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Women Therapists at Midlife

Laura Barbanel

Psychotherapy in Private Practice, Vol. 8(2) 1990
©1990 by The Haworth Press, Inc. All rights reserved.

Abstract. The decade between 45-55 is the decade in which we see “midlife crises” in our women patients and in women therapists. This is the Dominant Generation, the generation that leads and does the care-taking of the young and the old. It is related to menopause only symbolically. It is connected to a decline in physical and sexual vitality, to aging.

Two cases are reviewed of women psychologists in this age group presenting symptomatology characteristic of this age. The internal sense of being overwhelmed, of as King “Where do I go from here,” is paramount.

For men the answer has frequently been to redirect their energies to nurturance or generativity. For women, who have spent their years in nurturing, the answer lies elsewhere, in more self-absorbing changes.

What does it mean to be a woman at midlife in the practice of psychotherapy? Firstly, the definition of midlife is not agreed upon. It has been described as being anywhere from 35 to 65 by various writers in the field. There are those who see midlife as anywhere from 35 to 50. In a recent article in Contemporary Psychoanalysis, Mann (1988) speaks of the middle years in the professional life of the analyst as 5 to 10 years after graduation from an analytic institute, which she sees as bringing him or her to the middle or late forties. My preference is to speak of the decade from 45-55 roughly as a social-biological period of life, not necessarily in relation to the completion of training.

It is this time of life that has been noted as a time of shift, from growing and developing to a plateau before growing old. For the woman therapist, of she has been in the field without interruption for family, she may be in practice for as long as 15 to 20 years. If she has children, chances are they are half grown. Certainly there are other models –there are 50-year-old women who are relatively new in the field. Midlife issues raise themselves in anyone of these cases. It has become convenient in the literature, to see these issues as tied to the loss of children as they grow older or to the loss of childbearing capacity. It is, no doubt, not as simple as that.

Forty-five begins the Dominant Generation; the generation that leads, that administers. It is the generation that takes care of the young and the old; that is in the peak of responsibility. And as we know, after the longest day of summer, the days begin to grow shorter. At the peak of one’s powers, one begins to the see the decline. Although women in their forties today are probably in better physical shape than ever before in history, a certain loss of youthful vitality is felt nonetheless. The physical changes of aging begin. Despite the running, the sit-ups, the leg lifts, the face-lifts, the process of aging, begun at birth, inexorably continues. It is experienced dramatically in this decade. Scarf (1980) calls aging for women “a humiliating process of sexual disqualification.” It hardly matters if a woman has been raising children for twenty years or seeing patients for twenty years; this process goes on. Where it converges with children developing away from home, the sense of uselessness is added. Where she has no children, the sense of a missed opportunity is experienced. It isn’t’ avoided by having children later in life, which has become not uncommon among professional women today. The process has to do with a biological rhythm that gets connected to the social and personal history of the individual. Is this biological time related to menopause? In a direct biological sense probably not. In a symbolic sense, certainly.

Something of the same order occurs in men also. Men at 45 experience decline in physical vitality but are less likely to be seen as sexually disqualified. Adjustment reactions of later life for men seem to occur later –at retirement age. Perhaps not so dramatically in the field of psychotherapy where there is no official retirement age. However, for me the fear seems to be more linked to a fear of dying; for women the fear of aging seems paramount.

This sense of biological aging may converge with the sadness or loss of childbearing possibilities or sense of loss of professional potential; of being just a little usurped by a younger colleague. The sense of passage of one’s youth and its possibilities can lead to all of the depressive symptomatology that one sees in midlife crisis.

Erikson (1950) was the first to discuss this period in his “Generativity vs. Stagnation” period. He describes generativity as “establishing and guiding the next generation,” not necessarily one’s own offspring. The busy male business tycoon who wakes up one morning and says “What am I doing here?” may begin to answer the question of stagnation in his life by becoming involved in the next generation –the Little League or the like. That won’t work for the woman who raises the question at this point in life; who feels adrift and lost. Typically she has been involved in generativity, translated as nurturance, for some years already. For the woman therapist that is even more the case.

