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The author poses several questions about sexual object choice and sexual identity, problems that have not been sufficiently elucidated. Feminine homosexuality has not been studied as much as masculine homosexuality. One cannot extrapolate mutatis mutandis from masculine to feminine homosexuality. Chiland considers
in particular the problem of female transsexual patients, those either asking for surgical reassignment of sex, or who, already having obtained it, live with the identity of a man.
The countertransference in working with sex-changed persons is a difficult one; even in the attempt to refer to these patients, we find the pronouns confusing and may adopt some neologism such as “he/she.” How does one speak or write to such a person? How does one phrase a question (especially in a language that makes explicit gender distinctions)? Linguistic ways around the difficulties do not always suffice. “Male” and “female” must sometimes be employed rather than “man” or “woman” when one wants to distinguish the biological status from the social status or from the psychological experience or from appearance. In her work with transsexuals the author has not found it possible to speak of this group as an entity. Stoller's true or pure transsexualism is rare, begins in earliest infancy, pertains only to males, and is not based on conflict. However, many female patients have had an unsatisfactory relationship with their mothers.
The author expands a notion taken from Elizabeth Moberly that homosexuals in general suffer from a deficit in their capacity for a relationship with the same- sex parent. A problem with sexual identity is therefore always present in homosexuality, even if the patient's appearance is consistent with the patient's gender. The extreme or limiting case of this homosexual deficit is transsexualism and is the result of conflict, the deidentification with the same sex. All of the author's female transsexual patients, however, deny that they are homosexual, an