The Doctor, the Transsexual, the Bed-Shooting and the Lawsuit

The stormy relationship between a transitioning transsexual and a well-known sex counselor raises questions about the growing field of sexology

Tonight, all Toni Choate wants to do is spend a quiet evening at home, watch a little TV, and, if she's lucky, catch up with her teenage daughter. Tomorrow, the single mom will have to start work, as usual, before dawn and put in long, hectic hours supervising a commercial construction site. But for a few hours on this Sunday night, Choate must put that mundane — refreshingly mundane, she says — life on hold to revisit a painful, topsy-turvy past she would like to forget.

Choate is sitting in the conference room of a downtown San Francisco law office, across the table from two attorneys who silently flip through page after page of legal briefs stuffed into giant three-ring binders. She is preparing for an upcoming deposition in a lawsuit. Neither lawyer bothers to look at Choate as she tells her long, complicated story; both are busy scribbling notes that document the extraordinary hell she describes.

By the second hour, Choate seems to lose steam, as the story she's told so many times begins to make her sad once again. She is weary from recalling the confusing, scary, and arduous process of releasing the woman who lived inside the body of Larry Choate — the 6-foot, 220-pound, balding construction worker that Toni Choate physically was for the first 42 years of her life.

Since early childhood, Larry had been different from other boys, identifying more with girls. Soft-spoken and fair-skinned, he was teased at school and often called a sissy. As a teenager, a family doctor tried to cure him with testosterone injections. The resulting deepened voice and unwanted body hair repulsed him. Larry tried to stay Larry until middle age, even marrying twice, but his anguish continued as he realized the second half of his life would only be as miserable as the first.

Few understood Larry's cross-sexual dilemma; not his mother, not his ex-wife, certainly not the guys in hard hats he worked with. His daughter was accepting, but she wasn't allowed to see much of her father back when Larry began living as Toni. At first, Toni simply cross-dressed; then she started hormone treatments; breast implants came a few years later. Finally, Toni had sex reassignment surgery.

Before the surgery, Choate sought out a therapist to help her with the transition.

But what began as a journey toward well-adjusted transsexuality went horribly wrong. Elated to find someone who understood her, Choate fell in love with her therapist. The affair that she says developed is the focus of Choate's Sunday evening session with her lawyers.

By her account, Choate was seduced by her female therapist when she was still a man, and the affair continued after the surgery that made her a woman. Choate hoped therapy would help her sort out her identity — was she a straight woman trapped in a man's body, or a lesbian? — but the acts of her therapist, a married, straight woman, only created more confusion. Choate was even allowed to live with the married therapist and her husband, and the couple even employed her in the nightclub they owned. Eventually, Choate says, she came to believe her entire existence relied on the therapist.

As she approaches the part of her story that is the hardest for her to relate, Choate pauses. The lawyers look up, encouraging her to go on. It was unrequited love, Choate eventually says, that drove her to shoot her therapist's empty bed 10 times in a fit of rage. She describes the eight months she spent in jail for her crime; the prior attempts to drown herself in the ocean, which left her washed up on the shore, puking a mixture of Vicodin, tequila, and salt water; and the dozens of scars that cover her forearms, where she repeatedly cut herself to, as she puts it, “feel alive.”

Choate is worn and her eyes are moist. She lets out a sigh. But one of the lawyers asks her to perform one more exercise, setting a box on the table. In it are plush toys, dolls, love notes, cards, and various sweet nothings; all, Choate claims, gifts to her from her therapist.

Choate digs through the box and reaches for a book, True Selves: Understanding Transsexualism, which made Mildred L. Brown — the author, and Choate's therapist — famous. Choate opens the front cover and looks at the inscription inside: “You have become a warm, loving, dynamic woman,” Brown writes to Choate, “who brightens the lives of all who know you, including me. With love and appreciation for all you are, Millie.”

Mildred L. Brown is a sexologist. She has studied sex as a science and makes her living by helping people deal with their sexual issues. Brown's specialty involves gender dysphoria, meaning she counsels people, like Choate, who wish to change their sex from male to female, or vice versa. Brown's work and book have been more than well-received. She has high-profile clients, like Dana Rivers, the high school teacher near Sacramento who was placed on indefinite leave by the school board when she returned to class last fall as a woman, rather than the man she'd been the previous spring. Brown also counseled Marcia Chapdelaine who, as president of the San Mateo County Convention and Visitors Bureau, had a very public transition from man to woman two years ago and kept her job. In these and other cases, the San Jose-based Brown has been touted — by herself, by other experts, and by the press — as one of the nation's most authoritative and compassionate experts in transsexual issues.

