Nine Months Therapy with a Transvestite

This paper is a revised version of a talk that I gave at the Paddington Centre for Psychotherapy where I was working as an Honorary Therapist. The point of the talk had been to share with other people who were working there some of the impact that this patient had upon me. This still remains the central purpose of this paper. It is a description of our work together over the nine months that Mr G stayed with me, and as we plunged into the core complex (Glasser 1979) that he vividly reenacted. I hope that in keeping it at this descriptive level it shows something of the nature of the difficulty I had in holding this patient. As he allowed himself to be affected by the therapy he experienced an even greater threat to his autonomy and his individuality. We swung between his desperate need to ‘cement’ himself to women and never be left, to the threatening fear of annihilation and humiliation as he felt any closeness or understanding. In the end he felt forced to end the therapy as ruthlessly and abruptly as he experienced my breaks between sessions and holidays. He walked out one day and I never heard another word from him.

Mrg

When I was asked to take on Mr G I had had no experience of working with perverse patients. So the first question I had to ask myself was what propels someone to cross-dress. Freud (1927) suggested that what the fetish achieves is a ‘token of triumph over the threat of castration, and a safeguard against it. ‘This idea seemed to find agreement with Stoller (1968) who suggested that transvestism is fetishistic cross-dressing. I read further and was to discover that the literature was very pessimistic about changing perverse behaviour. Stoller (1968) had this to say. ‘Although he may ask the psychiatrist to cure him of the transvestism, what he is really asking is to be cured of his pain. He generally does not consider his transvestism as painful. Quite the contrary, it is most enjoyable; what it stirs up in others is what leads to pain.