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

• Artikkelen er en beretning om én pasient i dybdeterapi: «Maya», en ung kvinne som brukte testosteron i nesten to år og deretter identifiserte seg som kvinne igjen.
• Maya begynte å identifisere seg som trans som 14-åring etter å ha brukt mer og mer tid på nett. En skolepsykolog bekreftet raskt identiteten hennes og oppfordret foreldrene til å støtte medisinsk overgang.
• Som 18-åring, uten at foreldrene var involvert, fikk hun testosteron foreskrevet ved en klinikk som bare krever informert samtykke, etter et møte på 30 minutter med en legeassistent.
• På testosteron ble den psykiske helsen hennes verre, med to opphold på psykiatrisk sykehus, det ene fordi hun hadde til hensikt å ta sitt eget liv. Hun sluttet med hormoner delvis fordi hun mistenkte at de gjorde humøret hennes verre.
• Historien hennes inkluderte tapet av tanten som tok seg av henne som liten, følelsesmessig fjerne foreldre, bulimi og ADHD (oppmerksomhetsunderskudd og hyperaktivitetsforstyrrelse). Terapeuten ser transidentiteten hennes delvis som en måte å unngå sorg og et vanskelig bånd til moren på.
• Forfatteren hevder at bekreftende omsorg kan gjøre følelsesmessig nød om til et problem med kroppen og stenge for utforsking. Hun foretrekker dybdeterapi før medisinske skritt.

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.