From the Womb to the Therapeutic Relationship: Human Interaction, Biology, and the Shaping of Gender Identity

Drs. Lippe and Offner have written a stimulating paper that attempts to link their astute clinical observations of a complicated treatment with an overarching theoretical statement about approaching gender and gender disorders using both psychoanalytic and postmodern sensibilities. The authors organize the developmental history of their patient, E, around some of the multiple, interacting factors—from biology and trauma to parental dynamics—found in the research literature on the etiology of gender identity disorders (Coates, 1992; Bradley and Zucker, 1997). But, over and above the baffling enigma of etiology, what stands out in this paper is Lippe and Offner's interesting depiction of shifts in the structure of E's gender identity over five years of therapy. These shifts serve as the vehicle for their advocacy of the value of thinking about gender identity in terms of a working synthesis of postmodern and psychoanalytic positions.

I found myself deeply admiring Dr. Lippe's work with E, an anatomical male, who, over several years of their relationship, seems to