Because feminist scholars—like scholars in any orientation—do not always agree with each other, the opinions of the feminists that we cite should not be taken as presenting the views of all, or even of a majority of, feminists. Further- more, we want to make clear that we are not citing the views of feminists to contradict them. Rather, we cite these views because we want to consider them seriously; and the reader will find that we agree with many of these opinions.

16

How Is Therapy
With Women Different?

Feminist scholars have raised questions about the psychotherapy of women
that have to be considered if we are to know whether the recommendations
made in earlier chapters apply to the therapy of women as well as to the therapy
of men, and if we are to know how therapy should be carried out depending on
whether the client is a man or a woman.

Because feminist scholars—like scholars in any orientation—do not always
agree with each other, the opinions of the feminists that we cite should not be
taken as presenting the views of all, or even of a majority of, feminists. Further-
more, we want to make clear that we are not citing the views of feminists to
contradict them. Rather, we cite these views because we want to consider them
seriously; and the reader will find that we agree with many of these opinions.

Sigmund Freud’s views on the psychology of women changed during his
lifetime. In the chapter on femininity in his New Introductory Lectures (1932/
1964c) he softened the distinction he had previously made between the “active”
man and the “passive” woman; he said, “I shall conclude that you have decided
in your own minds to make ‘active’ coincide with ‘masculine’ and ‘passive’ with
‘feminine.’ But I advise you against it. It seems to me to serve no useful purpose
and adds nothing to our knowledge” (p. 115). Acknowledging his incomplete
understanding, Freud had conceded in an earlier work, “after all, the sexual life
of adult women is a ‘dark continent’ for psychology” (1926/1959b, p. 212).

Keeping in mind these limitations, we proceed with our survey of feminist
and of psychoanalytic views. We acknowledge that the disparagement of psy-
choanalysis because it supposedly devalues women is less hotly debated in this
new millennium than it was when the first edition of this book was published—
not, we think, because psychoanalysis is better thought of, or because it is bet-
ter understood that psychoanalysis does not devalue women, but because many
people have decided that psychoanalysis is dead. As we hope has been well
proven in the preceding chapters, psychoanalysis remains a vital and effective
method of therapy. For this reason, it is still relevant to discuss issues sur-
rounding women and psychoanalytic therapy.

Criticisms of Psychoanalytic Theory and Therapy

Some writers (e.g., Chesler, 1972; Friedman, 1979) have argued that Freud
altogether misunderstood the psychological functioning of women. If Freud did

217
http://dx.doi.org/10.1037/11084-016
Resolution of Inner Conflict: An Introduction to Psychoanalytic Therapy (2nd
Ed.), by F. Auld, M. Hyman, and D. Rudzinski
Copyright © 2005 American Psychological Association. All rights reserved.

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218 SPECIAL ISSUES IN PSYCHOANALYTIC PRACTICE

misunderstand the psychological functioning of women, the argument runs, a
therapy that is based on Freud’s theory of the psychological development of
women is necessarily headed in the wrong direction and must do more harm
than good.

Others (e.g., Gilligan, 1982; Lerner, 1988) have argued that there are spe-
cial issues, particular aspects of human living that apply to women and not to
men, or at least apply with greater pertinence to women. The therapist, these
authors say, has to have a sensitivity to these particulars.

Some, indeed, have urged that the oppression of women in our society (in
all societies? in most societies? in all patriarchal societies?) is so important to a
woman’s psychological functioning that this oppression must always be the fo-
cus of any woman’s psychotherapy. Gilbert’s chapter in Women and Psycho-
therapy (Brodsky & Hare-Mustin, 1980) defined feminist therapy pretty much
along these lines. Rawlings and Carter (1977) advocated a feminist therapy
that incorporates the political tenets of feminism. Feminist therapy, however,
can either recognize the importance of the oppression of women in our society
while dealing with other issues that the woman client may face in her life, or, if
the therapist is quite single-minded, focus on this issue to the exclusion of any
other problems in the client’s life.

