[Transsexual defense]

The prevalent approach to the treatment of patients displaying transsexual symptoms is one that favours somatic intervention of either a hormonal or surgical nature. Normally these patients refuse to avail themselves of the possibility of psychotherapy and are indeed regarded by many therapists as largely inaccessible to therapy of this kind. Pfäfflin looks into the factors involved in the disinclination displayed by both patients and therapists to embark upon such a process. He discusses the unconscious defence mechanisms operative in this disinclination with particular reference to the incipient stages of a course of treatment extending over a number of years and involving a patient initially determined to undergo a surgical "sex change". The patient's insistence on being acknowledged as a woman is regarded here as a creative defence against a major diffusion of identity from a genetically earlier phase, connected with incomplete separation and individuation. In the author's opinion the patient's ability to relinquish this defence will depend largely on the therapist's ability to acknowledge its creativity.