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

Abstract

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.

Transition Regret and Detransition: Meanings and Uncertainties

“…Clothes, haircuts, colors, mannerisms, etc., do not have a sex. The original Dutch protocol for transition of minors emphasized the role of psychotherapy in fostering self-acceptance of gender-nonconformity prior to contemplating medical interventions (de Vries et al, 2006 ) and a growing body of literature describes an exploratory psychotherapeutic approach that can help people expand their definition of what it means to be a man or a woman, thereby potentially eliminating the need for transition-related medical interventions (Bonfatto & Crasnow, 2018 ; Churcher Clarke & Spiliadis, 2019 ; Evans, 2022 ; Hakeem, 2018 ).…”

„The Gender Reassignment” Controversy - Between Affirmation and Kind Restraining

“…Detailed correlations were obtained in the studies for the co-occurrence of transsexual tendencies and high rates of psychopathology in the parents, in the child alone, relational problems within the family and problems with contact with parents, difficult relationships with peers, but also in terms of inappropriate parental reactions to the child's gender-nonconforming behaviour (Marianowicz-Szczygieł, 2021;Zucker, 2008). A significant group of authors believe that increasingly the development of gender dysphoria is linked to psychological factors (Bell, 2020;Bonfatto & Crasnow, 2018;Evans, 2022;Patterson, 2018;Rustin, 2018). The correlations that occur can be explained in various ways, including, as root causes (e.g., autism, sexual violence, anxiety disorders, depression, psychiatric disorders), but, not knowing why, the correlations obtained are most often interpreted in only one way: co-occurring psychological disorders would be supposed to be the result of the rejection of individuals with gender dysphoria and so-called minority stress (cf.…”

“…One of the most coherent models of the emergence of transgender disorders has been put forward by Marcus Evans, a psychotherapist and for over 20 years a member of the directorate of one of the leading clinics for children and young people in the UK, the Tavistock and Portman Clinic. According to Evans (2022), trans identity would be a defence against anxiety, depression and mental collapse, a way of coping and controlling psychological pain. The young patients (female/male type), according to the clinician, shared a common psychological profile: a fragile ego, prone to fragmentation and concrete thinking (thoughts were often experienced as physical actions), the frequent appearance of internalised grief, due to a failed relationship with an ideal object (e.g.…”