Finally, there is the question of whether it is better for a woman to get
psychotherapy from a female therapist than from a male therapist. Marecek
and Johnson (1980), participating in 1979 in a conference that assessed research
on psychotherapy and women, reviewed the research that showed “the influ-
ence of therapists’ and clients’ gender on the process of therapy; . . . the influ-
ence of sex-role stereotypes on therapists’ behavior toward their clients; and
. . . the incidence of sexist statements and actions by therapists during the
course of therapy” (p. 67). They lamented the sparseness of research on these
topics, especially the lack of research that made use of observation of real thera-
peutic interactions. Bernstein and Warner (1984) addressed this issue in a book
called Women Treating Women: Case Material From Women Treated by Female
Psychoanalysts. This book does not attempt to answer the question “Is it better
for a woman to get psychotherapy from a female therapist?” through a system-
atic comparison of therapy done by women and that done by men. Instead, the
book presents fascinating clinical vignettes indicating some of the issues that
arise in the analysis of women by women.

Did Freud Misunderstand Women?

We acknowledge that some of Freud’s beliefs about the psychological develop-
ment of women were erroneous. We arrive at this conclusion both from our own
clinical experience of psychotherapy with women and from reading some of the
extensive writings on psychoanalysis and women. We have found the discus-
sion of these issues in Women and Analysis (Strouse, 1974) particularly thor-
ough and illuminating.

When we grant that Freud made some mistakes in his theory of the psy-
chological development of women, we do not concede that such errors make a
psychoanalytic approach to the therapy of women misguided. If one takes psy-

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THERAPY WITH WOMEN 219

choanalysis to be a scientific discipline—and we do—then it does not make sense
to require total acceptance of all of Freud’s hypotheses or total rejection of them.
Whereas religious doctrines require total commitment of the believer, scientific
theories do not. As Hempel pointed out, scientists accept a hypothesis tenta-
tively on the basis of a sufficient body of confirming evidence (Hempel, 1965,
p. 42). That new evidence may cause them to change their minds, thereupon
regarding the hypothesis as disconfirmed, does not shake their confidence in
the methods that brought them originally to accept the hypothesis, nor does it
undermine their confidence in other hypotheses.

Accordingly, we ally ourselves with the views of Chasseguet-Smirgel. After
pointing out that the articles in the book she edited (1964/1970) questioned
Freud’s ideas, she argued that to shrink from challenging those ideas would be
to succumb to complacency and sterility. Then she said: “The vitality of any
doctrine depends on the possibility of rethinking certain aspects without dis-
rupting the whole structure” (p. 3).

The Moral Development of Women

In particular, we believe that Freud was wrong in saying that women have less
strongly developed superegos. Granting that there are differences within each
gender group in the approach of persons to morality—a fact that is well docu-
mented by the research that Loe.vinger (1976) and her associates have done—
there may nevertheless be something to the idea that men on the average are
somewhat more rigid in their application of moral rules. It is, of course, hazard-
ous to make sweeping assertions about men in general and women in general.

Alpert and Spencer (1986) provided a review of some of the research on the
development of morality in men and women, together with an evaluation of
what is known about it. Although they conceded that women on average may be
less strict and less consistent than men in their moral judgments, they argued
that differences between the sexes in making moral judgments are mostly quali-
tative; that is, these differences pertain to whether the man or the woman shows
concern about interest in human relations or about individual autonomy and
achievement. They described Kohlberg’s theory of morality as focusing on the
development of autonomous rights, something that, on average, men are more
inclined to be concerned about. Kohlberg acknowledged that caring, concern,
and responsibility for others has not been fully assessed by his measures of
moral development. Yet it is these aspects of morality, Alpert and Spencer
argued, that women emphasize more than men. Accordingly, they wrote,
Kohlberg’s view that men surpass women in their moral development is a
biased conclusion.

