A detransition case study: Concerns about affirmative care

Written by Genspect parent Lynn Chadwick.

In Gender detransition: A case study, her article published November 10, 2021 in The Journal of Analytic Psychology, Genspect advisor and Jungian analyst Lisa Marchiano describes a case that illustrates the complex and overlooked mental health needs of young people presenting with gender distress and how simplistic the affirmative gender transition model of care is.

She writes:

“I feel that the rising rates of transition and detransition call for a depth understanding; this cultural phenomenon has life-long physical and psychological effects on teens and young adults. The case of a young woman in my practice who detransitioned illustrates the complex psychological dynamics underlying the quest for gender change. This young person began to identify as trans in her teens, took testosterone for almost two years in order to acquire a masculine appearance and later reaffirmed her identity as female. Although a single case cannot represent the full range of issues involved in gender detransition, her story depicts the implications of unaddressed psychological complexities in gender transition.”

“Maya,” the young woman in the case, was encouraged in her transgender identity online, which echoes the findings in Lisa Littman’s recent study on detransitioners. Marchiano notes:

“Maya’s time on social media fed a rumination about identity. When she shared with some of her online friends that she wondered whether she might be trans because she felt uncomfortable in her body, her friends on social media were quick to affirm and celebrate her. Maya cut her hair boyishly short and began wearing oversized jeans and sweatshirts. In her online life – which felt more real and rewarding than her ‘real’ life – Maya adopted a male name. At 14 years-of-age, Maya announced to her mother that she was trans and wanted to see a gender therapist and begin hormone therapy. Although mother was at first dismissive, she eventually accompanied her daughter to the school psychologist. Even Maya was surprised by how quickly the psychologist confirmed her trans identity, agreed with the name change and encouraged her parents to affirm Maya’s identity as male and support medical transition.”

Getting to the root causes of Maya’s distress was difficult and took persistent, patient therapy, which also supports the research that shows connections between gender dysphoria and comorbidities like trauma. Marchiano writes:

“Maya came to see me after she had decided to dis-identify from her trans identification and to re-identity as female. After getting to know Maya I formed the view that her trans identification was an attempt to adapt to a complex array of interrelated factors: her social environment at school and online; the dynamic between herself and her parents; her rejection of her body inculcated in part by her mother’s insistence on thinness and dieting; and her unmetabolized grief about the loss of a primary attachment figure early in life. In Maya’s case, I understand that affirmative treatment addressed the superficial distress only and seemed to leave little room to explore other factors. It was only after Maya decided to detransition that psychological work in these important areas could occur.”

All this is why Marchiano is skeptical of the affirmative model of care:

“I have a number of concerns regarding the gender affirmative model of care. It is my view that this model rests on a false premise and encourages the patient to make critical health decisions, including surgical interventions, based on beliefs rather than ‘facts’. Gender identity is not a well-defined concept and lacks empirical validity. Although there have been efforts to identify biomarkers that might correlate with gender dysphoria, no robust evidence has been found.”

She notes too the therapist’s duty to patients: “We owe it to young people to explore multiple facets of any individual’s expressed desire to transition.”

Marchiano concludes:
“My view is that the affirmative model of care concretizes psychic pain, locates it in the body, and seeks biomedical treatments for it….If this is the corrective offered by gender identity theory, we would do well to allow ourselves to be informed by this impulse while also maintaining contact with embodied reality.”

Read the entire case study here: Gender detransition: a case study – Marchiano – 2021 – Journal of Analytical Psychology – Wiley Online Library

Copy link
Powered by Social Snap