Lesbian Identity and Contemporary Psychotherapy

A Framework for Clinical Practice

Eda Goldstein, Lois Horowitz

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134907410
• Edition: 1
• Topic: Psicología
• Subtopic: Psicología aplicada

Recent contributions to the psychoanalytic and psychotherapeutic literature have moved beyond traditional views of lesbianism, but they have tended to address lesbian identity from one theoretical vantage point or another. Rarely have new ideas been linked to the process issues that arise in actual clinical situations. Lesbian Identity and Contemporary Psychotherapy undertakes this very task, and, in so doing, documents the therapeutic gains that result from validating lesbian sexual identity and life experience. Drawing on contemporary relational thinking and new perspectives on gender and sexuality, Goldstein and Horowitz describe and illustrate an affirmative approach to clinical work with lesbians at various stages of the life cycle. Adolescent, young adult, and family issues are all brought within their compass. Making ample use of case vignettes, they demonstrate the ways in which therapists can elicit their patients' personal narratives of self-acceptance as lesbians and coming out experiences; work with the transference and countertransference dynamics subsequent to such disclosures; and finally explore the collaborative process through which therapist and patient seek to understand their therapeutic interaction. A range of life circumstances are brought within the authors' refreshingly "hands-on" clinical approach. Special consideration is given to issues arising when lesbians date and initiate romantic relationships and to the relationship problems that develop in ongoing partnerships during the middle and later years. The book concludes by discussing the issues faced by lesbian therapists in treating lesbian patients and in interacting with heterosexual colleagues. An exemplary overview of newer views of lesbian identity and of the challenges of lesbian life, Lesbian Identity and Contemporary Psychotherapy is equally valuable as an up to date, relationally informed guide to clinical work with lesbian patients.

Chapter 1
Introduction

This book is about clinical work with lesbians. It is based on both our personal and professional experiences. Our keen interest in applying relational concepts and treatment principles and new perspectives on gender and sexuality have provided the impetus for our writing. We shall try to describe and illustrate how contemporary psychoanalytic psychotherapy can provide women with the opportunity to explore the often difficult and complex process by which they have come to identify as lesbians, to understand the unique meaning that being a lesbian has to their self-concept and lives, and to validate their personal struggles and journey.

We are not proposing a unique approach or a set of rigid techniques for the psychotherapy of lesbians nor do we focus on the treatment of lesbianism itself. Rather, we are interested in articulating a way of working with lesbians that takes into consideration the special issues that they have confronted in the course of their lives and that affirms their sense of self and sexual identity. Our approach relies heavily on the therapist-patient bond and on the flexible use of a range of techniques that include interpretation, support, and therapeutic responsiveness to selected patient needs. Clinicians may differ with respect to where they place our approach on the continuum between psychoanalysis and psychoanalytic psychotherapy. We agree with those who have argued that there is not a clear dividing line between these two types of treatment and that they are more similar than different (Fosshage, 1991; Miller, 1991). Moreover, since Wallerstein's (1986) research, which led him to conclude that supportive techniques and other types of therapeutic activity are found in psychoanalysis as well as in psychoanalytic psychotherapy, psychoanalysis has evolved greatly. It encompasses the intersubjective and relational context and the "ever-present, fluctuating, mutual influence of patient and analysand on each other" (Miller, 1991, p. 46).

Unlike most psychoanalytic authors, we do not focus on why a woman becomes a lesbian nor do we view lesbianism as a pathological development that reflects a rejection of femininity and the adoption of a masculine gender identity. Since the Kinsey et al. (1948) seminal study of sexual behavior, mounting evidence has shown that there is a broad continuum of normal sexuality and that the development of a core gender identity proceeds separately from the sexual object choice. Numerous writers, such as Stoller (1968, 1976, 1985), Benjamin (1988), Schwartz (1998), Goldner (1991), Mitchell (1993), and Aron (1996), have argued that lesbianism is a normal variant of sexuality. Like women who identify as heterosexual, lesbians show the full gamut of psychosexual, ego, self, and object relations development and do not necessarily suffer from developmental arrests. Several decades of research on lesbianism have not reliably differentiated homosexual and heterosexual women with respect to their personality characteristics, family background, psychopathology, and social adjustment (Gonsiorek, 1982a, b; Reiter, 1989; Falco, 1991; Gonsiorek and Weinrich, 1991; Tully, 1992,1995; O'Connor and Ryan, 1993; Glassgold and Iasenza, 1995; Magee and Miller, 1997).

