Psychoanalytic Psychotherapy

ISSN: 0266-8734 (Print) 1474-9734 (Online) Journal homepage: https://www.tandfonline.com/loi/rpps20

Falling outside of the ‘nice little binary box’: a

psychoanalytic exploration of the non-binary
gender identity

Mairéad Losty & John O’Connor

To cite this article: Mairéad Losty & John O’Connor (2018) Falling outside of the ‘nice little binary
box’: a psychoanalytic exploration of the non-binary gender identity, Psychoanalytic Psychotherapy,
32:1, 40-60, DOI: 10.1080/02668734.2017.1384933

To link to this article: https://doi.org/10.1080/02668734.2017.1384933

Published online: 23 Oct 2017.

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Psychoanalytic Psychotherapy, 2018
Vol. 32, No. 1, 40–60, https://doi.org/10.1080/02668734.2017.1384933

Falling outside of the ‘nice little binary box’: a psychoanalytic

exploration of the non-binary gender identity
Mairéad Losty* and John O’Connor

Department of Psychology, Trinity College, Dublin, Dublin, Ireland

Received 28 May 2017; accepted 23 September 2017

The non-binary gender identity has recently emerged on the landscape

of gender variance. It captures individuals who may experience a gender
identity that is neither exclusively male nor female, is a combination of
male and female or is between or beyond genders. The availability of
literature exploring the non-binary gender experience is somewhat limited.
Consequently, our understanding of the development of ‘self’ amongst
such individuals seems to lag behind that of other gender variant identity,
in particular the binary transgender identity. A psychoanalytically informed
qualitative research design was used to explore the psychological realities of
6 individuals, aged between 19 and 29 years, who identified as gender fluid,
genderqueer, polygender, non-binary Trans person, non-binary trans guy and
non-binary gender. Analysis focused upon the integration of conscious and
unconscious material in order to provide some insight into the participants’
internal world and object-relating. Three core themes emerged from the data:
‘A developing gender identity’, ‘Correct and incorrect language’ and ‘Being
seen and unseen’. These themes, as well as the heterogeneity and complexity
of non-binary gender identity, are explored within the discussion, with some
implications around our clinical and wider cultural response to people who
identify themselves in this way.
Keywords: psychoanalytic interview; qualitative; non-binary gender;
non-conformity; identity

In the last decade, the Western world has seen an increase in the visibility of gen-
der variant identities. More recently the non-binary gender identity1 has emerged
within our gender landscape. Such individuals may experience a gender identity
that is neither exclusively male nor female, is a combination of male and female
or is between or beyond genders (Webb et al., 2016). The non-binary gender per-
son may prefer to use gender neutral pronouns, such as ‘they/them’ and may not
identify with male or female gender markers (Budge et al., 2013). This gender
identity challenges the fixed, binary and biological conceptualisation of gender,
in which ones’ sex at birth is used to define the person as either male or female,
as he or she. In attempting to understand the non-binary gender identity, it may be
useful to explore the concepts of identity and of gender within the psychoanalytic
literature and the wider culture.

*Corresponding author. Email: mlosty@tcd.ie

© 2017 The Association for Psychoanalytic Psychotherapy in the NHS

 Psychoanalytic Psychotherapy 41
The long history of psychoanalysis has seen a level of ambivalence in rela-
tion to the status of identity. There has been a conceptualisation of the self as
consisting of multiple elements with Freud’s (1923) tripartite model of the mind
– according to id, ego and superego – involving a sense of a divided mind; still
however involving a kind of an orbiting of the ego.
We have also seen Erikson (1950) conceptualise the mind as perhaps a more
singular concept consisting of the ego, in which ego development and the rela-
tionship between the person’s biology, psychology and culture are seen as the
driving force of identity. Such contrasting opinions create a tension within the
study of identity which is mirrored within the gender literature. While there was
always a seam of questioning and openness with regard to gender variance, early
psychoanalytic thinking, influenced by Freud’s (1905) ideas and those of his
immediate colleagues, as well as the prevailing professional practices of the time,
tended to portray such gender variant presentations as reflective of poor parental
practice, trauma, attachment difficulties and disruptions within the child’s ability
to individuate from parents (e.g. Fast, 1984; Stoller, 1967, 1968). Such theories
may have perpetuated a disorder-orientated conceptualisation of gender variance
amongst mental health professionals, which may have in turn had an influence,
likely a reinforcing one, upon society’s acceptance of the transgender identity.
Although contemporary psychoanalytic writers such as Harris (2000) and Kau-
fman (2000) have explored gender as a more fluid rather than a fixed concept,
the binary and fixed conceptualisation of gender appears to still dominate our
theoretical understanding.
In the 1960s, the second wave feminist movement used a social construction-
ist argument to challenge the essentialist biologically based conceptualisation of
gender and its role in determining the social identity of men and women (Friedan,
1963; Saiving, 1960; Steinem, 19633). The binary and fixed aspects of gender
were later challenged in the 1970s, when intersex conditions2 and the transgender
identity3 began to emerge within Western culture (Drescher, 2010). Although such
identities have been documented in the history of many Eastern, Indigenous and
Western cultures for decades, these individuals were largely viewed as second
class citizens, sexual deviants or mentally ill (Drescher, 2010). However, since
the 1970s, this disorder-orientated and non-conforming view of gender variance
has been challenged by queer theorists who contended that it is based on a socially
constructed view of gender in which only biologically derived gender identities
are seen as normative (Bornstein, 1994; Butler, 1990, 1993; Feinberg, 1996, 1998;
Halberstam, 1998).
In the past 50 years gender variant identities have become more visible within
Western culture, which may suggest that they are now being seen as more nor-
mative expressions of gender. However, much of the gender discourse within
Western society seems to be centred on the experiences of men, women, trans-
men4 and trans-women5 (Drescher, 2010; Mayer & McHugh, 2016; Richards et
al., 2016). There appears to be less attention given to the non-binary experience.
Our response to gender variant identities in terms of intervention also seems to be
rooted in a medical discourse and in changing the individuals’ body to match their
42 M. Losty and J. O’Connor
gender identity as a potential treatment option (Richards et al., 2016). Therefore,
there continues to be a sort of tension between the essentialist and constructionist
view of gender within the literature. Such tensions are perhaps also evident with
many mainstream societies and the contrasting options which can emerge with
regard to acceptability and perhaps the validity of gender variant identities (see
Budge, Rossman, & Howard, 2014; Budge et al., 2013; Ehrensaft, 2011; Rankin
& Beemyn, 2012). Therefore, while acceptance of gender variance may be present
at one level within some societies, there are potentially other layers where there is
still, within the same society, a struggle with the reality of such diversity.
The limited knowledge and awareness of the non-binary gender within the
Western world may suggest that the non-binary child is growing up in a world
without role models or mirrors to inform their identity (Hansbury, 2005) and
where there may be an absence of language to describe their experience of self
and to communicate this to others (Kaufman, 2000). The lesbian, gay, bisexual,
transgender and queer6 (LGBTQ) community may also struggle to adjust to the
non-binary conceptualisation of gender (Webb et al., 2016). Consequently the
non-binary gender individual may experience a lack of support from society, as
well as groups associated with embracing gender minorities within that society.
Indeed, the non-binary gender community within the Western world are believed
to be at a greater risk of poor mental health outcomes in comparison to the binary
transgender community as a result of the higher levels of discrimination they can
experience (James et al., 2016; Budge et al., 2014). Therefore, it is possible that
the limited understanding and visibility of the non-binary gender within Western
society may present a unique challenge to the development of ‘self’ amongst indi-
viduals who identify with a non-binary gender.
Drawing on a psychoanalytically informed approach to research and to the
functioning of the person, this study aims to go into aspects of the psychologi-
cal realities of people identifying themselves as gender non-binary. The themes
which emerge through this process will be explored by drawing upon psychoana-
lytic theory regarding the development of self and identity, with particular refer-
ence to object relations theory and Erikson’s theory of psychosocial development.
The relationship dynamics that emerged between the gender variant participants
and the gender conforming researcher, and the potential impact of such dynamics
upon the therapeutic relationship, will also be explored. Following this the current
findings will be integrated with the limited research which has been conducted
thus far into the non-binary gender identity. Finally, the paper will conclude with
a discussion of some of the limitations of the current research design and possible
directions for future research.

