Running head: THE POETICS OF THE ENCOUNTER WITH THE OTHER

SEATTLE UNIVERSITY
GRADUATE SCHOOL

Integration Paper
THE POETICS OF THE ENCOUNTER WITH THE OTHER:
ETHICAL TREATMENT OF TRANSGENDER PATIENTS.
BY
J. RODRIGO REYES
B.S. Universidad Autonoma Metropolitana, 2007
B.A. Universidad Nacional Autonoma de Mexico, 2006
Submitted in partial fulfillment of the
requirements for the degree of
Master of Arts in Psychology
(2012)

Running head: THE POETICS OF THE ENCOUNTER WITH THE OTHER

Abstract
THE POETICS OF THE ENCOUNTER WITH THE OTHER:
ETHICAL TREATMENT OF TRANSGENDER PATIENTS.

J. RODRIGO REYES
Seattle University Graduate School, June 2012
Department Of Psychology
Major Professor: Dr. Alexandra L. Adame
Assistant Professor Of Psychology
In this work I explore some of my experiences working with gender variant
patients. I describe my encounter with two of the many persons who have challenged me
in this work that I love; I give account of the inadequacy that I felt as a therapist and I
examine how these patients put into question my stance and guided me to help them
within the otherness of their experience. I give accounts of stories they shared with me;
describe my experiences providing therapy; and discuss how they taught me how they
wanted to be helped. Finally, I articulate how these encounters have enriched my life and
my professional practice. In this text, I have mainly referenced the works of Martin Buber
(1971) and Emmanuel Levinas (1980) to voice my experiences of otherness and
proximity and to describe the gifts I have been given in the mutuality of the therapeutic
encounter.

Running head: THE POETICS OF THE ENCOUNTER WITH THE OTHER

Table of contents
Title Page1
Abstract....2
Table of Contents.3
Introduction..4
Theoretical Foundation5
Accounts of surprise5
The help requested vs. the help offered..5
Sara..6
Fox..8
Not being at home.14
Where does the help come from ...16
Conclusion.....16
References.18

Running head: THE POETICS OF THE ENCOUNTER WITH THE OTHER

Introduction
Other, the Absolute over against me, that undefinable and unfathomable X that I
call God. God can never become an object for me; I can attain no other relation
to Him than that of the I to its eternal Thou, that of the Thou to its eternal
(Buber, 1988, p. 68)
In my work with gender variant identified (e.g., transgender, transsexual,
ungendered, etc.) individuals I have learned about what being therapeutic means as much
as I have been humbled by unfathomable experiences of otherness. I have established
relationships with people who have challenged what I thought I understood about human
suffering.
Previously unexamined beliefs were exposed as useless or even painful and
oppressive. Words like female: and male are enriched or rejected; the terms man or
woman are not sufficient to dialogue with people whose existence overflows any
generic categorization. Nevertheless, I have been able to be with these individuals and
hold them in their alterity.
I have been taken by surprise by the revelation of the Other (Levinas, 1980, p.
38) and the gift(Levinas, 1980, p. 205) that it is for me as a therapist. In my encounter
with this otherness, I have remained welcoming to what I do not know, and therefore I
have been, in turn, welcomed to the presence of the unknowable that is the Other.
Furthermore, I believe that by being welcoming to the Other, his or her otherness grows
in me, that is, as a therapist I become soil for whatever my patient brings to grow and
become present; and it is this growth and presence that in turn, allow me to be with them
and hold them. That is, in my experience as a therapist, I have, in more than one

