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

• Artykuł opisuje jednego pacjenta w pogłębionej terapii rozmową: „Josha”, mężczyznę transpłciowego, którego życie rozpadło się po tranzycji i który trafił na terapię z paraliżującym lękiem.
• Terapia przez długi czas utknęła w miejscu, ponieważ ukrywanie, kłamstwa i zamęt wciąż odgrywały się między pacjentem a terapeutą.
• Własny zamęt i lęk terapeuty w reakcji na Josha ostatecznie pomogły wydobyć tematy, które pozostawały zakazane.
• Przechodząc poza impas zbudowany wokół płci, praca dotarła do historii bycia naruszonym oraz pytań o więź, samotność, bycie wiernym sobie i stratę.
• Przypadek przedstawiono, by pokazać, że tranzycja może pozostawić nietknięte głębsze cierpienie i że długoterminowa terapia eksploracyjna może do niego dotrzeć. Nie jest to dowód na to, jak często się to zdarza.

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).