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'articolo è un resoconto su una paziente in terapia della parola approfondita: «Maya», una giovane donna che ha assunto testosterone per quasi due anni e poi ha tornato a identificarsi come femmina.
• Maya ha iniziato a identificarsi come trans a 14 anni dopo aver passato sempre più tempo online. Una psicologa scolastica ha subito affermato la sua identità e ha esortato i genitori a sostenere la transizione medica.
• A 18 anni, senza il coinvolgimento dei genitori, le è stato prescritto il testosterone in una clinica che richiede solo il consenso informato, dopo un incontro di 30 minuti con un assistente medico.
• Con il testosterone la sua salute mentale è peggiorata, con due ricoveri psichiatrici, uno dei quali perché intendeva uccidersi. Ha smesso gli ormoni in parte perché sospettava che peggiorassero il suo umore.
• La sua storia comprendeva la perdita della zia che si era presa cura di lei da piccola, genitori emotivamente distanti, bulimia e ADHD (disturbo da deficit di attenzione e iperattività). La terapeuta vede la sua identità trans come in parte un modo per evitare il lutto e un rapporto difficile con la madre.
• L'autrice sostiene che l'assistenza affermativa possa trasformare un disagio emotivo in un problema del corpo e bloccare l'esplorazione. Preferisce la terapia approfondita prima dei passi medici.

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.