Gilligan (1982) and Gilligan, Ward, and Taylor (1988) likewise argued
that the moral stance of women is different, that it is more attuned to human
relationships and to human caring than to abstract justice. Some researchers,
however, have taken issue with Gilligan’s generalization about a difference,
on average, between female and male ways of thinking about moral dilem-
mas. In a meta-analysis of studies of morality of men and of women, Thoma
(1986) found that women scored higher than men on Kohlberg’s scale of moral

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220 SPECIAL ISSUES IN PSYCHOANALYTIC PRACTICE

judgment. Thoma accordingly concluded that the most widely used measures
of moral judgment are not biased against women, and that men are not better
able to reason about hypothetical dilemmas. W. Friedman, Robinson, and Fried-
man (1987); Gibbs, Arnold, and Burkhart (1984); Luria (1986); and Walker
(1984) also were against the view that women are different in their approach
to morality.

Schafer (1974) characterized the apparently greater rigidity of men as a
“compulsive” approach. He believed that any such average differences between
the sexes does not justify disparaging of women as “less moral.” We agree.

We urge the reader to study Schafer’s superb discussion of the morality of
men and women, in which he made clear the importance of distinguishing be-
tween an adaptive morality and the superego (see Blum, 1977, pp. 333-341).
Schafer’s final paragraph on the subject reads: “One must conclude that Freud’s
estimates of women’s morality and objectivity are logically and empirically in-
defensible. In large part these estimates implement conventional patriarchal val-
ues and judgments that have been misconstrued as being disinterested, culture-
free scientific observations” (Blum, p. 341).

Thus there is a point to Gilligan’s argument that a male-centered point of
view led Freud and some of his followers into misguided statements about femi-
nine psychology (Gilligan, 1982, pp. 6-7). As we reflected on these matters and
as we read what others had said, we found the way that Schafer presented a
critical, current assessment of Freud’s views on women’s morality and objectiv-
ity and women’s early, prephallic development, and of Freud’s sometimes con-
fused, often inappropriate use of terms like “passive” and “feminine” to have
much validity.

Activity and Passivity

We believe that there are, as Gilligan (1982) pointed out, important differences
between the personalities of men and of women. (We will have more to say later
on about these personality differences.) Gilligan argued that a focus on the im-
portance of human relationships, a focus derived in women from their experi-
ences of inequality and interconnection, helps to lead to constructive resolu-
tions of conflict between human beings and to a valuing of justice and caring
(Gilligan, 1982, pp. 62-63).

Bakan (1966) drew attention to the overall difference between women and
men, in which men are often more oriented to active striving, to dealing with
the external, physical environment, and to doing so in a way that emphasizes
individuality, whereas women are often more oriented to dealing with relation-
ships among human beings. He calls the first orientation agentic, and the sec-
ond communal (pp. 102-153).

We believe that the social training of women to be more interested in inter-
personal relationships and attuned to a nurturant role is not accurately de-
scribed by the word passive, nor is the typical male preoccupation with the
world outside the family accurately described as active. Just a little reflection
should make it clear that nurturing can be very active. Nor do we believe that
the training of women to be concerned about the welfare of others (sometimes

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THERAPY WITH WOMEN 221

sacrificing themselves for other family members) is aptly described as masoch-
istic, even though women may sometimes overdo their self-sacrifice.

Accordingly, we think it inappropriate for a therapist to urge a woman to
become less assertive, when the therapist—adopting the norms of his or her
culture or subculture—believes that women should be submissive. We believe
that it is wrong for a therapist to take a stand on whether a woman should have
a career outside the home or should devote herself entirely to the household. As
should be clear from all that we have said in previous chapters, we would in-
stead advocate that the therapist explore with the client the inner conflicts that
play a part in making it hard for her to decide this issue for herself.

Penis Envy

Feminists consider the assertion that women and girls envy men and boys be-
cause men have penises and women do not to be hardly less derogatory of women
than the generalization about women’s inferior morality. Feminists may mis-
understand what psychoanalysts are asserting here. When the psychoanalyst
says that some women believe or have a fantasy that girls and women are infe-
rior, the psychoanalyst is not thereby asserting that women are inferior. It is
the troubled client who made this irrational judgment, not the psychoanalyst.

