In this paper we consider gender role/identity disorder, its nature, its etiology, and the degree to which it is changeable, with or without the aid of psychotherapy.

We begin with a clinical illustration concerning a boy suffering from a gender disorder. The child has been observed only indirectly through the treatment of his mother, Dr. W, in therapy with one of us (E.S.) for several years. Therefore, our focus will not be on E.S.'s patient, Dr. W, but on her son, Patrick, who has been a chronic concern for his mother since her treatment began. Patrick was 3 years old when his mother, Dr. W, started therapy. He had an older sister, Carolyn, whom the mother was quite attached to and identified with. Dr. W had wanted desperately to have another girl and so was quite disappointed when Patrick was born, but was soon after, even during Patrick's early infancy, considerably mollified when she noted how much like Carolyn Patrick seemed to be. She saw Patrick as having a “feminine sensibility”—unlike her husband, whom Dr. W perceived