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

• 这篇论文报告了一名接受深入谈话治疗的患者：“Josh”是一位跨性别男性，过渡后生活崩溃，带着严重的焦虑来接受治疗。
• 治疗长时间陷入停滞，因为隐瞒、说谎和困惑一直在患者与治疗师之间重演。
• 治疗师自己对Josh的困惑和焦虑反应，最终帮助引出了一直被禁止触及的话题。
• 走出围绕性别构成的僵局之后，治疗触及了被侵犯的经历，以及关于联结、孤独、忠于自我和失去的问题。
• 这个案例用来说明，过渡可能没有触及更深层的痛苦，而长期的探索性治疗可以触及它。它不是这种情况发生频率的证据。

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).