Summary

This paper describes long-term in-depth talking therapy with 'Josh', a trans man who sought help for severe anxiety after his life fell apart following transition. D'Angelo describes a long stalemate in which hiding, lying and confusion played out between patient and therapist. Looking closely at his own emotional reactions to Josh eventually opened up topics that had been off-limits. The work moved beyond gender to a history of being violated and deeper questions of connection, loneliness and being true to oneself. Marchiano (2021) cites the case as an example of transition used to escape painful feelings. Because it is one case, interpreted by one therapist, with no standard measurements, it raises questions for clinicians but cannot show how often transition leaves distress unresolved. The author is president of the Society for Evidence-Based Gender Medicine (SEGM).

Key findings

• El artículo informa de un paciente en terapia de conversación en profundidad: 'Josh', un hombre trans cuya vida se había venido abajo tras la transición y que acudió a terapia con una ansiedad incapacitante.
• La terapia estuvo atascada durante mucho tiempo, pues el ocultamiento, las mentiras y la confusión se repetían entre paciente y terapeuta.
• La propia confusión y ansiedad del terapeuta en respuesta a Josh acabó ayudando a sacar a la luz temas que habían seguido vedados.
• Al superar un bloqueo construido en torno al género, el trabajo llegó a una historia de haber sido violentado, y a cuestiones sobre la conexión, la soledad, ser fiel a uno mismo y la pérdida.
• El caso se ofrece para mostrar que la transición puede dejar intacto un malestar más profundo, y que la terapia exploratoria a largo plazo puede alcanzarlo. No es evidencia de con qué frecuencia ocurre esto.

Abstract

This paper explores the therapeutic process between analyst and Josh, a trans man whose life had fallen apart after transition. Repetitive enactments involving hiding, deceiving and mystification constituted a prolonged therapeutic impasse. The analyst's struggle with these binds and with countertransference confusion and anxiety, ultimately illuminated zones that had remained off-limits for a prolonged period of time. Where the couple had been snared in a bind structured by gender, they were now able to access a history of violation and to ask more profound questions about connection, aloneness, authenticity and loss.

Conclusion

Through a prolonged therapeutic process involving repeated enactments of hiding, deceiving and mystification, and the analyst's struggle with countertransference confusion and anxiety, analyst and patient moved beyond a bind structured by gender. This gave access to a history of violation and allowed them to ask more profound questions about connection, aloneness, authenticity and loss (summary of the published abstract).