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Photograph by George Sakkestad Trans Mission: Transgendered client Toni Choate says she suffered extreme emotional distress after having a sexual love affair with her therapist, first as a man and then, after her surgery, as a woman. Doctor Strange Love Nationally known sex therapist Mildred Brown paid off a former client to drop a $2.5 million lawsuit that alleged a personally damaging and ruinous sexual affair. But the field of sexology may never be quite the same. By Jim Rendon TONI CHOATE REPEATEDLY REACHES into a royal-blue bag of bite-sized Almond Joys, unwrapping each candy and holding it with delicate poise before placing it in her lipsticked mouth. They help calm her nerves, she says, and she needs that today, talking about all the things which were secret for so long, things with giant ramifications, things which embarrass her still. Even with a manicure, Choate's hands are large and callused from years of working as a building contractor and the four decades she lived as a man. And each time she reaches for a nerve-calming candy nugget, she exposes something else: raised, pale scars crisscross the inside of her forearms, stacked atop one another like a pile of pickup sticks. Though born a boy, Larry Dillon Choate, in Visalia, Calif., in 1953, Choate struggled all her life with the belief that she was a woman. It took two marriages, numerous bouts with drinking and drugs and eventually years of therapy for Choate to arrive at sex reassignment surgery. But Choate says the one person who was her bedrock of support and trust through all of that was the world-famous Santa Clara County sex therapist specializing in gender issues: Mildred Brown. "One of the biggest things growing up was trust," Choate says in her quiet, methodical way. "I only trusted two people in my whole life, my grandmother and my sister. I didn't trust doctors or lawyers; I didn't trust anyone," she says and looks up. "But I trusted Dr. Brown." ALL HER LIFE, Choate was ostracized. Any glimmer of her inner female identity led to rejection and abuse. In grade school, other children called her a sissy. In high school the school doctor gave her injections of testosterone because he detected elevated levels of estrogen, the female hormone, in her system. Choate says nothing ever felt right. "Every day people get out of bed and look at themselves in the bathroom mirror and they don't think anything. I would wake up and look in the mirror and say, 'Who is this?' " When Choate began seeing Mildred Brown, in 1994, she had reason to believe she was in good hands. Brown had made a name for herself locally by providing therapy and group sessions for transgender patients. In 1996 Brown published True Selves, an in-depth look at the challenges faced by transsexuals which was filled with lengthy quotes from her local patients. Brown was profiled in Metro when her book was published, and has been regarded as an expert on transgender issues in local papers and TV documentaries. With Brown's help, Choate began working toward her goal--sex reassignment surgery--that would transform her from a man to a woman. But in 1995, her relationship with her therapist changed. One day, a year into therapy, Brown asked Choate to fix a broken bracket in her closet. It seemed like a small request, Choate remembers, and given Choate's decades of contracting experience, perhaps not unreasonable. In the private closet in Brown's master bedroom, Choate pushed aside her therapist's clothes. When she looked down, she couldn't help but notice a box of sex toys. "I felt special--there was nothing I wouldn't do for her," Choate says. "But it was also like the first time that your parents tell you they have sex. You don't really want to know about it." In May 1995, Brown went further. She asked Choate to remodel her kitchen. Choate took the job. During a therapy session in June 1995, Choate began to cry. Tears flowed for a long time as Choate let go decades of pent-up anger and frustration. Though the reason for those tears escapes her now, she cannot forget what happened next. Rather than keep her professional distance, Choate says her therapist got up from her easy chair and sat down on the couch next to Choate. Brown held her hand, Choate says, and then hugged her. On July 30, 1995, Choate says she had finished her day's work on the kitchen when Brown encouraged her to spend the night in her guest room, rather than drive over the hill to Santa Cruz. Brown's husband, Bernard, had already gone to bed. Brown asked Choate to join her on the couch in the living room. Sitting side by side on the couch, Choate says her therapist stroked her face; then, she says, Brown kissed her. In August, Choate moved in with Brown and her husband. The two stayed up late watching TV, painting their nails and eating M & M's, Choate says. Choate even has a tattoo on her leg of two M & M's--under one is inked Mildred and under the other Mandi, Mildred's middle name, which Brown insisted on using. They did everything together, shopping, going to movies and plays. Choate loved to cook and often prepared meals for the couple. At night Choate slept in a small guest room, she says, but after Bernard left for work, she would join her therapist in the master