A Comfy Gender
Transitional Spaces and Virtual Reality
Repair: clinical conflict iii
Note: Consent from this patient— for the writing up of this case—was obtained by the author.
Nena’s name pops into the waiting room screen a few minutes early. Glimpses of the previous session come to my mind: Nena’s recent eighteenth birthday, her first bank card, the name on the card, and Nena’s idea to come to a session in virtual reality (VR) as one of her avatars.
It’s 12:20 p.m. EST. I click Admit and we begin.
Nena’s screen momentarily goes black. In this quick moment, I sense my anticipation. A virtual environment appears and it feels uncannily familiar and strange.
Nena is sitting on an unassuming brown couch in what I later learn is a train car. In the window behind her, colorful shooting stars fall from the sky. In this moment the environment is private, but at other times she opens it up to visits from other avatars.
Her hair is bleached blonde with black streaks. She has bunny ears that move around while she speaks. She is a kind of hybrid human/animal. There is a long earring with a star on it dangling from one of the bunny ears. She is wearing thigh highs, sneakers, and an oversized sweatshirt that has the name of a popular YouTuber she likes.
Nena is her preferred name, and she/her are her preferred pronouns. In some contexts, she is out as trans, and in others, she is not. In VR, she is out about her name and pronouns. In VR, she embodies various different avatars through which she can explore more comfortable, or “comfy,” as she would say, gendered ways of being. With her parents and in school, Nena goes by Patrick and uses he/him pronouns. With some friends in real life she is out, but with others she is not.
In the session, she talks about how she feels very “comfy” in this avatar, and that there is an important cuteness factor that she likes. She feels very cute. It’s a kind of comfyness that she does not experience in the clothes she wears in real life: boys’ clothes. She feels “comfy” when she is able to put on some of the newer clothes she has gotten with her birthday money, but these are clothes that she does not wear in public; she wears them in secret in her room, or when her parents are away, and sometimes in sessions with me. I ask her if she has ever worn any of the clothes in public. She says that one time she wore thigh highs to the mall. Her dad drove her, and although he didn’t say anything about what she was wearing, he began to drive very fast when she got into the car, and she could sense how uncomfortable he was. As she tells me this, she becomes tearful, and follows up by letting me know that after this incident she never wore those clothes in public again.
Toward the end of the session, when I ask her how it felt to meet in this way, she says that she felt very relaxed, that it felt easier to speak, and she liked showing me this part of herself.
Over the course of the treatment, I felt placed in the position of bridge in various ways: between Patrick and Nena, between the parents and Patrick, between Nena’s avatars and Nena, and more broadly between virtual reality and the real world. I also felt that I was the keeper of a secret that was becoming less of a secret as our work progressed.
Nena came to see me a few months after she told her mother that she was trans and wanted to transition. The mother reached out to me, expressing concern about Nena’s desire, the mother’s own unfamiliarity with “changing gender,” and the father’s disavowal of Nena after she attempted to voice something about her gender to the mother. Speaking about transness out loud is what brought Nena into treatment with me.
Speech was difficult for Nena. She entered a prior treatment because she would frequently become weepy and tearful when speaking, and subsequently be unable to speak. She told me that the treatment helped a lot, but that she still sometimes struggled to speak. This difficulty came up in our treatment as well, particularly, it seemed to me, when speaking about things that in some way felt negative to Nena—e.g., a negative feeling about her father, mother, brother, ex, herself, or me.
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Nena and I worked together for about a year and a half between 2020 and 2022. Our work was always virtual and mediated by Zoom. During the height of the pandemic, the psychological field’s abrupt shift to virtual platforms spawned ongoing debates and conflicts among clinicians about teletherapy—i.e., was something fundamental to the therapeutic process lost when the clinic moved online, was the convenience of remote sessions a clinical problem, were virtual treatments depriving patients of “real” therapy? In the field of psychoanalysis, the ghost of a timeworn question about what counts as real psychoanalysis was predictably recruited into this debate. The external world invaded the so-called protected space of the analyst’s office, instigating an immediate adjustment to the frame. All psychoanalytic treatments were forced to go virtual.
The debates, questions, and ruminations about virtuality and psychoanalytic therapy express broader technological and generational anxieties in the field that are tied to ontological questions concerning reality and existence. The expansion of virtuality and new technologies enjoins psychoanalysis to undergo a change that is parallel to the demand placed on psychoanalysis by gender transition. Extreme statements in the field concerning the alleged radicalization of trans children and adolescents through contact with trans peers are a clear example of how anxieties about virtuality and gender transition converge. I also noticed that, when discussing Nena’s case with colleagues, clinicians’ anxieties about gender transition seemed to intersect with anxieties about generational time and virtuality in complex ways.
