Vicissitudes of Gender Identity in the Female Therapist/Male Patient Dyad

Central to conceptualizing the special issues in analytically oriented treatment of male patients by female therapists is an examination of differences between women and men in the process of gender-identity formation. Of particular importance are the generally greater fragility of masculine identification, the concomitantly greater rigidity of defenses on its behalf, and the psychological threat of regression to the boy's early identifications with the preoedipal mother, or, using Stoller's phrase, “protofemininity” (Stoller & Herdt, 1982), in the absence of a maternal object.

I am proposing that an understanding of these differences assists in formulating the therapeutic process broadly, as well as many of the transference/countertransference concerns identified in the sparse but provocative literature on the topic. This literature will be referred to selectively as it illuminates aspects of the therapeutic process in the treatment of a gender-dysphoric male. The cogency of an object relations model of gender identity formation will be illustrated by a clinical vignette in the hope that an examination of the dynamic roots of the severe pathology, the unfolding gender identifications within the therapy, and the transference and countertransference manifestations will illuminate