Method
Design
A psychoanalytically informed qualitative research design was employed. Six
participants who self-identified as having a non-binary gender were recruited to
 Psychoanalytic Psychotherapy 43
participate in three 60-min interviews each, which were conducted over a period
of three to four weeks. Participants were recruited through an online campaign
facilitated by a national transgender organisation in Ireland. An advertisement
which provided: (1) a brief overview of the study aim (i.e. to explore the lived
experiences of individuals who identify with a non-binary gender identity); (2) the
inclusion criteria for the study and; (3) the participant requirements, was posted
to the Facebook account of this transgender organisation. Interested parties con-
tacted the researcher conducting the interviews directly to express their interest
and to ask further questions about the study. These individuals were then asked
to read an information sheet about the research before agreeing to take part in the
interviews. The interviews were largely unstructured to allow for participants to
engage in a relatively free-associative style of interaction with the researcher. The
interactions within the participant-researcher dyad were also considered as part of
the analysis. For this reason, interviews were transcribed alongside a reflective log
of interviewer observations and reflections regarding the participant-researcher
dyad. Analysis was informed by psychoanalytic principles and involved identify-
ing themes which emerged from conscious material across participant narratives,
as well as information gathered from discussions of the reflective log and the
participant-interviewer dynamic in supervision sessions.

Participants
Individuals who were above the age of 18 years and who identified with a non-
binary gender identity were included in the study. Participants were required
to have the capacity to partake in conversation for approximately 1 h and have
no condition affecting cognition or communication such that they were unable
to articulate their narrative. The sample used in the study reflects the first six
participants who contacted the researcher. All of these participants gave written
consent and agreed to meet for three interviews each. Of the six participants,
only one participant chose not to attend for the third interview. This participant
did not provide a reason for withdrawing from the research. In order to protect
the confidentiality of the participants they have been assigned a gender neutral
pseudonym. The participants will be introduced in the following section along
with a brief description of their unique experience of gender. Some additional
demographic information will be provided following this.
The participants were Harley (25 years), Reagan (19 years), Hayden (24 years),
Avery (29 years), Casey (20 years) and Addison (24 years). Harley, Hayden, Rea-
gan, Avery and Addison reported a preference for using they/them pronouns, while
Casey reported a preference for using he/him pronouns. Therefore ‘they/them’ and
‘he/him’ pronouns are used here when describing the participants gender experi-
ence. All of the participants self-identified as having a non-binary gender, but used
a variety of non-binary gender labels to describe their unique gender experience.
Harley self-identified as gender fluid which they described as a gender identity
44 M. Losty and J. O’Connor
which moves between male, female and other gender identities. They reported
that they had been self-identifying with the non-binary gender identity for approx-
imately three months at the time of interviews. Reagan identified as polygender
which they described as a gender identity which incorporates both male, female
and other gender identities. They reported that they had been identifying with the
non-binary gender identity for less than two years at the time interviews. Hayden
self-identified as genderqueer which they described as a gender identity which
falls outside of male and female gender categories. They reported that they had
been self-identifying with the non-binary gender identity for approximately five
years at the time of interviews. Avery self-identified as a non-binary trans person
which they described as a gender identity which falls outside of male and female
gender identities. They reported that they had been identifying with the non-bi-
nary gender identity for approximately two years at the time of the interviews.
Casey self-identified as a non-binary trans guy which he described as a gender
identity which incorporates elements of male and female gender identities but
with a stronger identification with male than female. Casey reported that he had
been identifying with the non-binary gender for approximately nine months at the
time of the interviews. Addison self-identified as non-binary which they described
as a gender identity which falls outside of male and female gender identities. They
reported that they had been identifying with the non-binary gender identity for
approximately five years at the time of the interviews.
All of the participants identified as being bisexual, gay, lesbian or queer with
regard to their sexuality prior to their identification with the non-binary gender.
Five of the participants were assigned female at birth, while one participant was
assigned male at birth. All of the participants were white and had completed third
level education. Four of the participants reported experiencing a mental health
history, three of whom described previous feelings of suicide.

