"Strange and otherwise unaccountable actions": category, conundrum, and trans identities.

Despite recognizing that gender identity is a complex compromise formation, psychotherapists struggle to tolerate gender variance. We still tend to favor binary gender identities and clear developmental lines, rather than embracing a stance of subversive curiosity about the variability and fluidity of gender in our patients. When gender identity is fluid or ambiguous, countertransferential affective disturbances can arise that meld states of abjection and excitement, challenging theoretical constructs and threatening therapeutic neutrality. Case material from the treatment of a female-to-male trans person is presented from the perspective of the transference-countertransference matrix.