McCully (1963) reported on the projective test findings of a 32 year old Catholic woman who wished to change her sex. The patient, the youngest of two female siblings, had an early identification with males (age 5) and was a tomboy during latency. She described her father as "a volatile person who was sometimes physically abusive" to her. When the patient was nine her mother died and she was sent to boarding school. At this time she felt isolated from her peers and she became "absorbed with the idea that something was wrong with her genitalia."

She had a sundry work history including one job on a farm where she dressed as a boy. Even as a young child the patient was aware of her homoeroticism. Later as an adult she retched orgasm through masturbation with the "belief that she had testicles inside her groin." McCully noted that she was quite convincing in her male role.

A mental status exam revealed that the woman's thinking was circumstantial and concrete. Moreover, she was depressed, tense, and had insomnia, declared that she was a psychic, was mildly paranoid, but revealed no evidence of an overt thought disorder, McCully was incredulous that there were no florid signs of schizophrenia (reflecting a pervasive clinical bias that transsexuals were either psychotic or schizophrenic). He interpreted the patient's male wishes (in the light of her aversion to female sexuality) as a "kind of reaction formation against deeply repressed feminine qualities," McCully also noted that the patient employed primitive defenses (including splitting, projection, denial, and grandiosity). McCully suggested that the patient suffered little anxiety because "she concretized her problem and projected it onto society," In the light of current thinking, the diagnostic issues of the case could best be explained along the lines of a borderline personality disorder.

Philippopoulos (1964) reported on a case of transvestism in a 17 year old girl who was treated in psychotherapy 3 4 times a week for 6 months (112 sessions). The case resulted in a complete reversal of the patient's gender identity conflicts and transvestism, Philippopoulos noted that the patient was born "the only daughter of an urban family who lived in a provincial town in northern Greece." The patient served the role of a go between for the parents and often watched helplessly as the father beat his wife in a drunken rage. The mother cursed the patient, stating, "Accursed be the hour when I delivered you a girl if you were a boy I should, at least, have the hope that you would grow up one day and avenge me." The mother dressed the patient in boy's clothes, stating, "even long trousers are worth more than a thousand girls," During adolescence the patient was identified as a tomboy and impersonated a boy, Eventually the mother demanded that the patient give up her male role "because it was now time to become a woman." Mother brought her daughter to a physician to cure her of her maleness. Philippopoulos, reporting on a follow up of the patient five years post therapy, stated that she was now living and working as a female. He speculated about the "over determining attitude which the mother played on a purely conscious level in the genesis of transvestism.