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

• L'article rapporte le cas d'un patient en psychothérapie approfondie : « Josh », un homme trans dont la vie s'était effondrée après la transition, et qui est venu en thérapie avec une anxiété invalidante.
• La thérapie est restée longtemps enlisée, la dissimulation, le mensonge et la confusion se rejouant entre le patient et le thérapeute.
• La propre confusion et l'anxiété du thérapeute face à Josh ont fini par aider à faire émerger des sujets restés interdits.
• En dépassant une impasse construite autour du genre, le travail a atteint une histoire de violation, et des questions de lien, de solitude, de fidélité à soi-même et de perte.
• Le cas est présenté pour montrer que la transition peut laisser intacte une détresse plus profonde, et qu'une thérapie exploratoire de longue durée peut l'atteindre. Ce n'est pas une preuve de la fréquence de ce phénomène.

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).