This article is adapted from a presentation the author gave at the Forty-Ninth Congress of the International Psychoanalytical Association in Boston, Massachusetts, in 2015. The author offers a reading of transphobic countertransference through a century of psychoanalytic literature on transgender patients, from Freud's applied analysis on the case of Schreber to today's relational trans-affirmative psychoanalysts. Through this reading, the author describes four basic “unthinkable anxieties” that appear to underlie transphobic countertransference reactions in cisgender analysts working with transgender patients. The author concludes that a relational psychoanalytic approach, with a focus on mentalization, can be a compassionate and transformative one for working with many trans patients.

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