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

• 論文報告了一位接受深度談話治療的患者：「喬許」是一名跨性別男性，過渡後生活崩潰，帶著嚴重的焦慮來接受治療。
• 治療停滯了很長一段時間，因為隱瞞、說謊和混亂不斷在患者與治療師之間上演。
• 治療師自己對喬許的混亂和焦慮反應，最終幫助帶出了原本一直是禁忌的話題。
• 越過圍繞性別形成的僵局後，治療觸及了遭受侵犯的歷史，以及連結、孤獨、忠於自己和失落的問題。
• 提出這個案例是為了顯示過渡可能沒有觸及更深層的痛苦，而長期的探索性治療可以觸及它。這不是此類情況發生頻率的證據。

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).