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.
Citation:
Int J Psychoanal 2000 Feb;81 ( Pt 1):21-35 an article published on the
Internet by The International Journal of Psychoanalysis <http://www.ijpa.org/>