Some psychoanalysts, however, seemed to think that all women—not just
troubled women—believed that they had been deprived of a penis (believed so
unconsciously, even if they consciously repudiated this belief). Freud built his
explanation of the girl’s turning away from “active, masculine” strivings, her
acceptance of what S. Freud (1932/1964c, the chapter on “Femininity” in New
Introductory Lectures) considered to be an appropriate “passive, feminine” posi-
tion, on her confronting the shocking information that boys and men had a
penis and she did not. We need to ask, first, whether penis envy is an inevitable
and typical reaction of all girls, and second, whether such envy—when it does
occur—is largely based on the basic facts of anatomy or, instead, owes most of
its force to societal circumstances.

We have become aware, through the research done by I. Fast and her col-
leagues (reported in Fast, 1984), that boys and men have dissatisfactions with
their capacities and achievements, and accept the limitations of their gender
with as little grace as girls and women accept the limitations of their gender. In
Fast’s opinion every child rails against the limitations to which he or she is
subjected. The issue, said Fast, is not one of how adequate one’s body is, but of
what one can and cannot do. Every human being wants to accept no limits on
his or her selfhood; to have to put up with such limits, as we all must do, is to
suffer a narcissistic affront. For the girl, the limitations she suffers by being
female rather than male can be symbolized through envy of the penis. Horney
(1926) had argued that the boy also rails against his limitations, that he has an
“envy of pregnancy, childbirth, and motherhood, as well as of the breasts and of
the act of suckling” (p. 337).

Reik (1959) pointed out some of the consequences of a woman’s unconscious
conviction that she is inadequate because she is female. Horney (1926) shrewdly
pointed out that male psychoanalysts see the woman’s dilemma pretty much

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222 SPECIAL ISSUES IN PSYCHOANALYTIC PRACTICE

from a male point of view and are, as a result, misled. Reik seems to have had
some awareness of the risks of a male point of view; delightfully, he showed
how the biblical story of God’s creating Adam and Eve reverses the capacities of
men and women. The woman in the biblical story was created out of the man’s
body, whereas in reality, a boy or a girl is brought out of the woman’s body.

When Mead (1974) commented on Freud’s 1932 article on femininity, she
complained that in all cultures, “without any known exception, male activity is
seen as achievement; whatever women do—gathering seeds, planting, weed-
ing, basket-making, pot-making—is valued less than when the same activity,
in some other culture, is performed by men” (pp. 99-100). She also enlarged on
the point that Horney (1926) had made, that our society, in placing a higher
value on what men do, inflicts a narcissistic wound upon girls and women. Horney
argued that the “typical motives for flight into the male role—motives whose
origin is the Oedipus complex—are reinforced and supported by the actual dis-
advantage under which women labor in social life” (p. 337). She made the point
that “we must not forget that this disadvantage is actually a piece of reality and
that it is immensely greater than most women are aware of.” Hence, said Horney
(quoted by Mead, 1974), “In actual fact a girl is exposed from birth onward to the
suggestion—inevitable, whether conveyed brutally or delicately—of her inferior-
ity, an experience that constantly stimulates her masculinity complex” (p. 338).

Bardwick (1971) argued against the central importance of penis envy. First
of all, she made the point, “The availability to the boy of an external, sensitive,
erotic organ makes genital sex more important to him at an earlier age” (p. 11).
In a somewhat contradictory vein she then said: “Those of us who have children
are quite familiar with the little girl’s verbalized envy of a boy’s genitals, espe-
cially a brother’s” (p. 12). Drawing back from this concession, she continued,
“But for normal girls this is an envy without intense affect, except insofar as a
girl might be jealous of a boy for some real reason. If a little girl perceives a boy
as receiving preferential treatment, especially from the parents, she may grasp
the idea that the origin of this difference in privilege comes from the only per-
ceptible physical difference between them. I believe that this allows her to make
her jealousy concrete, allows her to rationalize a more general envy, and that it
is less threatening to her self-esteem than questioning whether his greater privi-
leges come because he may be more loved, or nicer, or smarter” (pp. 12-13).
Finally, Bardwick offered this judgment: “Because of the less intense sexual
impulses in the girl, I think it probable that penis envy in neurotic girls is less a
function of sexual impulses than of aggressive impulses, with a concomitant
desire for castration of the boy” (p. 13).

