IS THE GENDER OF THE ANALYST IMPORTANT?

Victor Bloom, M.D.

Ladies and gentlemen, colleagues, friends, guests, it gives me great pleasure to have this opportunity to share and discuss with you an issue which has become increasingly important. Several years ago the issue of the gender of the analyst hit me between the eyes when a woman patient who had been what we call, 'coming along nicely', that is, having a significant reduction in symptoms and improvement in functioning, astonished me by telling me that in her reading about psychoanalysis and feminist issues, she was becoming convinced that I could be of no further help to her because I was a man and a Freudian. I asked her to explain and she told me that 'penis envy' was a crock, that Freud was severely limited in his thinking by being a turn-of-the-century 'bourgeoie' Viennese Jew who was socialized to be a dominant, authoritarian male, therefore he could not be expected to see beyond these restricted blinders. She went on that it was well recognized that he knew nothing about female psychology and that his ideas about women were inaccurate and insulting, such as assuming a moral inferiority and a biologic tendency to masochism. His famous question, "What Does Woman Want?" was ample indication that he did not know what he was talking about.

Furthermore, she said that the analytic establishment was clearly an 'old-boys' network designed to exert domination and control over American psychoanalysis and psychiatry, and that physicians were unfit for the task of psychoanalysis. They were clearly motivated by professional arrogance and economic greed and were perpetrating a hoax and a fraud. This diatribe was both unexpected and powerful. My patient was intelligent and becoming more and more articulate. My initial reaction was defensive and unempathic. I knew that much of what she said was true. It was unnerving to consider that the logical conclusion of her argument in my mind was that I should stop practicing, take down my shingle and close up shop. I attempted to explore her reasons for coming to these conclusions and her deeper motivations. And of course I tried to explore what was happening in our relationship, in terms of transference, resistance and the quality of our therapeutic alliance. She considered the possibility of seeking a feminist therapist because she was sure that I was only going to try to shut her up.

I invited her to continue to try me, and we worked together for another two years, some of it in a positive, constructive manner and at other times it was adversarial and mutually antagonistic. I should say at this time that my patient was also a lawyer, and there were hints of a malpractice suit. My patient conceded that I helped her to stay alive, remain in her marriage, and learn to think and be articulate. She used to be intimidated by her retired husband who was an automotive executive, but now she could stand up to him and he accepted a relationship of greater equality. He was 20 years her senior and this was his second marriage. They had four children together and often argued about her over-involvement with them. Before she came to me she had a hysterectomy, followed by a serious depression, in which she mourned the loss of having any more children. During the analysis she started to read extensively and discovered the feminist literature. In time I came to feel that although the feminist writings helped her to articulate her grievances and justified her feelings, she was using them as resistance to her deeper ambivalent feelings toward me as her mother. I believe she feared the frightening deeper rage toward and from the symbiotic, pre-Oedipal mother. However, she resisted interpretations at this level, claiming that she had worked through all that.

When I asked her why she thought I could help her no further, she said she could not trust me. And from her readings she took exception to the idea of being helped by a man. She claimed that our positions were not equal; in a relationship with me or with any man in our society, she felt inherently subordinate--- how could she be liberated and empowered when I held all the cards? One of the reasons she could not trust me was that she knew I knew very well that I had the power, only I would not admit it or relinquish it, because I was socialized as a male, and what is worse, was a Freudian. Did she think that all males and all Freudians were alike? Yes, she did, they all believed that 'anatomy is destiny', that women should be passive and submissive, that they were inherentlyly masochistic and untrustworthy. I told her I did not think this way. She said I must think this way, unconsciously. Ironically, even though she rejected Freudian concepts, she advised me to get back into analysis to look into my countertransference and get my consciousness raised. I was a chauvanist and did not even realize it.

Nevertheless, she continued to work with me as I examined my countertransference and attempted to analyze her transference. When I got close to her deeper fears of annihilation, she continued to take pot-shots at me, such as accusing me of suffering from testosterone poisoning. Frankly, it was difficult for me to keep my cool, and sometimes, with the rationale (or rationalization) of using the conceptual framework of interpersonal analysis, according to the neo-Freudian principles and technique of Harry Stack Sullivan, the character-analytic techniques of Wilhelm Reich and the gestalt techniques of Fritz Perls, I would express my anger at her disparagement of me, my profession, my entire way of working (even as she admitted that it helped her), her prejudice against males and Freudians and her stereotyping me as a defense. She would say that I am angry, that I am not sufficiently empathic, and therefore I am only trying to shut her up, just like her mother did. I said it was transference and she insisted it was real and present. I reminded her that she was becoming more and more thoughtful, philosophical and articulate, that she was obviously sufficiently empowered to be challenging me and the whole analytic establishment, how could she say that I was trying to shut her up? She said that she was intimidated by my anger, and I asked her what did she have to fear? What could I do to her? She was not an infant and I was not her mother.

