The language and theories of Winnicott offer a lens for examining the importance of play in the development of the queer, transgender, and/or gender-nonconforming patient and the safety that virtual spaces—specifically, video games—provide for this play. While much of the literature posits the primary therapeutic value of virtual space as the site of psychic battle, interaction with a video game avatar can also be understood as an act of queerness-as-play, a potential cornerstone of healthy identity formation that may otherwise be precluded. An example of this paradigm is given in the case report of a twenty-year-year-old transwoman who used her video game avatar as a tool in her therapeutic progress during her medical transition. For effective psychotherapy to take place, both patient and clinician must have a capacity to play. With this in mind, the clinician might best visualize the virtual space not as a battleground, but as a playground.
AbreuR.L.KennyM.C. (2018). Cyberbullying and LGBTQ youth: A systematic literature review and recommendations for prevention and intervention. Journal of Child & Adolescent Trauma11:81–97.
2.
BacchiC.BonhamJ. (2014). Reclaiming discursive practices as an analytic focus: Political implications. Foucault Studies17:173–192.
3.
BalickA. (2013). The Psychodynamics of Social Networking: Connected-up Instantaneous Culture and the Self. London: Karnac Books.
4.
BillardT.J. (2019). “Passing” and the politics of deception: Transgender bodies, cisgender aesthetics, and the policing of inconspicuous marginal identities. In The Palgrave Handbook of Deceptive Communication, ed. Docan-MorganT.Cham, Switzerland: Palgrave Macmillan, pp. 463–478.
5.
BurginV. (2013). The location of virtual experience. In Little Madnesses: Winnicott, Transitional Phenomena and Cultural Experience, ed. KuhnA.New York: I.B. Tauris, pp. 23–38.
6.
ButlerJ. (1990). Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge, pp. 32–33.
7.
CeranogluT.A. (2010). Video games in psychotherapy. Review of General Psychology14:141–146.
8.
ContiM. (2020). Trauma, fantasy, and identity development in a transgender client: The case study of Alex. In The Social Work and LGBTQ Sexual Trauma Casebook: Phenomenological Perspectives, ed. JaffeM.ContiM.LonghoferJ.FloerschJ.New York: Routledge, pp. 88-106.
9.
CoppolilloH.P. (1976). The transitional phenomenon revisited. Journal of the American Academy of Child Psychiatry15:36–48.
10.
CraigS.L.McInroyL. (2014). You can form a part of yourself online: The influence of new media on identity development and coming out for LGBTQ youth. Journal of Gay & Lesbian Mental Health18:95–109.
11.
DiniK. (2012). On video games, culture, and therapy. Psychoanalytic Inquiry32:496–505.
12.
EhrensaftD. (2012). From gender identity disorder to gender identity creativity: True gender self child therapy. Journal of Homosexuality59:337–356.
13.
FlemingT.M.CheekC.MerryS.N.ThabrewH.BridgmanH.StasiakK.ShepherdM.PerryY.HetrickS. (2014). Serious games for the treatment or prevention of depression: A systematic review. Revista de psicopatología y psicología clínica19:227–242.
14.
FrancoG.E. (2016). Videogames and therapy: A narrative review of recent publications and application to treatment. Frontiers in Psychology7:1085.
15.
Gay, Lesbian, and Straight Education Network (2013). Out Online: The Experiences of Lesbian, Gay, Bisexual and Transgender Youth on the Internet. New York: Center for Innovative Public Health Research, & Crimes against Children Research Center, July10.
16.
GoetzC. (2017). Securing home base: Separation-individuation, attachment theory, and the “virtual worlds” paradigm in video games. Psychoanalytic Study of the Child70:101–116.
17.
González-BuesoV.SantamaríaJ.J.FernándezD.MerinoL.MonteroE.RibasJ. (2018). Association between internet gaming disorder or pathological video-game use and comorbid psychopathology: A comprehensive review. International Journal of Environmental Research & Public Health15:668.
18.
GriffithsM.D.ArcelusJ.BoumanW.P. (2016). Video gaming and gender dysphoria: Some case study evidence. Revista de psicología: Ciències de l’educació i de l’esport34(2):59–66.
19.
HendricksH.L.TestaR.J . (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. Professional Psychology: Research & Practice43:460–467.
20.
HilgardJ.EngelhardtC.R.BartholowB.D. (2013). Individual differences in motives, preferences, and pathology in video games: The Gaming Attitudes, Motives, and Experiences Scales (GAMES). Frontiers in Psychology4:608.
21.
Human Rights Campaign (2020). Fatal anti-transgender violence in the United States in 2019. Human Rights Campaign Foundation. November18, online.
22.
JagoseA. (1996). Queer Theory: An Introduction. New York: NYU Press.
23.
JonesC.M.ScholesL.JohnsonD.KatsikitisM.CarrasM.C. (2014). Gaming well: Links between videogames and flourishing mental health. Frontiers in Psychology5:260.