bedroom. Perhaps most damaging, Choate says, was Brown's desire for Choate to use her penis during their sexual encounters. It was an organ which she planned to remove and which she says she never identified with. Choate always felt she was a woman; she had no desire to be a man or to be with one. But when Brown asked her to use her penis, Choate complied, leaving her feeling confused and disturbed. AS THE MONTHS ROLLED BY, Brown made it clear that no one was to find out about their affair, Choate says. The sexologist told her that if anyone found out, it would ruin her career and destroy her family. Choate needed Brown in order to make her transformation complete. According to the internationally recognized guidelines for treating transgender patients, surgeons must receive two letters of recommendation, at least one from a licensed therapist, before performing sex reassignment surgery. Brown devotes a number of pages to the guidelines in her book, and Choate says she preached about them to her patients. One reason so much care is required is because the procedure, especially for males, is nearly irreversible. In surgery, the penis' erectile tissue is removed. The skin is inverted and placed in a cavity created between the patient's rectum and urethra. Part of the top of the penis is used to create a clitoris, and the scrotum is used to sculpt the labia. Most patients can be orgasmic following surgery. But reversing the procedure is nearly impossible. Though Choate asked Brown for her letter again and again, the therapist just put it off. When she finally confronted Brown, Choate says that the sexologist, who had been Choate's only counselor for more than a year, told Choate that she did not want to do it. Instead, Choate says, Brown merely called the surgeon and promised to send the letter at a later date. The letter was never sent, Choate says. Since Brown was not a lesbian, Choate worried that her therapist would reject her once she recovered from her surgery. But instead, she says, the relationship only intensified. She did more work for the Browns, fixing family cars and remodeling many of their properties, including Mildred's home office. She went with Brown to Portland, where Brown had a face lift, and she planned elaborate parties for Brown's birthday and book release. Choate says she had fallen in love with her therapist. "Every part of my life revolved around Millie," Choate says. "She controlled where I made my money, where I lived, she was my sex partner, I cooked for her, I went everywhere with her." At the same time, Choate says she could not slow the creeping guilt she felt every time she looked at Bernard. Even now she has trouble talking about it. "At the time this was going on there was a lot of chaos inside because I was--" she says, pausing, closing her eyes. "They treated me nicely and I feel guilty about--" she stops again and takes a deep breath and holds it, exhaling slowly. "I don't like hurting people, and in the back of my mind I knew I was hurting Bernard." There was no one she could talk honestly with about her guilt, her changes, her relationship with Brown. "Looking back," Choate says, "I stepped out of one closet and was placed right into another one after I fought so hard to get out." Photograph by George Sakkestad Cross Purposes: Like most sex therapists, Mildred Brown has no state-issued license to practice sexology. In California, psychiatrists, psychologists, and marriage and family counselors are regulated by the state, but not sexologists. IN JANUARY 1997, after living with the Browns for almost a year and a half, the Browns and Choate formed a corporation. They called it Milberton, for Millie, Bernard and Toni, and they purchased the Savoy, a lesbian bar in San Jose. Toni and other women in the gay community renovated the bar and Toni managed it. Though Choate had a history of alcoholism and substance abuse that Brown, her therapist, was well aware of, Brown nonetheless chose to put Choate in charge of the bar. And not surprisingly, Choate began to drink and take pills. Saddled with her secret relationship, and turning to drink, she became increasingly unstable, and increasingly dependent on Brown. On June 6, 1997, in Brown's home office, Choate gave her therapist a surprise. She handed Brown a small felt-covered box. As Brown opened it, she began to cry, Choate says. Inside was a wedding ring. Brown slipped the ring on her finger, accepting it without pause. Choate says that Brown had often talked with her about leaving her husband and running off with her client. The Browns had planned a trip to Europe at the end of the month. Choate was making her play for Brown. And the therapist agreed that she would back out of the trip and move away with Choate while her husband was gone. Then she changed her mind. In the days before the trip, Choate and Brown made frantic calls back and forth. But by the end, Choate could tell that Brown was backing out. Crushed by abandonment, Choate told Brown she would kill herself. She says she drove to Mission Beach in Carmel, where she had often scuba dived, near where she had spent time with Brown. At sunset, Choate washed a fistful of painkillers down with half a bottle of tequila and swam into the setting sun. She clung onto a kelp bed, turned