The interviews
Participants were offered an interview in the transgender organisation which
facilitated the study or within the college affiliated with the researchers. All of the
participants chose to interview at the college. The room chosen was consistent
for all participants and interviews and reflected a private space in which partic-
ipants felt comfortable to talk. Each interview lasted approximately 60 minutes
and was recorded on a digital voice recorder and later transcribed. A psychoana-
lytically informed interview technique based on the recommendations proposed
by Cartwright (2004) and Holmes (2013) was employed during interviews. The
first two interviews consisted of generally unstructured dialogue following the
introduction of the specific research topic: in this case the non-binary gender
identity. This provided a central context around which the participant was able
to freely associate. A more direct approach using questions or reflective com-
ments was employed as the interviews progressed, to clarify material or address
 Psychoanalytic Psychotherapy 45
any striking gaps which had been identified in the participants’ narratives in
supervision sessions. Individual supervision sessions took place following each
interview and were provided by the academic supervisor of the interviewer. The
academic supervisor is a clinical psychologist and psychoanalytic psychothera-
pist. Regular group supervision also took place throughout the research process.
These sessions were again facilitated by the academic supervisor and attended
by individuals who were also completing research using a psychoanalytically
informed research method.

Data analysis
Types of data
The research methodology assumes that the meaning or motivation underlying
human behaviour is not always consciously accessible. Thus, in maintaining a
broad approach to the interviews, some sense may be gained in relation to what is
comfortable and uncomfortable for participants, and what they focus on and what
they do not attend to. The material consisted of the interview content, non-verbal
responses and the relationship dynamics that emerged between the participants
and interviewer. The content of the interviews was transcribed and anonymised,
with non-verbal responses recorded in the body of the transcripts (e.g. pauses,
changes in tone of voice and emotional, physical and behavioural responses). A
reflective journal was used to record the thoughts and associated feeling states of
the researcher before and after each interview and while listening to the record-
ings and reading transcripts.

The analysis
Data were analysed by the interviewer in this study. The interviewer is a white,
gender conforming female aged 30 years. At the time of the research, the inter-
viewer was in the final year of her Doctorate in Clinical Psychology. Data were
analysed through a process of comprehending, synthesising, theorising and
re-conceptualising as recommended by Morse (1994). Analysis reflected an
ongoing dynamic process which involved listening and re-listening to recordings,
between interviews, during transcription and following the transcription phase of
the research. Significant themes were identified from the core narratives which
emerged when transcribing the participants’ interviews, and through a process of
re-listening to audio-recording and re-reading transcripts following interviews. As
described above, the interviewer documented her thoughts and associated feeling
states in a reflective journal during this process. The interviewer also re-read this
journal as part of the analysis of the interview material. The relationship dynamics
that emerged between the interviewer and the participants, as documented in the
reflective journal, both informed and were informed by the analysis in a reflex-
ive process of interpretation. Individual and group supervision sessions were also
46 M. Losty and J. O’Connor
used to facilitate this meaning making process during the interview phase and to
further explore potential themes throughout the analysis.

Results
From the complex material collected, three interrelated themes emerged. These
themes reflect trends, patterns and areas of concern within the participants’
narratives and include what is experienced by the interviewer and communicated
by the participant. As highlighted above ‘they/them’ and ‘he/him’ pronouns are
used here when referring to particular participants. The most salient themes
were; (1) A developing gender identity, (2) Correct and incorrect language and
(3) Being seen and unseen. Before exploring these themes some reflections upon
the dynamics which existed between the gender conforming researcher and
gender non-conforming participant will be highlighted as these dynamics likely
influenced the analysis of the data.

Interviewer reflections
Throughout the interviews, the participants were noted to refer to the painful his-
tory of the gender variant community and the role that mental health professionals
played in invalidating such identities. The participants described how they con-
tinued to feel that their identity was not respected by society and by individuals
who referred to them using incorrect pronouns. The participants described how
such experiences could be invalidating and hurtful at times. Such narratives con-
jured up an image of a pathologising, unempathetic and bigoted clinician/gender
conformist within the mind of the interviewer. Throughout the research process,
this image was observed to enter the researcher’s mind as if to warn her of the
potential of taking on this role within the eyes of the participants. It was as if
the interviewer was constantly walking a fragile tightrope during interviews and
supervision sessions. On one side of this tightrope was understanding and accept-
ance, but on the other was misunderstanding and rejection and only one word was
needed to fall into either domain. When meeting with participants and exploring
their histories in supervision sessions, the potential for the interviewer to hurt or
wound the participant through her use of language was ever present which created
an atmosphere of sensitivity, tentativeness and tension within the interviewer’s
mind when attempting to understand the participants. Strong feelings of discom-
fort and guilt were observed upon unintentionally using incorrect pronouns within
supervision sessions which made it difficult to think about the participants at
times as individuals. This created a struggle between compliance and intolerance,
which presented a challenge in maintaining one’s own mind while thinking about
the participants. Feelings of guilt and anxiety were also noted when attempting
to integrate the participants’ gender and life history, which at times could make
it hard to sustain a position of relatively neutral researcher. Such dynamics were
 Psychoanalytic Psychotherapy 47
observed within the interviews and during the analysis phase of the research and
likely contributed to the themes which emerged.