24.
KolesB.NagyP. (2016). Avatars as transitional objects: The impact of avatars and digital objects on adolescent gamers. Journal of Gaming & Virtual Worlds8:279–296.
25.
LemmaA. (2014). Minding the Body: The Body in Psychoanalysis and Beyond. New York: Routledge.
26.
LiD.LiauA.KhooA. (2011). Examining the influence of actual-ideal self-discrepancies, depression, and escapism on pathological gaming among massively multiplayer online adolescent gamers. Cyberpsychology, Behavior, & Social Networking14:535–539.
27.
MarzulloM.A.LibmanA.J. (2009). Research overview: Hate crimes and violence against lesbian, gay, bisexual and transgender people. Human Rights Campaign Foundation.
28.
MeyerI.H. (1995). Minority stress and mental health in gay men. Journal of Health & Social Behavior36:38–56.
29.
MeyerI.H. (2003). Prejudice, social stress, and mental health in lesbian, gay and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin129:674–697.
30.
MooneyM. (2017). Recognizing, treating, and preventing trauma in LGBTQ youth. Journal of Family Strengths17, article 16.
31.
Morahan-MartinJ. (2008). Internet abuse: Emerging trends and lingering questions. In Psychological Aspects of Cyberspace: Theory, Research, Applications, ed. BarakA.Cambridge: Cambridge University Press, pp. 32–69.
32.
MorganH.O’DonovanA.AlmeidaR.LinA.PerryY. (2020). The role of the avatar in gaming for trans and gender diverse young people. International Journal of Environmental Research & Public Health17(22):1–11.
NasoR.C. (2011). Role-playing games: Bridge or barrier to object relationships in socially isolated teens?Division Review2:27–30.
35.
PileckiA. (2015). Transitional space: The role of internet community for transgender and gender non-conforming patients. In Psychoanalysis Online 2: Impact of Technology on Development, Training, and Therapy, ed. ScharffJ.S.. New York: Routledge, pp. 53–66.
36.
PileckiA. (2018). Screen images: Transitional and defensive internet use among LGBTQ adolescents and adults. In Psychoanalysis Online 3: The Teleanalytic Setting, ed. ScharffJ.S.New York: Routledge, pp. 153–168.
37.
RackerH. (1957). The meanings and uses of countertransference. Psychoanalytic Quarterly26:303–357.
38.
RehakB. (2003). Playing at being: Psychoanalysis and the avatar. In The Video Game Theory Reader, ed. WolfJ.M.P.PerronB.New York: Routledge, pp. 103–127.
39.
RobertsA.L.RosarioM.CorlissH.L.KoenenK.C.AustinS.B. (2012). Elevated risk of posttraumatic stress in sexual minority youths: Mediation by childhood abuse and gender nonconformity. American Journal of Public Health102:1587–1593.
40.
RubergB. (2019). Video Games Have Always Been Queer. New York: NYU Press.
41.
SaketopoulouA. (2014). Mourning the body as bedrock: Developmental considerations in treating transsexual patients analytically. Journal of the American Psychoanalytic Association62:773–806.
42.
SchneebergerA.R.DietlM.F.MuenzenmaierK.H.HuberC.G.LangU.E. (2014). Stressful childhood experiences and health outcomes in sexual minority populations: A systematic review. Social Psychiatry & Psychiatric Epidemiology49:1427–1445.
43.
SearlesH.F. (1949). Concerning transference and countertransference. International Journal of Psychoanalysis7:165–207.
44.
ShawA. (2012). Talking to gaymers: Questioning identity, community and media representation. Westminster Papers in Communication & Culture9:67–88.
45.
ShawI.G.R. (2010). Playing war. Social & Cultural Geography11:789–803.
46.
SlavinM.O.KriegmanD. (1998). Why the analyst needs to change: Toward a theory of conflict, negotiation, and mutual influence in the therapeutic process. Psychoanalytic Dialogues8:247–284.
47.
SulerJ. (2008). Cybertherapeutic theory and techniques. In Psychological Aspects of Cyberspace: Theory, Research, Applications, ed. BarakA.Cambridge: Cambridge University, pp. 102–128.
48.
The Trevor Project (2020). Youth Homelessness. The Trevor Project, May26.
49.
TurkleS. (1997). Life on the Screen: Identity in the Age of the Internet. New York: Simon & Schuster.
VaughanS.C. (2018). Suicidality in LGBTQ+ youth. Psychoanalytic Study of the Child71:40–54.
52.
WillsJ. (2019). Gamer Nation: Video Games and American Culture. Baltimore: Johns Hopkins University Press.
53.
WinnicottD.W. (1953). Transitional objects and transitional phenomena. International Journal of Psychoanalysis34:89–97.
54.
WinnicottD.W. (1965). The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development. New York: International Universities Press.
55.
WinnicottD.W. (1971). Playing and Reality. London: Tavistock Publications.
