Summary

Lisa Marchiano describes her therapy with 'Maya', who identified as trans as a teenager, was quickly affirmed by a school psychologist, and was prescribed testosterone at 18 after a short clinic visit with no real assessment. Her mental health got worse on testosterone, with two psychiatric hospital stays. She stopped hormones and identified as female again before starting therapy. Using Jungian ideas, Marchiano links Maya's gender distress to grief she never worked through for the aunt who raised her, a hard relationship with her mother, and a wish to escape being a woman. She argues that affirming care can turn emotional pain into a problem with the body. The case shows that gender distress can carry other meanings for some people. But it is one case, pieced together afterwards by a critic of affirming care, and can't be generalised.

Key findings

• الورقة تقرير عن مريضة واحدة في علاج حواري متعمق: «مايا»، شابة تناولت التستوستيرون قرابة عامين ثم عرّفت نفسها كأنثى مجدداً.
• بدأت مايا تعرّف نفسها كمتحولة في الرابعة عشرة بعد قضاء وقت متزايد على الإنترنت. أكدت لها اختصاصية نفسية في المدرسة هويتها بسرعة وحثت والديها على دعم التحول الطبي.
• في الثامنة عشرة، ودون مشاركة والديها، وُصف لها التستوستيرون في عيادة لا تطلب سوى الموافقة المستنيرة، بعد لقاء مدته 30 دقيقة مع مساعد طبيب.
• ساءت صحتها النفسية على التستوستيرون، مع إقامتين في مستشفى للأمراض النفسية، إحداهما لأنها نوت الانتحار. وأوقفت الهرمونات جزئياً لاشتباهها في أنها تزيد حالتها المزاجية سوءاً.
• شمل تاريخها فقدان العمة التي رعتها في صغرها، ووالدين بعيدين عاطفياً، والشره العصبي، واضطراب فرط الحركة وتشتت الانتباه (ADHD). وترى المعالجة أن هويتها المتحولة كانت جزئياً وسيلة لتجنب الحزن وعلاقة صعبة مع أمها.
• ترى المؤلفة أن رعاية التأكيد قد تحوّل الكرب العاطفي إلى مشكلة في الجسد وتغلق باب الاستكشاف. وهي تفضل العلاج الحواري المتعمق قبل الخطوات الطبية.

Abstract

Within the last decade, there has been a sharp global rise in the number of young people identifying as transgender. More recently, there appears to be an increase in the numbers of young people detransitioning or returning to identifying with their natal sex after pursuing medical transition. A case is presented of a young woman who pursued a gender transition and returned to identifying as female after almost two years on testosterone. The author considers and critiques the affirmative model of care for gender dysphoric youth in light of this case.

Conclusion

The case of Maya illustrates the extent to which her presenting problem was a metaphor for unresolved grief and deficient parenting which was later exacerbated by both peer and professional wounding. The purpose of psychological treatment is to bring unconscious issues to consciousness, thereby recovering and reconnecting affect, cognition and reality. Depth psychology posits the active presence of unconscious compensation and symbolization processes. We owe it to young people to explore multiple facets of any individual's expressed desire to transition. For some people, living life in the opposite sex role - even to the point of undergoing physical transition - may be what the psyche requires of them. We help our patients best by affirming the significance of their experience but without explicitly endorsing a specific course of action.