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

• O artigo é um relato sobre uma paciente em terapia de conversa aprofundada: 'Maya', uma jovem que tomou testosterona por quase dois anos e depois voltou a se identificar como mulher.
• Maya começou a se identificar como trans aos 14 anos depois de passar cada vez mais tempo online. Uma psicóloga escolar afirmou rapidamente sua identidade e pediu aos pais que apoiassem a transição médica.
• Aos 18 anos, sem a participação dos pais, recebeu testosterona em uma clínica que pede apenas consentimento informado, após uma reunião de 30 minutos com um assistente médico.
• Com a testosterona, sua saúde mental piorou, com duas internações psiquiátricas, uma delas porque tinha intenção de suicídio. Ela parou os hormônios em parte porque suspeitava que estavam piorando seu humor.
• Seu histórico incluía a perda da tia que cuidou dela quando era pequena, pais emocionalmente distantes, bulimia e TDAH (transtorno de déficit de atenção e hiperatividade). A terapeuta vê sua identidade trans como, em parte, uma forma de evitar o luto e um vínculo difícil com a mãe.
• A autora argumenta que o atendimento afirmativo pode transformar sofrimento emocional em um problema do corpo e encerrar a exploração. Ela defende terapia aprofundada antes de passos médicos.

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.