Theme 1: a developing gender identity

This theme explores the participants’ identifications with male, female and non-
binary gender identities through their childhood, adolescence and adulthood. This
theme captures a diversity of experiences with regard to the development of the
non-binary gender, as well as the meaning of this identity across participants. The
participants’ feelings of discomfort and distress with regard to their biological sex
is explored in this theme, as well as the participants’ descriptions of their non-
binary gender, which appeared to be still in a process of formation.
It seemed that the participants had experienced a mixed history of identi-
fication with and dis-identification from their biological sex during childhood.
Harley and Hayden described how they had found pleasure in activities and self-­
expressions that were typical of their biological sex, while Reagan, Avery, Casey
and Addison described how they had taken more pleasure from the play styles and
ways of self-expression typical of their opposite sex. Avery and Casey described
feeling that these preferences were not encouraged by others and described feel-
ings of hostility towards the self since early childhood, which they attributed to
feelings of discomfort towards their biological sex. Although Reagan and Addi-
son described a dis-identification with their biological sex in early childhood, they
reported that they only began to notice feelings of discomfort towards their bio-
logical sex in middle adolescence.
All of the participants reported that they began to identify as a non-binary
person following, what most described as, the ‘discovery’ or ‘realisation’ of the
non-binary gender category. For Hayden, Reagan, Casey and Addison this discov-
ery occurred during their middle to late adolescence, while for Harley and Avery
this occurred during their early to middle adulthood. The participants described
how, over time, they began to feel that their identity as gay man, bisexual woman,
lesbian woman or queer woman was not fully capturing who they were as peo-
ple; out of this they began to explore their feelings towards their biological sex.
The participants described how their involvement in the LGBTQ+7 community
had increased their knowledge of gender variant identities and re-positioned these
as valid expressions of gender. They described this attitude as being important
in their move towards exploring their dis-identification with their biological sex
more consciously. Hayden, Avery, Casey and Addison reported that they had iden-
tified with their opposite sex until they discovered that the non-binary gender was
a valid gender identity.
All of the participants described how their discovery of the non-binary gender
category allowed them to put their unique experiences of identification with and/
or dis-identification from their biological sex into context and make sense of the
confusing and/or hostile feelings they had experienced earlier in their lives. It
48 M. Losty and J. O’Connor
was as if they were perhaps re-experiencing their life through a different lens. All
of the participants reported that their identification with the non-binary gender
caused them to feel comfortable within themselves. However, Harley and Addi-
son described how they continued to have moments in which they questioned the
validity of their non-binary gender experience and noted thoughts such as ‘Am I
faking it?’ and ‘Am I non-binary enough?’ on an ongoing basis. It was as if these
participants were still in a process of forming their identity.
The participants’ experiences of gender appeared to vary between fixed and
fluid states. Harley reported that their sense of gender moved ‘between male and
other’ with the position of ‘other’ reflecting a state of being neither male nor
female. Reagan reported that they ‘sometimes feel masculine, sometimes feel
feminine and sometimes feel neither masculine nor feminine’. Harley and Reagan
both described how they could fluctuate between these different gender positions
several times throughout the day; however, unlike Reagan, Harley reported that
they could experience some days in which their gender remained constant for the
entire day. Although Harley reported that they can still feel like a ‘cute boy’ while
wearing a dress, Reagan described feeling ‘dysphoric or uncomfortable’ when
their gender experience was not in keeping with the clothes they are wearing at
that point in time. Hayden, Avery, Casey and Addison all described their gender
as fixed and therefore did not experience the fluctuations in gender identity and
gender expression that Harley and Reagan described. Hayden, Avery and Addison
described how they did not identify with male or female genders. Casey viewed
gender as existing along a spectrum between male and female; he reported that
he identified more towards the male end of the spectrum, but did not believe that
male fully captured his gender experience or history. For Casey, the non-binary
gender category allowed him to identify with both male and female gender iden-
tities at the same time.
All of the participants reported a desire to change aspects of their body (includ-
ing tone of voice) to reflect their gender identity. At the time of the study Avery,
Casey and Addison reported that they were availing of either hormone treatment,
breast removal surgery or both to achieve this goal. One of these participants
reported that they were self-medicating due to the fact that they could not avail of
this treatment as a non-binary person. Avery and Addison hoped that the physical
changes produced by hormone treatment would make it difficult for others to
determine whether they were a man or a woman. However, they described feel-
ings of uncertainty with regard to the stability of this state of androgyny over time
and reported that it was likely that hormone treatment would eventually cause
them to present as their opposite sex. Although these participants believed that
they would likely feel more comfortable presenting as their opposite sex (than
their biological sex), there was a sense of uncertainty regarding the future self
and a sense of sadness and disappointment towards the body. It was as if the par-
ticipants were perhaps experiencing a divided or uncertain mind that was caught
between desires to change the body so that it did not reflect man or women, and
 Psychoanalytic Psychotherapy 49
uncertainty regarding the ability to maintain this position of not-ness (not man,
not women) over time. This sense of tension within the mind with regard to the
future (including for some the future body) was observed in the narratives of all
the participants and spoke to an identity that was perhaps still in formation. These
body narratives also created a sense of the participants, perhaps describing what
there were, as opposed to whom there were.
At times the diversity and complexity of the participants’ gender identities
presented a challenge to the interviewer in attempting to understand the non-
binary gender – in part, as she sought to find some pattern here and in part, due to
the struggle to relate empathically to some of the material. Feelings of frustration,
confusion, separateness and a tendency to become lost within the language
were noted. Reflective journal entries reflected a desire to understand the person
behind the gender identity, alongside notes which suggested that this could not
be achieved without first understanding the participants’ gender. This caused
tension in the interviewers’ thinking process when attempting to understand the
participants as a whole person.

