Reid Vanderburgh - Frequently Asked Questions

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Moving toward an expanded life

Frequently-Asked Questions

FAQ 1. Do you accept insurance?
2. How much does it cost per session? Do you take credit cards?
3. Do you work with non-trans clients?
4. How long would I have to see you before getting a hormone or surgery letter?
5. Do you have names of doctors you recommend I see for hormones?
6. I'd like to work with you during my transition, but I don't live in Portland. Do you do phone or e-mail therapy?
7. Do you work with non-trans clients?
8. Do you work with FTMs, MTFs, or both? Do you work with partners?
9. I want to transition and see you as my therapist. Can I bring my partner/spouse to sessions with me?
10. My child seems to be transgender. Is this something I should worry about? Do you work with such children?

Do you accept insurance?
I have given this question a lot of thought, and have decided not to accept insurance. I would rather work out a financial arrangement with a client than seek reimbursement from an insurance company. My primary reason is confidentiality. I cannot guarantee client confidentiality when an insurance company is paying the bills. The company has the right to demand to see my notes. My other reason is freedom. Insurance companies dislike paying for services that can't be quantified scientifically, and therapy falls into this category. Insurance companies demand justification for continued treatment, and this means clinical diagnosis using the DSM (Diagnostic and Statistical Manual). This does not fit my paradigm of therapy. Nor do I want an insurance company calling the shots on when someone can see me, how many sessions, etc.

Another consideration is that insurance companies demand a diagnosis in order to reimburse, for any medical or mental health care procedure. Having a mental health care diagnosis in your medical records can be a liability in the future. A colleague of mine was denied health insurance because she'd seen a therapist for anxiety issues some ten years before, due to an understandable life circumstance, and had taken anti-anxiety medication for a few months until the situation was resolved. You may not want to involve an insurance company in your mental health care, for this reason alone. This kind of discriminatory practice may eventually be illegal, but right now, it isn't.

All that said, if you do want to try to get insurance to cover your visits to me, you can certainly submit the receipts I give at the end of a session to your insurance company and see if you can get reimbursement directly; it might work, and doesn't hurt to ask. If I'm not filling out their paperwork, they can't ask to see my notes. You would be seeking reimbursement directly from the company, without involving me in the process.

Some employers reimburse employees for therapy services, without regard to who the employee is seeing as a therapist and without asking for confidential information. (Intel is one example) You can contact your Human Resources department to see whether or not your company has such a policy. In these cases, I provide my client with a report that shows only the date of service, length of session and how much they paid me; their employers then reimburse them for the total they already paid.

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How much does it cost per session? Do you take credit cards?
I have a sliding scale from $60-90 per 50 minute individual session, and $80-110 for a 90-minute couples session. (I do occasionally go lower than this for some clients) The most common method of paying a therapist is at the end of each session, either by cash or check, and this is how I've set up my practice as well. As is true for most therapists in private practice, I am not equipped to accept credit cards; I don't have a high enough volume of transactions for this to be practical financially. Though there is an ATM machine in the lobby of my building, it is part of a small grocery and they are not open after about 3:30 in the afternoon (their hours are somewhat irregular). There is a credit union ATM a block and a half away, on SW 5th between Washington and Stark; this ATM does not charge a fee.

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Do you work with non-trans clients?
Absolutely. My specialty is working with people going through major life transformations. Transitioning from one gender role/bodily sex to another is one type of transformation, but there are many others as well, some much more common than transition: Death of a spouse; addiction recovery; existential upheavals often called "midlife crisis;" etc. From a process point of view, all transformations require a reinvention of Self from the ground up, and this is familiar territory to me. I have also found I work well with couples who are not the same gender as each other; I find my experience of living more than one gender role in the same lifetime has given me a unique point of view, as I can embrace more than one gender at a time without taking sides.

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How long would I have to see you before getting a hormone or surgery letter?
I don't require a set length of time or number of sessions, as some people feel ready for hormones much sooner than others. I do not view my role as determining anyone's gender. My role is to help clients answer the question, "How do I want to live my life?" I help clients face and navigate the difficult process of transition, as all relationships change. This process can't be done in the closet! To read more about my philosophy of the therapist's role, you can read A Therapist's Manifesto and Thoughts on the Standards of Care.

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Do you have names of doctors you recommend I see for hormones?
In my office, I have a resource table with various business cards of other service providers - a personal trainer (useful for post-surgery rehabilitation); various massage and acupuncture providers; other therapists, useful if you need a couples counselor or have a partner who would like their own therapist; and doctors, both allopathic (western-medicine) and naturopathic, who prescribe hormones. Some of these doctors have websites, and you can link to them from the Books and Websites page on this site.

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I'd like to work with you during my transition, but I don't live in Portland. Do you do phone or e-mail therapy?
I have worked with people who have come from as far away as Boise or Coos Bay to see me. Once I've established a good therapeutic relationship with such folks, via face-to-face sessions in my office (often on weekends, for clients traveling a long distance to see me), I am open to doing phone sessions as needed, if the client meets certain criteria. They have to be able to set (and maintain) a boundary with the people in their lives, saying to them, "This is my therapy hour. Don't disturb me." In addition, they have to be able to focus on the phone therapy session without being distracted by things in their environment, such as a computer game, cell phone calls, text messages, or e-mail. Though not as optimal as face-to-face sessions, phone sessions are better than no session at all, and may be the only regular option available for people who live far from Portland.