Everything pointed to a powerful transference-resistance, because her whole therapy centered around her anger toward her mother, who was domineering, controlling, critical, punitive, rejecting, humiliating and cruel, and the fact was clear that as my patient free- associated and vented her anger, her depression lifted. Her father was passive and distant, but there was also anger toward him for his rejection, his preferring his sons and other daughters after previously being close to her, his joining her mother in humiliating her. My patient was the family scapegoat, unfortunately, we both understood that, and I did empathize with her. It was both sad and infuriating for my patient in this large, dysfunctional family. At first I could not see how she could be so angry with men, when it was her mother who was the culprit. Of course my patient dismissed the idea of transference and resistance, concepts which she had accepted before. She insisted her problem was with men in the workplace; that is why she could not work, it was like a phobic avoidance, and rather than continue to explore her inner unconscious motivations , she grudgingly let her husband take care of her and blame society and the workplace for her plight. I suggested the 'Cinderella Complex' because she clearly relished being taken care of, and although she was familiar with the concept, she rejected it out of hand.

I sought a consultation with a respected feminist analyst, a friend and colleague, whose contributions to the feminist literature are considerable. We had known each other for a long time and have communicated well in the past. I suggested she sit in on one of our sessions, so that she could witness the interaction, because I wanted her opinion as to whether my allegedly 'male' and 'analytic' style was indeed chauvanistic. I wanted her input in the questions of whether or not I have some 'blind spot' that contributed significantly to the apparent impasse. It was curious why she continued working with me, all the while insisting I was doing her no good. I considered making a 'penis envy' interpretation and my consultant thought that it was admirable restraint on my part that I did not. Nowadays this deep interpretation is perceived like a violation. This feminist consultant told me afterward that my patient was indeed "very difficult", but that she, as a woman, in this case, could better empathize with her plight. I could not be sure of that. She had only seen the patient once and was not involved therapeutically.

My consultant proceeded to inform me that women have been oppressed, exploited and abused throughout recorded history, and that they, half the population of the world, were subordinated and disadvantaged, that it was unfair and a profound injustice, and that all of society suffers, including myself. She thought it was necessary to acknowledge these social and historical realities directly to my patient, otherwise my patient would not feel that I was taking her seriously and did not understand. She thought much of the rage was from social injustice, and I thought it was pre-Oedipal. Nevertheless, I agreed to do this, since the argument made sense to me, and I should keep an open mind and experiment.

Privately, I told my feminist colleague that I hated to be lumped into a category, that I did not feel all that powerful or dominant, that I myself had been the target of oppression and abuse because of my being Jewish in an anti-Semitic neighborhood in the Bronx, that I had to get past quotas to get into medical school, that I knew very well what it was to be abused and unfairly treated. In other words, I thought I really could empathize with social injustice. The history of my people is the most blatant example of prejudice and persecution. I had keen memories of what the Holocaust meant to me as a child and the intolerance I had to overcome.

She responded that my feelings were also understandable, but if I could acknowledge my patient's feelings, in light of her history and in light of what society has done to her mother, her mother's mother, and all women, I could empathize better and help my patient even more. I can only say I did this, I understood what she was saying and thought I could truly empathize being the object of unfairness and injustice as a human being, not necessarily as a man. But somehow, it was put to me that I could not truly and completely empathize with a woman since I was a white male in a position of power, and my patient was not. She was using the perspective of current and historical reality, supposedly the here-and-now, but I knew the psychic reality was the there-and-then of her infantile relationship with her mother. That is why the patient was still coming, part of why she felt she had to come. She depended on me as if I were her mother. She did not really want to end this fantasy of symbiotic fusion. I was nourishing her. I was not destroying her.

As an adult she could stop coming at any time.

The main advantage I had to help her was that we were involved in a long, intense therapeutic process; I knew her history, her character defenses, I liked and respected her, there was a great investment in time, energy and money. I did not think she could be helped at this point by another therapist, merely because she would be female. She had had four years of therapy with a competant female before she came to see me. A new woman therapist at this point had her own countertransferences and blind-spots, was in a position of authority, and probably had a Freudian background, herself.

