Gender-Specific Problems in the Treatment of Young Women

Adolescence is a time of change and development, of separation and individualization. It is standing on the threshold of adulthood and taking leave of the magic gardens of childhood. It is a time of progression, a time for regression, but what is perhaps the most exciting and challenging aspect of adolescence is that it is a time for creation. With all the force and vitality of a newfound energy, with the growing cognitive capacity that is now turned inward toward the self, as well as outward toward the limits of time and space, the young individual sets out to create a self.

One of my patients gave me a dramatic and concrete illustration of this creative self-discovery when she burst into my office, wearing a short candystriped dress, bobbysox, her hair tied into pigtails, and sucking on an enormous lollipop. “Today I am a little girl,” she announced coquettishly. There were other days and other roles. One of her favorites was being a creature from outer space. Wearing a silvery space-outfit, she would ride up and down in crowded elevators, emitting an occasional “beep-beep” sound and gleefully watching how her performance was received by her audience. Another day she was a seductive and very sophisticated lady, complete with mink and jewels—the next time a mysterious stranger dressed in black. Why the role playing? She states: “I am experimenting with creating a self.”

One of the essential ingredients in the creation of a self is a sense of gender, of being male or female. Gender identity is generally more stable in women than in men, perhaps due to the primary identification with mother.1 Although gender identity differentiation occurs in the first years of life, adolescence is of crucial importance in its further elaborations, as adolescence is the time for adopting and adapting to a sense of self as a sexually mature individual. It is in the area of sexual differentiation of the body, of the inward experience of self and the outward expression of the self that we