Chapter 6 Why Can't a Woman Be a Man … in the Transference?

Interest in the impact of the analyst's gender in psychoanalytic treatment has revived an interest in distinguishing transference from the “real” factors in the analytic relationship. To some extent this harks back to Greenson's (1967) distinction between transference and the “real” relationship between patient and analyst. Implicit in that distinction was the belief that some aspects of the analytic relationship were distorted by the patient whereas others were free from interference because the patient was healthy enough to retain a “real” relationship with the analyst. However, what may appear to be a “real” relationship to the analyst—and may even be desired by the analyst as a “real connection” —may be far from “realistically perceived” by the patient (Stolorow and Lachmann, 1980). Though “objective” or “realistic” aspects of the analytic encounter, such as the analyst's gender, appearance, or age and the prevailing cultural climate and stereotypes help shape the therapeutic situation, it is their meaning to the patient that is assimilated into the imagery and metaphors that organize a patient's subjective life. These meanings are the focus of our chapter.

Transference has been defined as the organization of the totality of the patient's experience in the treatment situation. This refers to all the ways in which the patient's experience of the analytic relationship is shaped by archaically rooted configurations of self and object that unconsciously organize subjective experience (Stolorow and Lachmann, 1984/1985; Stolorow, Atwood and Ross, 1978). At the most general level, transference is an instance of organizing activity through which the