her head to the sky and waited for the tide to drag her out to sea. When she came to, she was face down in the sand. The surf was breaking over her back as she puked up her suicide cocktail. The following day, Choate drove back to Brown's home. It was quiet--empty. Mildred had left her a note. "I love you, we'll talk when I get back. I hope you are OK," it read. Choate snapped. She tore pictures of Brown and her husband off the refrigerator and ripped them in half. Then she packed to leave. But on her way out, Choate passed the master bedroom. Seeing the bed where she and Brown had made love so often filled her with rage. In lipstick, on the bathroom mirror, she scrawled, "You don't sleep in my bed." Then, with her handgun, she unloaded 10 .38 caliber bullets into the bed. Choate put the smoking gun to her own head. She pulled the trigger. It clicked. She had run out of bullets. BEHIND BARS in Santa Clara County Jail, Choate had plenty of time to think over what had happened. Her defense team hired Dr. Jules Burstein, a forensic psychiatrist, to evaluate her. Burstein was appalled by what Choate told him about her relationship with Brown. "Apart from seriously injuring or killing a patient it is hard to imagine a form of betrayal more violative than to enter into a sexual relationship with them," Burstein says. Burstein has worked with many patients who have had sexual relationships with their therapists and says the impacts are tremendous. "There is an incredible experience of violation of trust and professional betrayal. Anyone who goes into therapy, there is a common knowledge that you don't have sexual relationships with your clients." When Burstein evaluated Choate he was hardly shy about what he saw as Brown's responsibility for Choate's mental deterioration. "[T]here were clear indications of moderate to severe psychological problems of a long-standing nature which have been geometrically exacerbated by the sexual relationship between the client and her former therapist," he wrote in his letter to the court. Nonetheless, Choate served eight months in county jail. Burstein points out that boundary violations are considered so damaging that any licensed therapist, whether a psychiatrist, psychologist or marriage, family and child counselor, will immediately lose his or her license once a sexual relationship with a client is disclosed. And in California it is against the law, punishable by jail time and fines. But only if the therapist is licensed. Brown, however, is not licensed. In California, psychiatrists, psychologists and marriage and family therapists and others are regulated by the state. Even barbers have licenses--but not sexologists. Sexology is only regulated in one state: Florida. According to her biography, Brown's only advanced degree is a Ph.D. in human sexuality from the Institute for the Advanced Study of Human Sexuality in San Francisco. Brown is certified by two professional organizations, the American Board of Sexology and the American Association of Sex Educators, Counselors and Therapists. Both groups have requirements for certification which include an advanced degree and a certain number of hours of clinical work. The later group has a detailed code of ethics that strictly forbids any kind of dual relationship between therapist and client, including a sexual one. The American Board of Sexology, on the other hand, has no ethical guidelines at all. But Bill Easterling, director of the organization, says that if verifiable allegations of a sexual relationship were reported to his organization, the member would most certainly lose certification. BUT LOSING CERTIFICATION does not mean losing the ability to practice. Without state licensing, there is nothing stopping Brown from continuing her practice as long as she can continue to bring in patients. Ted McIlvenna, who wrote a jacket quote for Brown's book, is president of the Institute for Advanced Study of Human Sexuality. He says that psychology and sexology are completely different professions and there is little need for state licensing of sexologists. "The strange thing is that I've never known a clinical sexologist to fuck their patients. They don't do that. Generally people in other fields have the magic cock theory," he says. Part of the reason that McIlvenna doesn't worry about long-term relationships between sexologists and their clients is because he does not see the work as long-term psychotherapy that confronts deeper issues. Much of that work is done by people who are already licensed mental heath professionals who specialize in sexology. Many students at his school are pursuing a specialty in addition to their clinical background and are already regulated by various state agencies. Those sexologists with no license for any mental health practice generally have short-lived relationships with their patients, some totaling only two or three visits, he says. But that is not how Brown conducted herself. Choate saw her several times a month for three years. Other patients also have had long-term therapeutic relationships with Brown. Given the kind of sensitive, moving materials she uses in her book, and that appear in her notes from sessions with Choate, she was doing far more than conveying technical information about sex