Article Author: Lin Fraser, Ed.D.
Sexual and Relationship Therapy
Vol. 24, No. 2, May 2009, 126-142

Informed by the author’s 37 years of clinical experience with transgender individuals, this article presents an introductory model for clinicians who provide depth psychotherapy to this population. The author points out that primary concerns of transgender individuals in psychotherapy are often the same as most people; yet developing their transgender self without the “mirroring” from others often uniquely underlies their psychological issues. Drawing upon contemporary psychodynamic theory, Jungian theory, and narratives from clients, the author proposes a developmental model which could be utilized to understand and conceptualize the development of gender identity and help foster healthy individuation of the transgender client through psychotherapy. The article starts with a discussion of a cultural shift over the years regarding attitudes toward transgender people where gender diversity and fluidity are becoming less pathologized and increasingly accepted in parts of the world. The author walks the reader through different stages of transgender identity development, from the early life, adolescence and pre-transition, to the coming out and post-transition. Through in-depth discussions of these stages, clinical issues that often emerge during therapy are highlighted and suggestions are provided to clinicians working with transgender individuals. The author recommends that clinicians take a stance where the transgender client is seen as “an authority of their own experience.” It is also critical for therapists to remain open-minded and be willing to examine their own attitude and belief about gender identity and sexual orientation.