Running head: THE POETICS OF THE ENCOUNTER WITH THE OTHER

occasion, felt at a loss as to how to help my patients. Nevertheless, my patients, with their
presence, their words, their silence or even their absence, have given me essential clues
of what they need from me. Therefore I believe that what I have given to my patients in
therapy or what they have found in me, was given to me first with wonderful openness
and generosity.
Theoretical Foundation
In this journey of discovery I have held the hands of giants to guide me and help
me understand my experience. For example, I will draw from the work of Levinas to
help illustrate the otherness (Levinas, 1980) that I have felt revealed to me in the presence
of my patients I also found in Bubers works some of the words I need to discuss the
concepts of mutuality and present-ness (Buber, 1971, 1988). I will also discuss Marodas
work to illustrate what I have identified as an experience of surrender (Maroda, 2002) of
the therapist. And, because the encounters I quote in this work involve gender-variant
patients, I have also referenced Girshicks (2009) writings about gender-variant
experiences that I have found useful and pertinent to enrich the context of this work.
These theoretical works will be discussed in greater depth in conjunction with my
discussion of specific case examples from my work with transgender individuals.
Accounts of surprise
The help requested versus the help offered
What [it] means to help people live better always depends upon a
peoples understanding of what it means to be properly human it depends
on the definition of the self. If the therapists idea about the proper

Running head: THE POETICS OF THE ENCOUNTER WITH THE OTHER

configuration of the self is radically different from the patients, chances

are the therapy wont last long (Cushman, 1995, p. 282)
In this section, I wish to briefly describe an example of the effect the disparity
between the help offered by a therapist and the help requested by a patient. Just like in the
sociological field we can find examples in of trying to help the poor by improving the
causes of their poverty like intoxication, laziness, and other kinds of unacceptable
behavior or use public policy and philanthropy to elevate poor peoples characters
(Hilfiker, 2003, p. xi); as therapists we can fall in the trap of morality, knowing what is
best for others or place mental health classifications in the forefront of our relationship
with our patients.
To illustrate this point I wish to share my experiences with three patients that I
will call Sarah, Louis and Fox. I saw them for individual therapy between the months of
September 2011 and the spring of 2012. By sharing my experiences, I want to awareness
about the risks of knowing before even meeting a patient.
Sara
Sara came to see me at the clinic where I work. She was on time, very anxious
and looked uncomfortable and tired. Sara was born male, and from an early age, felt cross
gender identification. Nevertheless, it was not until her forties that she actively started
seeking to transition to female. At the time of our first interview, Sara had lived as a
female for the past eight years, dressing like a woman and using female pronouns. Some
minutes into the first session I had already made many mental notes about how I was
going to help my patient. For instance, after months of working with sexual minorities
and transgender patients, I know that many ask for help in coming out, getting in touch

Running head: THE POETICS OF THE ENCOUNTER WITH THE OTHER

with a trans-friendly physician, an assessment so they can have access to hormone

replacement therapy, support during the emotional changes they undergo while on
hormones treatment, money for surgery, post-operatory care, voice coaching, and legal
counseling to change their names and to respond to possible harassment in their work
places. I was feeling very proud of myself, because after months of training, it was finally
clear to me about what kind of help a transgender person needs.
As Sara spoke with me I added items to my help list. She was currently
homeless, living in a shelter, and she had recently tried to kill herself with pills. Sara
continued to tell me her story as I listened intently. She told me what had it been like to
live with her former family as a man. She was a father and husband before, and had three
daughters. Recently, one of her daughters had given birth to a beautiful baby girl that
Sara was not allowed to see, and this pained her deeply.
She went on to tell me about losing her job at the family store, being disowned by
her father and her numerous attempts to take her life. I was struck by the despair of her
everyday life. As she told me her story, a therapeutic approach was forming in my head.
I had in mind the lessons learned from my teachers and my own experience. I thought
about her suffering. I tried to think like a phenomenologist, and I tried to identify themes
in Saras story.
There was a moment of silence, and then Sara told me with a tired tone, that this
was her story and she was used to it by now. Sara paused and then told me that the reason
she was in the clinic was that she could not go on living having a penis. At that moment
she showed me a note form a local psychiatric hospital where she had been recently. It
was a copy of a discharge note. The note stated that Sara had been released after spending

