Michael was a very boyish, appealing nine-year-old with a slender but athletic build.  His parents expressed concern about his development because he avoided playing with boys in school and his good friends were all girls.  His dad was a six-foot, pleasant looking High School teacher with a gentle manner.  His mom was a math teacher, very competent and somewhat masculine in appearance.

In the beginning of therapy Michael spoke freely about his feelings, his friends, his after-school sports activities and his hobbies.  He sat in my chair with one leg over the arm of it, and I listened, sitting on the couch.  Although he said he preferred playing games with me, he usually talked so long that we had little time left for games. 

Early on it became clear that Michael’s gender identification was very confused. One day he brought his knitting to the sessions telling me proudly that his grandmother had taught him to knit.  With his parents’ approval, he also brought his knitting to school. In one session, Michael told me that he thought it was better to be a boy because “boys could stand up when they pee although girls could wear pretty dresses.  Also, girls have to give birth to babies and that is very painful.”  In other sessions, Michael spoke about not liking to play with the boys in the schoolyard “because they fight too much.”

During one pivotal parent session, about four months into Michael’s therapy, his dad described, somewhat guiltily, the rages he would fly into when he lost his temper.  He felt that Michael must be afraid of his angry outbursts since he was a big man and was usually soft-spoken in his interaction with his son.   In that same session, when Michael’s mom began to describe her relationship with her father, her eyes began to redden.  With great difficulty, she tried to hold back tears and keep control of her voice.  When I drew attention to the intensity of her reaction, she was able to acknowledge the fear she has had since Michael was born.  She was always afraid that her son might turn out like her father, who was an angry, aggressive man who hit his children and terrified her throughout her childhood.

Michael’s mom and dad had no trouble seeing the links between their issues and their son’s fear of his own aggressive feelings and resulting problems identifying with the masculine world.  In subsequent sessions with Michael, I raised the topic of his dad’s anger and how scary that can be to children.  Michael described the things he did to avoid his dad getting into one of “his tempers,” and he confirmed that he was afraid of his dad at those times.  The insight gained by the mom had allowed her to modify her reactions to Michael’s aggressiveness and, when necessary, she was able to accept his getting angry at something she did.

Gradually, Michael became more comfortable expressing his angry feelings at home and he began to be more aggressive with his peers.  It did not take long before Michael lost interest in his knitting and he began to talk about a boy in school who had become his friend.  He was now able to spend time in the schoolyard joining in the rough and tumble play with the other boys.  In his therapy Michael re-connected with the masculine part of his personality, a part that had been so conflicted for him.  When Michael terminated treatment a few months later, he had become a boy with dirty knees from soccer who was becoming popular in the schoolyard!

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