Directions
During your practicum, you sit in on a therapy session with your preceptor, Chris, and Jasmine Lorry, a transwoman who is seeking treatment for depression, posttraumatic stress disorder from a sexual assault, and possible exposure to HIV. Chris mentioned earlier that he is the only psychiatrist in the area who takes Jasmine’s insurance.
Jasmine Lorry Transcript
Jasmine: Hello, I’m Jasmine Lorry. Thank you for seeing me.
Chris: Hello, Jasmine! My name is Dr. Christopher Woods. But you can call me Chris. So, tell me why are you here?
Jasmine: Well, I’m a transgender woman. I started my transition 10 years ago when I was about 15. Well, that’s when I started taking estrogen hormones and since then I’ve been living on my own. My family rejected me when I came out as trans and thanks to that I was homeless and living on the street for almost three years. Lately, I’ve been depressed.
Chris: So, you started your transition 10 years ago, but you don’t look too feminine. What steps have you taken towards physically transitioning?
Jasmine: I’m a housekeeper and don’t make enough money to be able to have breast augmentation or cosmetic facial surgeries. But, I recently started to clean two local offices to save money for my surgeries. I’m planning to have the surgeries in Mexico, where two of my friends had their procedures and they look amazing. You know the cost is half of what it is here so it might take me less years to save for it. With my insurance, all they covered is hormone therapy and sometimes I “pass in public.†Some people might stare at me, but mostly they will walk past me like nothing.
Chris: You are aware that even if you fully transition and maybe after cosmetic surgery you’ll never be a perfect woman!
Jasmine: Well, you know that there’s no such thing as a perfect woman?
Chris: Yeah, but a real woman can get pregnant and have kids. You’ll never be able to do that.
Jasmine: Well, I could adopt! If I even want kids. I don’t know yet.
Chris: Yes, I guess you can. You mentioned that you started taking estrogen hormones at 15. Did you consult a therapist or doctor during this stage?
Jasmine: Well…no! I started to take my friend’s estrogen since she was also transitioning and also started buying fillers from the streets. It’s a lot cheaper this way.
Chris: That was really stupid of you…were you that desperate?
Jasmine: [silence]
Chris: Ummm, okay, let’s talk about your depression. When did you start to notice it?
Jasmine: It started about a month ago, after I was sexually assaulted and beaten after this guy realized I was trans.
Chris: Did you report the assault?
Jasmine: Yes, and he was arrested. But, I don’t want to testify against him because I’m afraid of being humiliated and made fun of for being transgender.
Chris: Hmmm, yeah. I can understand that. Have you had any thoughts of suicide?
Jasmine: No, not really!
Chris: So, well, what do you expect from therapy?
Address two of the following questions in your first discussion post.
- In what ways was Chris (your preceptor) insensitive to Jasmine? How could you approach Chris about his lack of cultural competence?
- What are culturally appropriate ways to talk with a transgender patient to show empathy and build trust?
- What ways could you suggest Chris build cultural competence? Share at least two resources from your community. Include links if possible.
- How could you repair this therapeutic relationship? How would you explain to Jasmine why the situation occurred? What type of countertransference issues might you have about Chris as your preceptor?