Some of the consultant's own writings clarified the common problems of women therapists in having countertransferences of fear of a woman's anger. Many of them have been brainwashed about women's anger. Most women therapists were analyzed by men. Apparently, we have a long way to go before men and women are enabled to understand each other better and work together more co-operatively and comfortably.

The whole situation raised my consciousness tremendously, and I reviewed and explored the new feminist literature. Much of it was well known to me and the newer writings by traditional feminist analysts were quite understandable, acceptable and helpful. The newer writings did not contradict my experience and there were no startling revelations for me. Everything I read I already knew from my work with other women patients, from my own classical analysis, from my knowledge of the women in my life. It was hard for me to see women as downtrodden and exploited from my own personal experience. The women who came to me for therapy usually had a lot going for them. It was their neurosis, not society that was holding them down. Of course, societal mores become internalized, but that comes later and they are not as imprinted as the experiences of the earliest years, when society is the family. In other words it is not society at large that we internalize, but society as perceived through the particular screen of a unique family with unique interpersonal relations of the patient and family members. And this family exists within a certain community and subculture. All this can only be re-examined and restructured through years of intensive psychotherapy. A new female therapist was not the answer.

And I reject the notion that women are more injured by society than men, that a man cannot empathize with a woman. We are subverted by such political theorizing. A white therapist can treat a black patient even though he has not had 'the black experience'. There is no one black experience, no one woman, 'gay' or substance-abuse experience. Most competant therapists are hard-core middle class and can still do good work. It worries me as a therapist and scientist that there is a creeping metastasis of political rhetoric that threatens to contaminate our work. We have to take society and politics into account, but they are not central.

Despite all attempts to enlighten me and raise my consciousness, I continue to see men as equally wounded by society. Men have been expected to be the breadwinners, and are taught to be hard-working, non-complaining and responsible, for the most part. They work on assembly lines, coal mines, corporate and governmental offices. The pressure is great in our society for men to perform, to slay dragons, to compete in the rat-race, to work overtime, to strive for raises, bonuses and overtime. Men have great anxiety over the possibility of losing their jobs, but are not allowed to be too emotional or to complain. As a result they regress into gender stereotypes of the 'macho' man, the workaholic, the alcoholic, the 'couch-potato' or the wife-beater. In the end, and this is the bottom line, he dies eight years before the average woman. He dies of stress-related diseases, hypertensive and atherosclerotic heart disease, suicide, stroke and cancer. He is killed in battle, he fills the jails and goes to prostitutes. He watches sports and pornographic movies. He is more prone to crimes of aggression because he has no outlet for his feelings. He has been socialized to be hard and tough, separate and alone, unlike the woman. However bad is the state of woman in society, she has her home and children for the most part, and a network of woman friends for co-operation and socialization. Men are geared for aggressive competition and solitude, while women for are socialized for co-operation. These are the social gender stereotypes that evolved from our stone-age forbears, and what we now reject in the name of civilization. There is a New Yorker cartoon which shows a stone-age couple approaching another caveman. He carries a club; she carries a basket of grain. The caption reads, "I hunt and she gathers--- otherwise, we couldn't make ends meet."

Some of you may have read my essay in the winter Academy Forum on Dr. Renee Richards. It shows how a little boy was dominated and controlled by his mother and sister. He eventually underwent trans-sexual surgery to become a woman. His Freudian male analysts could not fully empathize with his plight and so he ultimately resorted to surgery. I nowadd another example of a young man whose family dynamics and early development pushed him in a direction we usually associate with women, the problem of masochism.

Fred initially came to me with an incapacitating depression. Although he improved greatly at first with ventilation and medication, after a few years he sunk again into another paralyzing depression. Despite the fact that there are earmarks of a genetic predisposition to depression, an affective disorder, a deep unconscious conflict is be involved. Although he is a male, he has the stereotypical picture of a depressed, masochistic, self-defeating woman. In his adolescence he had what he described as a ravishingly beautiful girlfriend, and for a time they had a wildly passionate and erotic relationship. In the course of their love-play, she became more and more assertive and dominant, she forced him into the male-supine position, which was more stimulating to both of them. Eventually she controlled the entire relationship and would belittle and humiliate him, which aroused him intensely. Ultimately, she became unfaithful, blamed him for his passivity, for not making her feel feminine. When she walked out on him, she said that "he had to be in control". At first baffled, he later came to understand that his masochism stimulated her dominance and sadism, which she could not control. Nontheless, he felt devastated by her betrayal and cruelty.

