WITH MICHELE O’MARA, PhD, LCSW
How long have you been providing gender counseling?
The first gender variant person I knowingly met was in 1995 while I was working as a counselor at a youth group. This 15-year-old biological male explained to me that she felt more like a girl than a boy. Having graduated with my MSW just three years prior, I was acutely aware of the lacking education I was provided on this topic and I began to research what was then called, Gender Identity Disorder (now called Gender Dysphoria) in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-V).
Do you have experience writing letters of referral for HRT?
Yes, a lot. I wrote my first letter of referral for HRT in 2000. Since that first letter of referral for HRT that I wrote in 2000, I have written hundreds and hundreds more, and continue to do so today.
What is your experience making referrals for gender reassignment surgery (GRS)?
My first client who came to me in 2000, started working with me as a male and soon began living full-time as a female once starting HRT. After her year of Real Life Experience (RLE), she traveled to Thailand for Gender Reassignment Surgery (GRS), which still some call sex reassignment surgery (SRS). That was the first letter of referral for GRS I wrote, back in 2001. Later that year, I started seeing my second client who also pursued surgery, and from there, word of mouth brought many, many, many clients to my doorstep, wishing to align their external lives with their gender truth.
I have written HUNDREDS of letters of referral to surgeons for GRS / SRS. Included in the list of surgeons with whom I have worked to provide my clients “bottom surgery” are: Dr. Gallagher (IN), Dr. Rumor (PA), Dr. McGinn (PA), Dr. Metzler (AZ), Dr. Brashard (Canada), Dr.’s Suphorn, Chettawutt and Piaget (Thailand), Dr. Schector, and Dr. Bowers (CA, CO). For top surgery, some of the surgeons I have referred to are: Dr. Ousterhaut (CA), Dr. Brownstein (now retired), Dr. Medalie (OH), Dr. Garrramone (FL), Dr. Chernoff (IN), Dr. Zukowski (IL), and Dr. Gallagher (IN). I have also worked with many clients who have pursued breast implants, facial feminization, and even more rare, voice surgery.
What kind of gender-related issues do you work with?
Folks come to see me or work with me online via skype coaching or internet counseling, for many reasons related to gender.
Some of the reasons include:
- I think I am transgender, but how do I know for sure?
- I like to cross-dress, does that mean I am transgender?
- My wife just found my clothes and I am afraid she is going to leave me.
- I am ready to begin a formal gender transition.
- I am ready for hormone replacement therapy (HRT).
- How do I tell my kids?
- I would like chest surgery (FTM) and I need a referral.
- I need help with my gender transition at work.
- I am unsure about my gender and I need help sorting it out.
What guides your therapy process?
If you are interested in a letter of referral for HRT, a typical counseling process with me is based on the World Professional Association for Transgender Health (WPATH) Standards of Care. My role is outlined in the Standards of Care (SOC), and in a nutshell, this involves two primary tasks. Assessing you to be sure you are dealing with Gender Dysphoria, and that it has not been confused with something else. And two, ensuring that your life is set up in such a way that you can be emotional, physically, socially, and financially successful in your transition (this is called the “readiness criteria”).
The process is pretty smooth and usually results in a letter at the end of the sessions unless you decide in the meantime that it’s not what you want, or if you have some unexpected complication (such as a serious drug addiction or mental health issues such as schizophrenia or another severe condition which might impede your ability to make such irreversible decisions). Note, I have written two letters of referral for HRT for persons with schizophrenia – it is not a deal breaker by any means, just an example of a condition that can complicate the process.
This is not typical, but it does occur for some folks, and I am invested in being completely transparent about how this process works, at every step.
Who provides the hormone replacement therapy?
I will write the letter of referral to the doctor of your choice. If you do not have a doctor and need a referral, I work closely with local doctors to whom I can refer you. For transgender skype clients who are working with me from different locations, finding a referral for you may be more challenging and we will have to work toward this together.
How much do your services cost?
About insurance, I have chosen to be out-of-network for all insurance panels, so the way it works is different than a medical doctor.
I request full payment at the time of the session ($130 for 50 minutes and $205 for 85 minutes) and I provide receipts which you are then welcome to use for reimbursement. The actual amount of reimbursement you would receive depends on your out-of-network benefits. To find out the level of benefits, you simply contact the customer care # on your insurance card and request the following information:
- > What are my out-of-network mental health benefits?
- > What is my out-of-network deductible?
- > How many sessions am I allowed per year?
- > Where do I send claims for reimbursement?
- > What is the typical length of turn-around time it takes you to reimburse a claim?
I do offer the use of MC/Visa to offset the delay between payment and reimbursement.
Do you provide services online?
COUNSELING: One is for mental health counseling, the other is for life coaching. While similar, there are distinct, and legally relevant differences between these services. Counseling is designed to identify and treat mental health issues within the scope of diagnoses listed in the Diagnostic and Statistical Manual which lists these “disorders.” The focus of counseling is on addressing mental health disorders and involves a diagnosis. This, frankly, is my least favorite way of working with people, but it is what allows clients to receive reimbursement for my services. However, in order to receive a letter of referral for hormones or surgery, you will need to engage in mental health counseling. Coaching is not sufficient.
COACHING: As a life-coach, my preferred style of working with people, I am focused on helping individuals identify the life they wish to live, and supporting them in achieving this. The focus is not on what’s “wrong,” rather the focus is on where you want to head with your life. I provide both coaching and counseling services to both individuals and couples. If you are interested in clarifying your gender, getting support and you do not feel you need a diagnosis, then life coaching is definitely an option for you.
How does internet counseling work?
1. If you don’t already have Skype software on your computer, download it for free at skype.com
2. Once you’ve done this, send me your Skype address.
3. Add my Skype address to your contacts on Skype.
4. Complete my online intake form and mail, fax, or scan and email back to me prior to our session. (My U.S. mailing address is 2680 E Main Street, Plainfield IN 46168 and fax is 866-540-9013 –
5. Pay for the session PRIOR to the time scheduled.
6. At our scheduled time, we will meet on Skype, Facetime, client portal or zoom.us for our session. (Be sure to test your connection prior to the call).
- Our counseling session will begin as if you had just entered my counseling office.