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several weeks in the hospital after being taken to the emergency room after successfully
cutting off a piece of her penis.
I was not prepared for this disclosure. I thought to myself, that is not how things
are done! This is not a proper way of being trans! I wanted to go back before her
disclosure, and tell her that we will go together through the standards of care and that I
would write the HRT letter and that I will go with her through the emotional changes. Or
perhaps we would write a letter to the pride foundation so she could get a grant for
surgery or something like that. I was not prepared to hear that she had cut off her penis. I
was prepared to give the help I imagined according to what I knew about my patients
demographic information and identification as transgendered. I was not prepared to give
the help that was needed from me.
Fox
The first time I saw Fox he was sitting in the waiting room of the clinic. Small,
delicate and beautiful. He was twenty-three years old when he became my patient. By
then he had starting to self identify as male for twelve months, dressing in manly clothes
and carefully hiding female gender markers. Fox did not report any concerns whatsoever.
He stated from the beginning of his time at the clinic that the reason he was there was to
obtain a letter of assessment to engage in hormone replacement therapy (HRT). When I
met him, Fox told me that he had been in a relationship for the past two years with his
boyfriend Dipper who at the time also was in the initial stages of transitioning from
female to male. In that first session Fox also told me that he was at the time enrolled in
school to become a mechanic; that living as a female did not make sense to him; and that
he was there because most physicians require a psychological assessment as part of the

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criteria to prescribe HRT. I explained to him that the clinics policy and the standards of
care dictated that he would have to come and see me for at least six sessions. I assured
him that I was not going to make it hard for him to get what he wanted. I just had to
comply with certain guidelines. However, he would certainly get the letter after those
sessions.
I previously mentioned that Fox was beautiful. A beautiful girl with a bad haircut
and a leather jacket reminiscent of a young Marlon Brando. Regardless, Fox was
determined to erase any trace of femininity from his body, his name, his language and
history. This detachment was unfathomable for me. As our sessions progressed Fox told
me about feeling strong cross gender identification and being very uncomfortable in
situations in which he was forced to identify as a female. His chosen profession
(mechanic), companionships, and preferred activities suggested a consistent introjection
of male roles and attitudes. However I felt that there was not much for me to do for Fox.
It came to my attention that Foxs biggest worry was that I would be difficult, or
deny him the hormone replacement therapy letter. The smallest indication of difficulty or
delay seemed to trigger in him a very anxious response. I thought my work would be just
to be there for a couple of sessions more with Fox and help him get that crucial letter.
We kept meeting regularly, and Fox slowly revealed to me more pieces of his
story. He was born and named Holly in rural Washington. He was the first of two
children from his parents union. Fox told me that his parents were in their early twenties
when he was born. His father does odd jobs, his mother is a homemaker, and his sister is
a student. He told me most of these things in a very matter of fact way; as if just to fill

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10

that time that we had to spend together. I felt that Fox had an easy time disclosing but he
was nowhere near having a real conversation (Levinas, 1980, p. 14) with me.
Around the fourth session he told me that his parents were both heavy drug users
while Fox was growing up. Presumably heroin and cocaine in different forms, but Fox is
not sure. He just remembers his mother beating him up after he found a stash of white
powder as a child. This topic has never been approached in Foxs adult life. And again he
told me these things without emotion, as if nothing affected him anymore.
Fox painted a picture in which his family was isolated without people visiting or
being friends with other families. They did not belong to any religious group nor
promoted any belief in to their children. Fox told me that in his parents house there were
not celebrations. I felt a profound lack of enjoyment(Levinas, 1980, p. 58) that he knew
too well. I learned that Foxs childhood was precarious in every sense. He and the rest of
his family lived in a trailer park for most of his childhood. He remembered being hungry
most of the time and spending a great deal of time alone. He also remembered his mother
calling him disgusting and kicking him out into the cold several times while she was
under the influence of drugs, and he remembered begging to be let into the house again.
He showed me the nakedness of his face [that] extend[ed] [into] the nakedness of [his]
body that [was] cold and that [was] ashamed of its nakedness (Levinas, 1980, p. 75).
Fox had never engaged in therapy nor had he received counseling of any kind.
The only support he has received in his life has been from the queer community of
Olympia where he currently resides with his boyfriend. Our sessions started always in the
same way: when we were at the door I would ask him to sit where he felt the most
comfortable. He would choose the corner chair with his back against the wall and the