The Nature of Lesbian Identity

As noted by Burch (1993, pp. 23-24), until recently, psychoanalytic theory was preoccupied with understanding the reasons for same-sex object choice rather than with the broader concept of sexual identity. A lesbian sexual identity encompasses emotional bonds, social connections, and sometimes political attitudes and actions, as well as sexual and romantic interests and behavior. There are women who identify as lesbians who do not engage in same-sex sexual behavior and there are those who have sexual encounters with other women, and some who even engage in long-term relationships, who do not identify as lesbians (Falco, 1991; Burch, 1993).

Sexual and gender identities evolve through an often complex and lengthy process and are based on a range of complex and ongoing identifications with early caretakers and internalization of relational patterns. From a cultural perspective, lesbianism is a stigmatized sexual identity even in today's more tolerant social climate. Whether it is determined early in life and remains fixed (the essentialist position) or stays more fluid, malleable, and responsive to environmental circumstances (the constructivist position) is a matter of debate. What is true, however, is that lesbianism is laden with highly charged meanings and may have negative as well as positive consequences.

The Diversity of Lesbian Experience

Lesbians are a diverse group with respect to their self-definition, coming-out process, gender-role behavior, personality characteristics, family and cultural background, life experiences, and environmental supports. Although many women are "primary" lesbians, having identified their same-sex interests at an early age, others evolve a lesbian identity later in life, often after having relationships with men, marrying, and having children (Burch, 1993, pp. 19-23). This distinction, however, is not always valid because some members of the latter group may have felt "different" with respect to their emotional attachments and sexual interests from childhood or adolescence. Still other women have romantic partners of either gender at different times in their lives and see themselves as bisexual. These common variations do not include those women who identify as heterosexual but have sexual encounters with other women at times.

In contrast to prevalent stereotypes that view lesbians as being more masculine and rejecting of femininity, most lesbians have s strong sense of being female in their core gender identity. Like women who identify as heterosexual, however, they differ in their gender-role behavior. Many exhibit traditionally feminine behavior, whereas others may appear androgynous. Some have engaged in cross-gender behavior from childhood or have adopted some traditionally masculine traits (Saghir and Robbins, 1973; Bernard, 1992). Older lesbians who came out in a more repressive and intolerant period may have taken on masculine characteristics and roles less because of a sense of being like a man but more because of a lack of visible role models.

The Process of Identifying as a Lesbian

In spite of their diversity, women who identify as lesbians confront similar types of internal and external challenges with which they must cope. An important shared feature of their lives is their ongoing struggle with feelings of being different in a hostile environment. Being a member of a stigmatized and marginalized group has devastating effects that shape the nature and process of lesbian identity formation and all aspects of personality development (Malyon, 1982a, b).

Numerous writers have described the lesbian coming-out process (Cass, 1979; Coleman, 1982; Lewis, 1984; Falco, 1991). This developmental achievement refers to two distinct but interrelated constellations of experience (Horowitz, 1998). The first, identity formation, involves the awareness and interpretation of sexual and romantic attachments to others of the same gender. In a second stage, coming out proper, a woman acknowledges her lesbian identity to herself and begins to disclose it to others. Coleman (1982, p. 32) describes these steps as pre-coming out, coming out, exploration, first relationships, and identity integration. Each has its own issues and poses crucial tasks although not all women go through each stage.

In the discovery period, a person becomes more or less aware of same-sex feelings but may feel alienated, alone, and stigmatized. Denial, repression of sexual feelings, or other defensive reactions, low self-esteem, and serious symptoms may result. Although marked by a great deal of confusion, coming out proper begins the task of self-acceptance. During this period, the person tends to seek out validation from the external environment; and in the exploration stage, she likely experiments with new behaviors. In the first-relationship stage, she looks for an intimate partner. The integration of a lesbian identity often is a lengthy, evolving, and complex development. It goes beyond acceptance to include pride and sometimes community involvement and political activism. Clearly, the outcome of all of these stages is affected by the presence or absence of peer, family, and social supports, positive role models, gratifying relationships, and societal attitudes and policies (Hetrick and Martin, 1988).

Psychoanalytic writings are beginning to incorporate knowledge about how women process their early feelings of difference and integrate them into their self-concepts. They recognize the shifts in sexual identity that some women undergo over time in response to the different relational, social, and historical contexts in which they find themselves (Schwartz, 1998; Horowitz, 2000).

