From Idealization to Ideal—From Attachment to Identification: The Female Analyst and the Female Patient

In my early days as a therapist, I found I was being referred patients on the basis of their supposed “need for nurturance.” Because I was a woman, it was assumed that this would be the major thrust of my work. The hard analytic stuff was sent to my male counterparts.

Inasmuch as psychological development, both in the earliest years and through psychotherapy, comes about within an interpersonal context and is profoundly affected by that milieu, the gender of the therapist cannot be without some significance, not only in terms of the kinds of transferences evoked, but in terms of outcome as well. Certainly the facts of the mother's femaleness and father's maleness play a major role early on.

This does not mean that the gender of the therapist either should or should not be chosen on the basis of some preordained concept of what the patient needs, but only that there will be an effect, and that effect should be paid attention. The purpose of this article is to consider one specific effect the therapist's femaleness has on the female patient, that of resolving conflicted identifications.

In recent years, we have become sensitized to looking at psychopathology in terms of developmental deficits, especially those associated with the borderline and narcissistic personality disorders. Structural impairment in these cases involves the basic organization of the representational world of self and object in terms of cohesion, differentiation, or integration. But there are other structural issues that are problematic, issues that arise at the end of the separation-individuation process and that come to the fore in the oedipal and postoedipal periods.

These pathologies arise not so much from failures within the mother-child dyad in the first year or two, but from the enmeshment