Transamerica

This weekend my friend, D, came to have dinner with us and to watch a movie. We had rented "Transamerica" from Netflix. I had heard that Felicity Huffman did an amazing acting job playing a Transexual woman. She did. I think this part has done for Felicity Huffman what "Monster" did for Charlize Theron. The acting was nuanced, brave and totally believable. What was also incredible was that a movie with the title “Transamerica,” with the main protagonist being a transsexual woman and her search for serenity and integrity of Self, should end up being a uniquely human movie about the power of love, the challenge of being oneself in the context of family, how we grow into being parents and what it means to live an authentic life. In fact, quite early on in the film, it becomes irrelevant whether Bree is transgendered or not. Her most important evolution in the film is not to do with her gender identity, but her ability to grow into authenticity in her relationship to herself and her son.

Okay, having said all that, what is one of my biggest beefs with some movies?

Stupid therapists. Here was another one. Margaret, Bree’s therapist, breaks most boundaries known to psychotherapists and their clients.

The treatment plan between therapist and client exists as an agreement about how therapy will proceed. The therapist and Bree clearly have an agreement about the therapist signing off on Bree’s gender reassignment surgery (GRS). Without any discussion, Margaret rescinds this agreement because she disapproves of Bree’s decisions concerning her newly discovered son. This decision should have been part of a longer conversation between therapist and client, particularly as Bree’s surgery is already scheduled. While it is a wonderful idea to encourage clients to work through old and life-restricting feelings originating from their families of origin, I have yet to hear of any reassignment surgery (and it’s certainly NOT in the Harry Benjamin Standards of Care!) that has a requirement of this work being undertaken prior to surgery. In fact, if this requirement were on the books, absolutely nobody would qualify for surgery!

It is unconscionable for a therapist to force their agenda onto their client, which is precisely what Margaret does when insisting that Bree tackle the relationship with her son, as a prerequisite for her signature. In addition, Bree’s statement that Margaret is her “only friend” is revealing. Indeed, it quickly becomes clear that Bree is almost completely without friends and family, living a solitary life in her small apartment, and therefore her relationship with her therapist unquestionably takes center stage in her life as her important relationship. While it might arguably be appropriate for a friend to change their minds about an agreement without discussion, it is never okay for a therapist to do so. Margaret appears to have lost sight of clinical process that she feels able to do this. It is an example of what can happen to the relationship between therapist and client when the therapist “forgets” the nature of the relationship. Friends can afford to change their minds. Therapists cannot.

While hugging a client occasionally is not a bad thing, sitting next to them on the couch, holding their hands, and stroking their face while calling them “sweetie” is definitely crossing a therapeutic line in the sand. Need I say more? Movies are very influential in how people view other groups. There is enough confusion already about the nature of the therapeutic relationship, and to my mind this film could add to that bewilderment. The obvious caring and compassion that her therapist displays towards her client, Bree, is heart-warming and not to be dismissed as an important prerequisite for the work that any therapist undertakes with a client. What is more, suggesting that her client undertake the difficult work of reconciling with her identity as a parent and offering to illuminate the path so that this work happens is a sound clinical recommendation.

Requiring it is not.