But Brown is not a psychiatrist, a psychologist, a marriage family therapist, or even a clinical social worker. She holds no state license in any of the regulated mental health fields. Brown calls herself a sexologist, a profession the state does not recognize and therefore does not regulate. Brown also calls herself a doctor, based on the Ph.D. she holds in sexology from San Francisco's Institute for the Advanced Study of Human Sexuality, a school founded 30 years ago by a former Methodist minister who claims to have amassed the world's largest erotic art collection. The Institute offers doctorate degrees in erotology and sexology; these three-year programs include practicum courses and require a dissertation. Brown's 1979 doctoral paper was titled “Initiating Marital Coitus.” [page]

“It's just like a degree from Stanford or any other university, except that it's in sex,” says Institute president Ted McIlvenna, who is also careful to say that his school — which is not accredited by the American Psychological Association — does not train people to practice psychotherapy. “A sexologist is an educator, someone who gives out information, not a psychotherapist. We say there needs to be full disclosure; that you put on the wall, 'I'm a sexologist,' and when someone comes to you with a problem, you're obligated to explain what it is you can and can't do.”

For the most part, regulators don't take sexology seriously. ” '-ology' means 'study of,' and sex is sex,” says Tom O'Conner, director of the California Board of Psychology, which licenses mental health workers statewide. “You don't often hear the word 'sexology' used legitimately; it's more of a slang [term] than a professional term. Of course, legitimate psychologists can focus on sex therapy, and many do.”

Brown was certified by the American Board of Sexology, a respected group based in Washington, D.C. that includes many bona fide psychologists as members. A certification from ABS, however, denotes only that a reputable psychologist specializes in sex therapy and is up-to-date and well-versed in sexuality. ABS certification alone does not allow someone to act as a therapist.

“Certification from ABS is not enough,” says Dr. Addison Somerville, a Sacramento psychologist and California State University professor who helped establish the ABS' requirements. “[Brown] can call herself a sexologist if she's completed the courses, but if she's going to practice therapy in California, she must be licensed.”

Because there are sex educators and researchers who don't practice as therapists, but would still like to be certified in sexuality studies, ABS issues certificates without any proof of license. Besides, licensing requirements for therapists vary widely from state to state, says ABS executive director Bill Easterling. “But that doesn't relieve anyone with ABS certification from their responsibility of getting a license,” he says.

Somerville worries that a shortage of traditional psychologists focusing on sex therapy could encourage a proliferation of unlicensed sexologists. Indeed, sexology is a growing field, as more people look for expert guidance in specialized areas such as gender dysphoria, which, until recently, was not well understood and rarely treated with a positive prognosis. (It was only in the early 1970s that the American Psychiatric Association officially removed homosexuality from its list of mental afflictions.) Somerville, who 25 years ago became one of the first mainstream sex therapists, and who then initiated the then-controversial Human Sexuality course at CSU-Sacramento, says there are still outdated mental health conventions when it comes to sex.

“I'm not confident that traditional psychology can yet meet the needs of people with sexual problems. The training is not focused enough on the importance of sexual issues,” Somerville says. “A lot of psychologists don't want to admit that they really don't know about things like gender dysphoria, and unfortunately, some still have biases regarding sexual variances.”

For Somerville, the solution is getting more psychologists to specialize in sex, which will reduce the demand for unlicensed sexologists, and, at least in theory, improve the quality and professionalism of sex counseling. But even state regulators admit that licensing cannot eliminate impropriety. Among licensed psychologists, in fact, the most frequent cause for disciplinary action is sexual misconduct. In the last five years, nearly 50 licenses were revoked in California for improper sexual behavior by professional mental health workers.

Jeff Thomas, special projects coordinator at the state Board of Psychology, said the state does not regulate sexology because it is a new field, and difficult to define; sexology could entail anything from teaching techniques for preventing premature ejaculation to educating someone about the process of coming out as gay.

“It's in a very gray area, like hypnotherapy,” Thomas says. “The bottom line is you have to look at the definition of psychology, and if what someone does matches that, then they need to be licensed as such.”

