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

• Artikeln rapporterar om en patient i djupgående samtalsterapi: ‘Josh’, en transman vars liv hade rasat samman efter transitionen och som kom till terapi med förlamande ångest.
• Terapin stod still under lång tid, eftersom gömmande, lögner och förvirring fortsatte utspela sig mellan patient och terapeut.
• Terapeutens egen förvirring och ångest inför Josh hjälpte till slut fram ämnen som hade förblivit förbjudna.
• När de tog sig förbi ett dödläge byggt kring kön nådde arbetet en historia av att ha blivit kränkt, och frågor om närhet, ensamhet, att vara sann mot sig själv och förlust.
• Fallet läggs fram för att visa att transition kan lämna djupare lidande orörd, och att långvarig utforskande terapi kan nå det. Det är inte evidens för hur ofta detta sker.

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).