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

• El artículo es un informe sobre una paciente en terapia de conversación en profundidad: 'Maya', una joven que tomó testosterona durante casi dos años y luego volvió a identificarse como mujer.
• Maya empezó a identificarse como trans a los 14 años tras pasar cada vez más tiempo en línea. Una psicóloga escolar afirmó enseguida su identidad e instó a sus padres a apoyar la transición médica.
• A los 18 años, sin que sus padres participaran, le recetaron testosterona en una clínica que solo pide consentimiento informado, tras una reunión de 30 minutos con un ayudante de médico.
• Con la testosterona su salud mental empeoró, con dos ingresos psiquiátricos, uno de ellos porque tenía intención de suicidarse. Dejó las hormonas en parte porque sospechaba que empeoraban su estado de ánimo.
• Su historia incluía la pérdida de la tía que la cuidó de pequeña, unos padres emocionalmente distantes, bulimia y TDAH (trastorno por déficit de atención con hiperactividad). La terapeuta ve su identidad trans en parte como una forma de evitar el duelo y un vínculo difícil con su madre.
• La autora sostiene que la atención afirmativa puede convertir el malestar emocional en un problema del cuerpo y cerrar la exploración. Prefiere la terapia en profundidad antes de dar pasos médicos.

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.