Let me describe two not atypical, although unique, cases.

Caroline, a 47-year-old married psychologist, mother of three children, came to see me in great distress at the beginning of this year. She had taken on a new, rather prestigious position at a local university several months before, which she had long coveted. This job was a feather in her cap. She had been working as a faculty member at the same university for fifteen years. To be selected by the President for the Deanship over more senior colleagues, was a true honor. Balancing that job with the private practice, the three children and community responsibilities, was another matter. By January she felt herself unable to make decisions on the job. Some physical problems had developed along the way as well. Vaginal bleeding of unknown origin and some hormonal irregularities had been noted. The gynecologist, who was also a colleague, had prescribed a mild antidepressant.


Caroline is the third of five children from a ranching family from the Western part of the country. Her two sisters and two brothers were all successful in their various pursuits. She had however, set herself apart in terms of her particular professional achievements; her brothers were in business and her sisters nurses. She had also married a Jewish man and moved to New York City. Her husband is a busy businessman himself who, although out of town a lot, shares responsibilities for the home and the children. He was at the time that Caroline came in to see me, very concerned and supportive of her. He had stopped traveling when she “got sick,” leaving that part of his work to someone else in his office.

Caroline always felt a little estranged in New York, although it was clear that she could not live in the West. This had become particularly clear after her father died some months before and she had spent some time “at home” with her family of origin.

It was clear when Caroline came in to see me that she was deeply depressed. She felt paralyzed. She couldn’t work; she couldn’t take care of her children. She had cancelled a number of social engagements. She told me in a flat, rather morose voice that when she called to say that she would not be attending a family engagement party, that this was the first time in her life that she had done such a thing.

Caroline’s situation could be characterized in a number of ways. Depression, midlife crisis, or burnout come to mind. Here was a woman who had worked very hard to achieve in all spheres of life. She had made it professionally, had a full family life and social life, and now she couldn’t handle it anymore. The compulsive perfectionistic defenses were now turning against her –she could no longer work and keep her children’s haircut appointments. Although this is clearly a woman who had assumed adult responsibility thoroughly at an earlier age, the death of her father six months earlier and the new responsibilities at the University for the lives of many, symbolized being the “responsible generation.” There was no longer a generation between her and death, between her and total responsibility.

Interestingly, she functioned reasonably well with her own patients.

Let me contrast this patient with another who came to me at about the same time.

Erna, a psychologist in her mid-forties, came in with a mild depression which she understood as chronic but somewhat exacerbated at this time because of a feeling that she had to make changes in her life. She had been working as a consultant to nursery schools for some years, her professional training being in education and child development. She has been living with a man for ten years, in a common-law marriage. They have no biological children; his son from a former marriage lives with them part-time. She takes a good deal of responsibility for him.


Erna’s mother was Austrian and her father American. She was an only child to her mother who had had a lot of difficulty with pregnancy, childbirth and child rearing. Her mother had been chronically ill during her childhood. The message she had gotten very early was that her mother’s illnesses were related to her birth and the subsequent hardships she caused. Erna had decided rather early that she didn’t wish to be at all like her mother. Ironically, although she had not married, nor had any biological children, she had a busy household with guests coming from all parts of the world, and a stepson whose care she seemed to be more and more responsible for.

Erna’s complaint was depression and anomie. Her job, which had sustained her for a number of years without too much effort, was now seen as somewhat boring and tedious. Although she was sorely tempted not to go to work, she managed to go and to function well.

What are these two women suffering from that is peculiar to the midlife years? What are the transference and countertransference issues? What is the cure?

Both women were sophisticated professional women who had been in analysis previous to their seeing me. Both had relatively good lives, full of professional success, family life, affection. On the outside, both of these are enviable women.

So what went awry? After fifteen to twenty years of work and family responsibilities these two women and other like them have begun to ask or experience the questions internally: “What is it all about? Where do I go from here?”

