Mourning the Loss of the Ideal Self: Short-Term Work with a Trans Patient Post-Transition

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.