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11

window. I would sit next to him, but not too close. He would quietly alternate between
observing me and looking through the window. At no point I expressed refusal or doubt
about writing the HRT letter for Fox. However as the sixth session approached he seemed
prepared for me betray him, to not do as I said. He seemed to be engaged in a fight that I
was not, at least not willfully, a part of.
In the next session he told me that he had not found a trans-friendly physician, but
he would let me know as soon as he found one. I assured him that we would move on
with the letter as soon as he provided the necessary information. I explained to him that
obtaining the letter was in fact a very simple process. I described the steps to follow: I
would type the letter stating that I found him fit to make an informed decision about his
own body. I would sign the letter and I would present it to my supervisor to co-sign it,
and voila.
Fox seemed a little more relaxed but still his body remained a little stiff and he
was sitting in the chair in the far corner of the room with his back against the wall. I
asked how his week was. He told me that he had come out to his parents recently and that
they were not very receptive. His father ignored him and his mother refused to referred to
him with the name he has chosen This seemed particularly painful Fox, for in this denial
his mother assimilated (Levinas, 1980, p. 296) him to something that he was not. I have
learned that whatever gender identity an individual has, it is important that others
confirm it (Girshick, 2009, p. 111). I cannot begin to imagine what it means to an
individual to be denied recognition by his own mother. But I remember Fox frequently
mentioning his mother calling him by his female name. Now I think I understand a little
more the profound implications of the name for Fox since he presents himself by stating

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12

his name, which permits evoking him, even though he remains always the source of his
own presence. [This] presentation consists [for Fox] in saying "It's me" and nothing else
to which one might be tempted to assimilate me (Levinas, 1980, p. 296). Fox
apparently sees in that other name and what it evokes a painful gesture of assimilation to
something that he is resolved not to be.
Fox told me that he wished that his family were supportive. I asked if he saw
them frequently and he told me that he had decided to live away from them to be a
healthier person. I asked him what he meant by that and he said: peaceful, loved. Then I
asked him, So your family does not make you feel loved? No, he responded, its not
that. They do what they can. They are very poor and they have a lot of issues.
I asked him if he would like to tell me about the issues in his family and he started
to talk about his mother. He told me that his grandmother, a young widow, had given up
her children when she remarried, abandoning them, nine brothers and sisters, in a house
to fend for themselves. Fox told me that his mother started using drugs at a very young
age and that she suffered from depression. He told me that as a young girl, his mother had
been repeatedly sexually abused by one of her brothers. She had it very hard, Fox said,
and explained that she was a drug addict because she was depressed. She did her best. I
asked Fox to tell me about his childhood and he described scenes of his mother hitting
him with a hose and kicking him to the street and telling him that he was disgusting. Fox
told me more than one horror story in the next session. I listened attentively and noticed
that after describing particularly painful episodes of abuse and neglect from his mother,
Fox would say: but I understand, it was the drugs or she couldnt avoid it she was a
drug addict or you know how drug addicts lose it.

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13

At one point I asked about these phrases and their meaning to Fox. I told him that
for every painful story, he had what seemed to be, a conciliatory ending. He got upset and
I thought that he was going to leave. I sat tight and so did he. I asked him, What did this
mean for him? He could not say.
At this point I was not sure if Fox would continue to come to therapy after he
received the letter and I did not want to start anything that I would not be able to finish
with him. I was afraid of something that was close to the surface but I could not see yet. I
was afraid of Fox. My fear was telling me that Fox had brought me close to something
and he was daring me to go with him. I heard a lot of pain and also a need to justify the
actions of his mother. I heard a child broken by the beloved parent. I heard him knocking
on the door of the trailer after being kicked out. Asking for forgiveness for something that
he had not done. He was denied of signification(Levinas, 1980, p. 40). He did not
understanding the world (Levinas, 1980, p. 97) he lived in. He was crying for an
unarbitrary life(Buber, 1988, p. 34).
He sat very still looking out the window. I asked him if now, as an adult, he had
talked about this with his mother. He has not. He has not brought it up because she was a
drug addict and she did not know better. I felt a deep pain in my own body. I asked Fox
what he would tell her if she was there in front of us. What he would tell her if she was
there now. Without making her excuses for her. What would he tell her about the pain she
caused him? Then I stopped. It is hard to know when it is too much and these sessions
only last fifty minutes. Fox looked away, tried to talk, started shaking violently and
crying. I just wanted to hold him. We had time. I slowed down my breathing and Fox
started to sigh as he calmed down.

