Overview

Psychoanalysis is the tradition of theory and talk therapy that Sigmund Freud founded in Vienna in the 1890s. It holds that much of mental life is unconscious (outside awareness), that early relationships shape the adult self, and that distressing symptoms can carry hidden meanings. Many later schools grew out of it, including object relations (Melanie Klein, Donald Winnicott), the French school of Jacques Lacan, and Carl Jung's analytical psychology (covered on its own page).

It matters here for three reasons: the modern idea of "gender identity" came partly from a psychoanalyst, Robert Stoller; psychoanalytic clinicians lead the case for slow, exploratory therapy with gender-distressed young people; and many detransitioners use its vocabulary (false self, splitting, dissociation, defence) to explain why they once needed to become the other sex and why that need faded.

This page explains the main ideas, how detransitioners and clinicians apply them, and the strongest criticisms. It is one of several philosophical frameworks people use to make sense of gender distress.

Why psychoanalysis keeps coming up

Unlike short-term, symptom-focused approaches such as cognitive behavioural therapy (CBT), psychoanalytic and psychodynamic therapy (a shorter form built on psychoanalytic ideas) is open-ended and treats what a person says about themselves as the start of an enquiry, not its conclusion. A recurring theme in r/detrans accounts is that this was what they lacked: clinicians accepted a trans self-description at face value. Some name psychoanalysis directly:

Look for psychoanalysis. When I had dysphoria during my pubertal development and during adolescence, I would have liked the psychoanalytic perspective. —Unimyri

The same commenter wishes they had explored grief over losing the child's body, anxiety about the sexual adult body, and learning to "integrate our male and female parts", all recognisably psychoanalytic themes.

Freud: bisexuality, identification and defence

Constitutional bisexuality

In Three Essays on the Theory of Sexuality (1905), Freud argued that every human being starts with a constitutional bisexuality: a mix of masculine and feminine tendencies, and attraction to both sexes, that development later sorts into a more settled pattern (Freud 1905). For Freud, being "masculine" or "feminine" in personality was an achievement of development, not a given. Neither was ever complete, and each person keeps traces of the other.

The idea cuts both ways. It can be read as early support for a spectrum of inner gender, or, as many detransitioners read it, as proof that having "the other sex's" traits is ordinary and says nothing about being the other sex. Freud never doubted that bodies were male or female; his point was that everyone's relationship to their sexed body is complicated.

Oedipal identification

In The Ego and the Id (1923), Freud described the Oedipus complex, the young child's rivalry and love toward its parents, as "complete" and two-sided. A boy loves and rivals both his father and his mother, and the outcome is a set of identifications (taking parts of another person into oneself) with both parents in different proportions (Freud 1923). The child's sense of being a boy or girl is built from these identifications, not simply read off the body.

If a child cannot safely identify with the same-sex parent, because that parent is absent, frightening or despised, identifications may tilt toward the other parent. Some detransitioners describe this pattern in hindsight:

I completely merged with my mother, she became my only source of happiness and I took her side completely against my father. She was a godess to me. Pure good, my father pure evil. —Affectionate_Act7962, desisted male

Defence and the symptom as compromise

Freud's other key contribution is the idea of defence: the mind's ways of keeping unbearable feelings, memories or wishes out of awareness. His daughter Anna Freud set these out systematically in The Ego and the Mechanisms of Defence (1936), which included repression (pushing material out of awareness) and identification with the aggressor (protecting oneself by becoming like the person who caused fear) (International Dictionary of Psychoanalysis).

For Freud a symptom is a compromise formation, partly expressing a wish and partly defending against it. Applied to gender: a girl who was abused may wish to be a boy because boys seemed safe. The wish expresses a real need for safety while keeping the abuse out of view; it is "wrong" as a literal plan but "right" as a message.

Freud's family romance (1909), a child's fantasy of belonging to a better family, is applied by one psychologist on r/detrans to some detransitioners' stories:

There is a theory called Family romance theory - and it is about childhood development and the despair and isolation some children feel, that leads to them into generating a fantasy of wishing they belonged to a different group. —FairytalesandTherapy, verified psychologist

Object relations: Klein and Winnicott

Object relations theory shifted focus from drives to relationships, the people ("objects") a child takes into its inner world.

