Psychotherapy with transgender and non-binary patients: a qualitative analysis of the countertransferential reactions of clinicians with different theoretical orientations.

Aim: Several studies evidence very strong countertransferential reactions of psychotherapists with transgender and non-binary patients. Such reactions include concerns, anxieties, and doubts related to patients’ gender incongruence. Additionally, literature has highlighted gender transition as an unfavorable element in the development of therapeutic alliances and trust in the therapeutic relationship. The present study aims to explore the countertransferential reactions of psychotherapists with different theoretical orientations and backgrounds, with transgender and non-binary patients. Specifically, the study explores the subjective experiences of clinicians during psychotherapy, their attitudes, and their knowledge regarding gender incongruence. Methods: The sample consists of 20 psychotherapists with psychodynamic, cognitive, and systemic orientations. A semi-structured interview created ad hoc was used for this study and a Consensual Qualitative Analysis (CQR) was applied to the transcripts. Results: Different themes emerged: 1) Specific countertransferential reactions of psychotherapists 2) Setting related aspects 3) Personal and professional reflections of clinicians matured during psychotherapy 4) Psychotherapists’ knowledge regarding gender identity and gender incongruence. Discussion: The study confirms the presence of very strong and poorly processed countertransferential reactions that concur with clinicians' lack of training and knowledge regarding gender themes. The importance of endorsing knowledge and informed training of clinicians on these issues is fundamental.