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14

We had only one more session left before I would be able to write him the letter
that he told me was here to get. Fox missed the next two appointments. Then on a
Monday he called and we made an appointment. He came and he gave me the name and
address of his doctor for me to write the HRT letter. I told him that I would have it ready
the next time I saw him. I asked him how these weeks had been for him and did not
mention his absences. He told me that he had been to visit his boyfriends family to
support him in coming out to his family.
A couple of days later I called Fox to tell him that his much wanted letter was
ready. He did not pick up the phone so I just left a voice mail. He got back to me. We
made an appointment for the upcoming Friday. He did not show up and did not call for
two weeks. Then he called me again and we made an appointment to pick up the letter on
a Tuesday. He did not show up.
Finally on a on a Friday after school he came to pick up the letter. I thought I
would not see him again after that. Nevertheless, he gave me a call the following week
telling me that he did not like the physician he had chosen. He wanted to come see me so
I could write him another letter. He came to see me and we talked. He told me that since
he was already there he would like to talk about his mother. He told me about their last
fight about her refusal to recognize him as he wanted to be recognized. They fought, she
kicked him out, he cried and he kicked the door. I was moved by Foxs revival of the
scene he told me from his childhood when his mother used to kick him out of the trailer
into the cold. I felt angry and had a hard time not crying.
When the session was over we said goodbye this time for good: he had gotten the
letter for a new physician and I would close his file at the clinic. But this was not to last;

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15

Fox came the next month and told me that he had not liked the new physician and he
would like me to keep the letter until he was sure that he had found the right physician.
Fox came to see me eight more times to talk about being out in the cold, about
poverty, about being hungry, about the dreams he had for when he started HRT, which
was the reason he was really there with me. Finally one day he asked me for the letter. I
gave it to him and he asked me if he could hug me, I said yes, he hugged me and did not
come back.
Not feeling at home
A theme that is present in the accounts of the patients that I have examined for
this work is the feeling of not being at home as they are, with themselves, with the world,
or with others. In different ways I have experienced these stories as stories of people who
want desperately to find a home in the world and give themselves to it, and redeem it
and, through the world, also themselves. (Buber, 1971, p. 100)
When I met Sara and Fox the wanted to be something else. They seem to want to
change themselves into versions of themselves that they can welcome and find a home in
themselves so the world is not such an inhospitable place for them. They seem to be
longing for a place in which they can recollect themselves, be familiar and intimate with
themselves. For it is in this recollection that they would be able to recover their
enjoyment and make sense of the world. These two clients want nothing other that the
recollection necessary to become familiar with nature by the means of its representation
away from it. In short, they want a home. And I cannot be anything but wholeheartedly
empathic, even if I have to accept that their experiences of the world escape me.

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16

I know that we can only be intimate with the world as having come to it from a
private domain, from being at home with [ourselves] (Buber, 1971, p. 100) from a place
where we at each moment [] can retire (Levinas, 1980, p. 152) to represent again and
work over nature, to make sense out of it, for it to take form as a livable world. Home is
undeniably essential for peoples well-being. Levinas states that home is the place for
recollection and representation (1980, p. 150), for it is there that signification is created
by the means of postponement. Buber states that there is a cosmos for man only when
the universe becomes a home for him (1971, p. 150).
Being with Sara and Fox this was revealed to me in all its painfulness, the absence
of recollection, the lack of familiarity, the ignorance of intimacy, is nothing but the
experience of being homeless, destitute, chased away from every corner of the world.
For, a person experiences him/herself as truly disinherited when he/she does not know of
a place they can call his or her own. Fox and Sara showed me the pain of not being able
to make any sense or meaning of nature. They walked me through the lack of enjoyment
of separation and they dared me to be with them and without a place for recollection;
without habitation, and without dwelling. Sara and Fox allowed me to be with them in the
unfathomable suffering of carrying an existence that is never at ease. I had the impression
of raw suffering; almost as if there was something between them and their feelings. I had
the impression that they did not have readily access to a place where one recovers from
the outside, from institutions, from what is imposed on us by being alive.
They welcomed me into their experience of not having a dwelling where [their]
emotions [could] dance before the interested glance. [Where their] liking and hate and
pleasure [could be] indulged, and [their] pain if it is not too severe (Buber, 1971, p. 43).