I don't provide e-mail therapy, for two reasons. First, there is ongoing debate within the therapy profession about the efficacy of e-mail as a means of providing therapy, as well as practical concerns about being licensed in one state and providing therapy services to a client who lives in a different state. (If a client has come to my office and established the therapeutic relationship here in Oregon, the occasional phone session is not a problem, even if the client lives in a different state.) Therapist licensing boards have yet to provide guidelines about the ethical considerations of working with a client strictly via e-mail, and until they do, this is an ethical gray area and most therapists are avoiding providing services in this fashion, lest their licensing board eventually decide such therapy isn't ethical. In that case, a therapist who has been providing this kind of service might find themselves in trouble with their licensing board.

The second reason I don't provide therapy in this format is that I value highly the face-to-face connection with clients, and don't believe e-mail therapy can be as effective as in-person counseling. I'm only willing to do phone therapy with clients I've already met face-to-face, and even then, I consider phone therapy a compromise. I would not do e-mail sessions even with a client I've met face-to-face. I realize that this stance on e-mail therapy may cut off isolated people from finding a knowledgeable therapist to work with around gender issues. For this reason, I am keeping up with the development of webcam technology, hoping for the day when webcams are reliable enough, cheap enough, and fast enough to prove useful in providing therapy.

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Do you work with FTMs, MTFs, or both? Do you work with partners?
Yes, yes and yes. I am an FTM myself. Some of my MTF clients marvel that I'm able to understand their issues, given that I transitioned in the opposite direction. However, when it comes to process, the journeys are quite similar. They differ in the "content" - different hormones, different surgeries, different gender roles. But - same decision-making processes, same adjustment process to a new hormone balance, new gender role, etc. As for partners... my own process began in 1995 as a partner of someone considering transition. Eventually, I came to realize I had gender issues as well, but prior to that realization, I experienced the gamut of emotions many partners grapple with when transition is on the table as a possibility: anger, betrayal, questioning my sexual orientation, wondering who I'd been involved with for seven years, etc. To read more about my view of the partner's situation, read For Partners Only.

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I want to transition and see you as my therapist. Can I bring my partner/spouse to sessions with me?
Yes, though not to every session if I'm your individual therapist. If you are in a relationship, your transition is a relational issue. No one transitions in a vacuum, and partners have to undertake their own transition. It is optimal if your partner can also have a therapist of their own, as they will have their own issues to deal with in light of your transition. Both of you will have issues to work through individually. However, there are times when your relationship issues will feel like the highest priority for you to work on, and in that situation, it's absolutely appropriate for you to bring your partner into session. (Your partner's therapist may say exactly the same thing.) You and your partner may feel the need for couples therapy on a regular basis. In these cases, I suggest seeing a different therapist specifically for that purpose, rather than seeing either of your individual therapists as a couple. When you see a therapist as a couple, the relationship is the client, rather than either of you individually. Just as it would be inappropriate for the same therapist to see each of you as individuals, it is not ideal for your individual therapist (or your partner's individual therapist) to also see you as a couple on an ongoing basis. As a once-in-awhile thing, though, it's fine to bring your partner into session. To learn more about the kinds of issues partners face, you can read For Partners Only.

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My child seems to be transgender. Is this something I should worry about? Do you work with such children?
I am trained and licensed as a Marriage and Family Therapist. I can work with your family around various issues. However, I find in these situations, the best thing is to work with the parents, not the child. It may be that your child is a gender-balanced individual, who doesn't quite fit the norms of how our society defines "male" or "female" behavior. It may be your child will grow up to be gay, or lesbian, or will end up being bisexual. It may be your child is heterosexual and just doesn't fit gender norms. Or it may be that your child will indeed desire to transition at some point. Gender and sexuality both seem to be innate identities, not changeable by parental actions. However, while parents can't change identity, they can have a profound effect on a child's sense of self-esteem and levels of self-acceptance. For this reason, I prefer to work with the parents, to help them come to an understanding of their role when it comes to issues of core identity. I find that often, education and helping them find social support are the keys to helping parents relax and allow their child to mature into whoever they were meant to be. (For more information about transgender children, you can read How Young is Too Young?)

All this said, it is not normal for a child's behavior to change radically for no reason. If this seems to be the case, it might be a good idea to have the child see a therapist who specializes in children's issues. I will be happy to work with you (and the therapist) if the situation seems somehow related to gender identity issues, however, I am not a child therapy specialist. Children don't suddenly change for no reason at all, and there may be things going on that you are not aware of (various forms of abuse, for instance). A good child therapist can help your child express what is going on. Once the situation is rectified, the child therapist can then help your child recover such that the incident will not deeply scar your child.

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If you would like to set up an appointment, send me an e-mail or give me a call at (503) 341-7001.