The “virtual” is defined as an unrealized potential or possibility. The virtual made it possible for Nena and me to connect and converse across different continents and time zones. We never met in person, and the pandemic was not the cause of the virtual boundary. More than anything, my sense was that the absence of clinicians with sensitivity to the complexities of gender, transness, and transitioning in Nena’s country and cultural context brought her into treatment with me. In this sense, the virtual was about creating potential space because of how it facilitated Nena’s access to a therapy that could give her room to be and live creatively.
The virtual frame of our work made it possible for Nena to freely and productively associate to a question I asked about the name on her new bank card. Three months into our work, Nena told me that she had opened up her first bank account and acquired her first bank card. I asked her how she felt about the name on the card. She said she hadn’t really thought about it and then became quiet and tearful. She reflected that she didn’t think she would have feelings about it. I tried to point out that perhaps my question caught her off guard and touched on something vulnerable. As I searched for clues in her body language through the screen, I felt that I might be losing her, and I asked about where her mind had gone. Hesitating a bit, she said she had thought it would be nice to come to a session as one of her avatars in VR.
In the spontaneity of the psychoanalytic process, Nena had an idea about how to engage her interiority with me. VR was a place in which Nena wanted to be. And while she expressed a distinction between VR and real life, longing for more sources of connection in real life, she came alive in new and different ways through avatars and communities in VR. In VR, Nena found other trans people, made friends, dated, hung out, and played games. I didn’t know very much about VR besides some associations to VR headsets, The Matrix, and the metaverse. I was curious and out of my element, not really understanding how Nena would technologically come to the session in VR as an avatar. Incorporating VR into the treatment demanded that I transition to this new technology and remain open to it. I felt old and young at the same time. Old in relation to Nena, who creatively experimented with new technologies, using them to explore the desires of gender in ways I could not have imagined when I was an adolescent, and young in relation to psychoanalysis, particularly to the field’s entrenched anxieties related to gender and technology.
Over the course of working with Nena, I came to understand virtual reality as an immersive and interactive computer-generated world. The condition of immersion is what makes virtual reality different from other virtual worlds, like video games. Virtual reality allows for experiencing the inside of the world three-dimensionally, which is made possible by a VR headset. Nena came to sessions in VR as an avatar a handful of times. Sometimes avatars and settings would repeat, but sometimes the avatar and the setting would change. In general, avatars were either cutesy (a woman in an oversized pastel pink sweatshirt with a teddy bear graphic in the center, a bob haircut with small bunny ears, in a setting full of comfy pink furniture) or sexy (a woman with large breasts in a crop top sweatshirt, long black hair with blonde streaks, with jewels in it, sometimes bunny ears, typically sitting on a couch on a train with shooting stars in the background). Sometimes Nena would show me around the virtual environment, excitedly shifting the camera to point out a favorite place to lounge, or features she thought were cool or interesting. In these sessions I was able to see into VR, but I was not in VR myself. Then, in regular Zoom sessions, Nena explained how the VR systems worked, showing me her headset and trackers and how she used them to control the comportment and mobility of her avatars.
As we continued to work together in and between these various virtual terrains, I began to conceptualize the transitional space of VR, both in terms of Winnicott’s transitional phenomena and of gender transition. For Winnicott, transitional phenomena are an “intermediate area of experiencing, to which inner reality and external life both contribute.” Winnicott’s quintessential example is when a baby, who has experienced good-enough mothering, is able to creatively turn to an object, like a teddy bear, to soothe depressive anxiety. It is the baby’s capacity to find a caregiving substitute in an object—like a teddy, blanket, or thumb—that repeats and is remade throughout life. In later parts of childhood, transitional phenomena could be animated through games or activities such as sports, writing, music, visual and performing arts, and video games. In adolescence, this can occur through the addition of crushes, dating, sex, and desire.
My sense is that, for Nena, VR was possibility, both in how it made possible what felt impossible, and in how it made room for the interplay between internal and external exploration. A character from the 2022 documentary We Met in Virtual Reality describes this interplay well: “The ability to be lots of different avatars allows us to see different aspects of ourselves in a lot of different ways.” The documentary was filmed entirely in VR, specifically VRChat. There are scenes of people hanging out at the bar, partying, in a belly dance class, a club, an ASL class, a community get-together, a wedding, nature. As a transitional space, VR offers unique ways to explore and connect fantasy and reality. Another character from the documentary speaks about the creative freedom—a certain break from the normative rules in real life—in the transitional space of VR.