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17

A place they could call home. In a way it seemed to me that Fox and Sara were doing
their best to show me an appalling form of raw suffering. Neither of them elaborated
much about their feelings in our initial sessions. Their initial presentation would be
withdrawn or extremely sensitive. At times, I felt that my interventions would do nothing
but hurt them more, and I could feel the physical presence of a nameless pain in their
bodies and mine. At some point this changed, they felt safer. Their feelings started to
have different names and somehow were able to say what they needed to hear. I found in
myself new words and silences that I knew I had not learned in any of my books. They
apparently seemed somewhat more rested, a little more in contact with their feelings.
They also seem to be in a lot of pain but some how their pain was not too severe
(Buber, 1971, p. 43), they were able to talk about it without starting to shiver or just
becoming overwhelmed.
Surrender and mutuality, where does the help come from?
These encounters with gender-variant people have taught me to leave all things
that are not my patient outside of the therapy room. Somehow these patients seemed to be
the source of what they needed to make their pain less severe. They have taught me to
engage, to give in and welcome their burdens, their poverty, their destitution and
homelessness and be with them. I believe that in this encounters I have effectively
surrendered (Maroda, 2002, p. 43) to being a participant, an interlocutor, not the one who
will dispense the help but a person who can be with another in his or her search for a
place to put their head to rest; to make their lives, maybe, a little less hard.
Conclusion

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18

As I reviewed the stories that I have shared I have come to realize that I did
identify some themes in the accounts of my patients. These themes certainly illuminated
my journey and helped me to sit with them. I believe that identifying these themes helped
me understand more about the phenomena of not feeling at home with oneself, the world
and others. However, what helped my patients seemed to happen before I identified any
themes or gained any insight into their experiences. I believe that my interventions in
their recovery, my silences and my words, were given to me by my patients precisely as I
met their gaze. My own reflection happened at later time in the writing of this work. I
believe that they enabled me to help them. They welcomed my surrender and let me be a
witness. That is how the healing happened. That is what they needed. I did not realize this
at the time, but they taught me through the therapy process. Our time together was an
opening and a revelation. I believe that through our conversations they were able to feel
the possibility of a home for themselves. I believe that I was able to be the space or them
to enact being at home. I believe this was only possible in in the mutualrecognition(Stolorow et al., 2002, p. 88) that happened between these particular patients
and me. We were able to meet in the mutuality that is the gate of entry into our
existence (Buber, 1971, p. 177).
It is not a small challenge to renounce the armor of our knowledge about the
nature of the help we think patients need. Our egoist gravitation(Levinas, 1980, p. 236),
and the nave arbitrariness of [our] spontaneity (Levinas, 1980, p. 43) tend to be
entangled with judgment, with social superiority and even with the mirage of academic
knowledge. We are called to strip ourselves of these garments of vanity and ignorance
and become small and weak to welcome those who come to us for help. For, it is them

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19

who determine the nature of our labor and it is them who command(Levinas, 1980, p.
178) what we offer from the beginning to the end of our relationship. Sara and Fox taught
me that making a pause and "letting happen may turn out to be the most [therapeutic]
thing [I] can do to.(May, 1999, p. 177)
I believe that the gift of the face (Levinas, 1980, p. 56) of those others who are
my patients, fosters in me the therapeutic presence that they need: I am able to help a
human being whose presence continually surpasses my hard-learned skills. Nevertheless,
the revelation of their otherness, floods what I feel is my inadequacy and allows me to be
therapeutic. At every encounter I am presented with the gifts I need to be therapeutic. To
be helpful, to hold and to care are not fixed stances but gifts of the generative revelation
of a person that I cannot, ever, truly know. I am now thankful for the experiences of
being surpassed by the otherness of my patients. For I have traded the safety of knowing
for the gifts of the encounter.

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20

References
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Levinas, E. (1980). Totality and infinity: an essay on exteriority (4th ed.). Dordrecht,
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