Klein: splitting and idealisation

Melanie Klein argued that the infant's earliest defences divide experience into all-good and all-bad. In her 1946 paper "Notes on some schizoid mechanisms" she listed the typical defences of the early ego as "splitting the object and the impulses, idealization, denial of inner and outer reality and stifling of emotions" (Klein 1946). Splitting keeps love and hate apart so that the good object is protected from one's own rage. Idealisation inflates the good side so it feels safe.

Klein called this the paranoid-schizoid position. Its healthier successor, the depressive position, is the painful capacity to see that the same person, and the same self, is both good and bad. The model maps onto accounts of the female self as weak and the male self as strong, or the reverse in men (see splitting in detransition accounts).

Winnicott: true self and false self

Donald Winnicott, a paediatrician turned psychoanalyst, set out the distinction between the true self and false self in "Ego distortion in terms of true and false self" (1960) (Winnicott 1960). The true self is the infant's spontaneous aliveness, the "spontaneous gesture" a good-enough mother meets. When a caregiver repeatedly substitutes her own gesture, the infant learns to comply, and a false self forms: an adaptive surface protecting the hidden true self. In severe forms the person feels unreal or empty, often without knowing why. Few psychoanalytic ideas have travelled further on r/detrans:

I was very ashamed of being a masculine bisexual Black woman and I created a false self (trans man) in order to cope with that shame. And everyone DID go along with it. —Admirable_Treacle_97, detrans female

I basically adapted a fake persona after a traumatic childhood and it took YEARS to realize it wasn't really me. … You wouldn't know your new identity is purely protective. —Fantastic-Tough9610, detrans female

Trans discourse uses the same vocabulary in reverse, calling transition living as one's "true" or "authentic" self. Winnicott's concept cannot settle which reading is right, because a false self feels real from the inside. Some detransitioners reject the frame altogether:

Basically what people mean by true self is who they'd like to be if their life was better. That's all it really means. —furbysaysburnthings, detrans female

Read closely, Winnicott sides with neither popular version. His true self is not a hidden gender but the capacity to feel alive, and the marker of a false self is compliance, organising oneself around what others need to see. That raises a hard question: is a new identity that depends on constant validation an escape from compliance, or a new form of it?

Transitional objects and transitional space

Winnicott's transitional objects (1953), the blanket or soft toy that is a child's "first not-me possession", belong to an intermediate area between fantasy and reality that later becomes the space of play and culture (Winnicott 1953). Applied loosely to adolescence, trying on identities in that space is healthy play. The difficulty comes when play or a temporary refuge is treated as fixed fact and made permanent in the body, what some psychoanalytic writers call concretisation, turning a symbol into a medical plan (see trauma).

Robert Stoller and "core gender identity"

Robert Stoller (1924–1991), a psychoanalyst at the University of California, Los Angeles (UCLA) gender identity clinic, popularised the distinction between biological sex and psychological gender in Sex and Gender (1968). He introduced core gender identity, the child's basic sense of "I am male" or "I am female", which he held was fixed in the first two or three years by the genitals, parents' attitudes and a possible biological force. A 2025 history notes he is usually credited with the sex/gender distinction, though it was partly worked out in dialogue with the cross-dressing activist Virginia Prince (History Workshop Journal 2025).

His theory of male transsexualism (his era's term) was family-based. Reporting two brothers who both became transsexual, he described a mother who kept a very close physical relationship with each son for years, and an absent father who could not interrupt this "symbiosis" or offer a masculine figure to identify with (Stoller & Baker 1973). Stoller saw this extreme, lifelong femininity as laid down too early, and with too little inner conflict, for analysis to undo. He distinguished this "true" or primary transsexualism from other cross-gender presentations, a typology later clinicians used when deciding who should be offered medical transition.

