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Transsexualisme/ transgenderism : psychothérapie et transformation hormonale et chirurgicale

Abstract : Objectives At the end of the French evaluations and the international revision concerning the standard of care (SOC) for transsexual and transgender patients, the interest to propose psychotherapy as a supplement to the sex reassignment therapy (SRT), was unanimously recognized. But, it is clear that the works concerning this subject are rare, and that the methods of this proposal remain ill-defined. So, many questions remain unsettled such its frame, modalities, methods, objectives and its place and relation with or in the SRT, as well as on the theoretical models on which these psychotherapies base themselves. The goal of this article is therefore to present the conception and the evolution of this psychotherapy in the various versions of the standards of care, as well as the theoretical approaches on which the current model is established, then to expose the questions which according to us, still persist concerning this subject, as well as our remarks and proposals relating to the latter. Materials At start, with the first SRT in the 50’s, this practice and his combination with psychotherapy suffered from a strong ethical but also partially ideological, controversy. An important number of medical practitioners met around the endocrinologist H. Benjamin to establish the first standards of care by SRT for transsexual, and defended that this treatment was the only one that could relieve the problem of gender identity of the transsexual patients. In the opposite, some psychiatrists and psychologists were in strict opposition to this treatment and postulated that transsexualism was a psychotic disorder which needed to be cured only by psychotherapy. In spite of this fist hard confrontation, it seems accepted today that the SRT can bring beneficial effects, and that an additional psychotherapy is maximizing the prognostic of this treatment. So, in the present, in the SOC, the goal of psychotherapy is “to help transsexual, transgender […] individuals achieve long-term comfort in their gender identity expression,…”. However, the question of the modalities, forms and theoretical fundaments stay still not well defined. Results Today, the SOC recommend that psychotherapist actively collaborate and participate to the decision-making reunions of the SRT’s professional team. In the same way, the role of the psychotherapist is described very near of a role of coaching and counseling, to optimize the SRT’s final result. In complete consistency with these points, the theoretical models exposed are unconflict and unpathologized models which postulate that the true gender of patients couldn’t be expressed because of social stigmatizations which can make them present a gender dysphoria. But, these points of view are more controversial that it’s appearing. Conclusions The more controversial point concerns the narrow collaboration and the active participation of the psychotherapist with the SRT’s professional team and its potential consequences. In that configuration, a collusion of the different therapeutic spaces can take place. The patients can feel unease with this particular therapeutic relation. In the same way, on the theoretical level, the conflict is a primary fundament in a psychodynamic perspective, but it also can be considered as a normal element of the therapy and the SRT’s way. For all of those remarks, the question and works on the psychotherapy in complement with the SRT have to be continued.
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Submitted on : Friday, April 30, 2021 - 11:42:55 AM
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Jean-Baptiste Marchand, Elise Pelladeau, François Pommier. Transsexualisme/ transgenderism : psychothérapie et transformation hormonale et chirurgicale. Annales Médico-Psychologiques, Revue Psychiatrique, Elsevier Masson, 2017, 175 (3), pp.210-216. ⟨10.1016/j.amp.2016.05.016⟩. ⟨hal-03211688⟩

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