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Inspiring Conversations with Dr. Lori Becker

Today we’d like to introduce you to Dr. Lori Becker.

Alright, so thank you so much for sharing your story and insight with our readers. To kick things off, can you tell us a bit about how you got started?
After 12 years of working as a staff psychologist in a hospital setting, I found that I truly missed working with patients doing more traditional intensive psychotherapy. While working in a large managed care environment, I felt a hurried pressure that did not afford the opportunity for deeper therapeutic work and a meaningful connection. Craving a return to my original roots of clinical training, I set out to work one evening per week, seeing a few patients in private practice. I was able to sublet an office from a colleague/friend and received a few referrals. I remember feeling an immediate sense of relief the moment I got to sit in a comfortable chair, no physical or mental barrier between me and this other person, no pressure for phone calls or the next patient or the doctor waiting on a report, and I was free to ask them the sacred question, “Can you tell me what brings you to therapy?” I knew I had the capacity to truly listen and to give them the space to freely share. It was the moment of therapist-patient connection that only the people sitting on either side of the couch have ever experienced.

Three patients turned into 4 and 5, and I started working a few evenings per week. Before I knew it, I had a booming “moonlighting” practice. Eventually, I needed to make a decision: I had to choose to stay in my Medical Psychology hospital-based work, or make the transition over to private practice exclusively. Balancing both, and providing good care, was not possible.

So let’s dig a little deeper into the story – has it been an easy path overall and if not, what were the challenges you’ve had to overcome?
It is well known among mental health providers that we make great therapists, but terrible business-people.  We receive almost no training on issues of business ownership and operation.  We are taught to be empathic and help our patients grow, not how to determine fees, collect payment, or negotiate contracts for office leases.

In healthcare, there isn’t the opportunity for “mistakes”.  When you have an ethical commitment to your patients, you have to maintain proper care while learning, navigating the small things, streamlining your practice, and growing both as a clinician and business owner.

Please tell us more about your business or organization. What should we know? What do you do, what do you specialize in / what are you known for? What sets you apart from others?
When I was working as a medical psychologist at a large hospital, one of the endocrinologists informed the Psychology staff that he had a patient who was transgender, and requesting to be started on gender-affirming hormone therapy. The physician requested that a psychologist conduct a “psychological evaluation” of this patient to assess her “appropriateness and readiness for accessing hormones.” Having always been a fervent supporter of LGBTQ rights, I volunteered to see this patient. In fact, I was one of 3 psychologists who volunteered, among a staff of over 40. I had no idea what to “evaluate” and was encouraged to approach this similarly to other evaluations of medical readiness (organ transplant, bariatric surgery). I met with this patient, incredibly inspired by her story, embarrassed by my intrusiveness and excessive questioning. It felt out of place and unnecessary.

Several months later, I was asked to see another transfemale patient for the same reason. This time I wanted to be better prepared. I began researching trans-affirming health care, and fell deep into what felt like an underground healthcare subculture. Initially, I felt like I was “winging it”. Eventually, I became familiar with the World Professional Association for Transgender Health (WPATH) which had well-established Standards of Care (two versions prior to the current Standards). These two patients turned into 3, then 4 and 5, and so on. I became known as “the psychologist who saw transgender patients” and was flooded with referrals and consultation requests. Although I would use different language to describe myself these days (a great deal of my work is dedicated to working with gender-diverse people), I took pride in this reputation, as I saw a profound need for gender-affirming health care. I gave Grand Rounds and clinic presentations on the topic, eventually championed for a trans-affirming interdisciplinary clinic, and urged my superiors to expand on services such as Speech Therapy and Prosthetics, and to streamline access to Hormone Therapy.

Some of my patients had heart-breaking circumstances. I remember one patient who was actively suicidal and needed to be admitted to the inpatient unit for intensive treatment. She refused to even consider this because she was worried she would be forced to stay on the men’s side of the hospital ward and would not be permitted to use a razor to shave her face. This took hours of careful, focused care, calling and paging nurses to problem solve this issue for one person. One human being. One lovely woman in a state of crisis.

My passion for working with gender-diverse people stayed with me as I moved into private practice. A major part of my therapy practice is dedicated to working with people who identify as transgender, non-binary, gender diverse, and gender questioning. This may include exploring one’s gender identity, discovering what gender means, or problem-solving specific issues related to gender transition. I run a Gender Identity Support Group and see adolescents and adults for individual therapy.

Are there any books, apps, podcasts or blogs that help you do your best?
I find consultation with trusted colleagues is the best resource of all! Aside from that, I rely on the expertise of the leading medical agencies (American Psychological Association and World Professional Association for Transgender Health). I enjoy reading books that continue to sharpen my skills as a therapist. Lastly, I think it’s important for therapists to seek supervision or engage in their own therapy. Being on the “other side of the couch” is invaluable.

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