In my case, I am nonbinary and being in VRChat means I can run around as a space dog, as a deer . . . as any number of different avatars I collect across different worlds . . . it doesn’t mean that misgendering doesn’t happen and that assumptions about gender and sexuality do not happen because they do. They certainly happen a lot, but there is a little bit of a sense of having a little bit more control over how you might represent yourself and a little bit more fluidity of representation that is harder to achieve in real life because of the expectations of society and how people see you.
For Winnicott, the transitional space is an area of play and creative living; every baby needs this space to grow into their distinctness from the caregiving figure(s). VR is a play area in that it allows for what the nonbinary VRChat user above calls “fluidity”—a fluidity between inner and outer reality that is much less accessible in real life.
Oren Gozlan, who reads Winnicott’s idea of transitional phenomena through Lacan, recommends seeing gender as a placeholder for desire, a transitional space where things are in suspense. It is “where masculinity and femininity are thought of as attempts at representation of an internal struggle between unity and separation, identification and its excess.” Gozlan highlights Winnicott’s rejection of developmental formulas that favor continuity (ideas about a certain causal ordering, progression of stages, and developmental achievements that integrate the self and are universal) and emphasizes the importance of his idea of contiguity. Simply put, contiguity means to consider the interdependency of two elements not in terms of causal ordering but rather proximity. A lens of contiguity asks psychoanalytic questions about the closeness and distance between different internal and external elements, rather than their causal relation. For gender transition, this emphasis on contiguity exposes the flaws of conceiving gender in terms of a true gender self. Understood as a transitional space, gender then is an attempt to put oneself together and be known to the Other in spite of the impossibility of both. Gozlan takes this further to say that gender, and specifically gender transition, is “the space between what has not happened and what is yet to come.” As a space in-between reality and fantasy, VR is well suited to this kind of exploratory play, or, put another way, the “trying on” of different avatars and different worlds.
About a year and a half into treatment, Nena, in response to my gentle prying, revealed her desire to pause sessions. She said she felt much better at handling her emotions and that, although we could keep meeting and go deeper into things, she worried about money. She wanted some new things for her computer, and she thought that her parents might give her more money if they weren’t paying for sessions. She expressed a wish to resume sessions when she could pay for them herself. At this time in the treatment, Nena was beginning to tell me more about her dysphoric feelings about the sound of her voice. She didn’t like how crackly it was, and this contributed to her difficulty with speaking. She communicated a longing for her voice to be lighter and softer. She was also telling me about beginning to build her own avatar from scratch. This would be an avatar made with her own 3D modeling skills, rather than an avatar pieced together from preexisting templates. The money for the new equipment would support the building of her own avatar.
As she began to tell me more about her internal experience outside of VR, she also began to explore building her own avatar. This is perhaps a part of the ruthlessness of transitioning that Gozlan describes, wherein Nena moves to take control over her own fantasies and authorize her experience. Building her own avatar in VR coincided with Nena taking more initiative around certain aspects of gender transition in real life, such as making an appointment for sperm banking as a step in the direction of beginning hormone therapy. As Nena aimed to move from templated avatars to an avatar made from scratch, the transitional function of VR was changing. I also wondered if part of how the ruthlessness interacted with the treatment involved separating from me as a bridge and transitional object. My sense was that the transitional space of the treatment was no longer needed in the same way. As Nena reflected, we had reached a point where we could go deeper—the treatment could change and become a space for a different kind of exploration. But I think that it was important for Nena to separate from me, or shed the transitional object, in order to, at a later time, make her own choice about returning to treatment if she wanted to. Nena’s desire to pause the treatment was an important bid for autonomy that required respect.
In our last session, Nena discussed what she felt was made possible in our work together: “If I can make an analogy, it’s like I was searching for a foundation for many years, like a house, and now I feel I have the foundation, but now questions are coming up about it, is this what I want, so it’s better to have some idea of what I want and to question from there than to not know what I want at all; it does feel good enough.” Here, Nena articulated what Gozlan refers to as the “frustration factor to transitioning, and to gender more broadly—no matter what happens, the gender one creates or finds can never be what one expects.”1 Nena was able to use the transitional space of the treatment, and me as a transitional object, to find this foundation. The foundation was not a resolution of gender, but became a more stable place from which to ask questions about the desire of gender. The foundation was a good-enough place from which to bear the uncertainties and future meanings that gender would bring.