His legacy is double-edged. Core gender identity became the basis of today's "gender identity", including the claim that it is fixed early, which many detransitioners now reject from experience. His family model is what affirming clinicians call pathologising, yet it is echoed, unattributed, in some detransitioners' self-understanding:

In some of the earlier psychiatric writings from back before the gender movement, one of the reasons is often described as being too close to an unstable mother (borderline?) along with a distant and/or (real/perceived) dangerous father. —Affectionate_Act7962, desisted male

The model rests on a few clinical cases and has not been confirmed by controlled research: a hypothesis that fits some life stories, not a general cause.

Lacan: the mirror, the image and the real

Jacques Lacan (1901–1981) reworked Freud through linguistics. Three of his ideas bear on gender distress.

• The mirror stage. In a 1949 paper, Lacan argued that an infant who experiences its body as fragmented meets a unified image of itself in the mirror and joyfully identifies with it (Lacan Online, explainer). The ego is thus built on an outside image, a flattering illusion of wholeness, and is always partly a misrecognition.
• The body image. Because the body is first known as an image seen through others' eyes, distress about it is never purely physical. r/detrans posts about not recognising oneself in the mirror, or suddenly recognising oneself after detransition, fit this lens.
• The real. The real is what resists words and images: the raw fact of the body, sex and death. Sexual difference is where language fails, and everyone must invent a way of living with it.

Lacanians have disagreed sharply about transsexuality. Catherine Millot's Horsexe: Essay on Transsexuality (1983; English 1990), whose title puns on hors-sexe, "outside sex", read the demand for surgery as, in some patients, a wish to stand outside sexual difference altogether (Wellcome Collection). Later Lacanians, notably Patricia Gherovici, reject that reading as pathologising and argue for a "depathologizing of the transgender experience" (Gherovici 2017, Routledge). For her, transition can be a creative solution to the problem of sexual difference everyone faces.

Contemporary psychoanalytic writing on gender dysphoria

Within psychoanalysis today, there is a deep split.

The exploratory camp

• Alessandra Lemma, a British psychoanalyst, argues that a trans identity can cover many inner positions and that embracing the label too early can cut short the work of understanding it. She calls for "equidistant curiosity" and warns against using psychoanalysis as a conversion tool (Lemma 2018; see also her 2022 book Transgender Identities).
• Roberto D'Angelo, an Australian psychiatrist and psychoanalyst, described "Josh", a trans man whose life got worse after transition, and whose analysis uncovered a history of violation (D'Angelo 2020). In 2025 he described "Elly", whose maternal abuse and neglect surfaced only after 18 months of analysis, and argued that framing exploration as conversion therapy obscures:

the psychic pain that is sometimes humming beneath the experience of gender dysphoria. — (D'Angelo 2025)

He suggests the profession may be over-correcting out of guilt for its past treatment of homosexuality, and co-wrote a defence of psychotherapy for gender dysphoria (D'Angelo et al. 2021).

• Susan Evans and Marcus Evans, both formerly at London's Tavistock clinic, wrote Gender Dysphoria: A Therapeutic Model (Phoenix, 2021). It stresses the ordinary psychic pain of coming to terms with the developing sexed body and the need to treat comorbid conditions, and its main concern, one reviewer writes, is creating "a calm place for reflection" (Buchholz 2022; New Books Network).

These writers influenced gender exploratory therapy and the systemic Gender Exploratory Model (Spiliadis 2019). The English Cass Review later found the evidence for youth medical transition weak and called for broader, holistic assessment (Cass 2024).

Affirming psychoanalysts

Other psychoanalysts reject the exploratory camp's framing:

• Avgi Saketopoulou, a New York psychoanalyst, wrote an award-winning 2014 paper on analysing a five-year-old trans-identified child, introducing massive gender trauma: distress where misgendering meets anguish about the natal body (Saketopoulou 2014, JAPA). In this view, refusing affirmation itself traumatises.
• Her 2023 book with Ann Pellegrini, Gender Without Identity, abandons Stoller's "core gender identity", argues that every person acquires gender, and accepts that trauma sometimes plays a part, without this invalidating trans lives (Barnard College; review).
• The American Psychoanalytic Association (APsaA) opposes attempts to change gender identity. In 2023 it issued a statement opposing laws restricting gender-affirming care (APsaA 2023).

