A twenty-five-year-old person who had apparently met the diagnostic criteria for "true" transsexualism in his adolescence came for treatment to have the sexual

reversal surgery itself reversed. While the patient had made a fairly good adjustment as a female, she was unable to overcome the knowledge that she was in fact a man. Psychological evaluation revealed a primitive level of ego development with marked impulsivity and severely unstable identifications, but there was no evidence of psychosis. The patient remained in treatment for only six sessions and resumed life as a female, later requesting transformation surgery once again. Using Kubie's concept of a drive to become both sexes, the author demonstrates that in this case and in a similar one described by Stoller and Newman the gender dysphoria is not a specific complaint to be cured by specific surgery, but the manifestation of a developmental failure of separation-individuation. The solution to such problems, the author implies, is intrapsychic, not surgical.