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

• 這篇論文是對一位接受深度談話治療的患者的報告：「瑪雅」是一名年輕女性，使用睪固酮近兩年後，又再度認同為女性。
• 瑪雅在越來越多時間待在網路上之後，14 歲開始認同為跨性別。學校心理師很快肯定了她的認同，並力勸她的父母支持醫療過渡。
• 18 歲時，在父母沒有參與的情況下，她在一家只要求知情同意的診所，與一名醫師助理會面 30 分鐘後被開立睪固酮。
• 使用睪固酮期間，她的心理健康惡化，兩度住進精神科醫院，其中一次是因為打算自殺。她停用荷爾蒙，部分原因是她懷疑荷爾蒙讓她的情緒變得更糟。
• 她的經歷包括失去在她年幼時照顧她的姑姑、情感疏遠的父母、暴食症，以及ADHD（注意力不足過動症）。治療師認為她的跨性別認同，部分是一種逃避悲傷以及與母親之間困難關係的方式。
• 作者主張，肯定式照護可能把情緒上的痛苦轉變為身體的問題，並中斷探索。她主張在採取醫療步驟之前先進行深度治療。

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.