Karen horney our inner conflicts pdf

Abstract Many ideas currently circulating in the psychological and psychoanalytic communities have

correspondence with the theories put forth by Karen

Horney during the first half of the twentieth century.

This paper provides an overview of Horney’s theoret-

ical departures from Freud and an introduction to her

then controversial views of motivation and relation-

ship. Compatibility between Horney’s ideas and

attachment theory, self-psychology, intersubjectivity,

and the person in the environment is discussed. Two

clinical cases are presented, illustrating Horney’s the-

ory and approach.

Keywords Karen Horney Æ Theory of neurosis Æ Basic anxiety Æ Neurotic trends Æ Attachment theory Æ Self-psychology

Introduction

The work of Karen Horney, who died 50 years ago, is

remarkably relevant to the problems faced by psy-

chotherapists in the twenty-first century. Anxiety, a

central and organizing theme in her work, is present in

today’s world at a level which would have been

unimaginable to Horney and her contemporaries. Her

recognition of the role of the family in both engen-

dering and mediating anxiety as well as in shaping the

individual’s response to it is today reflected in systems

and developmental theories.

Many of her ideas are not only deeply compatible

with theories currently circulating in schools of psy-

choanalysis, but may also be seen as early versions of

notions thought to be newly emerging in the areas of

motivation, behavior, and development as well as in

the theory and practice of psychoanalytic psychother-

apy. This paper provides an overview of some of

Horney’s fundamental departures from Freudian the-

ory, such as her construct of neurosis and neurotic

strategies and her view of the analyst’s role. In the

contemporary context, I will discuss the ways in which

her thinking is compatible with attachment theory,

self-psychology, intersubjectivity, and the social work

perspective of understanding the person in his

environment. I then will offer some clinical material as

seen through a Horneyan lens.

Social Historical Context

Karen Horney was born in 1885, in Hamburg, Ger-

many, to a Protestant upper middle class family. Her

Norwegian father was a sea captain and a Bible reader.

Her mother was a free-thinking Dutch woman who

encouraged her daughter to pursue medical studies,

still a fairly unusual career for women at that time

(Kelman, 1967). According to Horney’s daughter,

Marianne Eckardt, her mother ‘‘pursued her profes-

sional development with a remarkable sureness of aim.

She knew early in her medical studies that she would

study psychoanalysis’’ (Natterson, 1966, p. 451).

An earlier version of this paper was presented at the 2004 National Meeting of the Committee on Psychoanalysis of the Federation of Societies for Clinical Social Work in New York.

W. B. Smith (&) School of Social Work, University of Southern California, Los Angeles, CA 90089-0411, USA e-mail: wsmith@usc.edu

Clin Soc Work J (2007) 35:57–66

DOI 10.1007/s10615-006-0060-6

123

O R I G I N A L P A P E R

Karen Horney and Psychotherapy in the 21st Century

Wendy B. Smith

Published online: 8 August 2006 � Springer Science+Business Media, Inc. 2006

Horney studied medicine at the universities of

Freiburg, Gottingen, and Berlin and, after entering

analysis with Karl Abraham, became a founding

member of the Berlin Psychoanalytic Institute. In 1932,

Franz Alexander asked her to become Associate

Director of the Chicago Psychoanalytic Institute; she

stayed 2 years before moving to New York and joining

the New York Psychoanalytic Institute. There, her

unorthodox views created controversy, and in 1941 she

was disqualified from teaching at that institute. In the

same year, she founded the American Institute for

Psychoanalysis, serving as its dean until her death.

Nineteenth century science had been based on

closed systems and determinism; it was in this intel-

lectual atmosphere that Freud began to develop his

ideas. The early twentieth century saw the beginning of

shifts toward less tightly structured views in which

degrees of determinism might be recognized and moral

and aesthetic values might have a place (Kelman,

1967). This more open, less concrete way of thinking

informs and, indeed, characterizes some of the differ-

ences I shall outline between Freud’s ideas and those

of Karen Horney.

Horney and Freud

In Freud’s schema, the present can only be understood

in terms of infantile experience. It is determined by the

biological development of the psychosexual structure,

which is molded to some degree by environmental

forces. Human behavior is seen as the result of the

interaction of instinctual and counter instinctual forces

within the person, who has a fixed quantity of energy.

The three structures of the id, the ego, and the super-

ego comprise the person, and neurosis is seen as the

result of conflicts among these three structures (Kel-

man, 1967).

In a major departure from Freud, Horney proposed

that the person was ruled not by the pleasure principle

but by the need for safety (Horney, 1945). She rejected

the idea that the instincts were the source of all moti-

vation; she saw instead a mixture of forces, both

internal and external, at work in creating behavior.

