Clinical and Developmental Issues of Lesbianism

Introduction
Female Same-Sex Attraction (SSA) is complex in its origin and very diverse in its expression. The elements of the struggle vary in degree and intensity, as do the temperaments and personality types of the women. My clients present with a variety of Axis I and II disorders as well as unique stories and histories. Therefore, in my treatment of the client, I first and foremost want to meet and interact with the unique individual sitting in front of me. Lesbian women are intelligent and intuitive and can tell if I am truly "seeing" them or trying to squeeze them into a box or theory. I hold my models and theories loosely so I can meet the true person. I also want to encounter the "whole" woman, not just her SSA. I want to give her the message that she is more than her lesbian struggle. I want her to know that she is important, and I am not sitting with her simply because I think her sexual orientation needs fixing or that I can "fix" her.

As a therapist, I want to respect her human dignity. Many of my clients are not sure they want to totally resolve the lesbian conflict. The emotional aspect of their struggle seems to reach down into the very core of their being. It is often a long process for a woman to just define the struggle, let alone to begin to disidentify with it. Over six years ago, about two years into my practice, I decided to make a commitment to myself and to my clients that I would work with them regardless of where they are at in their decision to resolve the lesbian conflict. I agreed that I would not place demands or expectations on them with respect to their sexual struggle that would, in any way, condition or impede our ongoing work together. In other words, I have decided to be committed to them, wherever their journey leads, and to remain committed for the long haul. The "long haul" seems to be an average of 4-5 years of weekly to bimonthly appointments.

While there is much variation among women with SSA, there are still many notable themes that consistently emerge in their stories and struggles. I would like to highlight a few of those here.

common Roots of female ssa

In broad sweeping terms, the roots of female SSA can be discovered in four basic elements:

• A strained, detached or disrupted bond or attachment with mother without an available mother substitute, resulting in a need for secure attachment.
   
• A lack of respect and/or protection from men, often in the form of sexual abuse or rigid gender roles, resulting in a fear or hatred of men.
   
• Few, if any, close girlhood friendships, resulting in a need for belonging and fun.
   
• A sense of emptiness and lostness in lieu of a full and rich sense of self and identity as a feminine being, resulting in a need for a self and gender identity.
   

While the presence of these elements is not an absolute predictor or determinant of the SSA struggle, they are nevertheless the most common and frequently reported facets of the story. These elements are generally sequential in order of development or experience, can be causal or predisposing for the subsequent element and are therefore interrelated. An adult woman actually cycles in and out of these elements and related needs as she acts out the lesbian bond in an attempt to repair the inherent dilemmas. Unfortunately, this "acting out" can actually intensify these predisposing conditions of lesbianism.

I would also like to suggest that there are some common innate characteristics shared by SSA women. These would include an above average intelligence, strong sensitivity to hypocrisy and injustice, athleticism, natural draw to more stereotypically masculine interests, capacity to feel deeply and passionately. It is the combination of the above environmental factors and inherent characteristics that may eventually lead to a SSA struggle.

Developmental Issues

To highlight the specific developmental issues that are present in most female SSA struggles, I wanted to share the research findings from an unpublished doctoral dissertation by Dr. Sheryl Brickner Camallieri. Dr. Camallieri used an instrument called the Measures of Psychosocial Development (MPD) to assess the developmental differences between 54 allegedly heterosexual and 54 allegedly homosexual women. The MPD measures the developmental resolution based on Erik Erikson's model of psychosocial development. The eight stages are listed below.

While Dr. Camallieri admits that the scope of her research does not establish the cause of the differences (which could be developmental or attributed to the social and political climate regarding lesbianism), "Of the 19 scales analyzed, six of the scales indicated a significant difference in the scores between the two groups of women" (p. 3). The heterosexual women scored significantly higher on the favorable resolution scales of Trust, Intimacy and Generativity (marked in squares below). The lesbian women scored significantly higher on the negative resolution of Identity Confusion and Stagnation and Total Negative Resolution (circled below).

