Bob Withers, an SAP analyst, describes his interest in working with trans people.  He will be speaking on the clinical implications of working with transgender people in a forthcoming talk.

My interest in transgender issues was sparked by a patient who came to see me 25 years ago wishing to return to living as a man after nine years as a trans-woman. He believed that if he had explored his gender dysphoria (GD) analytically he could have avoided irreversible genital surgery. But he conceded that he only realised this after medical transition had failed to solve his problems. Since then I have tried to find ways of helping pre-surgical trans-people address their psychological issues. My article ‘The seventh penis’ explores some of the difficulties I have encountered doing this.

Those difficulties are numerous! Firstly there are the trans-people themselves. They experience their problems in their body and resent the implication that they might be able to benefit from therapy. They feel they are being accused of being mad. Secondly there is the trans-affirmative lobby who believe they are protecting trans-people from further persecution by branding such psychological thinking ‘transphobic’. Thirdly, fear of treating GD as pathology can lead therapists to derail therapy by treating their patients as more robust than they really are. Fourthly the therapeutic profession itself is in danger of closing down effective therapeutic work by deeming it ‘conversion therapy’.

But failing to address the psychological elements in GD runs the risk of exposing more people to my patient’s fate.  Given the rapidly increasing number of young people seeking medical transition, this has the hallmarks of a major medical scandal in the making.