Gender Dysphoria: A Therapeutic Model for Working with Children, Adolescents and Young Adults (Phoenix Publishing House, 2021) by Susan and Marcus Evans is an uncomfortable book on the politically and clinically contested subject of gender dysphoria in young people. From their psychoanalytically informed perspective, gender dysphoria is a developmental disorder that looks to control ordinary developmental processes by employing primitive psychological mechanisms, much like a psychic retreat in John Steiner's sense. By firmly asserting basic psychoanalytical tenets like the inevitability of psychic pain in coming to terms with the developing sexual body or the need to take psychodynamic account of so called comorbidities, they question a one-size-fits-all affirmative approach to adolescent gender dysphoria and the wish to transition. Rather they offer a model of psychotherapeutic treatment for the complex difficulties faced by some gender-dysphoric teens that they elaborate in a rich array of case descriptions. There are many issues with their approach that are being discussed in the interview: What is the use of offering psychotherapy, let alone psychoanalysis, to a population that wants no part of it? How do we stay in an analytic position of curiosity, doubt and uncertainty when faced with demands to act either in favor or against medical transitioning? And why do they focus almost exclusively on de-transitioners in their clinical narrative? Listen to the conversation to hear their perspective on these and other problems.

Sebastian Thrul is a psychiatrist and psychoanalyst in training in Germany and Switzerland. He can be reached at sebastian.thrul@gmx.de.

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