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

• Straipsnis yra ataskaita apie vieną gilios pokalbių terapijos pacientę: „Maya“, jauną moterį, beveik dvejus metus vartojusią testosteroną ir paskui vėl besitapatinusią kaip moteris.
• Maya pradėjo tapatintis kaip translytė 14 metų, vis daugiau laiko praleisdama internete. Mokyklos psichologas greitai patvirtino jos tapatybę ir ragino tėvus palaikyti medicininę tranziciją.
• 18 metų, be tėvų įtraukimo, jai buvo išrašytas testosteronas klinikoje, kuri prašo tik informuoto sutikimo, po 30 minučių susitikimo su gydytojo padėjėju.
• Vartojant testosteroną jos psichikos sveikata pablogėjo, du kartus gulėjo psichiatrijos ligoninėje, vieną kartą dėl ketinimo nusižudyti. Hormonų ji atsisakė iš dalies įtardama, kad jie blogina jos nuotaiką.
• Jos istorijoje buvo globojusios tetos netektis jai esant jaunai, emociškai nutolę tėvai, bulimija ir ADHD (dėmesio trūkumo ir hiperaktyvumo sutrikimas). Terapeutė jos translyčią tapatybę mato iš dalies kaip būdą išvengti sielvarto ir sudėtingo ryšio su motina.
• Autorė teigia, kad patvirtinanti priežiūra gali paversti emocinę kančią kūno problema ir užgesinti tyrinėjimą. Ji pirmenybę teikia gilios terapijos prieš medicininius žingsnius.

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.