It is interesting that when they wrestled, she always came out on top and when they played gin rummy, she always won. And he says he didn't let her come out on top or win every game, but it happened, just the same; he cannot say how, but he knew it was psychological. He was inwardly not allowed to dominate or win. He tried other relationships, but they turned out the same. He was only attracted to domineering and sadistic women, not to women who were kind and gentle. Those who were nice, according to him, ran the other way, as if they were afraid of his unconscious anger--- besides, he was not attracted to them.

At first I thought his problems with women stemmed from his relationship with his mother, this was my sexist bias. But he always spoke positively of his mother and defended her behavior, even if it was not in his best interest. His father, however, was near-psychotic, and was abusive to my patient on a daily basis. His mother would try to protect him from it, but always made allowances for the father, who was very temperamental and fragile. It infuriated and confounded my patient when his mother would always say that there were two sides to every argument, even multiple perceptions of external, objective reality. My patient was in danger of psychosis himself, but the analysis helped him to gain insight and perspective and reinforced his contact with reality.

He eventually made a break from his family and developed a business of his own, but Fred retreated more and more from dating women. He could never make the first move to engage a woman's interest, and all blind dates ended disastrously. He concluded he was not meant to have sexual relations, marriage or children. It could be that he was so traumatized by his nuclear family, that bachelorhood was the only answer. However, what is interesting about this case is that my patient had to remind me repeatedly that his masochistic involvement with women was not based on his relationship with his mother, but with his father. And although his erotic fantasies were characteristically female, he had no homosexual inclinations. His gender identity was clearly heterosexual. His insight was that despite the fact that his first love was a woman, the only way the relationship as it developed could be understood, was that he so feared his father's hostility, aggression and dominance, that his fantasy of a masochistic relationship with him was an effective defense against his castration anxiety and fears of annihilation. The standard Freudian analysis of masochism as a defense against castration anxiety did not apply in this case. It did not go deep enough. Dr. Doryann Lebe gave a wonderful paper in the spring Academy meeting that pointed to fear of loss of the pre-Oedipal mother in cases of refractory masochism.

This case shows me that men can have female gender stereotypes of character, fantasy and behavior, and still have a strongly male sexual identification. Which should not be too surprising when we really stop to think of it. Freud's observation that men and women are both essentially bisexual is by now a basic truth. We know it from our studies of embryology and anatomy as well as psychoanalysis. Children develop from little boys and girls to adult men and women depending on their genetic endowment and how they are socialized along gender stereotypes. Male babies are more physical and aggressive from birth and are generally socialized to remain that way. Girl babies tend to be less aggressive, more passive and compliant, and they are socialized to develop that way. But there is every shade of difference along a continuum, in which some males are encouraged to be passive and compliant and females encouraged to be dominant and aggressive, a process which creates 'tomboys' and 'sissies'. A lot depends on the character and gender identification of the parents. Sometimes the dominant parent is the father, most often it is the mother, as the mother does most of the early parenting, which is most important, it is tantamount to imprinting at the earliest, critical stage. Which is why it is hard for me to appreciate the idea that men run things or are the dominant force in society. It seems to me that women carry the torch of civilization--- they are the masters of their domain, which is the domicile, not the workplace. We learn who we are more from our mothers in the kitchen, not from the men who write books.

Men have been dominant in the workplace and battlefield, but not for long. Things are changing rapidly, and therefore men and women share not only the workplace, but domestic duties. Bisexuality is becoming more accepted, androgyny is getting to be the rule, as mothers leave the home to work and men remain at home to care for the children and do the cooking and dishes. I will never forget the Indian resident who asked me what was the treatment for latent homosexuality. I asked what was the data for latent homosexuality, and he replied that his male patient told him he often did the dishes! So we must look at gender and stereotypes more and more across cultures, as well as within our heterogenous society.

If men have had an undue influence in literature, science and the arts, it is because of a division of labor between the sexes that originated in prehistory. The men hunted and waged war, the women took care of the children, the dwelling, and prepared the food. They were physically weaker and dependent upon the men and therefore they had to submit to them. The biologic facts of pregnancy, birth and nursing also put females at a disadvantage, economically. The pattern is similar in other primate social groups. We are striving to adjust to the fact that physical strength is no longer so important, that might does not make right, at least in the developed nations, but in the undeveloped world, the law of the jungle is still a reality. Women do most of the basic work in the world, harvesting, reproducing and child care, while men do most of the talking, writing, killing and sowing wild oats in the Third World.

Male power has traditionally been in the realm of the outside world and the world of abstraction, while women's power resides in the concrete realm of the home and family, where I think the real power, the real world is. Psychoanalytically, our insights about the pre-Oedipal mother explain why Woman is so feared, especially her anger. What does Woman want? She wants help, recognition, affirmation, co-operation, security, love, affection, respect--- what every Man wants.

