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

• O artigo relata um paciente em terapia de conversa aprofundada: 'Josh', um homem trans cuja vida havia desmoronado após a transição e que chegou à terapia com ansiedade incapacitante.
• A terapia ficou travada por muito tempo, enquanto esconder, mentir e confusão se repetiam entre paciente e terapeuta.
• A própria confusão e ansiedade do terapeuta em resposta a Josh acabaram ajudando a trazer à tona temas que haviam permanecido proibidos.
• Ao superar um impasse construído em torno do gênero, o trabalho chegou a uma história de violação e a questões sobre conexão, solidão, ser fiel a si mesmo e perda.
• O caso é apresentado para mostrar que a transição pode deixar intacto um sofrimento mais profundo, e que uma terapia exploratória de longo prazo pode alcançá-lo. Não é evidência de com que frequência isso acontece.

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).