This case is a typical gender identity obstacle caused by factors such as acquired growth environment. The visitor was born in the original family model dominated by the mother and the father lacked the right to speak. The visitor only completed the physiological gender confirmation, and the psychological gender identity was difficult. In the case, the psychodynamic counseling scheme is adopted, focusing on identifying the visitors’ internal psychological conflict, defense mechanism, traumatic experience, etc. Through the establishment of treatment alliance, awareness of empathy and anti-empathy, listening and talking technology, sort out the sources of internal conflicts of the visitor. Through consultation, the visitor s has a deeper exploration of self-identity and gender identity, and internal conflicts and pain reduced.