Here we find a sensitive, thoughtful, well-informed expert on the psychol-
ogy of women expressing the view that at times penis envy is important in a
girl’s development, that at times it gives expression to deeper-lying conflicts,
and that it surely is not so straightforward a dynamic as one would suppose
from reading the early accounts of it by S. Freud (1905/1953b). Freud put the
matter thus: “Little girls do not resort to denial of this kind [against recognizing
the lack of a penis in girls and women] when they see that boys’ genitals are
formed differently from their own. They are ready to recognize them immedi-
ately and are overcome by envy for the penis—an envy culminating in the wish,
which is so important in its consequences, to be boys themselves” (p. 195).

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THERAPY WITH WOMEN 223

Despite Freud’s prestige, which predisposes us to accept his views unless
there is strong contrary evidence, a number of contemporary psychoanalysts
have come to the conclusion that usually observation of the differences between
male and female sexual anatomy is not the decisive factor in a woman’s devel-
oping penis envy. According to these authors (who include Torok, 1964/1970),
awareness of objective anatomical differences does not account for the idealiza-
tion of male genitals, and the absence of a body part—namely, the penis—does
not in itself produce pathological envy or self-depreciation. Torok holds this
view even though she recognizes that many female clients attribute their sense
of deficiency to their lack of male genitals.

The underlying conflicts that find expression in an envy of the penis and of
the male role include narcissistic injuries, deprivations of love, and provoca-
tions to envy. Grossman and Stewart (1977) pointed out that such underlying
conflicts could find metaphoric expression in penis envy. According to these au-
thors, the discovery of differences between the male and the female genitals is
only one among many possible experiences of deprivation, all of which would
lead to feelings of deprivation and to self-disparagement.

Lerner (1980) reported that in her experience as a clinician, the woman
who devalues femininity and desires a penis usually does so because of a dis-
turbed relationship with her mother:

The female child may desire a penis in order to better express her hatred
toward her mother, or as a means of possessing the envied omnipotent mother
and her magical attributes, or as a means of extricating herself from a de-
pendent and frustrating relationship with mother—that is, as a desperate
attempt at separation and differentiation. Penis envy may be an expression
of a revolt against the narcissistic wounds inflicted by the omnipotent mother
or may be the girl’s attempt to protect a jealous, intrusive, maternal imago
by making an unconscious “oath of fidelity” to the mother that she (the daugh-
ter) will not achieve genital fulfillment (Chasseguet-Smirgel, 1970; Torok,
1970; Lerner, 1977). (pp. 49-50)

Lerner also pointed out that when a girl experiences her mother as dominant
and controlling—as destructive, castrating, and bad—the girl may try to avoid
being like her by imagining herself to be weak, powerless, and “castrated.”

In the article by Torok (1964/1970) that Lerner cites so frequently, Torok
shows in a most impressive way how the little girl who had a domineering,
intrusive mother, a mother who tried to meet her own needs through keeping
her daughter for herself, would produce a child who felt compelled to give up
her genital strivings and her basic womanliness. Such a girl would imagine
that a man’s penis gives power and would idealize that penis; what she could
not do is accept a mutual giving with a man, one that would allow both of them
pleasure and mature functioning. Such a girl would renounce sexual maturity
and pleasure. Her fantasy that a man’s penis gives him everything serves a
defensive function. It spares her from the temptation to turn away from her
mother; the girl fears that the price of separating herself from her mother will
be her mother’s abandonment and her own annihilation.

