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My contribution draws on 15 years of treating trans patients of various genders, embodiments and self-identifications, in private and institutional/inpatient settings. I have worked analytically with patients who wanted to explore transitioning, who were in the process of transitioning, who wanted to resolve gender conflicts, and some who came to understand themselves as trans during their analysis. I also have, and continue, to treat atypically gendered and trans children and adolescents – again in private and institutional settings. This work also oftentimes involves meeting with parents who navigate difficult decisions of various kinds including medical interventions.
This clinical experience leads me to regard with caution statements made by colleagues who have not analysed trans patients. I urge my fellow analysts to be similarly discerning. This should not be a controversial statement. But I feel the need to make it because I have often heard surprisingly strong opinions from analysts inexperienced with this population. Further, colleagues unfamiliar with trans scholarship should be aware that an extensive psychoanalytic literature about trans already exists.†
Trans is a still-evolving term.† Currently, it describes a heterogeneous set of individuals who share a felt sense of misalignment between experienced gender and the gender to which they were assigned at birth on the basis of observed sex. Trans includes, at least, the following: people experiencing varying degrees of distress about bodily morphology that marks, or is seen as marking, gender; a subset seeking hormonal interventions to modify secondary sexual characteristics; a group feeling the need to surgically align their body with their self-identified gender; individuals only altering social signifiers (e.g. name, pronouns) but uninterested in medical/surgical procedures; some who experience no bodily distress; and persons who do not identify as male/female, yielding new terms such as “gender non-bina