Withdrawn: The seventh penis: towards effective psychoanalytic work with pre‐surgical transsexuals

Abstract

The author reflects on his contrasting analytic work with two transsexual patients. He uses three previous psychoanalytic studies (Stoller, Morel and Lemma) to explore whether effective analytic work with the issues driving a person's determined wish for sex reassignment surgery (SRS) is possible. Particular consideration is given to how such work might navigate a path between traumatizing and pathologizing the patient on the one hand and avoiding important analytic material out of fear of so doing on the other. The author proceeds to ask whether it is possible to tell in advance, with any degree of reliability, who is and who is not likely to benefit from surgery. He considers certain diagnostic issues in relation to these questions. Illustrations are given of how, in practice, countertransference anxieties about psychopathologizing transsexual patients can contribute to significant difficulties in working clinically with them. It is argued that the understanding and containment of such anxieties could eventually lead to more effective analytic work, and that such work might be further facilitated by considering the contribution of mind-body dissociation to transsexualism.

Clinical material

“…What feelings did it evoke? in my own experience, working with people who use the transnarrative to distance themselves from feelings of vulnerability in this way can evoke hard to reach feelings of hatred in the countertransference (Winnicott, 1949;Withers, 2015). is it possible that something similar was happening here?…”

Transgender medicalization and the attempt to evade psychological distress

“…This presents further challenges to the therapeutic couple. Withers (2015) writes more about the role of paternal trauma in trans‐identification.…”

“…There is a rapidly growing body of literature (Withers 2015; Patterson 2017; Ayad 2018; Bonfatto and Crasnow 2018; Lemma 2018; Littman 2018; Rustin 2018; Withers 2018b; Stagg 2019; D'Angelo 2020; Pick 2020) suggesting that psychological issues can play a crucial role in young people's trans‐identification. These include difficulties coming to terms with puberty, other sexual difficulties including abuse, social isolation, affect dysregulation, alexithymia, anxiety, depression, self‐harm, body dysmorphic disorder, attachment trauma, problems with triangulation and symbolization, as well as unconscious homophobia and autistic traits.…”

Gender detransition: a case study

“…Detransitioners are now sharing their stories online and entering therapy. Though there is still little research on this population, discussions of individual cases are available (Withers 2015 , 2020 ; Levine 2017 ; D’Angelo 2020 ; Korpaisarn & Modzelewski 2019 ; Turban & Keuroghlian 2018 ; Marchiano 2017 ). Detransition has also begun receiving increased attention in the clinical literature (Butler & Hutchinson 2020 , Expósito‐Campos 2021 , Entwistle 2021 , Guerra et al 2020 ).…”