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

Introduction: 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 gender diversity. 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). Method: Empirical measures include the Shedler-Westen Assessment Procedure-200 (Westen & Shedler, 1999a, 1999b) and the Countertransference Questionnaire (CTQ; Betan, Heim, Zittel Conklin, & Westen, 2005) and the Psychotherapy Relationship Questionnaire (PRQ; Westen, 2000). Results: 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 ten years after) and the findings on the measures collected at each stage. Conclusions: The results show the benefits and the complexities of the psychoanalytic treatment with gender variant patients, supporting them in key aspects of their transition.