Exploring Gender Dysphoria: A Psychotherapeutic Perspective on Internal and External Influences, particularly looking at the developmental issues associated with some young trans men.
Gender dysphoria refers to the discomfort or distress experienced by individuals due to a mismatch between their biological sex and gender identity. This article provides a psychotherapeutic perspective on the internal and external factors contributing to this condition. Understanding the root of psychological distress and its manifestations is complex and multidimensional. While social forces play a significant role, this exploration primarily focuses on the internal narratives shaped by early experiences. It is important to acknowledge that internal factors significantly influence perception, and a combination of nature and nurture influences an individual's development and worldview. The thoughts presented here are not intended to constitute a comprehensive theory applicable to all children experiencing gender confusion but rather an exploration of general phenomena. Many young people with gender dysphoria express a strong sense of knowing their true gender from an early age and feel the need to undergo a medical transition to live authentically. They often hold firm beliefs and may express doubts about their decision to their parents or relatives. However, it is crucial to consider the potential risks and long-term consequences of medical transition, including irreversible physical changes and the need for lifelong medical care. Challenges for psychotherapy Firstly, the young person may resist any questions or doubts raised by others, believing they have found the solution to their suffering. Secondly, instead of addressing distressing psychological symptoms such as feelings of detachment from their birth body, the patient may view their issue as being born into the wrong body, seeking a physical solution to a psychological problem.
Gender Dysphoria: A Therapeutic Model for Working with Children, Adolescents and Young Adults
In recent years, there has been an explosion in the number of children and young people who diagnose themselves as gender dysphoric, or trans. In the UK, and worldwide, there is a growing tendency to refer them on to 'specialist' gender services almost as soon as they express any confusion or distress about their biological sex or gender identity. Due to the rapidly rising numbers and various pressures on the system, patients are increasingly likely to be offered life-altering medication and/or surgical treatments, often with little exploration of their emotional world.
Freedom to think: the need for thorough assessment and treatment of gender dysphoric children
https://www.cambridge.org/core/journals/bjpsych-bulletin
Referrals (particularly natal female) to gender identity clinics have increased significantly in recent years. Understanding the reasons for this increase, and how to respond, is hampered by a politically charged debate regarding gender identity. This article starts with a discussion of the so-called ‘affirmative approach’ to gender dysphoria and considers the implications of the Memorandum of Understanding on conversion therapy. I then say something about the relationship between gender dysphoria and the developmental problems that are characteristic of adolescence. Finally, I outline what changes to the current approach are needed to do our best to ensure these patients receive the appropriate treatment.
MOURNING THE LOSS OF THE IDEAL SELF: SHORT-TERM WORK WITH A TRANS PATIENT POST-TRANSITION
Abstract
Many individuals who have been through transition struggle to obtain the necessary medical and psychological support. This paper explores the importance of psychological support for post-transition individuals. In my experience, there is a subgroup of patients who struggle to come to terms with life post-transition, particularly the losses involved. They remain stuck in the mourning process. There is a loss of fantasies regarding an ideal transition, and the gap between the hoped-for transition outcomes and the post-transition reality can be painfully large. In addition, issues that the transition was meant to address remain in some form for some people, and they may also be haunted by misgivings about how the transition occurred. This paper employs a heavily anonymised composite case to illustrate and elaborate on how these issues emerged and were dealt with in the context of a psychotherapeutic process. Working through issues that led to transition and grievances about perceived and actual failures in care from the past allowed the patient to mourn the loss of her pre-transition image. The patient was able to come to terms with the reality of her transfer from male to trans-female and her body and life post-transition and to shift from a preoccupation with the past to move on with her life.
Read more: MOURNING THE LOSS OF THE IDEAL SELF: SHORT-TERM WORK WITH A TRANS PATIENT POST-TRANSITION
In: Making Room for Madness in Mental Health: Psychoanalytic Understanding of Psychotic Communication.
Chapter 3. Psychoanalytic Supervision in Mental Health Settings
Introduction
Patients who suffer from a serious and enduring illness often need psychological, chemical and sometimes physical containment. The types of settings that provide this containment and the balance of the interventions used will vary according to the patient and their level of disturbance at any given time. It should also be remembered that the patient’s state is dynamic and changes according to many influences, including the clinical care setting. For example, patients in psychotic states may present as calm and controlled in a psychiatric intensive care unit but become more disturbed once transferred to a less intensive setting. Patients need to be cared for by staff who are receptive to their experiences and who are willing to take in the patient's communications. To sustain this receptive capacity in the minds of the staff, they have to feel they are also looked after and that senior clinical management takes their concerns and feelings seriously. When staff do not feel that they are cared for by management, this affects staff morale and they tend to become more anxious and less psychologically receptive to their patients.
In: Psychoanalytic Thinking in Mental Health Practice
Chapter Six: Therapeutic Work with Patients Borderline states of mind
https://www.routledge.com/Psychoanalytic-Thinking-in-Mental-Health-Settings/Evans/p/book/9780367567385
The presentation of patients with a diagnosis of borderline personality can fluctuate rapidly between integrated functioning and fragmented, psychotic states of mind. In a crisis, their fragmented states of mind are usually accompanied by actions designed to expel disturbing emotional states of mind. One patient I saw would carve abusive messages on her body, while another would threaten to throw herself in front of the traffic. These states of mind, which can be dismissed by some as attention-seeking, are alarming and cause severe management problems for psychiatric services, general practitioners, and others. Although this group of patients are, at times, capable at times of insightful and mature thinking, their mental functioning can deteriorate when faced with psychic conflict, as this causes them mental pain. When this happens, such patients may lose their capacity to digest and tolerate the frustrations of psychic reality and fall back on primitive defences. They split off aspects of their ego associated with perception and project these into the body or an external object. These projections, designed to externalise internal conflicts, are often accompanied by dramatic action (acting out).
A Critique of Queer Theory's Resistance to Definition, Categorisation, and Critical Thought
Fear of Thought and Curiosity Associated with Transition
Read more: Fear of Thought and Curiosity Associated with Transition
Understanding the Dynamics Behind Transition and Detransition: Psychoanalytic Perspectives
The surge in individuals seeking gender transition, coupled with a rising number of detransitioners, presents a profoundly intricate and delicate issue. As a psychoanalyst, my perspective is rooted in a therapeutic model that focuses on comprehending the emotional, developmental, and unconscious dynamics underpinning these experiences. While each case of transition and detransition is unique, this exploration hones in on specific recurring psychological patterns that may be pertinent to some individuals.
Understanding the Dynamics Behind Transition and Detransition: Psychoanalytic Perspectives
There has been a surge in individuals seeking gender transition, coupled with a rising number of detransitioners, which presents a profoundly intricate and delicate issue. As a psychoanalyst, my perspective is rooted in a therapeutic model that focuses on comprehending the emotional, developmental, and unconscious dynamics underpinning these experiences. While each case of transition and detransition is unique, this exploration hones in on specific recurring psychological patterns that may be pertinent to some individuals.
More Articles …
- Detransitioners Awareness Day
- The Conflation of Psychological Suffering and Severe Mental Illness: Why Clarity Matters
- Therapeutic Relationships in Mental Health Settings:Online Course for Front-line Mental Health Professionals that will help them understand Psychotic States and improve Risk Assessment
- ‘If only I were a boy …’: Psychotherapeutic Explorations of Transgender in Children and Adolescents
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