedule, and I can easily see you at a different time every week.

Q: Do you do couples’ counseling?

A: Yes, I do. I have hundreds of hours of training in couples’ counseling, and I work with couples of all ages, races, sexualities, and gender identities. In addition, I work with couples who are in open, non-traditional, or poly relationships. I also work with triads, communes, and poly families.

Counseling for Transgender and Gender-Nonconforming Individuals

Q: Do you write letters of recommendation for hormones and/or surgery?

A: Yes. I have written letters of recommendation for both hormones and surgery. As a mental health professional, I recognize that these procedures can drastically help improve one’s mental health. When your body finally begins to match the person you feel you are inside, you might feel happier, more relaxed, and less conflicted about your gender. We can process and discuss this in therapy.

Q: How long do I have to see you before you write me a letter?

A: The short answer: probably a few weeks, although each person is different. The long answer: The World Professional Association for Transgender Health (WPATH) states in their Standards of Care that “therapy is not a pre-requisite” for either hormones or surgery. This means that, under WPATH Standards of Care, you don’t have to go through therapy before you can access these procedures. However, you do have to have a “mental health screening” to ensure that you are psychologically and practically prepared to start these procedures. Some doctors may feel competent enough to do this mental health screening themselves before prescribing you hormones or performing surgery. However, most doctors prefer that a qualified mental health professional, such as me, perform this screening. Keep in mind that a “screening” is more of an assessment, and not really the same as therapy. A typical screening usually takes about 2-3 sessions. During this time, I will collect your history, talk to you more about your gender, and make sure you understand the risks and benefits of hormones and/or surgery. After the screening, I will typically write you a letter (the most common scenario) or recommend further therapy (for some circumstances, such as substance addiction, as a client cannot safely take hormones while actively in addiction).

Q: After you write me a letter, can I still see you for therapy?

A: Most clients choose to continue therapy with me after I have written them a letter. I encourage this! My clients have told me that being able to have a “transition ally,” and a safe, supportive space to discuss and reflect on their transition, was immensely helpful for them. In addition, many clients come to work on issues not related to, or only slightly related to, transition, such as trauma, anxiety, or family problems.

Clients might also find that hormones can change their emotions, thoughts, or reactions to events. It can be helpful to have a therapist with whom to discuss these things.

A few clients choose not to see me for therapy after I write them a letter, and that is perfectly okay as well. Some of these clients will return to me in the future if they face unexpected challenges during their transition.

Q: I have depression (or anxiety, or bipolar disorder, or PTSD, etc). Will you still be able to write me a letter after 2-3 sessions?

A: In most cases, yes. Mental health conditions, such as depression and anxiety, can be related to the feeling that one’s body does not match one’s gender (gender dysphoria). Having access to medical interventions such as hormones or surgery can greatly help to reduce the symptoms of depression, anxiety, and other mental health conditions. In addition, having a mental health condition usually does not impair your ability to make your own medical decisions.

The WPATH Standards of Care state that if you have a mental health condition, it must be “reasonably well-controlled” before you can be prescribed hormones or undergo surgery. What does “reasonably well-controlled” mean? This will probably be different for every client. You and I can discuss what “reasonably well-controlled” means to you. In some cases, it might mean being able to come in and see me on a regular basis to process your feelings and get support. However, this does not mean I will delay writing you a letter; I usually simply write in your letter that you have a mental health diagnosis , and that you and I plan to address this with regular therapy. I have never had a physician reject my letter of recommendation based on a client’s mental health diagnosis. The medical community is becoming more aware that mental health diagnosis should not disqualify a transgender individual from obtaining medical interventions.

My clients tell me that it is a relief to be able to “be themselves” around me, and fully express their pain and struggles without worrying that something they say is going to disqualify them from getting a letter. I am aware of that, historically, therapists have been “gatekeepers,” holding the unfair power to decide whether or not a client could access medical interventions. My goal is to create as little hassle for you as possible to access these interventions, while at the same time providing you with individualized support under the WPATH Standards of Care.

Q: I have been told that I need three (or six, or twelve) months of therapy before I can get a letter. Is this true?

A: Under WPATH Standards of Care, this is not true. You are not required to have therapy to get a letter of recommendation, only a mental health screening. Of course, many clients find that therapy can be extremely helpful to them throughout their transition. But the decision to pursue therapy is yours alone.

Q: My child says they are transgender. Can I sit in with them in the session?

A: Yes, and I encourage it! As a parent, you have the greatest influence over your child— transgender youth with supportive families are exponentially less likely to suffer depression and have problems in adulthood. When a child or teen comes out as transgender, this means a change for the whole family in some way, and therapy can be very helpful to help parents, siblings, and other family members navigate that change. Therapy can help increase communication between you and your child, especially around topics like name change, appearance, medical options, transition at school, and coming out to other members of the family.

Of course, sometimes your child will not want you to sit in on session. In this case, we’ll discuss our options and try to find some sort of compromise for all parties (maybe you will sit in for the first ten minutes of sessions, or only every other session).