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

• Makalah ini adalah laporan tentang satu pasien dalam terapi bicara mendalam: 'Maya', seorang perempuan muda yang memakai testosteron hampir dua tahun lalu kembali mengidentifikasi diri sebagai perempuan.
• Maya mulai mengidentifikasi diri sebagai trans pada usia 14 setelah makin banyak menghabiskan waktu daring. Seorang psikolog sekolah dengan cepat mengafirmasi identitasnya dan mendesak orang tuanya mendukung transisi medis.
• Pada usia 18, tanpa melibatkan orang tuanya, ia diresepi testosteron di klinik yang hanya meminta persetujuan berdasarkan informasi, setelah pertemuan 30 menit dengan asisten dokter.
• Dengan testosteron kesehatan mentalnya memburuk, dengan dua kali dirawat di rumah sakit jiwa, satu di antaranya karena ia berniat bunuh diri. Ia menghentikan hormon sebagian karena curiga hormon itu memperburuk suasana hatinya.
• Riwayatnya mencakup kehilangan bibi yang merawatnya saat ia kecil, orang tua yang berjarak secara emosional, bulimia, dan ADHD (gangguan pemusatan perhatian dan hiperaktivitas). Terapis memandang identitas transnya sebagian sebagai cara menghindari duka dan ikatan yang sulit dengan ibunya.
• Penulis berargumen bahwa perawatan afirmatif dapat mengubah tekanan emosional menjadi masalah pada tubuh dan menutup penjelajahan. Ia lebih menyukai terapi mendalam sebelum langkah medis.

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.