Countertransferential reactions with transgender and non-binary patients: a qualitative enquiry among clinicians with different theoretical orientations

Aim: Recent literature highlighted the challenges encountered at countertransferential level by many therapists working with transgender and non-binary (TNB) patients. The reactions, ranging from regulatory anxiety to unconditional acceptance, seem to undermine the working alliance and patients trust in the therapeutic relationship. However, research on this aspect is still scarce. The aim of this study is to explore the countertransferential reactions of Italian psychotherapists of different orientations when encountering these patients. Methods: The sample consists of 20 psychotherapists with dynamic, cognitive and systemic orientations. Consensual Qualitative Research (CQR) was applied to transcripts of a semi-structured inter-view created ad hoc. Results: Several themes emerged: 1) Strong countertransferential reactions regarding gender transitions; 2) Therapists opinions and knowledge about the concepts of gender identity and gender incongruence; 3) Developing trust in the therapeutic relationship with TNB patients. Discussion: The results highlight the presence of intense and poorly processed countertransferential reactions. The importance of updating training curricula to enhance the effectiveness of psychotherapies with people presenting these conditions is discussed.