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

• この論文は、徹底した心理療法を受けた1人の患者についての報告です。「マヤ」は、ほぼ2年間テストステロンを使用し、その後再び女性として自認するようになった若い女性です。
• マヤは、オンラインで過ごす時間がますます増えた後、14歳でトランスだと自認し始めました。学校の心理士はすぐに彼女の自認を肯定し、両親に医学的トランジションを支持するよう促しました。
• 18歳のとき、両親が関わらないまま、インフォームド・コンセントのみを求めるクリニックで、フィジシャン・アシスタントとの30分の面談の後に、テストステロンを処方されました。
• テストステロンの使用中、彼女のメンタルヘルスは悪化し、精神科病院に2回入院し、1回は自殺するつもりだったためでした。ホルモンが気分を悪くしていると疑ったこともあって、ホルモンをやめました。
• 彼女の経歴には、幼い頃に世話をしてくれた叔母を失ったこと、感情的に距離のある両親、過食症、ADHD（注意欠如・多動症）がありました。心理療法士は、彼女のトランスの自認を、悲しみや母親との難しい関係を避ける方法の一部と見ています。
• 著者は、肯定的ケアは感情的な苦痛を身体の問題に置き換え、探索を閉ざしてしまう可能性があると主張しています。医学的なステップの前に、徹底した心理療法を行うことを支持しています。

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.