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It is easy to be seduced by case material, especially material about a trans patient, and especially about a trans patient who comes to psychoanalytically-oriented therapy sessions in VR. In practice, the sessions in VR, while certainly important to the work, felt like any other session in a psychoanalytically-oriented process. The VR sessions were significant not by measure of what Nena and I talked about, or even how we talked, but insofar as it was possible to talk with each other in this way, in the intermediary space between VR and the real world.
In my own adolescent mind, I felt very cool for being let into something very insider as an outsider. Gozlan talks about how it is important to think about adolescence not only as a developmental stage, but also as a state of mind that anyone can enter into. Invariably, this state of mind is part of the analyst’s countertransference and can lead the analyst to feel disturbed, challenged, or seduced by a patient’s demand. Demand here, in the psychoanalytic sense, refers to the unconscious wish or desire on the other side of a conscious statement. In Nena’s case, the idea to meet in VR was a demand, and part of the analytic work was to investigate the unconscious meanings of this idea. As a state of mind, adolescence is entering a place “in which there is difficulty distinguishing between wrecking objects in one’s mind and building the world outside.” I had to be attentive to my own seduction into this new thing, VR, that I knew very little about. Was I a voyeur? Could I be following a fetishistic impulse because VR felt so unknown to me? These questions, I realized, raised the same sorts of issues that would come up in transphobic countertransference—for instance, a cis analyst being particularly fixated on a patient’s transness in a way that is misaligned with the patient’s unconscious demands in the treatment. As I worked with Nena, and also presented this work in a variety of clinical contexts during and after our work, it became clearer to me how VR, as a new and developing set of technologies, challenged entrenched ideas about human nature in ways akin to gender transition.
When I presented a version of this material in a clinical case seminar on adolescents at my psychoanalytic training institute, I was deluged with the anxieties of my instructor and colleagues about virtual reality and gender transition. The instructor expressed feeling fascinated with the material and on the edge of her seat. She also interrupted me three times at the start of my presentation to question how I was using the term “being out” in relation to gender. She kept asking me if I was speaking about sexual orientation, so much so that I thought I might be speaking a foreign language. I needed to explain that in many trans subcultures, the language of “coming out” or “being out” is used to speak about a person’s orientation in relation to gender. And to keep the instructor’s ignorance from completely absorbing my presentation, a colleague helpfully chimed in to confirm that my comment about language was valid.
According to Griffin Hansbury’s survey of psychoanalytic literature, transphobic countertransference anxieties play out in four different ways: one, I will be deceived into homosexuality; two, I will become ungendered; three, my body will fall apart; and four, I will go crazy. My impression was that the instructor was dealing with number four and struggling to catch hold of her own ramped-up adolescent state of mind. She seemed disturbed and fascinated by me, my patient, and the work between us. Her repetitive and interruptive questions seemed to also bespeak a certain generational anxiety. She had decades of experience working with adolescents and was behind the times when it came to gender and sexuality. At the heart of this generational insecurity, which is widespread in the field, was a fear of irrelevancy and, fundamentally, of death.
In preparation for the seminar presentation, I considered my own anxieties about being a trans analyst working with a trans patient in an unorthodox way with VR. The two extremes of my anxiety were that my colleagues would either respond with an overly self-conscious praise and affirmation of me and the clinical work, or with hostility toward me and a pathologizing interpretation of my patient. I considered how trans adolescents are currently a hot topic in the field, and in contemporary culture more generally. I considered the potential compounding of anxiety, given that both patient and clinician were trans. Finally, I wondered if the additional element of virtual reality on top of transness would create so much anxious confusion about bodies and feelings that it would be impossible to have a psychoanalytic discussion.