Theme 2: correct and incorrect language

This theme explores the participants’ relationships with their preferred pronouns
and gender labels (e.g. gender fluid, genderqueer etc.), which were being used by
the participants to different degrees in their everyday lives. All of the participants
described how this non-binary gender language was an important aspect of their
identity and provided them with support when disclosing their gender identity to
others. It was as if it communicated to others the fact that the non-binary gender
was valid and therefore could be experienced as empowering for the participants.
However, at times it seemed as though this language could lead to feelings of
isolation and disconnection from others. The potential of this language to foster
feelings of connection and disconnection, empowerment and hurt will be explored
within this theme.
Harley, Hayden, Reagan, Avery, Casey and Addison described how the non-bi-
nary gender label allowed them to feel connected to a community of people who
shared similar gender experiences with them. However, some participants noted
that the diversity of the non-binary gender experience could at times act as a bar-
rier to feeling connected to a community of like-minded individuals. Hayden and
Casey described how their unique gender label maintained a sense of connection
to the wider LGBTQ community which had previously embraced them as either a
queer/lesbian woman or a transgender man. Hayden for example, described feel-
ing disconnected from the queer community as this community perceived their
identification with the non-binary gender as rejecting of queer womanhood. Like-
wise Casey described feeling disconnected from this community because he was
being perceived by others as a straight man and therefore not transgender, not
gay and not part of the LGBTQ community. Hayden and Casey noted feelings of
50 M. Losty and J. O’Connor
discomfort and guilt as a result of their sense of disconnection from the LGBTQ
community, as well as the struggles that this community can experience within
society. They described how their specific non-binary gender label provided them
with a sense of re-connecting to this community, which seemed to reduce the feel-
ings of guilt and discomfort they had experienced. At times, it seemed as if these
participants were caught between wanting to individuate but perhaps needing to
stay connected to the LGBTQ community. This sense of tension was perhaps also
reflected by participants who described feelings of uncertainty about their specific
gender label alongside feelings of reluctance towards not having one. It was as
if the gender label could foster feelings of connection to others and perhaps to
one’s subjective experiences, while at the same time could also perhaps be expe-
rienced as something that was being imposed upon the participants by an outside
force. This process of an identity, perhaps being imposed upon the participants is
reflected by Hayden, who stated ‘non-binary isn’t something that I would really
identify with as such … it’s just that I fall into that category’.
In addition to gender labels, the participants reported having a preference for
pronouns which differed to the pronouns associated with their biological sex (i.e.
‘they/them’ or ‘he/him’) and a preferred name which reflected their self-identi-
fied gender. The participants described a mixed experience of how their preferred
name and pronouns were being used by others; for some participants, their pre-
ferred names and pronouns were used relatively quickly, which was described as
a hugely validating experience; while for others their old names and pronouns
were continuously and repeatedly used. The latter reflected what the participants
described as being ‘misgendered’, which referred to any incident in which the par-
ticipants were perceived as a gender other than a non-binary gender. Depending
on the participants’ biological sex and pronoun preference this could consist of
being called ‘Ms’, ‘Mr’, ‘she’, ‘her’, ‘he’, ‘his’, ‘women’, ‘man’, ‘trans-women’
or ‘trans-man’. Harley also described how they could misgender themselves by
referring to themselves in terms of their biological sex. They described how such
incidents led to feelings of guilt, anguish and hostility towards the self. For Har-
ley it was as if the ‘they/them’ pronoun was like a uniform that perhaps had to
be worn in order to be a part of the non-binary community. This may again speak
to an identity that is perhaps being imposed upon the self by an external agency.
All of the participants described how being misgendered could have a
negative impact upon their emotional well-being, relationships and social life.
The participants recognised the instinctual nature of pronoun use and the difficulty
that can arise when attempting to inhibit this instinctual response, however they
described how their ability to tolerate these mistakes reduced over time. Over time
a pronoun mistake seemed to represent more than just a language error, but rather
reflected an intentional attack and rejection of participants’ gender identities. All
of the participants reported feelings of discomfort or ‘dysphoria’ when being
misgendered however the severity of this discomfort appeared to vary amongst the
participants and ranged from mild discomfort to high levels of frustration, anger
 Psychoanalytic Psychotherapy 51
and emotional ‘pain’. Hayden, Reagan and Avery described using conversations
about gender and pronoun usage as a means of assessing how their gender identity
would be perceived by others if disclosed, as if it could protect the participants
against being directly invalidated by others. Three participants described how they
had ended relationships with peers as they were being intentionally and repeatedly
misgendered, while two participants reported that they intentionally limited the
amount of time they spent with family members. It was as if the way in which
others used the non-binary language could be experienced as either hurtful or
empowering by the participants and foster a sense of connection or disconnection
from others. Four participants described how their discomfort in being misgendered
also caused them to avoid going to restaurants or cafes, socialising with unfamiliar
people in unfamiliar places, using supermarkets without self-service and avoided
spaces which did not have gender neutral bathrooms. This marrying of liberation
(i.e. liberation of gender boundaries) and restriction was observed within all of
the participants’ narratives to varying degrees and perhaps contributed to a sort of
tension within the minds of the participants.

