Crossing guardians: Signaling and safety in queer and trans therapist/patient dyads.

Abstract

Decades of relational psychoanalytic work have critiqued the classical notion of the analyst as a blank screen, acknowledging that patients can and do respond transferentially not only to their projections onto the therapist but also to the real person of the therapist. Despite this recognition, there has been limited attention to describing how therapists communicate to patients, explicitly or implicitly, the elements of their own identities and experiences that are salient to the treatment relationship; indeed, there remains some hesitation to acknowledge that social identities such as sexual orientation, race, class, and gender identity are salient to the therapeutic relationship. Engaging psychoanalytic thought through queer theory, clinical/theoretical literature, and two extended case vignettes, this article describes dynamics often present in clinical dyads in which both the therapist and patient are queer-and/or trans-identified. The authors introduce new conceptual language to describe transference/countertransference configurations structured by queer understandings of family, allyship, and diaspora and attempt to map the ways that shared experiences of navigating oppression can be held and expressed in the clinical dyad, meeting needs for accurate mirroring and attuned caregiving that were often absent, developmentally, for queer and gender-expansive patients. Eschewing prescriptive treatment "recommendations," the article instead invites all clinicians to reflect on the personal experiences and identities they bring into the consulting room, the meanings that patients make of them, and the implications for clinical theory and practice.