I have since given this assessment to over 25 of my lesbian clients and continue to see extremely high identity confusion and stagnation scores as well as low trust and high mistrust scores. Additionally, there is another pattern that has emerged in my client's testing: relative to their other scores, the lesbian woman scores significantly high in the positive resolution of Initiative and/or Industry (also circled above). If we were to just consider the results of the MPD based on suggested methods of interpretation, we would conclude that these are women who feel very insecure and unsafe in their world; are unsure of others and doubt that anything good will last. They have used performance, competence and assertiveness in a compensatory fashion, probably to gain a sense of control, value and purpose. They hold no inherent value or clear identity and therefore have little capacity or motivation to sacrificially give to others. Emotionally, they remain in a depressed state of self-absorption. This is a fairly accurate description of the lesbian experience.

As you might guess, these developmental deficits and compensations coincide almost perfectly with the clinical themes in a lesbian's history.

A strained, detached or disrupted bond Mistrust
or attachment with mother without
an available mother substitute, resulting
in a need for secure attachment.

A lack of respect and/or protection from Initiative/Industry -
men, often in the form of sexual abuse assuming a toughened or
or rigid gender roles, resulting in a masculinized stance towards
fear or hatred of men. life and survival.

Few if any close girlhood friendships, Identity Confusion (solid-
resulting in a need for belonging and fun. ified during adolescence)

A sense of emptiness and lostness in lieu Stagnation
of a full and rich sense of self and identity
as a feminine being, resulting in a need
for a self and gender identity.

Specific treatment options need to take into consideration these developmental needs. Ultimately, treatment should start with the beginning issue of trust, move through the subsequent developmental issues with a major emphasis on identity formation and conclude when the woman is free to give, love and contribute to the betterment of the world.

Contrasts Between the Masculine and Feminine

I would now like to offer some framework around the differences between the male and female developmental journey in order to highlight the nuances of the lesbian struggle. I hope to also provide a framework for understanding the essence of the true masculine and feminine. It is essential to have some framework such as this if we are to help gender-confused clients.
 

Attachment and Identification

Boys and girls follow different developmental paths in terms of attachment and identification. Both boys and girls are to be initially attached to mom at birth. To develop healthily, a boy must move, strive and initiate to successfully separate from mom and ultimately attach and identify with dad. Homosexuality becomes a serious possibility when this step or process is frustrated or altogether missing for the boy. A girl on the other hand is supposed to remain and rest, so to speak, in an experience of ongoing or continuous connection. Figuratively speaking, she warmly rests secure at home with mom, to eventually receive dad who is to gently move towards her to offer his love, affirmation and protection.

Lesbianism initially becomes a possibility when this needed ongoing attachment with mom is absent, insufficient or undesirable. (Lesbianism becomes an even greater possibility if dad's movement is non-existent, abusive, or becomes masculinizing of his daughter.)

If for the girl, her initial attachment to mom is perceived to be weakened or broken, a type of homelessness is created for the girl that even the homosexual boy does not experience. In this way, the lesbian condition is more primal and perhaps more entrenched emotionally and psychologically than male homosexuality. The girl is essentially stripped of her most fundamental tether in the universe. There may be no greater trauma in a girl's life developmentally than one that interferes with her primal relationship with mom. Mom is not only the first bond and attachment for a little baby girl, but is the relational object with whom this little girl will form her first sense of self and eventually rely on to complete her identification process as a female.

Besides internalizing the insecurity that a break in this foundational relationship creates, the girl will activate or move in an effort to find the attachment for which she was designed and so desperately needs. She begins to follow the developmental path of a male, that is, moving, striving and initiating. Unfortunately, trust in others and her self is not adequately formed to support secure and meaningful connection or relatedness (this is the mistrust that the MPD measures). She is filled with a sense of aloneness and need that further fuels her movement and initiation to resolve her dilemma (herein lies the high initiative and industry scores on the MPD). Simply put, this emotional movement disrupts her normal growth and development and identification as a feminine being (identity confusion), not to mention the false paths such movement will uncover. Let me add another picture of gender differences.