Theme 3: being seen and unseen

This theme explores the participants’ experiences of being validated for their per-
sonal identity throughout their life, including their opportunities to be mirrored
and seen by others. At times there seemed to be a tension within the participants’
narratives between wanting to be seen or heard by others, yet being unseen. The
feelings of rejection, misunderstanding, hostility and anguish which emerged
within the participants’ narratives when discussing their relationships with others
will also be explored within this theme.
All of the participants described feelings of invalidation within their family
relationships with regard to their non-binary gender. This led to varying levels of
distress amongst the participants and at times poor mental health. Reagan, Avery
and Addison reported that they had disclosed their non-binary gender identity to
their immediate family – either their parents or siblings or both. Reagan reported
that their parents immediately accepted their non-binary gender identity. How-
ever, Reagan also noted that their parents continue to believe that they are in
denial of their desire to fully transition to the opposite sex. Reagan described
this belief as uncomfortable and, at times, invalidating, but reported that overall
they ‘didn’t mind’. Unlike Reagan, Avery and Addison reported that their fam-
ily were overtly unsupportive and dismissive of their non-binary gender identity.
They reported that this reaction was unexpected and described experiencing feel-
ings of rejection, confusion and anger towards their family. Harley, Hayden and
Casey had not yet disclosed their non-binary gender identity to their family as
they believed that their gender would not be understood or accepted by family
members. This sense of segregation between the participants’ gender identity and
their family life was observed within the narrative of all of the participants, par-
52 M. Losty and J. O’Connor
ticularly Hayden, Reagan, Avery, Casey and Addison, who described needing to
physically move away from their family in order to live as their true selves. It was
as if the participants were experiencing difficulties in voicing their psychological
needs and in having these needs seen, heard and mirrored by their family. A sense
of being seen as their biological sex, yet not being seen as their gender identity
emerged across the participants’ narratives, creating a sense of being seen yet
unseen within the family dynamic.
The participants’ beliefs regarding their potential to be invalidated and unac-
cepted appeared to mirror their family experiences in childhood and adolescence.
Hayden, Harley, Avery, Casey and Addison described how they had experienced
implicit and explicit messages from their mother, father, siblings and/or peers
which communicated to them that their social skills, play styles, self-expres-
sion and/or sexuality were not acceptable. The participants described how these
experiences had caused them to experience anguished and self-critical thoughts
regarding their sense of self. For example, Avery described feeling that they were
not normal as a result of such messages and reported how they had often found
themselves thinking ‘what’s wrong with me?’ prior to their identification with
the non-binary gender. The impact of these experiences was particularly evident
within the narratives of Harley, Hayden, Avery and Casey when discussing their
sexuality. These participants described how the messages they had received from
their family and/or peers with regard to the validity and acceptability of the gay,
lesbian and bisexual identities had impacted upon their ability to ‘come to terms
with’ and ‘accept’ their own sexuality and ‘come out’ to their family. All of the
participants described how, to varying degrees, they continued to keep aspects of
themselves (e.g. their romantic relationships, their LGBTQ+ activism) separate
from their family due to feelings of uncertainty regarding how this information
might be received. It was as if there was a sort of tension between wanting to be
seen yet also remaining unseen, perhaps in order to protect the self.
This dynamic also emerged within the participants’ narratives regarding the
decision to disclose their gender identity to others. The participants described how
this process could be scary and anxiety provoking due to the potential that their
identity would not be respected. As a result, they described how they only dis-
closed their gender identity to important figures within their life or people whom
they were likely to engage with frequently. The participants reported that this
decision was linked to the assumption that their gender identity would likely not
be understood or respected by others and could lead to the breakdown of impor-
tant relationships. As a result, there was a sense of an anguished thought process
between wanting to share their gender identity with others yet wanting to protect
the self against the potential of being invalidated by them. Although there may
have been a sense of protection in being unseen, this position also seemed to fos-
ter feelings of rejection, invalidation, isolation and perhaps a longing to be seen.
This tension between being seen and unseen was also perhaps reflected within
the participants’ styles of interacting with the interviewer. The participants were
 Psychoanalytic Psychotherapy 53
noted to respond to the call for participants within an hour of the research adver-
tisement going online. This perhaps suggested an eagerness to be heard (or seen)
by another. However, it was noted that during interviews the participants fre-
quently moved between their own life story and the story of the LGBTQ and
non-binary community. For example, reflections upon their own life experience
tended to be followed by discussions about how such experiences were consist-
ent amongst their friends who were LGBTQ and/or non-binary gender or were
reflective of this community as a whole. At times it was as if this may have been
a strategy employed outside of the participants’ awareness to perhaps create a sort
of distance or separateness or barrier between the interviewer and the participants’
personal stories. This created an atmosphere in the interviews that moved between
moments of connection and disconnection from the participants. This sense of
separateness was also perhaps reflected in the difficulties the interviewer noted in
seeing the participants as individuals outside of interview sessions, rather she saw
the participants as a group or as fragments of an individual (e.g. hair, clothes etc.).
At times this led to feelings of separateness, frustration and confusion within the
interviewer’s mind.