reassignment. Choate's attorneys say she was, in effect, counseling people who were going through dramatic changes in their lives. "There is a lot of danger with a sexologist who is not licensed," says John Winer, one of Choate's attorneys. There is a tendency to compartmentalize the mind, he says--to go to a drug counselor for drug use, a sexologist for sex issues--but most problems run much deeper than that, requiring someone more qualified. "Alcohol abuse is more than just having too many drinks," he says. HIDDEN BEHIND the Billy DeFrank Center is a place called "Carla's" where the transgendered community can come to meet, spend time together and shoot a few games of pool. Many of Brown's patients have spent at least a little time hanging out in Carla's. Jennifer Woolcott and Connie Place, two of Brown's patients, want to talk about how important Brown has been to them. Enveloped by the room's pink walls and fading flowers, Woolcott explains that Brown saved her life. Woolcott tried to run her car off the road into a pylon and end her life rather than explain her gender identity to her family, her children. She missed, and survived unscathed. She began reading Brown's book and called the therapist before she'd even finished it. Brown agreed to see her. In less than a year, Woolcott says, Brown's expertise, warmth and compassion helped her find her way again. "If I had not found Millie, there is no doubt in my mind that I would have finished the job soon," she says. There are hundreds if not thousands of others who feel the same way, they say. Though Brown was not licensed, no one has alleged that she ever claimed otherwise, they say. Both Woolcott and Place say that Brown was professional but compassionate, and that she always provided referrals to mental health professionals, physicians, whatever her patients needed. Both have been to many mental health professionals, licensed and not, and say that Brown was unquestionably the best. In 1996, the community had a chance to show Brown how much she had helped. At the Billy DeFrank center, 250 of Brown's friends and clients gathered to celebrate the publication of her book, True Selves. One woman told the group that Brown had saved her life. Brown told Metro in 1997, "He asked how many people in the room felt their lives had been saved because they met me. Forty or 50 hands went up, and the whole room burst out in tears." Woolcott and Place are not surprised that Brown hired Choate to help around the house, even that she went into business with the patient. Most people who go through sex reassignment surgery lose their jobs, homes and family. The surgery itself costs more than $30,000 and is not covered by insurance. Many people in the community lend a helping hand. Place says that Brown has even waived her therapist fee when Place was down on her luck. Her generosity has helped to make the transgender community here generous, they say. JUST OFF MERIDIAN AVENUE in west San Jose, Mildred and Bernard Brown's home, with its two-car garage and manicured lawn, blends perfectly into its winding, tree-lined suburban neighborhood. Brown did not return calls from Metro, but instead referred them to her attorney, Steven Fink, who refused to comment on the case, or on the settlement reached last month. Choate's attorney Linda Scaparotti said that keeping the dollar amount paid to Choate by the Browns private was a condition of the settlement. She would not say whether it approached the $2.5 million sought. "You saw the [seven-volume] file [at the courthouse]," she said. "We would not have gone through all of that for nothing" was all she would say. Also as part of the settlement agreement, all the countersuits were dropped. "Our argument was that there is a standard of care that everyone needs to live up to," Scaparotti says. "She [Brown] was acting as a psychotherapist. She called herself a therapist in her book and therefore she should be held to the same standard of care as a psychotherapist." Ultimately, licensing and state regulation for sexologists may be the best way to curb the kind of abuse that Choate says she suffered. And this case may help to spur that cause. "We hope that ... it will cause sexologists to tighten up the standard of care with firm boundaries," Winer says. "We hope this case could cause the Legislature to want to regulate this field." Howard Ruppel, director of AASECT, agrees that licensing is important. "It's on our agenda for the next century," he says. "But it is a huge task to undertake. It's going to take awhile." As Choate stands up from the table in the conference room, she twists a ring perched at the end of her index finger. Letters punched into the thick silver band read "Woman in Love." "It's a gift from my daughter," Choate explains. Her teenage daughter has been living with her for a year now, and Choate says that the teenager has recharged her entire life, giving her the strength to move forward, the strength to dredge up all the pain she experienced with Brown. She knows she is doing the right thing. "If there is someone else out there in a similar situation, I know they will hear about this and know that they can get out," Choate says, turning to walk away. "That is worth everything for me." [ San Jose | MetroActive Central | Archives ]