Erikson Research on Preadolescent Play Constructions

In the 1940's Erik Erikson conducted research at Berkeley on preadolescent play constructions. While he wasn't specifically addressing gender differences in his study, Erikson was struck by the fact that when given a set of blocks, little boys and girls built different constructions of space.

The boys' construction looked something like the one below. The construction would also include such things as cars among the buildings and people atop the buildings. As one can see, boys seem to be naturally preoccupied with the outer world, nature, objects and things.

The girls' constructions tended to look like the picture below. The people sat close together and faced the inside of the room. Girls seem to be naturally preoccupied with the inner world of human relatedness, communication and connection.

Theological Perspective

Theologically, the creation story of Adam and Eve parallels Erik Erikson's findings and adds some important notions about the true masculine and feminine. First, Adam and Eve were created equal in terms of dignity, value, call and purpose. (To work with a lesbian successfully, you must truly believe and hold to this conviction.) They were to both Fill and Multiply - the realm of human relationship and Rule and Subdue - the realm of nature, animals and the earth (found in Genesis 1:27, New International Version). Second, they were created differently. Adam was created from the ground, was placed in the garden with the plants and animals and became very busy working, moving, initiating, ruling and subduing. Eve, on the other hand, was the only created being made from another living being. Her primal essence is one of human relatedness. She was immediately placed in front of Adam and became busy relating-being known and loved. Both Adam and Eve were needed to complete God's purposes for humanity, but it seems that their very origins and initial experiences point to difference and uniqueness.

True Femininity and the Inner World of Connectedness

Another way to look at these differences is seen in the complementary circles below. Perhaps the masculine (I believe gender is not merely a construct of socialization or learning processes but a fundamental and inherent aspect of our humanity) has a greater exterior strength of movement, initiation and courage to face and deal with the outer world but with an inner core of tenderness and compassion for human relatedness. It is this exterior strength, movement and confidence that homosexual men seemingly lack or struggle discovering.

Perhaps the true feminine means having an exterior that is inviting, restful and receiving with an inner core of solidness and strength of being and courage to face the complexities of another soul and the requirements of ongoing intimacy. Lisa Beamer (the wife of Todd Beamer who helped guide United Flight 93 away from human targets) is a great example of a woman with an inviting, restful exterior and a solid inner core. She was sad, but not crushed as she faced the tragedy of losing her husband. She was not fragile, wispy, whiney, needy, overly dependent but solid, strong, articulate, lovely.
The true feminine is not weak, but boasts of the strength, courage and power to be - to be present and connected with her own heart, emotions and thoughts and with another, even in the most difficult or tragic time. The true feminine can weather loneliness. Lisa can stand in the face of her husband's death because she has her self and many other vital relationships.

Lesbian women typically lack or struggle discovering and accepting both of these aspects as women. They are toughened and defended on the outside and sense emptiness and desperation on the inside. Their toughness defies their inner need and their inner need, which so often is expressed in terms of dependencies, speaks to the depth of their gender brokenness. They are not living out of the strength of the true feminine.

Of interest is the typical profile of the mother of a lesbian daughter. According to my clients, their mothers typically had no solid self or strength of character or integrity, regardless of how they presented on the outside. The mom of a lesbian struggler is a mom who:

- hid in bed under the covers when dad became abusive or rageful
- was mentally ill and relied on her daughter to continually talk her out of committing suicide
- didn't even know the basics of housekeeping let alone caring for a baby or child
- was a social butterfly and alcoholic leaving her little daughter alone and unsupervised
- was unable to separate from an abusive husband
- was a dutiful wife but a shell of a woman
- bragged incessantly about herself and kids, negating any negative feelings or experiences in her daughter
- hated being a woman, never shed a tear and despised her daughter
- was openly jealous of her daughter

These vignettes do not describe a woman who is solid in being and strength of heart. They describe a woman who is insecure, dependent, afraid of being alone, weak, lost and broken and underdeveloped in her own femininity. It is easy to understand why a daughter who has a sharp intellect, strong sense of justice and integrity, high energy level with deep passions might conclude that if becoming a woman means becoming like mom, she wants nothing to do with it. Unfortunately, in the girl's detachment and flight from femininity as portrayed by her mother, she too begins to live out a deep inner desolation and crisis of her true gender identity. She has had no "home" in which to develop or become. "I don't know who I am," "I hate being a woman," and "I don't know how I feel." Many of my clients feel and believe they are not women. This is not a symptom of a transgender struggle but is an indication of their alienation from their inherent design as a feminine being.