The overlap is notable. Saketopoulou and Pellegrini agree with many detransitioners that there is no innate gender identity and that trauma can shape gendered selves. They differ on what follows: for them a trauma-shaped gender can be a valid one to live in; for many detransitioners, discovering the trauma dissolved the need to transition.

Symptom or identity?

At the heart of the debate is whether gender dysphoria is a symptom, pointing to something else that may resolve when addressed, or an identity to be recognised. Many r/detrans commenters describe moving from the second view to the first:

I think gender dysphoria is a real symptom. I don't think being "trans" is an innate identity anymore —Lokisminion13, detrans female

Classical psychoanalysis does not force the choice: a symptom can be a meaningful solution someone builds a life around. The analytic stance is to keep asking what it means without deciding the answer in advance, a neutrality critics on both sides say clinicians rarely achieve.

Defence mechanisms detransitioners describe

These patterns recur in r/detrans accounts. They are personal interpretations, often reached in therapy, not diagnoses or explanations of anyone else's identity.

Dissociation

Dissociation is a disconnection between thoughts, feelings, body and sense of self; depersonalisation is feeling detached from one's own body or self. Many r/detrans commenters say dissociation was mistaken for gender dysphoria:

No one told me dissociation can look like dysphoria. No one told me that not recognizing myself in the mirror could be dissociation and not a gender issues. —SolidElderberry

When people refer to me as "she" or my name … I feel a complete disconnect, as if they are speaking about someone else. But when I switched to he/him, I felt the same disconnect, which was part of why I decided against medical transition and eventually desisted. —shorterversion, desisted female

This works as an informal test: if the disconnect follows the person across both gender roles, the problem may lie in their relationship to themselves rather than to their sex.

Identity as protection and repetition

Freud called the tendency to re-enact old solutions repetition compulsion. Some accounts describe a male identity as a shield, a way of becoming one's own protector against men:

We started to work through this together and have figured out that my brief period of transition was an attempt to "camouflage" myself as a man for my own protection, something I had done as a child, which had worked fairly well back then. —evergone3

So I created a fantasy identity that protected me from men and dissociated me from my trauma. —L82Desist, detrans female

Splitting

Some describe Kleinian splitting with precision. One desister describes an inner feminine figure who held all the lovability they felt they lacked, and the therapeutic answer:

A therapist and I discussed this in detail for a while, and the typical way to resolve this sort of psychological split is through integration. It's where you work on pulling that projection ("her" in my case) back into yourself, and integrating it back into your sense of self. —cranberry_snacks, desisted

Splitting can also continue after detransition, as the old identity becomes the new "all bad". One desister warns another about this:

Black and white thinking is a symptom also, good and bad, now trans to you could be "bad." This is calling splitting and it's a defense mechanism. —littlelunacy, desisted female

In Kleinian terms, healing means holding both past and present selves as neither all good nor all bad, not flipping from one idealisation to its opposite.

Idealisation and envy of the other sex

Many r/detrans accounts describe an idealised picture of the other sex, built partly on devaluing one's own. Women often describe men as free and safe; men often describe women as kind and loved:

the men in my life hurt me, both in my family and in school, and were such insensitive people, that I came to the then logical conclusion, that only women had any appreciable character refinement, and that therefore I must have not been a man. —GunscheHans, desisted male

The idea that women are just kinder, smarter, more beautiful, and in general are just wonderful beings that should be put on a pedestal and men are mediocre/boring/ugly in comparison. For me, feeling this way contributed to me wanting to transition to male because I felt like I didn't fit in with women and I would never live up to how I saw other women —mantis_princess, desisted female

Idealisation does not always point toward the idealised sex: here it pushed the writer away from womanhood, because she could never measure up. The problem is the idealisation itself and the devalued self it leaves behind (see internalised prejudice).

