Termination of a fe/male transsexual patient's analysis: An example of general validity

Abstract

The author describes the termination of an analysis, which, while relating to the particular case of a male-to-female transsexual patient, may be relevant to all analysts, particularly those whose patients need to integrate disavowed and split-off parts of themselves. The patient had undergone sex-change surgery at the age of 20. Having lived as a woman thereafter, she had asked for analysis some twenty years later. The author, who discussed the first three years of that analysis in an earlier paper, as well as her hesitation about undertaking it, considers that its termination after seven years illustrates not only the specific problems posed by transsexuals but also the general ones presented by "heterogeneous patients". To the best of her knowledge, this is the first published case history of a transsexual patient who has undergone surgery. In the author's view, the patient has acquired a new sense of internal unity based on a notion of sex differentiation in which mutual respect between the sexes has replaced confusion and mutual hate, and her quality of life has improved. On the general level, this termination shows how the reduction of paranoid-schizoid anxieties and the reintegration of split-off parts of the personality lead, as the depressive position is worked through, to a better toleration of internal contradictions, a new sense of cohesion of the self and a diminution of the fear of madness.

Withdrawn: The seventh penis: towards effective psychoanalytic work with pre‐surgical transsexuals

“…At first sight, it may appear that the analytic treatment of transsexualism simply devolves into a question of the analytic treatment of psychosis, or of psychotic elements in the psyche. Consideration of the critical incident above certainly suggests that this is important, but a search of the literature reveals remarkably few accounts of the analytic treatment of transsexuals (though see Stein , Chiland , and Quinodoz , ). None, to my knowledge, involves the ‘successful’ analysis of a pre‐surgical transsexual who is determined to have SRS.…”

“…Quinodoz () wonders whether transsexualism constitutes a special case of what she calls ‘heterogeneity’, ‘I use the term heterogeneous patients specifically to denote those who fear that inner contradictions might lead to the loss of their sense of internal cohesion.’ (Quinodoz , p. 784). While this certainly rings true of transsexuals, I am not sure if the term ‘heterogeneous’ really adds anything significant to the notion of psychotic material threatening the integrity of the container, as already outlined by Bion () and others.…”

The body one has and the body one is: Understanding the transsexual’s need to be seen

“…What can be achieved through SRS is a closer alignment between the outward appearance with inner experience. This undoubtedly brings relief to some transsexuals – I have no doubt of that – and makes a difference to their quality of life, but history and hence loss cannot be bypassed without psychic consequences (Quinodoz, 1998, 2002). How this treacherous internal course is negotiated makes a significant difference to post‐operative adjustment.…”

Pentheus rather than Oedipus: On perversion, survival and analytic ‘presencing’

“…They work 'in there' to bear, contain and mitigate the ferocity of the destructiveness, violence, rage, desire; they survive the intense helplessness, the failures, collapses, depression and despair, and the feeling of being fundamentally, irreparably fl awed. These are all revived, grasping and clinging to the analyst-to the analyst's presence and the connection with him or her, and they 11 Quinodoz (2002), in a paper summarising a transsexual patient's analysis, writes of the change in the patient's psychic space from a two-dimensional, fl at, concrete reality to a volumetric, three-dimensional internal space when the dimension of psychic reality is added. To my way of thinking, this change is the consequence of the interconnected existence with the analyst's psyche, which establishes the third dimension.…”

“…To my way of thinking, this change is the consequence of the interconnected existence with the analyst's psyche, which establishes the third dimension. 12 In this context, I would like to relate to Quinodoz's (2002) account, in a subsection entitled 'An earthquake prior to the establishment of order', about the extremely strong feelings of dismay, disappointment, collapse and abandonment that she experienced when her transsexual patient informed her, after approximately fi ve and a half years of analysis (which lasted seven years), that s/he plans to go ahead with a series of sex-change operations. She writes, 'For a moment I felt that everything was collapsing; Simone was abandoning me, slapping me in the face, administering the most violent aggression ever: there she was putting everything back on the concrete level, on that of external appearances, whereas I had thought that she was now in search of a more internal, psychic, sense of identity' (p. 787).…”