Emotional Dependency

To briefly summarize, healthy development for a girl first requires that she rests and remains in the warm and secure home of mother so that she can form and develop an inner home for herself - out of which she will live, express her strength and power, create, relate, connect, nurture, bring forth life, etc. Without this inner sense of home or a secure and solid sense of self and feminine identity, she will not have the capacity to enter into healthy intimacy. Yet she will live with a deep belief that she cannot be alone. Therefore, she is unconsciously driven or on the move to find a "home" or true "self" outside of her self.

This is the drive behind an emotionally dependent relationship. When another woman comes along that triggers a sense of familiarity or presents herself to be a strong and competent woman (unlike mom perhaps), the lesbian literally wants to lose herself in this woman, hoping to find rest, receive the care and nurture she craves and to finally appropriate, albeit vicariously, an identity. Emotional dependency is not an inordinate love but is the consequence of a woman's deep fear of and inability to sustain intimacy. The partner is not loved or known for who they truly are. It is the sense or illusion of warm connection or secure attachment that is desired. Sadly, the "emotional dependency," if sustained, will prevent a woman from any substantial healing or change. A woman does not need to lose herself (in another woman or man) but in fact, needs to find her true self and this goal should be the primary focus of therapy with the lesbian client.

Personality Disorders and Traits

It is this missing core and the accompanying restlessness that I believe leads to conflicts and struggles within the lesbian woman that qualify as full blown personality disorders and traits. The most common configurations I encounter in my practice generally include a depressed and/or dependent disorder with associated self defeating, avoidant and borderline disorders or traits. Depressed - empty, dejected, pessimistic, worthless and full of self and other centered contempt, dependent - needy to the point of desperate yet fearful of rejection, self defeating - negative, self pitying and hostile, and avoidant - defended and isolated. This list accurately describes the predominant characteristics of the average lesbian woman.

Effective Therapy for the Lesbian Client

Work with the lesbian will require a long-term commitment which will be tasking and draining but also rewarding if the client is highly motivated to change. The individual characterological profile must be considered and appropriately handled in therapy. Generally speaking, lesbian women are deeply conflicted. But remember, every woman you see will be unique in this regard. The general goal of therapy is to establish trust (this may be the first experience of trust for many clients) so that the client can accomplish the deep inner formation work, or as quoted by Elaine Siegel, "attainment of firmer inner structures," (Female Homosexuality: choice without volition, Hillsdale, NJ: The Analytic Press (1988)). The woman must come into her own. She must be able to embrace the breadth of her identity and humanity, her strengths and weaknesses, her glory and her shortcomings, her dreams, hopes and visions as well as her disappointments and losses. This process will involve among other things, extensive work in identifying, challenging and restructuring the woman's belief system regarding the world, God, others and herself. Lesbianism is supported by a complex system of distorted, negative and self-defeating beliefs. This system must be rebuilt. The client's defensive maneuvering and unhealthy attachments with women need to be addressed while the woman is being challenged to take risks with new and healthier relationships. Eventually she will need to deal with her opposite sex contempt and ambivalence and appropriate her own individual style of feminine relating.

In conclusion, because healing for the lesbian requires the establishment of her "home" so to speak, I believe that the most effective component of therapy with a female homosexual is the quality of the attachment and therapeutic relationship formed between female counselor and client. While there are many techniques that can be used to access deep unconscious conflicts and to teach cognitive truths and principles of healthy living and relationship, it is the consistency, faithfulness, caring and loving attitude of the counselor that begins to finally establish a solid center of trust and inner core or sense of being in the women we work with. It is as I love, accept and affirm my client that she can begin to unfold and continue to develop as a female being. In essence, I provide the home in which she can rest and simply become.