Because many lesbians, particularly those of earlier generations, were socialized into a society that viewed heterosexuality as normal and compulsory (Rich, 1980) and homosexuality as undesirable, their healthy narcissism and self-acceptance may have been seriously compromised. Often lacking positive reflections of herself in family, friends, media images, and society (Buloff and Osterman, 1995), a lesbian's core identity went unmirrored and her true self was hidden (Gair, 1995, p. 111). Parents and other close relatives who were shaming, rejecting, or devaluing may have compounded the struggle to achieve a positive self-concept. Many lesbians remained in the closet and hid their sexual identity from family and coworkers out of fear of disapproval or more serious negative consequences should it become known. Those who were more openly lesbian may have experienced actual threats to their sense of security and safety. It was difficult for many lesbians to escape the development of internalized homophobia themselves. "These negative feelings about sexual orientation may be overgeneralized to encompass the entire self" (Appleby and Anastas, 1998, p. 30).

Lesbians do differ, however, in their degree of and manner of coping with internalized homophobia. Some may recognize their own negative attitudes and lack of self-acceptance, whereas others may think and act in ways that are connected to deep-seated antihomosexual sentiments of which they are not fully aware. Participation in a gay or lesbian subculture buffers and helps to overcome the sense of difference and alienation and creates "a separate space that allows a sense of community and naturalness" (Appleby and Anastas, 1998, p. 29). Yet there are those who continue to hide their sexual identity. Some open lesbians who experience social acceptance in the "straight world" and who achieve career success may shun association with the so-called lesbian community, minimize their difference from their heterosexual counterparts, or show a lack of interest in lesbian organizations and causes. At the opposite end of the spectrum, many lesbians are politically active in the gay movement. In recent years, some lesbians have embraced the term queer to define themselves. They identify as members of a broad grouping of nonheterosexuals (gay men and lesbians, bisexuals, transsexuals, and transgender persons).

Factors such as age, geographic location, socioeconomic status, education, and religion influence the ways in which lesbians view themselves. For example, middle-aged and older women, who grew up prior to the gay rights movement in the 1970s, and those who have been raised outside large urban centers may have lacked positive role models and parental and peer supports. Because of the invisibility of lesbians in their world, they experienced isolation and it was necessary for them to interpret what it meant to be a lesbian on their own (Parks, 1999). They searched for themselves in the limited resources that were available. Some read novels, such as The Well of Loneliness (Hall, 1928), in which the main character suffers disappointment and despair, or viewed films, such as The Children's Hour (1961), in which the protagonist, who fears she is a lesbian, commits suicide. Others may have studied religious texts that viewed homosexuality as a sin or psychoanalytic journals that equate lesbianism with mental illness.

Younger lesbians live in a time in which there is increasing tolerance of homosexuality and in which successful gays are more visible in society and the media than previously. Many women today have experienced more family and social supports than previously and may be more self-accepting regarding their lesbianism than were lesbians of earlier generations. They have access to a vast literature and even prime-time television programs, such as Ellen, Will and Grace, and Queer as Folk, that provide more positive images of gays and lesbians. They also can locate resources on lesbian life on the Internet and access organizations that offer help with the psychological and social consequences of coming out as well as opportunities for peer support and socialization. Some states recognize lesbian marriages or other domestic partnership arrangements. Increasingly, single and coupled lesbians are raising biological, foster, or adopted children and are struggling with parenting issues that are sometimes similar to those of heterosexuals and sometimes unique to lesbians (Baptiste, 1987).

In spite of the greater visibility and acceptance of lesbians and the presence of social supports, today's generation of lesbians still struggle with complex identity issues and continuing stigmatization and discrimination. Moreover, they confront new challenges as they take on roles and pursue options that were previously off limits. Family members, friends, coworkers, and the community regard them in considerably variable ways (Herek, 1984, 1995; Nava and Davidoff,...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Acknowledgments
• Chapter 1 Introduction
• Chapter 2 Psychoanalytic Theory and Lesbianism: The Changing Landscape
• Chapter 3 A Framework for Clinical Practice
• Chapter 4 Lesbian Narratives and the Treatment Process
• Chapter 5 Working with Transference
• Chapter 6 Working with Countertransference
• Chapter 7 The Initial Stage of Lesbian Relationships: Clinical Considerations
• Chapter 8 Issues in Midlife and Later Life: Clinical Considerations
• Chapter 9 Experiences of the Lesbian Therapist
• References
• Index