How detransitioners use these ideas

Classical psychoanalysis is expensive and rare. More often, commenters describe a psychodynamic, trauma-focused or Jungian therapist who shifted the conversation away from gender:

I talked to my therapist less about transgender issues and more about my life; what happened in my childhood, how I was treated at school, what I wanted for my future. At a certain point I stopped mentioning anything to do with being trans, and that was when I started questioning. —Bladekind, detrans female

In the site's cohort of 3,094 r/detrans users who transitioned in some form, the most common primary detransition reason was realising that trauma or abuse drove the dysphoria (450 accounts); dissociation was flagged in 328, benefiting from therapy in 198 and a negative therapy experience in 318. These are AI-extracted from self-selected posts and are not rates (detrans.ai stats).

There are risks. "Narcissism" and "false self" are sometimes stretched in r/detrans threads into claims about all trans people, which no one can know from their own life and which Winnicott's concept does not support. The ideas work best as tools for understanding oneself, not verdicts on others.

Trans perspectives

Some trans commenters describe therapists who return every problem to gender as a source of harm:

Unfortunately in my experience people in especially certain mental health fields seem to pathologise trans people more than even the average person on the street. I guess this is because they have frameworks for it —old_creepy, MTF

Others draw a line between exploration and conversion that is close to the exploratory camp's own:

helping you explore +/or process your feelings about identity or sexuality, is different that therapy that's trying to enforce a change on it - like, it's not conversion therapy to help someone detransition, or delay transition, necessarily, if they're following their patients lead and affirming their agency in the situation —JudiesGarland, ftm

The legal scholar Florence Ashley argues that gender-exploratory therapy, despite calling itself neutral, assumes trans identities may have pathological roots and shares features with conversion practices (Ashley 2022). Some trans people content with transition also use psychoanalytic ideas such as dream work; the framework does not belong to one side.

Criticisms of psychoanalysis

Unfalsifiability

The philosopher Karl Popper used psychoanalysis as a leading example of a theory that cannot be falsified, meaning no observation could ever prove it wrong (Internet Encyclopedia of Philosophy). If a patient accepts an interpretation it is confirmed, and if they reject it that is "resistance". The philosopher Adolf Grünbaum later argued that Popper misdiagnosed the problem, because some Freudian claims can be tested and have failed. Either way, the result is the same: psychoanalytic explanations are interpretations, not established causes (Grünbaum 2009).

This applies here in full. "Your trans identity was a defence against trauma" can be as unfalsifiable as "your doubts are internalised transphobia". The detransitioners quoted here found their reinterpretations convincing because their distress lifted and the need to transition faded. That is meaningful evidence for each of them, not proof for anyone else.

The history with homosexuality

Freud himself was relatively tolerant. In his 1935 "Letter to an American Mother" he wrote that homosexuality is "nothing to be ashamed of, no vice, no degradation" and "cannot be classified as an illness" (PBS). Yet mid-century American psychoanalysis turned homosexuality into a disorder to be cured. It excluded gay candidates from training, and APsaA reversed its position only around 1991, nearly two decades after psychiatry. In 2019 APsaA formally apologised for its role in "discrimination and trauma" (Reuters 2019).

This history is the strongest reason trans advocates distrust exploratory work. It matters to detransitioners too: many r/detrans accounts describe same-sex attraction, and some describe transition as an escape from homosexuality (see internalised homophobia). A psychoanalysis that once tried to "cure" gay people and a gender medicine that may turn gender-nonconforming gay youth into straight-appearing trans adults can look, from that vantage point, like two versions of the same failure to let gay people be.

Conversion-therapy concerns

Conversion therapy, efforts to change someone's sexual orientation or gender identity toward a preferred norm, is condemned by professional bodies including APsaA (APsaA statement). The concern is that a therapist who believes dysphoria is "really" trauma will steer the patient there, which is as directive as automatic affirmation. Exploratory writers reply that they have no preset goal, and that treating every question about meaning as conversion makes psychotherapy impossible (D'Angelo 2025; Lemma 2018). The real test is whether a therapist can tolerate any outcome, including one they did not expect.

