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Sexuality Conflicts Depression and Anxiety in Female Patients: The Neglected Path

Mia W Biran

This paper reviews the neglect of sexuality conflicts and confusions in adult female patients in the psychotherapy literature and some possible causes for it. This problem was already pointed at by Biran, Britton and Yarom.

Biran described a case of 50-year old female presenting dream material, memories, and associations revolving around gender identity conflicts (see below). In another paper, Biran presented a case of a menopausal patient with depression related to the reemergence of old sexual identity conflicts. Yarom perceives hysteria as a problem resulting from thwarted sexual development. For both the boy and the girl, the development of sexual identity is halted due to pathological reactions from both parents. The resulting hysteria expresses itself through 1) Vacillations in gender identity (Am I a man or a woman? Am I weak or strong, passive or active?); 2) Over usage of repression, dissociation, splitting, denial and foreclosure; 3) The use of the body and mechanisms of conversion to represent and project the internal conflicts around sexual identity. All of these defenses are operating in the transference and countertransference between therapist and patient.