Key Findings

• Clinical case study of a trans man ('Josh') whose life deteriorated after gender transition
• The therapeutic process revealed repetitive enactments involving hiding, deceiving, and mystification
• These enactments constituted a prolonged therapeutic impasse between analyst and patient
• The analyst experienced significant countertransference confusion and anxiety
• Working through the impasse allowed access to a history of violation beneath the gender-structured bind
• The case illustrates complexities of post-transition psychological distress that may not be addressed by transition alone
• Published as a Clinical Communication in the International Journal of Psychoanalysis

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.

Summary

This 2020 clinical case study by Roberto D'Angelo, published in the International Journal of Psychoanalysis, explores the psychoanalytic treatment of a trans man ('Josh') whose life fell apart after transitioning. The therapeutic process was marked by prolonged impasses involving hiding, deceiving, and mystification, which the analyst eventually worked through to access deeper psychological material about violation, connection, and authenticity. The case illustrates how gender transition may not resolve underlying psychological distress and highlights the value of extended psychoanalytic exploration.

Conclusion

Through the prolonged therapeutic process, the analyst and patient were able to move beyond the gender-structured bind that had maintained the impasse. By working through repetitive enactments involving hiding, deceiving, and mystification, they accessed a deeper history of violation and explored fundamental questions about connection, aloneness, authenticity, and loss — suggesting that the transition had not resolved the underlying psychological distress and that psychoanalytic exploration revealed complexities beyond the gender dysphoria framework.