Assessment

Psychoanalysis cannot tell anyone what their gender "really" is, and its best practitioners do not claim to. It offers questions (what a wish does, what it protects against, what it repeats) and a vocabulary that many detransitioners found named experiences no one had named for them.

Its weaknesses are real: its theories are hard to test, its history with homosexuality is shameful, and interpretations can be imposed rather than discovered. But the alternative many detransitioners met, rapid acceptance of a self-diagnosis followed by permanent medical steps, often skipped the questions entirely. For many on r/detrans, the tradition's value is that it slows things down, treats the person as more than a gender, and leaves room for an answer that does not involve changing the body. Gender non-conformity itself needs no explanation or cure. What psychoanalysis can help with is the pain that sometimes attaches to it.

Related pages

• Philosophical frameworks: other lenses for making sense of realisation
• Jung and analytical psychology
• Gender exploratory therapy
• Trauma and gender distress
• Reframing dysphoria
• Gender as an explanatory framework
• Internalised prejudice
• Gender non-conformity without labels
• Support directory: gender-exploratory therapists and detrans support groups

References

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• Freud, S. (1923). The Ego and the Id. Standard Edition vol. XIX. text.
• Freud, S. (1935). Letter to an American mother. PBS.
• Freud, A. (1936). The Ego and the Mechanisms of Defence; see "Identification with the aggressor", International Dictionary of Psychoanalysis. source.
• Klein, M. (1946). Notes on some schizoid mechanisms. International Journal of Psycho-Analysis, 27, 99–110. PubMed.
• Winnicott, D. W. (1953). Transitional objects and transitional phenomena. International Journal of Psycho-Analysis, 34, 89–97. PEP-Web.
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• Stoller, R. J. (1968). Sex and Gender: On the Development of Masculinity and Femininity; (1975) Sex and Gender vol. II: The Transsexual Experiment. Discussed in: Virginia Prince, Robert Stoller and the trans feminist intellectual history of the sex/gender distinction. History Workshop Journal (2025). source.
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• Lacan, J. (1949). The mirror stage as formative of the function of the I. Explainer: Lacan Online.
• Millot, C. (1983/1990). Horsexe: Essay on Transsexuality. Autonomedia. catalogue.
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• Lemma, A. (2018). Trans-itory identities: some psychoanalytic reflections on transgender identities. International Journal of Psychoanalysis. study page, PubMed.
• Lemma, A. (2022). Transgender Identities: A Contemporary Introduction. Routledge. source.
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• D'Angelo, R., Syrulnik, E., Ayad, S., Marchiano, L., Kenny, D. T. & Clarke, P. (2021). One size does not fit all: in support of psychotherapy for gender dysphoria. Archives of Sexual Behavior, 50, 7–16. DOI.
• D'Angelo, R. (2025). Do we want to know? International Journal of Psychoanalysis. study page, PubMed.
• Evans, S. & Evans, M. (2021). Gender Dysphoria: A Therapeutic Model for Working with Children, Adolescents and Young Adults. Phoenix. Review: Buchholz, M. B. (2022), International Forum of Psychoanalysis. DOI; New Books Network.
• Spiliadis, A. (2019). Towards a gender exploratory model. study page.
• Cass, H. (2024). Independent review of gender identity services for children and young people: Final report. study page.
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• Saketopoulou, A. & Pellegrini, A. (2023). Gender Without Identity. Unconscious in Translation. Barnard College, review.
• Ashley, F. (2022). Interrogating gender-exploratory therapy. Perspectives on Psychological Science, 18(2), 472–481. DOI.
• American Psychoanalytic Association (2023). Position statement opposing anti-trans legislation. PDF. Statement on opposition to conversion practices: apsa.org.
• Reuters (2019). U.S. psychoanalysts apologize for labeling homosexuality an illness. source.
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• Grünbaum, A. (2009). Popper's fundamental misdiagnosis of the scientific defects of Freudian psychoanalysis. In Rethinking Popper, Boston Studies in the Philosophy of Science 272. Springer. source.
• detrans.ai statistics: AI-extracted features from 3,094 self-selected r/detrans accounts. stats.