The psychoanalyst and the transsexual patient

The author remarks on the dearth of psychoanalytic literature concerning analyses of transsexuals and of clinical experience with such patients in general. Drawing on her personal work with transsexual patients at a specialised centre, as well as with children suffering from gender identity disorders and their parents, she is able to specify the factors which, in her view, make the psychoanalysis and psychotherapy of these subjects so difficult. In particular, they are totally focused on the body and on their intention of securing sex reassignment by hormonal and surgical treatments, so that they rule out the involvement of any psychic element. The psychic functioning of these patients is illustrated by some clinical vignettes, and the transference and countertransference problems are discussed. The author shows how the patients concerned have great difficulty in accepting a psychological approach to their problems; they do not speak the language of wishes and conflict, and claim to remember nothing of their childhood or past life. She concludes that transsexualism is a narcissistic disorder in which the constitution of the self has been profoundly impaired and that it is only since analysis have embarked on the treatment of non-neurotic patients that the condition has become accessible to psychoanalytic psychotherapy or indeed to psychoanalysis. The difficulties notwithstanding, the author considers that such work is worthwhile and that patients can benefit from it.