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

• 这篇论文报告了一名接受深入谈话治疗的患者：“Maya”是一位年轻女性，她使用了近两年睾酮，然后再次认同自己是女性。
• Maya在越来越多地待在网上之后，14岁时开始认同自己是跨性别者。一位学校心理学家很快肯定了她的身份，并敦促她的父母支持医学过渡。
• 18岁时，在没有父母参与的情况下，她在一家只要求知情同意的诊所，与一名医师助理会面30分钟后被开具了睾酮。
• 使用睾酮期间她的心理健康变差，两次住进精神病院，其中一次是因为有自杀意图。她停用激素，部分原因是怀疑激素让她的情绪变得更糟。
• 她的经历包括失去在她小时候照顾她的姨妈、情感疏远的父母、暴食症和ADHD（注意缺陷多动障碍）。治疗师认为，她的跨性别身份在一定程度上是回避悲伤和与母亲之间艰难关系的一种方式。
• 作者认为，肯定式护理可能把情绪痛苦转变为身体的问题，并终止探索。她主张在采取医学步骤之前先进行深入的治疗。

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.