Counselor         Bobby Kizer, Ph.D. Psychotherapist
Licensed Psychologist
Spokane, Washington


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Transgender Services

Therapy Services

In my practice, I particularly enjoy getting the opportunity to do therapy with transgender individuals.  Being anywhere in the transgender umbrella (gender queer, non-binary, pre-operation, post-operation, cross-dresser, intersex, figuring out one's identity, etc.) can bring a great amount of stress.  On the one hand, it can be stressful to explore and understand one's identity; And on the other hand, it can be difficult to publically express this identity in a transphobic society.  Due to these added stresses, it is very common for transgender individuals to struggle with mood and personality issues such as: depression, anxiety, suicidal thoughts, social anxiety, self-harm, and substance abuse.  Therapy can help transgender individuals in their self-discovery, in transitioning (if applicable), and in thriving as an individual in this world.  Transgender patients are welcome in all of my therapy modes. 

Individual therapy- As with my other patients, individual therapy with transgender individuals is highly individualized based on your needs and desires in therapy.  I work from a psychodynamic perspective which pays special attention to unconscious factors and interpersonal relationships (see "Therapy Services" for a more complete description of my therapeutic style).  I treat your gender identity as an important part of your identity, and do not see it as an illness or a "problem" to get rid of or explain away.  It is part of the therapy, but only one important part of a much larger therapeutic process that aims at helping you be the most complete and thriving person you can be.  To develop a strong therapeutic relationship, I prefer to meet once per week or more if possible.  Due to the limited availability of transgender therapists, I frequently see patients who live far away from my office.  For such individuals, I am happy to meet via video-conference. 

Some transgender individuals decide that gender transition is the best way for them to express their gender identity.  If you are considering or have already decided on gender transition, you will likely have many questions about the length and process of transitioning.  There is a great amount of variability in how much time it takes and what the process looks like.  Each individual comes from their own unique life experience.  There are certainly recommended steps to take for many people (e.g. "coming out," Real Life Experience, Hormone Therapy, Sex Reassignment Surgery, etc.), but these recommendations are not necessarily right for everyone and they do not necessarily follow any specific order or take any specified amount of time.  They might depend on factors such as family supports, financial resources, job/career implications, and physical characteristics.   Additionally, some transgender individuals come to therapy in the very early stages of thinking about transitioning, while others wait until much later (perhaps after many years of planning their transition and being involved in trans advocacy or support groups).  Although this might seem vague, this degree of flexibility is very important in helping you figure out what will work best for you. As we work together in therapy, we will discuss many contributing factors and together figure out a time-line that works well for you to achieve the most satisfying transition possible.  When appropriate, I am happy to write referral letters and recommend you to physicians for the medical/physical aspects of transition. 

Couples therapy- As with any other person, transgender individuals have important romantic relationships and sometimes have difficulty in those relationships.  Sometimes conflicts arise from the transgender identity (e.g. if a partner discloses their transgender identity later in the relationship).  Other times, the conflicts are really not related to transgender identity much at all.  In either case, it is important to have a couples' therapist who understands transgender identity and how to address it in therapy.  This will make it easier to talk about anything from family dynamics to sexual concerns. 

Group therapy- I lead a process oriented psychodynamic therapy group.  This group consists of a broad range of individuals working through many different life challenges.  Transgender individuals are welcome to join the group and are respected like any other member.  Group therapy can be particularly helpful for transgender individuals to experiment with social relationships in an atmosphere where they will not be negatively judged.  Please note that this group is focused on overall personal and relational development and is not a transgender specific support group.  If you would like a support group in the area please follow this link to the Louisiana Trans Advocates

Psychological Evaluations

Most physicians require a psychological evaluation before prescribing transgender hormones or doing gender reassignment surgery.  These evaluations typically serve a number of purposes: a) to ensure that a person if fully capable of making a major medical decision, b) to ensure that a person's transgender feelings are not actually a specific symptom of a mental health disorder such as schizophrenia or obsessive compulsive disorder, c) to help medical professionals and the patient be aware of any other mental health related issues that should be monitored during transition (such as depression or anxiety), and d) to establish a relationship between the patient and a therapist just in case the patient needs any therapeutic support through the process. 

I am happy to provide these evaluations.  If you are already in therapy (with myself or another therapist), this typically requires one hour of clinical interview, and about two hours of formal personality testing.  If you are not in therapy, the evaluation will likely take longer in order for me to develop a good understanding of your personal history and current life.  Basically, I will need to get to know you pretty well.

Unfortunately, this evaluation can sometimes be seen as a road block to transitioning.  I will admit, it is certainly a complication to the process particularly because it adds time and cost.  In such situations, I encourage patients to try to see this as an "opportunity" rather than simply a "requirement."  In conducting the evaluation, my goal is to encourage the healthiest and most satisfying transition process possible. 

Referral letters for hormones and surgery

After completing the evaluation and/or therapy, I am happy to write referral letters to appropriate physicians for hormones or surgery and consult with them as needed.

Please call or email me to schedule an appointment for therapy (individual, couple, or group) or evaluation.

Dr. Bobby Kizer