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

• 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。「ジョシュ」はトランジションの後に生活が崩れたトランス男性で、重い不安を抱えてセラピーに来ました。
• セラピーは長い間行き詰まり、隠すこと、嘘をつくこと、混乱が患者とセラピストの間で繰り返されました。
• ジョシュに対するセラピスト自身の混乱と不安が、やがて、触れてはならないままだった話題を引き出す助けとなりました。
• 性別を軸にした行き詰まりを越えて、作業は侵害された過去、そしてつながり、孤独、自分に正直であること、喪失についての問いにたどり着きました。
• この症例は、トランジションがより深い苦痛に手をつけないままにすることがあり、長期的な探索的セラピーがそこに届きうることを示すために提示されています。これがどのくらいの頻度で起こるかを示すエビデンスではありません。

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).