In the three-part model I described three different components that combine to create the conditions that contribute to gender/sex dysphoria. In order to create flexibility and relieve the suffering of dysphoria each of these components must be addressed.
Narratives are constructed. (This is not necessarily a conscious process). In order to gain flexibility in constructing narratives, one must first realize that one is not their narrative. One is not their story. A common issue that is one mistakes oneself for their story. In ACT this is known as “fusion with the conceptualized self” the antidote for this is defusion. It is no wonder that many detransition narratives contain mindfulness as an important component, because it is this that is precisely this practice that can help with defusion. Once one is defused from their narrative, they might be able to see an element of choice, and how it is just a story, and not the absolute reality.
Trauma & Schemas can be healed. Healing these can be a long process and there also ways to cope. Coping with trauma involves learning how to deal with triggers, returning to the body when dissociated, learning grounding exercises and educating oneself on trauma and its effects. Healing from trauma can be done by processing the trauma through a technique such as EMDR or Somatic Experiencing These components include non-verbal, preverbal and somatic components so require more than talk therapy. Guided imagery and parts-based work can be helpful here. The aim is integration. Sometimes people talk about having a “female self” and a “male self” which they experience as figures in their psyche. These also can be integrated through parts-based therapies such as IFS.
Erotic Imprinting cannot be changed, it can only be managed. This is where we find activities such as compulsive cross dressing, autogynephilia and porn addiction. Testosterone exacerbates this issue. This can become compulsive. I believe one of the reasons that some MTF people feel relief on anti-androgens/estrogen is precisely because the reduction of testosterone provides relief from compulsive sexuality. Anti-androgens are used to treat all kinds of unwanted compulsive sexuality. It is important to note that preferring certain hormones is only proof of preferring certain hormones, and doesn’t necessarily mean anything to one’s identity. There is no requirement to transition just because one doesn’t like testosterone. Likewise there is nothing wrong with eliminating / reducing testosterone if it improves your quality of life.
These practices are helpful whether one transitions or not. The goal is to create choice where before there was compulsion. One of the primary stresses of being transitioned is being misgendered. Trans people often take this as a threat to the very self. I know I used to. This is also a product of being identified with the conceptualized self. When one is identified with the conceptualized self, this identification is very vulnerable and needs constant approval from others. Letting go of that through defusion can help one to accept that some people will never see you as your target gender, and that is just their perception and doesn’t effect who you are. This can also help one to accept the reality that one can only partially change their sex, which is another common source of pain.