Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Social Work


Self-mutilation of the genitals is a complex phenomenon that can provoke strong countertransference reactions amongst mental health clinician. Transsexuals who engage in self-inflicted mutilation of the genitals face a potentially increased risk of alienation from healthcare providers due to marginalization and lack of understanding by treating clinicians. Frequently, assumptions are made regarding the motivation for the behavior that fails to take into account the complex interplay between contributing psychological, social, and environmental forces.

This qualitative study explored the experience of four psychotherapists who had encountered the behavior in their work with transsexual clients in order to gain a more accurate picture of how psychotherapists understand the phenomenon. Participating psychotherapists engaged in semi-structured interviews which were transcribed and analyzed utilizing an interpretative phenomenological theoretical framework.

Data analysis revealed nine emergent essential themes. These themes were mapped onto the domains of therapist activity inherent to the interaction with the phenomenon. Within the domain of conceptualization, therapists understood the manifestation of the behavior as connected to the client experience of psychological pressure, constraints on the client sense of agency, and attempts to protect the self of the client through action. Within the domain of treatment, concepts shaping the interventions of the therapists included affirming female gender identity, mediating the vulnerability associated with the client coming out process, and using safety planning to promote the client's self-reflective capacity. Within the domain of the impact of the phenomenon on the self of the therapist, relevant themes included the therapist experience of countertransference as a parallel process to the client's experience, the therapist desire to engage in competent practice in the context of emotional stress, and active coping on the part of the therapist to manage personal and professional challenges associated with treating clients who engaged in genital self-mutilation. The author concludes the investigation with relevant clinical recommendations to assist clinical social workers and psychotherapists in competently assessing and intervening with this behavior amongst this population.

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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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