Choate argues that Mildred Brown used misleading titles — Dr., certified sexologist, clinical therapist — that gave her the appearance of being something she was not. “When she introduced herself to me as 'Dr. Brown,' it's not like I said, 'Let me see your diploma,' ” Choate says. “I automatically assumed she was a real, licensed therapist.”

Beyond the 58-year-old Brown's Ph.D. education in sexuality at the San Francisco Institute, her schooling is sketchy. Her résumé is a hodgepodge of universities she never graduated from; she lists sporadic introductory-level psychology and sociology courses she says she took at Montreal's McGill University in the early 1960s and San Jose State University in the mid-1970s. She did earn a Bachelor of Arts degree from UCLA in 1976 — in French.

Brown and her attorneys refused to comment on her professional standing or the lawsuit. But Brown has filed court papers pointing out that she is not a psychologist, and therefore not bound by regulations applying to licensed psychologists. And so far, the lawsuit references no direct evidence that Brown held herself out to be a mental health professional.

But Toni and her lawyers assert that Brown did act as a psychologist, and that her actions should be considered professional negligence.

“There's a difference between having a reputation and being reputable; anyone can get a big reputation through self-promotion, and in many ways, Mildred Brown's big reputation allowed her to perform therapy with no questions asked,” says Choate's co-counsel, John D. Winer. “If the state of California chooses not to regulate sexology, then it's up to civil litigants to say there needs to be a standard of care.” [page]

Choate saw Dr. Brown for one year before anything happened to propel their relationship past that of a client and therapist. The first line was crossed, Choate contends, when Brown — knowing Choate worked in construction — asked her to fix a broken pole in the sexologist's bedroom closet. Looking back now, Choate says, it felt strange to go into her therapist's closet, to move clothes and other personal items around. Choate was also startled to see an open box filled with sex toys.

Later, Brown asked Choate to remodel her kitchen. Money was exchanged both ways, Choate says; Brown compensated Choate for the construction work, and Choate continued to pay for her therapy sessions. At the time, Choate was still physically a man, and Brown was helping her prepare for sex reassignment surgery. The therapy sessions — held in Brown's home — were becoming increasingly intense, and Brown invited Choate to live there in the guest room. Brown's husband, Bernard, did not mind, Choate says.

“You are very much an outcast as a transsexual. You don't get a lot of acceptance from anybody, and you struggle financially and emotionally,” Choate says. “But then here's my therapist, a person who was so supportive and wanted to be with me. I felt very special; like I was on cloud nine.”

Choate moved in. Shortly after, she says, Brown began using the sessions to talk about her own personal life, where, she claimed, she was lonely, living in a loveless marriage. Soon a sexual relationship began, Choate says. Court papers filed on Brown's behalf deny there was a sexual affair.

“Late at night, after her husband went to sleep, we used to eat M&M's, paint our toenails, and make love,” Choate says. “Our lives became more and more entangled, and we began doing everything together, from grocery shopping to going to plays.”

Brown and Choate even visited a tattoo parlor together. Choate had two M&M candy characters tattooed on her right ankle, with “Millie” written under the blue one, and “Mandy” under the green. When Choate changed her first name from Larry, she chose Amanda as a middle name. It was a name, Choate says, that Brown preferred because it sounded more feminine.

In the sexual relationship, Choate says, Brown encouraged her to use her male genitalia. This caused Choate much consternation; as a therapist, Brown was helping her become a woman, but as a lover was focused on Choate's penis. Choate had already gotten breast implants, and Brown's attention to her soon-to-be removed penis confused her. Choate was also fearful that Brown would not love her once she fully was a woman. But after the surgery, Choate says, the affair continued.

Choate was becoming increasingly depressed. Having to keep the relationship secret while living with Brown and her husband was painful. “Millie told me many times that if I told anyone we were lovers, it would destroy her, and I took that to heart,” Choate says. “But it hurt very much.”

Choate says Brown would talk about leaving her husband and being with Toni, but never followed through. They would often fight about how to resolve the problem. “Every time I would tell her how I felt, she would get ill and say, 'Please don't leave me, I need you, and we'll work it out,' ” Choate says. “Now I can see that I was codependent, and there was major manipulation going on. I was still very vulnerable as a transsexual in the early stages, and looking for my identity.”

Among the gifts Choate says she received from Brown was a self-help book for couples, I Love You, Let's Work It Out. “What a joke,” Choate says now. “It was all games and lies.”

