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Kevin was 19 when referred to a Consultation Centre because of his self-cutting. He had no awareness of his motivation for cutting, and little capacity for self-observation. He spent much of his initial interviews complaining of physical symptoms, blaming others for his difficulties and fearing others would see him as homosexual. Chronologically in late adolescence, he had found no acceptable sexual identity. His masculinity, his femininity and his homosexuality were all intolerable to him. Unable to remain the dependent child or be the little girl he longed to be (or felt he was) he switched repeatedly from one identification to another. Gratification of his sexual fantasies had to be avoided as too bad, too dangerous to himself or others. Most of all he condemned his paedophilic fantasies about little girls. His sexuality and his aggression were channelled into self-destructive acting out: drinking, burning himself with cigarettes, cutting his face and stomach, getting himself attacked, and attempting suicide by throwing himself down the underground stairs. His experience of affect was often short-circuited via somatisation, in giddy fits, pains, and, at times, epileptic fits.
In current literature there is considerable agreement that the roots of difficulties in gender identification and sexual perversion lie in the pre-oedipal phase, although they may be reinforced in the oedipal phase and at later stages. Many authors describe difficulties in the separation-individuation phase (Mahler, 1965) as fundamental, resulting in the lack of a fully differentiated sense of self, and an ongoing longing for and terror of merging. (See for instance, Blum, 1977; Karasu and Socarides, 1979; Rosen, 1979). Some authors, notably Socarides, (1979b) and Volkan (1979) have pointed to the rapprochement sub-phases as critical. A number of writers point to the unintegrated, shifting and apparently superficial quality of the identifications in severe cases. (Glasser [1985a]