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

• Artikeln är en rapport om en patient i djupgående samtalsterapi: ‘Maya’, en ung kvinna som tog testosteron i nästan två år och sedan åter identifierade sig som kvinna.
• Maya började identifiera sig som trans vid 14 efter att ha tillbringat alltmer tid på nätet. En skolpsykolog bekräftade snabbt hennes identitet och uppmanade hennes föräldrar att stödja medicinsk transition.
• Vid 18, utan att föräldrarna var inblandade, fick hon testosteron utskrivet på en klinik som bara kräver informerat samtycke, efter ett 30 minuter långt möte med en läkarassistent.
• På testosteron blev hennes psykiska hälsa sämre, med två vistelser på psykiatrisk klinik, varav en för att hon tänkte ta sitt liv. Hon slutade med hormoner delvis för att hon misstänkte att de försämrade hennes humör.
• I hennes historia fanns förlusten av mostern som tog hand om henne när hon var liten, känslomässigt avlägsna föräldrar, bulimi och ADHD (uppmärksamhetsstörning med hyperaktivitet). Terapeuten ser hennes transidentitet delvis som ett sätt att undvika sorg och en svår relation till modern.
• Författaren hävdar att bekräftande vård kan förvandla känslomässigt lidande till ett problem med kroppen och stänga ned utforskande. Hon förordar djupgående terapi före medicinska steg.

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.