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

• 이 논문은 심층 대화 치료를 받은 환자 한 명에 대한 보고입니다. ‘마야’는 거의 2년 동안 테스토스테론을 복용한 뒤 다시 여성으로 정체화한 젊은 여성입니다.
• 마야는 온라인에서 점점 더 많은 시간을 보낸 뒤 14세에 트랜스로 정체화하기 시작했습니다. 학교 심리학자는 곧바로 그녀의 정체성을 확인해 주었고 부모에게 의학적 전환을 지지하라고 촉구했습니다.
• 18세에 부모가 관여하지 않은 채, 사전 동의만 요구하는 클리닉에서 의사 보조원과 30분 만난 뒤 테스토스테론을 처방받았습니다.
• 테스토스테론을 복용하는 동안 정신 건강이 나빠져 정신과 입원을 두 차례 했고, 한 번은 자살할 의도 때문이었습니다. 호르몬이 기분을 악화시킨다고 의심한 것도 이유가 되어 호르몬을 중단했습니다.
• 그녀의 이력에는 어릴 때 돌봐 준 이모의 상실, 정서적으로 거리감 있는 부모, 폭식증, ADHD(주의력결핍 과잉행동장애)가 있었습니다. 치료사는 그녀의 트랜스 정체성이 부분적으로 슬픔과 어머니와의 어려운 관계를 피하는 방법이었다고 봅니다.
• 저자는 확정적 진료가 정서적 고통을 몸의 문제로 바꾸고 탐색을 닫아 버릴 수 있다고 주장합니다. 그녀는 의학적 단계 전에 심층 치료를 선호합니다.

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.