Discussion
Through the analysis of the material arising from the interviews, the following
three core interrelated themes emerged in relation to the experience of having
a non-binary gender: ‘A developing non-binary gender’, ‘Correct and incorrect
language’ and ‘Being seen and unseen’. These themes highlight the diversity and
complexity of the non-binary gender identity and the importance of gender labels
and pronouns in the development and communication of this identity to others.
They also highlight the potential for the non-binary gender person to experience
a sense of tension within their mind, perhaps between being seen and unseen,
being connected and disconnected, being understood and misunderstood and
being accepted and rejected. The themes will be first explored by drawing upon
psychoanalytic theory regarding the development of self and identity. Following
this the dynamic which developed between the gender variant participant and the
gender conforming interviewer will be explored in a way that might be useful for
individuals working clinically with this population. The discussion will conclude
by integrating the current findings with some research which has already been
conducted in this area and by providing some directions for future research.
The participants’ narratives suggested that they may have experienced some
difficulties when individuating or separating from others, perhaps originally from
parents, but perhaps now from the LGBTQ community. The LGBTQ commu-
nity had perhaps represented an accepting parent that provided the participants
with a secure base from which they could explore their sense of self even further.
However, when the participants began to identify with a non-binary gender they
described feeling disconnected and rejected by this community. This sense of feel-
54 M. Losty and J. O’Connor
ing rejected by a previously accepting other seemed to mirror the participants’
experiences of how their families had responded to their behaviour, play styles,
self-expression, sexuality and gender identity earlier in life. It is possible that the
feelings of care the participants may have experienced as infants progressed into
feelings of disconnection, misunderstanding and rejection as the development of
a more independent sense of self began to form. Such experiences of rejection and
invalidation may have impacted upon the development of a confident sense of self
amongst some of the participants. These early experiences, perhaps in combina-
tion with a potentially fragile or vulnerable sense of self, may have contributed
to the varying levels of tension described by the participants with regard to their
separation from the LGBTQ community following their identification with the
non-binary gender. In this context, the participants desire to stay connected to the
LGBTQ community may have functioned as a defence against further feelings
of disconnection and loss. Such difficulties and tensions in separating may speak
to the earliest experiences of the person and the tensions described by Erikson
(1950) between trust and mistrust as well as shame and doubt in the early rela-
tionship between the infant and caregiver. These feelings of tension, loss and con-
fusion described by the participants within their current relationships with family,
peers and the LGBTQ community could also speak to the tension Erikson (1968)
described between identity and role confusion and in the process of letting go of
earlier childhood identifications in order to establish one’s own commitments in
life.
A tension between trust and mistrust was perhaps reflected within the
atmosphere of sensitivity and tentativeness that emerged within the interviewer-
participant dyad and was perhaps also reflected within the tensions observed
within the participants’ relationships with others. This contention is perhaps
reflected within the participants’ descriptions of their styles of relating to others
and the tensions which were noted between connection and disconnection,
acceptance and rejection and being seen and unseen. The non-binary language
may also speak to this sense of trust and mistrust and perhaps a sense of
unconsciously wanting to distance the self from a potentially unaccepting other.
This created a sense of a divided mind which may speak to the mirroring process
within the parent-infant dyad described by Winnicott (1960), in particular the
formation of a True and False Self in response to a disruption within this process.
Ehrensaft (2009) conceptualises the True Self in relation to the transgender
individual as the transgender identity and not the biological sex. Using this
conceptualisation, the tension observed within the participants’ narratives with
regard to their relationships with others may reflect a tension arising from a
world which does not recognise or mirror the participants True Self. In a world
built around a binary conceptualisation of gender the non-binary individual
may feel forced to present their biological sex to the world (the False Self) and
conceal their non-binary gender identity (their True Self) in order to protect the
self from further rejection, invalidation and loss. This tension between the True
 Psychoanalytic Psychotherapy 55
and False Self may be reflected in the participants’ desires to change aspects of
themselves (e.g. the body, name, pronouns) and is perhaps also reflected in the
participants’ descriptions of their relationship with others, for example, keeping
elements of themselves separate from family members and only disclosing their
identity to individuals whom they trusted. Ehrensaft (2009) suggests that such
tensions between the True and False Self may make it difficult for the transgender
individual to develop a cohesive sense of self. Although the participants’ pronoun
preferences may have been influenced by the non-binary gender culture, in this
context, the participants’ use of they/them pronouns and therefore the descriptions
of oneself as plural may be to unwittingly describe multiple allied parts of oneself
serving a protective function against further rejection and loss, as it may be to
describe a conflicted divided sense of self.
Feelings of tension, confusion and separateness were noted at times within the
dynamic between the gender variant participant and the gender conforming inter-
viewer. This dynamic may have brought the power struggle between conformity
and non-conformity to the forefront of the interviewer’s mind which may have
led to feelings of tension and uneasiness within the mind of the interviewer when
attempting to understand and integrate the participants’ life stories, including their
experiences of gender. In the current study, the desire to resolve this tension may
have led the interviewer to focus upon gender labels as they perhaps symbolised a
safe zone which reflected the participants’ own desires. Consequently, it was as if
the participants’ gender was being explored as a symptom within the interviewer’s
mind, as something that the participants had, as opposed to something the partic-
ipants were. At times, it was as if any questioning of the participants’ identities or
attempts to understand its development in terms of the person’s life history was a
narrowing, even pathologising act which had the potential to perhaps turn the par-
ticipants True Self into something that was disordered. The feelings of tension and
guilt experienced by the interviewer during this process of wondering may have
been reflective of an unconscious projection of the messages that the participants
described receiving from others, namely that they were perhaps unacceptable. In
this context, the interviewers experience of their thoughts as unacceptable, per-
haps served the function of eliminating what the participants may have perceived
as the bad or unacceptable aspect of the self (Klein, 1959). Likewise the sense of
negation within participants’ descriptions of the self (e.g. not female, not male
etc.) may be to unintentionally destroy these bad or unacceptable aspects of the
self.
The current study explores the narratives of individuals who identify as non-
binary gender as well as the relationship dynamics which emerged between these
individuals and a gender conforming researcher. Cartwright (2004) highlights
that the psychoanalytic research interview differs to the therapeutic encounter
in terms of context and motivation. In a therapeutic context clients are seeking
therapeutic intervention, typically over a prolonged period of time. In this context
the therapist is motivated to find meaning in the clients unconscious and intra-
56 M. Losty and J. O’Connor
psychic processes so that they may convey this understanding to the client in
order to facilitate therapeutic change. In the research context, the interviewer
is likewise attempting to understand the participant’s intra-psychic processes,
however, unlike the therapist they do not attempt to convey this understanding
to the participant. This is because the researcher’s motivation is to understand a
specific research question, rather than to facilitate therapeutic change. Despite this
important distinction between the research and therapeutic context, Cartwright
(2004) argues that the findings emanating from the psychoanalytic research
interview can offer interesting insights to individuals working clinically with
the population under investigation. Likewise the current authors believe that
the findings emerging from their research have clinical relevance that may be
useful for clinician when working with individuals who have a non-binary gender,
particularly in terms of the dynamics that may emerge between a conforming
therapist and a non-conforming client. It appears that in attempting to understand
the non-binary person we can experience feelings of tension, confusion and a
sense of separateness from the individual. This dynamic may have a multitude
of meanings. It could reflect a style of relating that is emanating from tensions
between trust and mistrust within the parent-child relationship or reflect a style of
relating that has been inherited from societies, and the mental health professions,
history of understanding and responding to gender variance. Likewise, it could
reflect the cognitive challenges that emerge when attempting to assimilate the
complexity and diversity of the non-binary conceptualisation of gender into
existing gender schemas. It may be important for clinicians to hold all of these
possibilities in mind when working with the non-binary gender person, as well as
the sense of uncertainty and tensions that these possibilities create. In line with
Hansbury (2005) reflections on working with the transgender client, the clinician
should be sensitive to the potential for feelings of trust and mistrust as well as
perhaps shame and doubt to emerge within the therapeutic relationship. The
clinician could perhaps foster feelings of trust by respecting the clients’ gender
labels and preferred pronouns and should recognise that the incorrect use of
this language may lead to feelings of misunderstanding, rejection and potential
disengagement from therapy. However, the clinician should also be mindful of not
becoming too focused upon the non-binary language as this may lead to feelings
of confusion and separateness from the client. Such tensions in thought may cause
the individual behind the gender identity to seem elusive within the mind of the
clinician, which may impact upon the clinician’s ability to see and experience
the person behind the gender label and recognise the multitude of experiences
that may have contributed to their sense of self. Such dynamics may be useful
to explore within the safety of the therapeutic space as it may relate back to the
clients’ styles of object relating.
The findings obtained in the current study are consistent with findings
obtained within the small level of literature regarding the non-binary gender expe-
rience. The participants’ descriptions of their gender identity reflected a complex
 Psychoanalytic Psychotherapy 57
and diverse range of experiences and highlighted the importance of viewing the
non-binary gender as a valid alternative to their biological sex in their journey
towards identifying as non-binary. This is consistent with findings from Rankin
and Beemyn (2012) and Budge et al. (2013) which both highlight the diversity of
experiences captured under the non-binary umbrella. The diversity of experiences
within the participants’ narratives in terms of their relationship with parents and
peers is perhaps also consistent with Harris’s (2000) conceptualisation of gender
development as reflective of a ‘soft assembly’ that incorporates the possibility
of both positive and negative Oedipal identifications and multiple and complex
characterisations of self-objects and parental objects. In addition the experiences
of poor mental health, as well as feelings of rejection, discrimination, misun-
derstanding and isolation described by the participants in the current study are
consistent with findings reported within the gender variant literature (e.g. Tebb
& Moradi, 2016; James et al., 2016; Budge et al., 2014; Kirkpatrick, 2003). In
addition, the tendency amongst some of the participants in this study to engage
in a perhaps avoidant style of coping is consistent with findings from Budge
et al. (2014).
The present study expands upon this research by going beyond conscious
content to explore the psychological realities of the non-binary gender person
and their potential styles of object relating. However, the findings of the cur-
rent study should be interpreted in a tentative and cautious manner due to the
subjective nature of the analysis. Holmes (2013) highlights that the psychoan-
alytic interview method produces findings, which are inevitably and inherently
a product of the particular researcher-participant dyad. Therefore the clinical
background and life experiences of the interviewer likely influenced the material
that she was drawn to during the interviews and analysis phase of this research,
potentially at the expense of other defences and unconscious material. Although
the interviewer adopted strategies to counteract this, such as reflecting on her
own reactions, feeling states and thoughts during interviews, as well as using
individual and group supervision to explore potential themes; this study could
have benefitted from more formal reliability and validity checks such as the inter-
pretation of the transcribed interviews by an independent evaluator/s, the use of
multiple analysts and the use of a larger sample size. Therefore, without further
psychoanalytically informed research into the non-binary gender population the
generalisability of the current findings are limited at this point in time. In addi-
tion the current findings may reflect the sense of self at a particular stage in the
development of the non-binary gender identity, as well as a particular stage of
the lifespan (i.e. early to middle adulthood). Therefore it may also be useful for
future research to explore the experiences of individuals who have been iden-
tifying as non-binary for longer periods of time than the individuals within the
current study, as well as the experiences of the non-binary gender individual at
different stages of the lifespan. A longitudinal design may prove especially useful
in exploring such questions.
58 M. Losty and J. O’Connor
Disclosure statement
No potential conflict of interest was reported by the authors.