Around this time, Choate says, she began cutting herself on the forearms, and abusing alcohol and prescription drugs, even though she was also becoming increasingly ensconced in Brown's life. Brown and her husband purchased the New Savoy nightclub — a lesbian and transsexual bar in Santa Clara — and made Choate a business partner with 15 percent ownership. Choate managed the bar.

The strain of the affair was equally affecting both Brown and Choate. Professionally, Brown was gaining prominence for authoring a well-received book about the transsexual experience and was being lauded in the press as an expert. Choate was more in love and dependent on Brown than ever.

“I was stuck in a situation of chaos, going in circles,” Choate says. “I'd get stronger, Millie would get weaker, then I'd fall down; it was a continual chase. And not being able to talk about it put me over the edge.”

After a particularly nasty fight with Brown, Choate says, she tried to commit suicide. Santa Clara police officers were called to the New Savoy twice in one night after the bar had closed — first by Brown, when Choate began cutting her arms again, and then later by Choate, when Brown began having chest pains that began, she claimed, after Choate chased her with a knife.

A few weeks later, Choate was still living with Brown and upset that her lover was going on a trip to Europe with her husband. Choate says she attempted suicide again, driving to Mission Beach near Carmel and swimming out into the ocean after ingesting a combination of pain killers and tequila. Choate held on to a kelp bed, hoping the waves would drown her. But, she says, she blacked out and was eventually washed ashore. She checked into a nearby hotel for the night and arrived home the next morning to discover Brown had indeed gone to Europe. But Brown left a note that said she hoped Choate felt “better and calmer,” signing it “love, Millie.” Choate says she snapped. She tore up photos of Bernard and Mildred on the refrigerator, grabbed a handgun she kept in her room, walked into the master bedroom and wrote in lipstick on the adjoining bathroom mirror, “Don't sleep in my bed.” Then she shot the bed Mildred slept in with her husband, and secretly shared with Choate. [page]

Choate says she fired 10 rounds, put the gun in her mouth, and squeezed the trigger. There were no more bullets.

“All I had done my entire life was be self-destructive; I didn't know better. But now that I do, I won't be a silent victim anymore, and no one else should have to be, either,” Choate says. “I loved Mildred and I was hurt by her. What makes me the angriest is that she continued to give therapy to people when she knows what damage she has done to me.”

Choate's lawsuit alleges that Brown has been professionally negligent, inflicted emotional distress, and committed sexual battery, and seeks $2.5 million in damages. Brown and her husband have countersued, claiming it was Choate who inflicted the emotional distress by assaulting Mildred Brown, threatening both Mildred's and her husband's lives, and interfering with Dr. Brown's “prospective economic advantage” by telling other transsexual clients to stay away from her practice. Mildred Brown's attorney, Steven Fink, had no comment on the case, other than to say, “The proper place for the resolution of these issues is in the courts, not trial by unproven allegations in the media.”

Bernard Brown's lawyer, Rick Pedersen, however, questions Choate's claims. “This case revolves around credibility,” Pedersen says. “This person is a convicted felon who shot up the Browns' house. You have to view some of what she says with some degree of skepticism.”

It is a fact that Choate pled guilty to the felony of discharging a firearm in an uninhabited dwelling in connection with the bed-shooting incident; she subsequently served eight months in the Elmwood Correctional Center for Women. The forensic psychologist who evaluated her for the court said in his report that Brown's misconduct contributed greatly to Choate's behavior. Choate, then in her 40s, had no history of violence or aggression, nor any propensity for it, the report said.

“The relationship between the professional boundary violation by Dr. Brown and Ms. Choate's offense is self-evident,” psychologist Jules Burstein concluded. “But for the betrayal of trust by Dr. Brown — the erosion of maintaining a professional role as a therapist by inviting Ms. Choate to… live in her house, and finally become her lover — there would almost certainly be no offense.”

Burstein ended his report with a scathing opinion: “I would say that this case is one of the most pernicious I've ever worked on. This is so because Ms. Choate began her therapy as an aspiring transsexual with Dr. Brown at a time when she was more emotionally vulnerable than ever before in her life, anticipating a surgery which would revolutionize her sense of self in largely unforeseeable ways. And it was precisely during this period that Dr. Brown violated her professional commitment to do no harm.”

Burstein recommended that Choate receive probation, with this caveat: “Though Ms. Choate must bear responsibility for her actions, it is important that the court consider the malignant damage done to patients by therapists who exploit vulnerable patients for their own narcissistic motives.”

