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

• L'article est un rapport sur une patiente en psychothérapie approfondie : « Maya », une jeune femme qui a pris de la testostérone pendant presque deux ans puis s'est de nouveau identifiée comme femme.
• Maya a commencé à s'identifier comme trans à 14 ans après avoir passé de plus en plus de temps en ligne. Une psychologue scolaire a rapidement validé son identité et a exhorté ses parents à soutenir une transition médicale.
• À 18 ans, sans l'implication de ses parents, on lui a prescrit de la testostérone dans une clinique qui ne demande que le consentement éclairé, après un entretien de 30 minutes avec un assistant médical.
• Sous testostérone, sa santé mentale s'est dégradée, avec deux hospitalisations psychiatriques, dont une pour intention suicidaire. Elle a arrêté les hormones en partie parce qu'elle soupçonnait qu'elles aggravaient son humeur.
• Son histoire comprenait la perte de la tante qui s'occupait d'elle enfant, des parents émotionnellement distants, la boulimie et le TDAH (trouble déficitaire de l'attention avec hyperactivité). La thérapeute voit son identité trans comme en partie un moyen d'éviter le deuil et un lien difficile avec sa mère.
• L'auteure soutient que les soins d'affirmation peuvent transformer une détresse émotionnelle en problème du corps et fermer l'exploration. Elle privilégie une thérapie approfondie avant toute démarche médicale.

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.