Transgender Issues: A Guide for Therapists Working with Clients in Transition

transgender issues, a guide for therapistsPsych Central contributor Edie Weinstein interviewed Nicole and Lori Bray, a couple she met last year when Nicole was in the process of transitioning from male to female. Their story touched her heart particularly, since they defied the statistical odds and are exceedingly devoted to each other through this arduous process.

Their raw vulnerability in sharing their story is evident. The decision to transition is not one to take lightly. She also had the honor of interviewing them on the radio in 2014.

The purpose of this article is to provide helpful information for therapists who may encounter clients or family members of those embarking on the journey of transitioning from one gender to another.

In the case of Lori and Nicole, one therapist’s interaction with Nicole prior to coming out to Lori, a therapist herself who works with LGBTQ clients, exacerbated an already stress-filled situation. Nicole is a documentary film maker producing her story called “I’d Rather Be Girl.

Edie Weinstein: When did you meet with the therapist who advised you not to tell Lori?

Nicole Bray: I began meeting with that particular therapist in April of 2012. I found her after doing a thorough Internet search for a therapist who specialized in Transgender care who also lived in my region. You can only imagine how disappointed I was to discover there were only three therapists meeting these criteria at the point I was ready to initiate counseling. I chose to see the therapist who was regarded as the “Transgender Guru” since it seemed she would be the one with the most knowledge and experience.

However, I want to clarify that this therapist didn’t advise me not to tell Lori about me being Transgender. Instead, she wanted to focus on what my life was going to be like after Lori divorced me after I come out as Transgender, rather than focus on anything related to transition.

This idea alone immediately started my tailspin into depression and suicidal thoughts. My therapist automatically made the assumption that Lori would divorce me before she even met her! Granted, the statistics are particularly bleak for couples who stay together throughout transition. In fact, less than 20% of couples stay together.

Nevertheless, she never considered the possibility that Lori might stay. As it turned out, my therapist’s assumption was wrong and Lori did stay. Her assumption was incredibly damaging to my already fragile emotional functioning at the time.

EW: When did you actually tell her?

NB: My original intention was to come out to Lori at the end of September of 2012. The significance of this time is it was right after our planned trip to Disney World to celebrate our five-year wedding anniversary.

I recognized that my coming out as Transgender was big news and to tell her before the Disney trip risked ruining her vacation. Therefore, I planned to tell her afterward, but circumstances don’t always work out as we planned.

However, my therapist’s comment about Lori divorcing me quickly sunk me into a depression that didn’t go unnoticed by Lori. On repeated occasions, she asked me about my down mood, but I deflected the questions by telling her I had other things I was working through.

Lori, being a psychologist, continued to notice the pattern of my moods and was not willing to accept this as my answer as time marched on.

On July 29, 2012, I was having a particularly dysphoric day and I provided Lori with an irritable, short response to a simple question she asked.

As a result, she notified me that we needed to discuss what was really going on because my moods and behaviors were starting to affect the marriage. I spent the next three hours dropping hints about what the actual issue was while I mentally debated whether I was ready to tell her or not.

The moment I told her, I knew everything would change. I just wasn’t sure in what direction things would change for us. Even though I knew that my wife was a psychologist who specialized in working with the LGBT population, I was still uncertain how she would react to the news of knowing that her own spouse was Transgender.

To me, it seemed like an entirely different ballgame to have your spouse be Transgender as opposed to your clients.

Finally, at the three-hour mark, I stated, “I have a medical condition recognized by the APA and AMA and it’s a problem I was born with. It’s called Gender Identity Disorder. All my life I have felt like I am a woman. I think like a girl, I feel like a girl, yet I am a guy. I hate it.”

At the time, my gender dysphoria was so severe, I despised the condition and myself. Furthermore, I called it “Gender Identity Disorder” because this is what it was called at the time before it was appropriately renamed “Gender Dysphoria” via the American Psychiatric Association through the use of the DSM-5.

Amazingly, Lori responded with “I will stay with you and we will work our way through this together.” I was beyond shocked and could only utter back, “Will you?” She replied, “Yes, of course. I’m not going to leave you over something like this.”

We spoke for the next 5 hours about everything transition entailed, how to come out to friends and family, ways they might react, and we shed lots of tears together. We are still happily married today.


Transgender Issues: A Guide for Therapists Working with Clients in Transition

Edie Weinstein Moser, MSW, LSW

Edie Weinstein, MSW, LSW is a journalist and interviewer, licensed social worker, interfaith minister, radio host and best-selling author. A free-lance journalist, her writing has been printed in publications and on sites such as The Huffington Post, Elephant Journal, Beliefnet, Identity, Inner Child Magazine, New Visions, Holistic Living, Conversations, Bellesprit, The Whirling Blog, The Doylestown Intelligencer, The Philadelphia Inquirer, YogaLiving, Wisdom, Mystic Pop, In Your Prime, the “What The Bleep Do We Know?” website and The Bucks County Writer. She has been interviewed by the Philadelphia Inquirer, Fox 29 news, CBS 3 news, WWDB 96.5 and National Public Radio as well as numerous blog talk stations. Check out her website at:


APA Reference
Weinstein Moser, E. (2016). Transgender Issues: A Guide for Therapists Working with Clients in Transition. Psych Central. Retrieved on April 1, 2020, from


Scientifically Reviewed
Last updated: 12 Apr 2016
Last reviewed: By John M. Grohol, Psy.D. on 12 Apr 2016
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