Superior Court Judge James C. Emerson, however, sentenced Choate to a year in jail, later reduced for good behavior.

Choate's lead attorney, Linda Scaparotti, believes her client was open to abuse by Brown because of a phenomenon, known as transference, that commonly occurs during psychotherapy. That is, a patient who trusts her therapist may transfer feelings she had for significant people in her life — such as a parent — onto her therapist, in hopes of acting them out. “The appropriate therapist explores those feelings, and does not exploit them to fulfill her own needs,” Scaparotti says. “Toni says Mildred wanted to be called 'mom'; how confusing then, if the mother wants a romantic, sexual relationship.”

Those who know both Brown and Choate — they could be seen together at the New Savoy, the Santa Clara lesbian and transsexual bar that the Browns purchased — say their relationship was gossiped about and was hardly a deep secret.

“What Millie did looks bad, but whether it was intrinsically evil is another question; the flesh is weak, and while she may have had high-minded principles, when you find another person physically and emotionally attractive, it's hard to put that aside,” says one of Brown's former clients who was counseled in group sessions that included Choate. The former client declined to be identified. “This is a shock to most people who know Millie. She is very well loved and respected in the community. She's like a saint, which is probably what got her into trouble. She feels so deeply for people, and Toni's situation was so desperate. That is probably what prompted Millie to give Toni her heart.”

The fact remains: Choate, a client, was invited into many aspects of her therapist's life. Several of the situations that Brown admits to in her own court filings — asking Choate to remodel her kitchen, letting Choate live in her home, making Choate a business partner in the New Savoy — would be considered egregious violations of therapist/ patient ethical standards, if, of course, Brown were licensed. And for licensed psychotherapists, engaging in sexual relations with a client — even relations that occur up to two years following termination of therapy — is a crime.

Brown has had many successes in her care for transitioning transsexuals, and, aside from Choate, no clients have come forward with serious complaints. One of Brown's success stories is Marcia Chapdelaine, who two years ago transitioned from man to woman while serving as president of the San Mateo County Convention and Visitors Bureau. Chapdelaine still holds that very public position, saying she is happy to be “living my life as an ordinary, natural woman.” [page]

“All my experiences with Millie were positive,” Chapdelaine says. “If you're on the transgender road of life, Millie is a very good guide. But we all control our own destiny.”

For well over a year, attorneys for Choate and Brown have tossed complaints and cross-complaints at one another, filing amendments and motions to strike and demur. No trial date has been set. But in the pretrial legal showdown, one fact has become clear: By her own admission, Brown is not and never was a licensed psychologist. Paradoxically, this lack of official imprimatur could provide her a legal defense. Whether there is even a civil penalty for sexologist-client sex remains to be seen. As a sexologist — a practitioner in a field the state does not officially recognize — was Dr. Brown merely a glorified, exaggerated, non-professional advice-giver? Unless Choate's lawyers can prove that Brown masqueraded as a licensed mental health professional, there ultimately may not be any legal recourse against her. Up to this point, no state authorities have pursued action against Dr. Brown for claiming to be something she was not.

“Had Millie and Toni never been in a client-therapist relationship — if Millie were just a housewife — nobody would be talking about this affair. This would just be another tragic case of when an angry relationship falls apart, and people get vindictive,” says someone close to both Dr. Brown and Choate, who declined to be identified. “The whole situation is as ugly as you can imagine, and there won't be any winners.”

Because Brown is a sexologist, and counseled clients in what appeared to be a professional setting, this lawsuit could have a meaning that stretches well beyond the sordid details of a messy sexual affair. It could begin a debate over the role of sexology within the regulated mental health community, and what standards an unregulated counselor should — or must — adhere to. “There will be winners in this case,” Choate says. “Not me or her, but the people in situations of power abuse who will learn that it is wrong, that they can get out, and get help.”

Choate is getting her life back in order. She has been seeing a licensed psychologist for a year. She has an apartment in San Francisco and a steady job at a local construction site. Her 17-year-old daughter has chosen to live with her. “I'm in a totally different space now,” Choate says. “I've become responsible for my actions, and I want Mildred Brown to be held accountable for hers.”

A gender therapist acts as an “anchor point” for the confusion and turmoil that transsexuals experience in what could be described as a turbulent sea on their journey to self-discovery. The therapist's role is to guide and help pace the transsexuals' progress along their chosen path. This is done without bias on the part of the therapist toward the outcome.

Mildred L. Brown, True Selves

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