Harvey and Tina are a middle-aged mixed-race couple who present for counseling after 20 years of marriage. They state that there are no known problems in their marriage, but they would like to establish a safe space to discuss issues as they might develop. While gathering history, you learn that Tina was born as Anthony and went through sex reassignment surgery two years into her relationship with Harvey. Shortly after going through sex reassignment, Harvey and Tina married. Harvey and Tina appeared well groomed with superior insight and no plans to use insurance for counseling.