First do no harm

Bell, David

doi:10.1080/00207578.2020.1810885

Cited by 35 publications

(12 citation statements)

References 2 publications

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“…A growing body of knowledge connects the development of gender dysphoria with psychological factors (Bonfatto & Crasnow, 2018; Patterson, 2018; Rustin, 2018). Bell (2020) highlighted a link between some families who are either consciously or unconsciously homophobic and the presentation of a wish to transition in some young people who may otherwise have been gay or lesbian. It is as if the child internalizes the homophobic attitude of the family and believes they would be more acceptable to the family if they transition.…”

Section: Discussionmentioning

confidence: 99%

‘If only I were a boy …’: Psychotherapeutic Explorations of Transgender in Children and Adolescents

Evans¹

2022

Brit J Psychotherapy

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This paper is based on the author’s experience of working with a particular group of female/male trans children and young people who present a similar clinical profile: a fragile ego prone to fragmentation and concrete thinking. Often, there is evidence of a grievance over the failed ideal object, which is internalized, projected into the body, and then attacked. Faced with the developmental challenge of sexuality at puberty, young adults withdraw to a psychic retreat designed to halt development. This paper focuses on the development of a trans identity in defence against an underlying fear of depressive anxieties and psychic collapse. It describes the ongoing assessment of Joanne, a 19‐year‐old biological female who wanted to be known as Luke in therapy and wished to transition in the belief that this was the only way she could have a life. The concrete nature of Joanne’s thinking created problems in the therapy, as thoughts were often experienced as physical actions. This paper describes the function of the phantasy that transitioning performs in creating a psychic retreat from the demands of psychological development.

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Section: Discussionmentioning

confidence: 99%

‘If only I were a boy …’: Psychotherapeutic Explorations of Transgender in Children and Adolescents

Evans¹

2022

Brit J Psychotherapy

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“…Ideally, the model can be used to break down into smaller pieces the oft-overwhelming subjective experiences of GD that can be difficult to describe with words. The clinical focus should always be on the idiosyncratic dynamic of GD of each young TGNC individual and their wider social context (Bell, 2020;Saketopoulou, 2020;Wren, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…In the global West since the mid-2000s, there has been an increase in the number of teenagers referred to clinics in an effort to alleviate GD through gender-affirming healthcare (de Graaf et al, 2018;Kaltiala et al, 2020a;Zucker et al, 2008). This has created increased attention both within clinics and in public debate regarding what constitutes best treatment for TGNC youth seeking such help (Bell, 2020;Saketopoulou, 2020;Wren, 2019). The first evaluative research of medical treatment for adolescents was promising.…”

Section: Introductionmentioning

confidence: 99%

Negotiating Gender in Everyday Life: Toward a Conceptual Model of Gender Dysphoria in Adolescents

et al. 2021

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A growing number of adolescents are seeking medical care to alleviate gender dysphoria (GD). This qualitative study explored the subjective experiences of GD among help-seeking transgender and gender nonconforming (TGNC) youth in order to develop a more nuanced conceptualization of the phenomenon. Fifteen life-mode interviews were conducted with newly referred youth between the ages of 13 and 19. All participants were assigned female at birth. The data were analyzed using thematic analysis. The participants targeted five major themes that characterize GD: (1) Bodily sensations were constant reminders of GD throughout the day, (2) emotional memories from the past of being different and outside triggered GD, (3) the process of coming out was a transformative experience that changed how the participants understood themselves, (4) GD both increased and decreased in relation to others, (5) everyday life required careful negotiation to feel whole without developing new forms of GD. Based on the results, we suggest a more conceptually nuanced model of GD, one which accounts for how bodily sensations and emotional memories from the past were sources that elicited GD. The sources were mediated through the process of coming out and relating to others, and this resulted in the negotiation of GD today. The conceptual model suggested in the present study could ideally shed light on preexisting knowledge on TGNC youth struggling with GD. In addition, an improved understanding of GD could ideally help clinicians when addressing individual treatment needs.

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“…2 Each position represents the analyst’s anxieties with regard to the adolescent’s agency, autonomy, and future. There are concerns over the possibility of regret, concerns that the transition will interfere with the natural process of development, and concerns over the potential evasion of underlying issues such as underlying hatred of homosexuality (Bell 2020) and experiences of loss or trauma being displaced onto gender (Lemma 2015). 3 It is impossible to separate mental pain from gender.…”

mentioning

confidence: 99%

“…On the other is the dilemma of analysts trying to think about the scene of transitioning and their capacity be with trans patients. I frame this encounter between the adolescent trans or nonbinary patient and the analyst using the Winnicottian concept of ruthlessness partly because of my dissatisfaction with traditional psychoanalytic approaches to the question of transitioning (and, in particular, demands made by children and adolescents), which take the form of searching for a cause (Bell 2020; Lemma 2015, 2018; Heenen-Wolfe 2021), of grounding transitioning in trauma theory (Bell 2020; Lemma 2015; Heenen-Wolfe 2021; Evans and Evans 2021), or of conceptualizing transitioning as a disruption of the natural course of development. Such theories reflect a normative imaginary in conceptualizing development and gender that is contradictory to the psychoanalytic view of normalcy as an exception and the radical notion of desire whose causes are overdetermined, subject to internal life, and understood only in the strange temporality of afterwardsness (après-coup).…”

mentioning

confidence: 99%

Adolescent Ruthlessness and the Transitioning Of The Analyst’s Mind

Gozlan¹

2022

J Am Psychoanal Assoc

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Features of ruthlessness may come into play in the encounter between adolescents who come into the therapeutic space with clear and precise demands to be supported through their gender transition. Winnicott’s concept of ruthlessness, extended from the infant-mother matrix to the emotional situation of the clinic, allows a consideration of the conditions under which the analyst can think about adolescent demands. These conditions involve the desire of both patient and analyst for certitude and the analyst’s urgency to respond, as well as the adolescent’s contradictory desires to both destroy and create gender. The work of Sally Swartz, who brought to Winnicott’s conception a notion of ruthlessness in protest, helps us consider the qualities of ruthlessness in constituting gender. A snippet of work with a nonbinary patient shows how questions of gender cannot be understood apart from the intersubjective transferential field. Tying ruthlessness to the enigma of desire illuminates the emotional situation of the clinical encounter between the nonbinary or trans patient and the analyst, a situation that is also libidinal. An analytic move from the question of gender identity to the realm of an emotional situation allows the analyst to meet adolescent ruthlessness. This meeting is an ethical attempt to understand the other, but also reveals one’s resistance to giving up something in order to understand.

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First do no harm

Cited by 35 publications

References 2 publications

‘If only I were a boy …’: Psychotherapeutic Explorations of Transgender in Children and Adolescents

‘If only I were a boy …’: Psychotherapeutic Explorations of Transgender in Children and Adolescents

Negotiating Gender in Everyday Life: Toward a Conceptual Model of Gender Dysphoria in Adolescents

Adolescent Ruthlessness and the Transitioning Of The Analyst’s Mind

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