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This book is based primarily on a selection of papers presented at a conference on gender identity development, held at the Tavistock Centre in London, in November 1996. It is edited by Domenico di Ceglie, the director of the Gender Development Unit at the Portman Centre, together with David Freedman. The title of the book most successfully evokes a sense of the unthinkable quality of the experience of children who are suffering from a gender identity development disorder, or, as termed by di Ceglie, as having an ‘atypical gender identity organization’. The fact that experience of such children or adolescents is at the core of this book is a reflection of how sensitively the issue has been treated. The contributions all come from professionals who are involved with the problem in different settings. Each of them brings a great depth of experience or research, which gradually allows the reader to appreciate the complexity of the issues related to the condition and its relation to the mental health of the child and adolescent.
In his own contribution to the conference, in a chapter entitled ‘Management and therapeutic aims’, di Ceglie makes a most important statement which clearly comes from his long clinical experience with children and adolescents brought to a gender clinic. He says: ‘Without the recognition and non-judgemental acceptance of the gender identity problem, no exploration can start’ (p. 186). Although this may seem something that psychoanalysts believe that they take for granted in their clinical work, di Ceglie is here warning us how difficult it is for anyone, parents, educators, doctors, as well as psychotherapists, not to fall into the trap of believing that it is a matter of a conscious choice made by the individual, even if we recognise that the motives for that choice are fundamentally unconscious. Freud said that the first thing we register when we see someone approaching us from a distance is whether they are male or female. Being confronted by