Notes
1. The non-binary gender identity is an umbrella term for those whose gender does not
fit within the traditional binary gender construct of male and female (Webb, Matsuno,
Budge, Krishnan, & Balsam, 2016).
2. Intersex conditions are conditions which lead to atypical development of physical sex
characteristics (American Psychological Association [APA], 2011).
3. When an individual’s gender identity and gender expression is inconsistent with their
biological sex (i.e. gender non-conforming) they may be described as ‘transgender’
(APA, 2011).
4. People who were assigned female, but identify and live as male, and alter, or wish to
alter, their bodies through medical intervention to more closely resemble their gender
identity, are known as transsexual men or transmen. They may also be known as fe-
male-to-male or FTM (APA, 2011).
5. People who were assigned male, but identify and live as female, and alter, or wish to
alter, their bodies through medical intervention to more closely resemble their gender
identity are known as transsexual women or transwomen. They may also be known as
male-to-female or MTF (APA, 2011).
6. In this context queer is referring to an umbrella term for sexual minorities who are not
heterosexual. It should be noted that the term queer can also refer to individuals whose
gender identity does not correspond to their biological sex.
7. LGBTQ+ is an umbrella term referring to all sexual and gender variant identities,
including the non-binary gender identity.

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Glossary of terms
Non-binary gender identity
The non-binary gender identity is an umbrella term for those whose gender
does not fit within the traditional binary gender construct of male and female
(Webb et al., 2016).
Intersex conditions
Intersex conditions are conditions which lead to atypical development of
physical sex characteristics (APA, 2011)
Transgender
When an individual’s gender identity and gender expression is inconsistent
with their biological sex (i.e. gender non-conforming) they may be described as
‘transgender’ (APA, 2011).
Transman
People who were assigned female, but identify and live as male, and alter, or
wish to alter, their bodies through medical intervention to more closely resemble
their gender identity, are known as transsexual men or transmen. They may also
be known as female-to-male or FTM (APA, 2011).
Transwoman
People who were assigned male, but identify and live as female, and alter, or
wish to alter, their bodies through medical intervention to more closely resemble
their gender identity are known as transsexual women or transwomen. They may
also be known as male-to-female or MTF (APA, 2011).
Queer
Queer is an umbrella term for sexual minorities who are not heterosexual. It
can also refer to individuals whose gender identity does not correspond to their
biological sex.
LGBTQ
In the current article LGBTQ is used to refer to the lesbian, gay, bisexual,
binary transgender (i.e. transman or transwoman) and sexually queer (i.e. sexually
attracted to people of the opposite sex) individuals
LGBTQ+
In the current article LGBTQ+ is used to refer to all sexual and gender variant
identities, including non-binary and binary gender variant identities.