Is it menopause, empty nest? Certainly Erna had some thoughts of childbirth –did she miss something by not having children? But that wasn’t a major theme. For Caroline the sense of being overwhelmed by responsibility for so many lives was a strong theme. But also, why do I want this responsibility? What good does it do? Who cares anyway? What’s in it for me? As the full strength of her powers became clear, the end too was in sight. On the longest day of summer, the days begin to wane. The dynamics of each of these women in complicated and not to be fully explored here. One could raise the question of the previous analyses. I did not. Both had been analyzed well. The problems being dealt with now just weren’t around then. Why these two women and others life them are struck so strongly, and some are not, is not currently an answerable question. Rather we need to look at these two cases as illustrative of the propensities of this time of life.

There is the beginning of a literature on midlife as a developmental stage. Levinson’s, Seasons of a Man’s Life (1978) is a model study of men’s lives in this period. Passages (1976) by Gail Sheehy is the more popular, somewhat comparable work on women’s lives. All of the writers use a kind of Eriksonian formula of generativity vs. stagnation. As stated earlier, however, the turning back to the care of and for others is to the answer for women as it is for me. For the man, the renewal of himself is frequently in the devotion to others. For women at midlife the scenario is typically different. The complaints usually involve being too devoted to others’ needs, with little time for oneself. Men don’t talk about time for themselves. For women the paradoxical position is of being needed and discardable. Children who need attention but who are leaving home; parents who need care-taking but don’t care. In the case of therapists, patients who are draining and who go away.

The renewal and hope for a woman at midlife lies in her turning to some new kind of self-involvement. We’ve all read countless novels about women who devote the best years of their lives to their children, get depressed at midlife as their children begin to need them less and who go back to school or work as the cure, with all of the stress on the family that this creates. Perhaps those of us who didn’t sacrifice career for children (or so we thought) thought we would avoid the midlife blues. On the contrary. Having it all at once, or thinking one does, makes the loss at least as poignant. The loss of youth, a certain energy, of becoming. The cure is not in more work! In the patient’s described earlier the cure has been in less involvement in work and family needs and more in the selfish needs. For Caroline it involved a leave of absence from the university with a great deal more examination of her own needs. She goes to fewer engagement parties and community events. She is no longer on the school board, her co-op board. She reads more novels. For Erna certain changes in her work life are evolving which involve narcissistic pleasures that she could not have imagined for herself earlier. For both patients, there has been a seeking out of “Fun,” a word neither recalls having used in their previous analysis.

Countertransference issues abounded and abound. As a therapist at roughly the same season of life, it was difficult at times not to confuse each of these women’s lives with my own. Caroline came in as a more fragile, seemingly more depressed and passive woman who after a while I felt I wanted to sake and scream at, “Enough with your depression! Everyone has troubles, get on with it!,” and furthermore, “You’re destroying your children.” I had to work harder to listen and empathize with the endless complaints of not being appreciated. Erna, on the other had, was so sturdy that I had to work hard to insist that she express the fragility, the rage. She had such a good cover that the contents could easily be missed. I took a dream of hers in which she clearly expressed her wishes to be soft and delicate, to wear silk rather than her usual cotton and wool, to impress upon me her vulnerability. I believe that she kept this part of her well hidden in her first analysis. It became available only through the stresses of midlife development. I felt awed by its being unveiled to me at this time in her life. Would these countertransference issues be different if this therapist were at another stage of life? I suspect so. The countertransference issues of depression and rage have to be monitored in a particular way.

The trick in long life is hope and regeneration. How does one appreciate the same ness and find uniqueness? Although there are people who make major changes in their lives at this point, more often it is through subtle small changes. In the “olden days” a woman would buy a new hat to symbolize a new beginning. Each of us has to find a new hat for a new decade. If we do, we can both cure ourselves and our patients.


Erikson, E. (1950). Childhood and society. New York: W.W. Norton.

Levinson, D.J. (1978). The seasons of a man’s life. New York: Ballantine Books

Mann, C. (1980). The middle years. Contemporary Psychoanalysis, 24, 3, 478-485.

Scarf, M. (1980). Unfinished business: pressure points in the lives of women. Garden City, New York: Doubleday.

Sheehy, G. (1976). Passages: predictable crises in adult life. New York: E.P. Dutton.