How Cis?: Recognizing and Managing Transphobic Countertransference in Psychotherapy

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


As the previously sanctioned pathologization of gender non-conforming identities is rapidly challenged within medical models, many transgender people are newly seeking out affirming mental health care. In turn, guidelines for trans competent psychotherapeutic practice are being developed to help practitioners best respect client self-determination, to better understand the multi-facets of gender identity, and to identify challenges to effective treatment. Yet many of these resources have overlooked the identification and management of what emerging scholarship has called transphobic countertransference (TCT), referring to the ways in which a clinician’s unconscious prejudice can be felt, and potentially acted out, within the consulting room. This chapter normalizes two underdiscussed elements of clinical work with 2TNG populations: first, the undeniable presence of transphobia within the consulting room; and relatedly, the impact and uses of TCT in psychotherapy of any orientation. Clinical transphobia is framed here as an “unresolved issue” that gains utility only through its identification. Borrowing from Hansbury’s (2017) foundation, I define psychotic TCT as a set of infantile affective distortions, and contribute two additional common forms of TCT to this conceptualization: perverse TCT, relating to the internalized law and omnipotence of diagnosis; and neurotic TCT, in which the clinician’s previously held gendered meanings and social learning materialize. Ultimately, this investigation aims to help cisgender therapists better recognize their own distinct and heterogeneous reactions to 2TNG gender difference in the consulting room and, further, to curtail potential enactments.
Original languageCanadian English
Title of host publicationGender-Affirming Psychiatric Care for Transgender and Gender Diverse People
EditorsT. G. Goetz, A. S. Keuroghlian
Publication statusPublished - 2023


  • countertransference
  • transphobia
  • clinical case
  • psychiatry
  • transgender
  • transgender patients
  • patient care
  • Psychotherapy
  • psychoanalysis
  • ciscentrism
  • gender-affirming care
  • gender diverse
  • transference
  • transphobic countertransference


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