Countertransference Madness: Supervision, Trans∗, and the Sexual

Drawing on Ferenczi's “confusion of tongues” paradigm, the author argues that the internalization of the supervisor's superego has the potential not only to expand the supervisee's ego (introjection), but also to repress their idiosyncratic functions and attack their thinking activity (intropression). To illustrate this argument, the author recounts his own supervised treatment of a transgender patient during which the supervisor-supervisee transference lapsed into a sadomasochistic dialectic and a folie à deux, leading to the premature termination of both the therapy and the supervision. While the initial interpretation of this experience underscored the supervisor's transphobia, the après-coup of writing up the case has revealed more complex thinking. Accordingly, the countertransference madness to which the author succumbed with his supervisor can now be understood as the unbinding of repressed infantile sexuality and the reenactment of paradoxical scenarios that the patient experienced with his parents.

The transgender patient in primary care

The number of people who identify as transgender or non-binary in the UK is increasing. The RCGP has identified that many transgender patients’ experience of healthcare is poor, and that general practitioners may lack experience in the assessment, referral and management of patients with gender dysphoria. This article seeks to cover the key topics in the general practice training curriculum relating to the care of transgender and non-binary adults to allow trainees to practice confidently, safely and compassionately within this field.