It can be seen that in Torok’s view, penis envy develops out of a distorted
object relationship with the girl’s mother. It turns on the issues of control ver-

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224 SPECIAL ISSUES IN PSYCHOANALYTIC PRACTICE

sus autonomy, separation, and the girl’s movement toward a mature sexuality.
And, Torok writes, the boy is faced with similar conflicts when he has a control-
ling mother whom he is afraid to declare his independence from, and a father
whom he is afraid of challenging by asserting his own genital desires. Within
this framework, the boy will defensively construct the fantasy that a woman is
an inferior creature, ready to be subjugated. In this way the boy, out of his own
fear of a mature sexuality, adopts what Torok (1964/1970) called “this phallo-
centric prejudice, old as humanity itself (p. 170).

The Female “Oedipus Complex”

Freud’s theorizing about the female “Oedipus complex” was consistent with his
views about other aspects of female psychological development (see S. Freud,
1932/1964c, pp. 132-135). One central element in those views was the
conceptualization that men relate emotionally and unconsciously to their par-
ents as depicted in the myth of Oedipus; that is, men love their mothers and
compete with and wish to destroy their fathers. Women relate to their parents
in the opposite way, hating and competing with their mothers and loving their
fathers. Freud assumed that in resolving the Oedipus complex, boys renounce
their mothers (under the threat of castration by the father), identify with their
fathers, and internalize the strong morality personified by the fathers. He be-
lieved that girls, on the other hand, were unable to achieve the same resolution
of the Oedipus conflict because, seeing themselves as castrated, they had no
motive to renounce the father as the love object. He believed that women, lack-
ing this motive to identify with the father and to internalize the morality that
the father personified, would as a result turn out to be weak, powerless, and
without the same moral fiber as men. In our opinion, even though it is possible
that a woman might come to experience her parents emotionally according to
such a pattern, and reveal it during her psychoanalytic therapy, it makes no
sense to expect such a pattern in all women.

This early conceptualization of the female Oedipus complex carried with it
notions about the expectations analysts should have about the analysis of women
and its outcomes. For example, the stereotypical image of the woman as a mem-
ber of the “weaker” sex, subordinate to men and emotionally fit primarily for
domesticity and childbearing, led some analysts in the past to view assertive-
ness in a woman as a defense against castration, a protestation of “maleness”—
something to be analyzed and resolved. Indeed, it seems that it was the stereo-
type of the times that dictated the psychodynamic formulation of the female
Oedipus complex rather than observations made during psychoanalytic work.

Psychoanalytic thinking and practice in regard to female development have
gone far beyond the earlier conceptualization. Although this brief discussion of
psychoanalytic techniques and practices cannot include a comprehensive re-
view of the vast literature on alternatives to the classic view of the issues, we
can note that, in general, emphasis has shifted from the oedipal stage to the so-
called preoedipal one. The preoedipal period is characterized by, among other
things, the essential emotional attachment of mother and daughter as a critical
element in the psychological development of women. A noteworthy example of

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THERAPY WITH WOMEN 225

the importance of this earlier period is supplied by Kulish and Holtzman (1998),
who proposed that, in so far as women are concerned, the Oedipus myth might
well be replaced by the Persephone myth, which would provide the prototype of
the attachment of women to their parents. The myth tells of the intensity of the
attachment of mother to daughter, the anguish that ensues when the daughter
separates from the mother to enter into womanhood and motherhood, and the
competition between mother and father for daughter’s affection. At the very
least, Holtzman and Kulish’s suggestion takes account of the complexity of at-
tachments during female psychological development, a complexity that is not
inherent in applications of the Oedipus complex.

Further, psychoanalysis in general has been focusing increasingly on
preoedipal issues in the treatment of both men and women. This trend has been
supported by the study of the psychology of attachment during development, a
trend that has certainly been encouraged by psychoanalytic theorizing about
the psychology of women.

The shift in focus in psychoanalysis from the oedipal stage to preoedipal
development in both men and women has been paralleled by a shift away from
the study of clients’ inner, unconscious psychic life to an examination of rela-
tionships and attachments both in and out of awareness. Technique has also
changed. The current model seems to be of a psychoanalysis that …