Every child, male and female, has been mothered, and during infancy the mother has the power to gratify and frustrate, to destroy or to maintain life. I believe that even if there is no conscious memory of the first year of life, the feeling states are indelibly recorded and ineradicable. This fact may well account for fixations and resistance to change in analysis. We try to select patients who are capable of object relations, who had some positive mothering experiences, who have internalized a good mother, or a 'good-enough' mother. Those people who have had the benefit of good parenting, which is a harmonious combination of good mothering and good fathering, have a basis for stability and integrity, are not so split or narcissistic as our patients. Those who come for analytic therapy I truly believe can be helped by either a good male or female therapist.

Therefore, the answer to my original question is "no". The gender of the analyst is not important. What is important is his or her competance, his or her basic character, which includes integrity and stability, insight and empathy. Of extreme importance I would think, is the thoroughness of his or her personal analysis, whether it be from a male or female analyst, such that self-analysis is ongoing, a lifelong process, such that countertransferences and blind spots are recognized and dealt with, discussion with colleagues of both sexes is continuous, keeping up with the literature and the media is maintained, along with a never ending examination of the processes and the influence of socialization and culture. It is necessary to elevate one's self from the narrowness and particulars of one's uniquely personal gender development, to gain a transcendent view of humankind in an evolutionary dimension. Our lives are but a blink in time as is the existence of our species on this planet. We must take the long view and yet remain an objective and empathic participant-observer in this 'avant-garde' process of psychoanalysis. We are very fortunate to have the tools Freud gave us at our disposal to examine our condition. As the proper study of man is man, let us now graciously concede that man is also woman and woman also man, if we really believe in our inherent bisexual nature. A healthy, adult man is a man and a woman, and a healthy adult woman is a man and a woman. And this Man-Woman is called a Person. As therapists we can help our patients by our unique knowledge and powerful techniques to realize their full potential in both their male and female qualities.

This final word: The feminist legalist, Professor Catharine McKinnon, who has been in the media of late and who has espoused rather radical views of feminist goals, claims in her Yale Law Journal article that,

"No woman had a voice in the design of the legal institutions that rule the social order under which women, as well as men, live. Nor was the condition of women taken into account or the interest of women as a sex represented. To Abigail Adams' plea to John Adams to 'remember the ladies' in founding the United States, he replied, 'We know better than to repeal our Masculine systems'"

Although this seems like a callous dismissal, which indeed it was, I believe that John Adams was strongly influenced by his wife. Just as I believe that all men are influenced by their women, the influence being both powerful and invisible. (If we remember the words of "The Little Prince", the most important things in the world are invisible). The framers of the constitution designed a modern and unique democracy, one that incorporates certain basic and inalienable rights, and one that evolves. They created a government which had principles which would outlive the narrow constraints of their time. Jefferson kept slaves. Franklin was a womanizer, but they are not known for that, do not go down in history for their private lives. What is public is historic and though men's names are on the titles of books and their portraits adorn paper money, they would not accomplish what they do without the co-operation and love of their women. Although Abigail's name is hardly ever mentioned, consider what she said to John Adams, and tell me that she was subjugated or lacked power. I believe her letter is prophetic, if we consider what is happening today, sparked by a feminist movement which began centuries ago. This in turn will generate a masculine movement and if we develop even more positively and our consciousness is raised even more, we will become a humanist movement, in which men and women work together more harmoniously and co-operatively, side by side.

This is the letter of Abigail Adams, it is dated May 17, 1776, Braintree, Massachusetts, over two hundred years ago:

"In the new laws which I suppose it will be necessary for you to make I desire you would remember the ladies and be more generous and favorable to them than your ancestors. Don't put such unlimited power in the hands of husbands. Remember all men would be tyrants if they could. If particular attention and care is not paid to the ladies, we are determined to foment a rebellion and will not hold ourselves responsible for any laws in which we have no voice or representation. Whilst you are proclaiming peace and good will to men, emancipating all nations, you insist upon retaining absolute power over wives. But you must remember that arbitrary power is like most other things which are very hard, very liable to be broken, and notwithstanding all your wise laws and maxims, we have it in our power not only to free ourselves, but subdue our masters, and without violence throw both your natural and legal authority at our feet. If we mean to have heroes, statesmen and philosophers, we should have learned women. If much depends as is allowed, upon the early education of youth, great benefit must arise from literary work by women."

Signed, Abigail Adams.

Thank you for your kind attention.