The instructor and some of my colleagues commented on how I was doing a lot of containing in the treatment, and wanted to know whether I felt overwhelmed by this patient, having to hold in mind multiple pronouns, names, and realities. I found it uncanny that the psychoanalytic concept of containing was being used to foreclose psychoanalytic thinking and exploration. I was certainly moved, unsettled, and challenged in the treatment many times. The incorporation of another mediated layer of technology, VR, into an already complexly mediated relationship was new territory for me. I remained open to what might happen in this transitional space, and, clinically speaking, I neither felt that I was containing nor thought that containment was necessary. I had hoped the clinical material would inspire discussion about the various creative ways in which Nena was existing and expressing herself. My own wishful thinking about psychoanalysis’s relationship to gender transition led me to believe that the material would generate psychoanalytic discussion about transitional phenomena, play, creativity, desire, the potentials of virtual reality, and the interplay between fantasy and reality. The transness of my patient and me and the challenges of VR to the psychoanalytic frame were too much for this setting. The instructor and some other colleagues quickly judged the use of VR to be a breach of the psychoanalytic frame, propping up this border as a cover for transphobia. Technological befuddlement about VR also cloaked the transphobic confusions about Nena’s gender. The question of how Nena could move between different pronouns in different settings was replaced with how a patient could be an avatar on the screen in a Zoom session with a psychoanalyst. Both questions hinge on a commitment to impossibility. Both questions are symptomatic of impoverished imaginations that foreclose future worlds and ways of existing.
When I chose to take this course, I was already licensed as a psychoanalyst and was hoping to enhance my training with children and adolescents. After this experience, I began to consider withdrawing from the course and the larger program in which the course was offered. Before licensure, I was somewhat willing to put up with transphobia—I was determined to become a psychoanalyst—but after licensure, I feel much more compelled to address and openly criticize institutionalized transphobia in psychoanalysis. At the same time, even in writing this essay, I have had to come to terms with how the institutionalized transphobia is in me. It took me several edits of this essay to realize that what I thought was a fierce critique of transphobia was actually a restrained problematizing. My own transphobia about transphobia expressed itself through a fearfulness of backlash and controversy. The closet around institutionalized transphobia in psychoanalysis needs to be gutted. And if my language still seems restrained, then, to be clear, my discussion of institutionalized transphobia is not a bid for repair, but an incitement to psychoanalysts to think better, to be uncomfortable, and to change.
At the conclusion of the seminar, I received an uncanny evaluation that seemed to hold within itself the two extremes of transphobic anxiety. Gozlan calls these extremes “affirmation and condemnation,” and Brian Kloppenberg calls them “defensive acceptance and defensive opposition.” One line of the evaluation felt particularly troubling to me, not only on a personal level, but also, and more urgently, on the institutional level. The instructor wrote, “I suspect that [the analyst’s] clinical stance was infused with his ideas about trans identity and gender politics, sculpting his responsiveness to a trans patient with less analytic inquisitiveness and uncertainty than was called for, but he is right in time with more recent thought on the trans discourse.” My clinical decision to use VR in the treatment was cast as “less analytic.” My lapse in clinical judgment was caused by my commitments to a political agenda and trans ideology. Trans discourse and psychoanalytic theory and practice were framed as opposites. Trans discourse led to being “less analytic.” This splitting of trans discourse from psychoanalytic theory also implies that it is possible to be an analyst without political commitments, which I had evidently failed to accomplish, given that I was infused with trans discourse.
When I read this line in the evaluation, my association was to an absurd fantasy of an IV of testosterone pumping into my system, changing not only my biochemistry but also my political commitments. At the same time, I was also praised for being on the cutting edge of new thought, “trans discourse.” This defensive retreat into policing what is more or less analytic, presuming a psychoanalytically correct relationship between “trans discourse” and psychoanalytic practice, and disavowing one’s social and political positioning are all part of the larger institutional problem of transphobia. I reached out to the instructor, and we began a relatively productive conversation about what happened. My sense was that the instructor, who was cis, over sixty, and with decades of expertise in working with adolescents, was not only contending with a transphobic panic, but was also encountering an incipient unconscious envy of me, as a young person in the field, who was generally less stymied by normative traditions and able to work with more facility with transness and virtuality. And while this conversation was a good start, it is not enough in addressing the discipline-wide problem of transphobia.
This is one case study of the kind of psychic closure that happens when deep-seated fears of something new are triggered. In the context of the field at large, before it is even possible to discuss the richness of the case material, the institutional problem of transphobia requires critical thought. To be clear, my point here is not about whether or not I made the right or wrong clinical decisions, or even about my personal feelings, which are no less relevant. My point is that intense anxieties about gender, technology, and desire were triggered in the classroom and are part of a larger web of transphobic inhibitions and anxieties in the discipline. This problem impoverishes psychoanalytic metapsychology as a whole, makes psychoanalytic environments inhospitable to potential trans candidates, and reinforces psychoanalysis’s failures to engage with patients’ trans desires.