There is a large case report literature on the treatment of children with GID using psychoanalysis, psychoanalytic psychotherapy, or psychotherapy, some of which is quite detailed and rich in content. The psychoanalytic treatment literature is more diverse than the behavior therapy literature, including varied theoretical approaches to understanding the putative etiology of GID (e.g., classical, object relations, and self psychology); nevertheless, a number of recurring themes can be gleaned from this case report literature.
Psychoanalytic clinicians generally emphasize that the cross-gender behavior emerges during the “preoedipal” years; accordingly, they stress the importance of understanding how the GID relates to other developmental phenomena salient during these years - for example, attachment (object) relations and the emergence of the autonomous self. Oedipal issues are also deemed important, but these are understood within the context of prior developmental interferences and conflicts. Psychoanalytic clinicians also place great weight on the child’s overall adaptive functioning, which they view as critical in determining the therapeutic approach to the specific referral problem.
Apart from the general developmental perspective inherent to a psychoanalytic understanding of psychopathology, one might also add to this the general developmental perspective on gender development (Ruble and Martin 1998). Many developmentalists, for example, note that the first signs of normative gender development appear during the toddler years, including the ability to correctly self-label oneself as a boy or a girl. Some authors have even postulated a sensitive period for gender identity formation (Money et al. 1957), which suggests a period of time in which there is a greater malleability or plasticity in the direction that gender identity can move (Coates 1990). Thus, early gender identity formation intersects quite neatly with analytic views on the early development of the sense of self in more global terms. It is likely, therefore, that the putative pathogenic mechanisms identified in the development of GID are likely to have a greater impact only if they occur during the alleged sensitive period for gender identity formation (Coates and Wolfe 1995).
Some of the more common themes identified in the analytic literature are reviewed below.
Revision date: July 7, 2011
Last revised: by Jorge P. Ribeiro, MD