From a Pictogram to a Symbol: Working with a Transgender Patient in an NHS Gender Clinic Using Piera Aulagnier's Theory of Identity Formation

Abstract

This article presents clinical work with a transgender patient who was attending a regional NHS gender clinic in England. It aims to link aspects of the patient's identity formation with the theoretical framework offered by the French psychiatrist and psychoanalyst Piera Aulagnier. Emphasizing the complexity of (gender) identity and its process of development, the concept of the 'birth of the body' is used to situate the development of gender identity as a process of the creation of an individual narrative, with the experience of embodiment based on unconscious fantasy as specifically troubling for transgender individuals. This struggle may be seen in the clinical material presented. Recommendations are made for working with transgender clients who suffer from a disturbance in creating and navigating relationships. By using the concept of the 'word-bearer', an exploration may be opened up of the unconscious dynamics between the clinic as an object that offers understanding, and the service user who is seeking meaning and a remedy for subjective suffering.