Paola on the couch: An empirically supported psychoanalytic psychotherapy of a trans woman

Psychoanalytic accounts of gender variant patients in the recent literature are fairly rare. Psychoanalysis with these patients suffers from old biases which determined short-sighted and pathologizing interpretations of transsexualism. This contribution provides an account of a long-term psychoanalytic psychotherapy, based on an open and affirmative approach towards gender reassignment, of a trans adult woman during the crucial years prior to the decision for gender reassignment surgery (GRS). Empirical measures include the Shedler-Westen Assessment Procedure-200 (Westen & Shedler, 1999a, 1999b; Shedler & Westen, 2006) and the Countertransference Questionnaire (CTQ; Betan, Heim, Zittel Conklin, & Westen, 2005; Tanzilli, Colli, & Lingiardi, 2009). The study illustrates the progress in Paola’s psychological functioning and in the therapeutic relationship through the clinical description of various phases of a long-term therapy (referral, one year after, and follow-up nine years after) and the findings on the measures collected at each stage. The results show the benefits and the complexities of the psychoanalytic treatment with gender variant patients, supporting them in key aspects of their transition.