Like Freud, Horney believed that the past is always

contained in the present. Unlike Freud, she viewed

people as conditioned by early experience rather than

fixated at a given point or stage (Paris, 1999a, b). She

focused more on the current character structure than

on infantile experience, and she was particularly

interested in the strategies the person developed and

employed to cope with what she called ‘‘basic anxiety.’’

According to Horney, basic anxiety results when

pathogenic conditions in childhood cause children to

feel unsafe or unloved, leaving them with a sense of

helplessness in a potentially hostile world (Paris, 1999a,

b). Horney advocated a focus on understanding neu-

rotic character structure and defenses in terms of their

current function for the individual. Underlying her

notion of basic anxiety is another fundamental differ-

ence between her view and Freud’s. Freud postulated a

destructive instinct present within us all; Horney be-

lieved that people were not inherently either good or

bad, but could become destructive as a result of neg-

ative environmental circumstances that caused the

constructive forces within them to be blocked. The

defensive strategies that people adopt to fend off

anxiety can and often do eventually become self-

defeating or self-destructive.

Freud emphasized biology as the source of instincts

and therefore of behavior. Since biology is universal,

he assumed that the course of development and the

conflicts among people he observed were likewise

universal. The result of this assumption was an

undervaluing of the important roles played by other

factors such as the immediate environment, the larger

culture, the plasticity of human development, and the

continuation of significant aspects of human develop-

ment past the age of puberty. These other factors are

now much more widely acknowledged as being central

to the course of development.

In contrast to Freud, Horney focuses on the world in

which the child finds him or herself: the family, which is

‘‘the most important component of the child’s envi-

ronment’’ (Horney, 1950, p. 159), peers, and the larger

societal surround. Like such other ‘‘Neo-Freudians’’ as

Fromm and Sullivan, she believed that the drives were

given meaning by interpersonal, social, and cultural

forces rather than the other way around (Eckardt,

1984). Sexual difficulties, in her view, were the result,

rather than the cause of personality disorders.

Feminine Psychology

The impact of culture is perhaps nowhere so clear in

Horney’s departures from Freud as it is in her work on

feminine psychology. Indeed, her collected papers on

this subject were published posthumously in 1967, and

it was this work which returned Horney to the public

eye. These papers were written over a 14-year period

during which her ideas about feminine psychology

evolved and crystallized. As early as 1922, Horney was

beginning to examine and to question the classical

analytic view of women. In 1926, in ‘‘The Flight from

Womanhood,’’ she pointed out that the psychology of

58 Clin Soc Work J (2007) 35:57–66

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women was described from men’s point of view, and as

such, represented ‘‘...a deposit of the desires and dis-

appointments of men’’ (Horney, 1926, p. 56). She no-

ted that women unconsciously yield to these notions

and that it is necessary to ‘‘try to free our minds from

this masculine mode of thought...’’ (p. 59).

I will not review here her exhaustive unpacking of

the logic (or illogic) of the classical view, including

penis envy, as that has occupied many papers and

books in feminist literature over the past three dec-

ades. It is perhaps most important to note that her

conviction that cultural factors exert a powerful influ-

ence on our ideas of gender and development has

passed into mainstream thought, but was radical for

her time. Her comments about ideologies functioning

to reconcile women to subordinate roles by presenting

these roles as innate and unalterable likewise seem

obvious now. Yet Horney was telling us 70 years ago

that women presenting the traits specified by

men—passivity, compliance, masochism, dependency,

for example—are more frequently chosen by men, so

that their erotic chances in life depend on conformity

to the image of what constitutes their ‘‘true nature’’ as

outlined by men (Horney, 1933). While much has

changed in the status and understanding of women

today, one need only glance at the fashion and men’s

magazines on any news stand to see how these classical

conceptions by men of men and women continue to

have pervasive presence and influence in our culture.

Horney’s Theory of Neurosis

Horney believed that each person has a central inner

force which is common to all people, yet possesses

unique character in each individual. This force, she

argues, is the source of growth. She calls this force the

‘‘real self’’ (Horney, 1950, p. 18). Each person needs

both love and friction or frustration in order to develop

healthily. If people in the environment cannot love the

child or ‘‘even conceive of him as the particular indi-

vidual he is,’’ (p. 18), he becomes alienated from his

real self and develops basic anxiety.

All people develop strategies to deal with the envi-

ronment, but in the usual case—in Winnicott’s term the

‘‘good enough’’ environment—these can be flexibly

taken up or discarded according to the situation. In the

child who develops basic anxiety because of a perni-

cious or indifferent environment, strategies become

extreme and rigid, giving rise to internal conflicts be-

tween and among strategies. The child attempts reso-

lution of the conflict by making one strategy

predominate, usually to his or her detriment.

