Gatekeeping psychologists

At the moment transgender people often still are forced to see a psychologist. We don’t see the logic in that. An example: someone’s mother lives in a little village in the north of the Netherlands. Let’s assume she has serious concerns about her son. She becomes so worried that one day she decides to go see a psychologist: she wants this psychologist to interfere and keep an eye on her son, because he has moved to a place near Amsterdam and his mother reads the newspaper: it is full of stories about robberies, street fights, drugs and prostitution - she is sure he will get into trouble. The mother asks the psychologist to see her son every 3 months and report to her on how he is doing...

What will this counseling psychologist do? Help the mother, or force her son to make use of the psychologist’s services to protect him against himself?

I think every counseling psychologist knows the answer: the son will not be forced to accept help, but the psychologist will investigate the mother’s concerns. The psychologist will try to find out what she fears exactly, where these fears are coming from and subsequently he will assist her in accepting that hair son is an adult and that she can no longer tell him what to do. If the psychologist does his work well, the son will only notice that his mother isn’t as worried as she used to be. If everything works the way it should, the son will never meet his mother’s psychologist because the problem of being over-protective is solved and not the "problem" that he has moved to the Amsterdam area.


Now another example. A transgender person needs hormones or an operation. The doctor worries about the way transgender people make decisions and has the opinion that transgender people are not capable of making the right decisions based on their own criteria. He is also afraid all sorts of mental disorders, unresolved traumas and bad coping mechanisms will surface.

What does the gatekeeping psychologist do?

He doesn’t do the same as the counseling psychologist did in our previous example. The gatekeeping psychologist will go along with the fears of the care provider; he will examine the transgender person, and will accompany this person in their “difficult route”. And after that the gatekeeping psychologist decides about the need for hormones and operations for this person and about the person’s capability to make decisions independently. Why is that? Because the care provider asked him to. Usually not because the individual was having doubts about their criteria, capability to make decisions, coping mechanisms or mental health...


Psychologists create the image that their diagnostic process makes them able to decide which patient needs (or doesn’t need) which kind of care, they call it a diagnostic process after all. However, what a psychologist can see from the outside is (at best) just a derivative of what the patient truly feels. There are also situations where patients consciously lie to prevent jeopardizing their supply of hormones or operations and that is often not detectable for psychologists. So the diagnostic process for transgender people is in that sense much more inaccurate than the diagnostic process for broken arms or diabetes. Our point of view: patients know what they feel, unless it is very clear that they don’t.

In our view the care for transgender people has gone awry. Transgender people are normal people. They can, just like any other human being, make decisions about themselves and make choices independently unless there are specific problems. We see no problem in mental care for transgender people on a voluntary basis, but we think it is utterly wrong to force people to undergo mental examinations or mental care. By doing this type of assessments, the gatekeeping psychologist confirms the non-realistic fears of the care providers instead of trying to reduce them.


We want all gatekeeping psychologists to stop examining transgender people if the request for such an examination doesn’t come from the transgender people themselves. The only one exception applies for transgender people who have been put under guardianship by a court of law, or those who, after multiple sessions, turn out not to understand the implications of their transition process. As soon as it is clear that a transgender person does understand the implications, treatment can start at the moment and in the way this person deems most suitable.


If it is the trans person who wants the psychologist to make a decision about hormones or operations, it is a good idea to investigate why the he or she doesn’t feel capable of making such judgments. The transgender person may need to acquire the strength to be able to do that. Only if, after being offered such reinforcement, the trans person still really wants a gatekeeper and that is not caused by their environment, the psychologist may assume the role of a gatekeeper. In our view transgender people can always decide what is the most appropriate care in their situation, even if we see that differently as a group.


If the request for help comes for a care provider, this care provider needs to be examined for unrealistic fears and needs help to be able to treat transgender people in the same way they help other patients with any other treatment.


If the request for help comes from a guardian a meticulous assessment is necessary, in which the feelings of the transgender person and the possibilities that are available should be the focus of interest (and not the fear about everything that might go wrong of the person’s environment, the guardian, or the psychologist).


Counseling psychologists

Of course there is still a role for the psychologist. Help from a psychologist is often appreciated. There is a great shortage of psychologists who can assist people after their operation. Many transgender people have the feeling their lives only begin after the operation. In that phase there is a need for more help than is available now. Of course all the requirements for counseling psychologists still apply: only provide help if the trans person wants it. And if they want to stop the mental care, that must be without any consequences for the medical care they get.


We believe sharing knowledge is a good idea, but we are not in favor of certification of psychologists as a requirement for providing care. In working with transgender people an open mind is the first requirement, not knowledge. If a caregiver accepts all people the way they are, that is enough qualification to work with any transgender person. Those who see it as their duty to classify and label transgender people and then give them a treatment only according to a standard protocol, are in our view not suitable to be counseling psychologists for them.


Research psychologists

We welcome research psychologists, but their work must not be connected with counseling or gatekeeping, because otherwise either the research or the counseling would lose value. See the page about interests and confusion of roles for an explanation.