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The authors describe conflicts experienced by women who request therapeutic intervention because of symptoms of depression, anxiety, marital discord, difficulty in asserting themselves, or inability to complete work that would lead to advancement. They discuss the developmentally based difficulties experienced by women in making career choices, advancing their careers, and facing midlife issues. The therapist who deals with such patients must be aware of reality-based factors and of his or her own values and attitude as they influence choice of therapeutic approach.