Transference and Countertransference in Work with Gender Dysphoric Patients

Transference and Countertransference Issues with Gender Dysphoric Patients

Robert Withers

The experience of gender dysphoria- a painful discrepancy between a person’s biological sex and their internal gendered sense of identity- can occur in a wide variety of clients. These range from teenagers anxious about the bodily changes of puberty and their emerging sexuality, to adults with a profound life-long unease with their sexed body. Degrees of mental health co-morbidity can also vary greatly. So, it is difficult to generalise about the transference and countertransference dynamics in gender dysphoria. Each person, and each therapeutic relationship is unique. Nevertheless, it may be possible to identify some common dynamics.

Gender dysphoria can be a symptom of underlying issues such as dissociated trauma carried unconsciously in the body, sexual attraction that is defended against, or other dysregulated affects that a person experiences bodily rather than emotionally, perhaps because of some kind of neurodiversity. In such cases, taking an affirmative stance towards a person’s gender identity can create the illusion of a positive transference and countertransference. But this amounts to a collusion to avoid tackling these underlying issues by wrongly regarding the body as a problem requiring medical treatment.

Engaging with dysregulated affects, dissociated trauma and unwanted sexual feelings can be a painful process for both client and therapist, giving rise to resistance and negative transference and countertransference. In this workshop Bob Withers will be exploring ways of working with these dynamics. He will be drawing on Donald Winnicott’s famous (1949) paper ‘Hate in the Countertransference’ as well as his own (2020) paper Transgender Medicalization’.