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

• 논문은 심층 대화 치료를 받은 환자 한 명에 대해 보고합니다. ‘조시’는 전환 후 삶이 무너진 트랜스 남성으로, 극심한 불안으로 치료를 받으러 왔습니다.
• 환자와 치료사 사이에서 숨김, 거짓말, 혼란이 계속 되풀이되어 치료는 오랫동안 막혀 있었습니다.
• 조시에 대한 치료사 자신의 혼란과 불안이 결국 금기로 남아 있던 주제를 드러내는 데 도움이 되었습니다.
• 성별을 중심으로 한 교착을 넘어서자, 작업은 침해당한 이력과 연결, 외로움, 자기 자신에게 진실한 것, 상실에 대한 질문에 이르렀습니다.
• 이 사례는 전환이 더 깊은 고통을 건드리지 못한 채 남겨둘 수 있고 장기적인 탐색적 치료가 거기에 닿을 수 있음을 보여주기 위해 제시된 것입니다. 이런 일이 얼마나 자주 일어나는지에 대한 근거는 아닙니다.

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).