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In this paper, Marcus Evans expands on the ever-evolving literature of a psychoanalytic approach in supporting young people with symptoms of gender dysphoria (GD) or gender-related distress (GRD). Evans discusses a composite case, where a female-bodied young adult presents with a history of early-life trauma and later-onset GRD. The paper starts with some important considerations and reflections; namely, that not all people experiencing gender dysphoria will benefit from the same therapeutic/exploratory approach. This can be helpful to anyone interested in developing more experience working with GRD, as there is currently a developing literature from a psychoanalytic, systemic and cognitive-behavioural approach.
Evans also acknowledges that both an extended assessment process and a focus on meaning-making are crucial when working with individuals whose distress presents as relating to their sexed corporeality. Furthermore, the multifactorial aetiology of GRD is revisited throughout both the assessment process and the psychoanalytic intervention. Those clinicians who have longstanding experience working therapeutically with GRD will surely recognise Sam’s complex psychosocial presentation and connect with Evans’s plea for a cautious therapeutic intervention.
There are, however, some thorny issues that relate to the ‘domain of ethics and aesthetics’ of the paper, and could have been expanded further. Evans refers to his decision to use female pronouns (she/her) when referring to Sam, as ‘she had not embarked on any hormonal treatment and was still referred to by feminine pronouns at home’. Sam, a male identified young adult, is not presented as lacking capacity; it can therefore be inferred that the analyst’s decision not to use the preferred pronouns possibly signifies an alliance with the parents’ position. I wonder how decisions around preferred names and pronouns could be explored from different angles in the early stages of therapy, irrespectively of the therapeuti