I shall describe the strategies or solutions in some

detail, both to convey the power and applicability of

the model and to set the stage for discussing the rela-

tionship of the model to other current theories, and

eventually, to the clinical examples that follow. First,

however, an introduction to Horney’s view of the self

will provide a foundation.

Horney’s Conception of the Self

Horney conceptualizes three versions of the self: real,

ideal, and actual. The real self (see above) refers to the

panoply of possibilities existing within each person,

including temperament, talents, capacities, and pre-

dispositions. This is the self that is the source of values,

a healthy conscience, and a sense of vitality. The real

self, which is a ‘‘possible self,’’ cannot develop fully

without a positive environment (Horney, 1950; Paris,

1999a).

The ideal self arises in response to the anxiety

generated by a problematic environment. The child

becomes alienated from his/her real self when it does

not evoke sufficiently positive or growth-affirming

responses from significant others. He/she attempts to

address feelings of isolation and/or hostility via a

fantasied idealized self that holds the imagined

promise of a felt positive identity and the satisfaction

of inner needs for security and safety. Energies are

shifted from true self-realization to the aim of actu-

alizing the idealized self, which of course, cannot be

actualized and is therefore an ‘‘impossible self.’’

Horney refers to the pursuit of the ideal self as ‘‘the

search for glory.’’ That search involves the need for

perfection, neurotic ambition, and, often, the need for

vindictive triumph (Horney, 1950). It is important to

note that the ideal self also contains the despised self

who cannot live up to the fantasied and impossible

expectations.

The despised self or image results from failure to

meet the exaggerated compensatory demands of the

idealized self. Self-hatred is the rage of the idealized

self toward the actual self for not being what it

‘‘should’’ be. Horney’s concept of the ‘‘tyranny of the

should’’ (Horney, 1950), describes the powerful need

to live up to a grandiose self-conception, thereby

avoiding the unbearable awareness of helplessness and

weakness in a hostile or indifferent world. Thus, the

‘‘shoulds’’ are often extreme, as in ‘‘I should always be

understanding of others,’’ or ‘‘I should never feel hurt

by others.’’

Finally, the actual self is the mixture of strengths and

weaknesses, strategies and strivings that describe the

Clin Soc Work J (2007) 35:57–66 59

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person’s current being in the world. In a good situation,

the real and actual selves are close to each other; in a

less positive situation, great disparities exist between

the two (Paris, 1999a).

Horney’s Schema of the Neurotic Trends

The neurotic trends are the ad hoc strategies we all

have at our disposal to cope with the worlds we find.

Each strategy has a different emphasis, and all are

present as potentials. The neurotic individual is unable

to use them in flexible and situation-specific ways. Each

basic attitude has a positive, as well as a negative value

(Horney, 1945).

The first strategy is moving toward people; it

emphasizes compliance and helplessness. The individ-

ual wants to be liked, wanted, accepted, protected, and

has an insatiable need to feel safe. Self-sacrifice may be

involved. The positive value here lies in the capacity to

create a friendly relationship to the outside world.

The second strategy, moving against people,

emphasizes hostility and aggression. Life is seen here

as a struggle of one against all; the individual has a

need to control others, possibly to excel and to win

recognition. This person chokes off feelings for the

sake of expediency and must fight the softer feelings

within. As with the person who moves toward people,

however, the center of gravity lies outside oneself. The

positive side of this strategy is that it enables the per-

son to equip him/herself for survival in a competitive

society.

The third and last strategy is that of moving away

from people, with an emphasis on isolation. This

strategy addresses the desire for independence and

self-sufficiency. The person becomes neurotically de-

tached and attempts to prevent anyone or anything

from mattering. The positive value here is that the

individual may attain integrity and serenity in a dis-

turbing world.

These were the versions of the three basic strategies

delineated by Horney in 1945 in Our Inner Conflicts. In

1950, she published Neurosis and Human Growth, in

which she further elaborated and fleshed out each of

the neurotic solutions.

In the later elaboration, moving toward people was

described as the ‘‘self-effacing solution,’’ involving the

appeal of love. The idealized self in this case glorifies

suffering and martyrdom, and in the extreme, leads to

a morbidly dependent relation to others. Moving

against people was called the ‘‘expansive solution’’ and

its main appeal was the sense of mastery. The idealized

self here is superior, grandiose; it requires admiration.

Finally, moving away from people was described as

‘‘resignation;’’ a sense of freedom is its goal. Horney

saw this as the most radical solution to conflict because

it restricts life and growth most severely. In every

individual, all trends are present; in neurotics, one

trend predominates in a self-destructive way.

This truncated overview of some of the main points

of Horney’s theory of neurosis shows evidence of

compatibility with both self-psychology and attach-

ment theory. At least two other writers have noted

these affinities, as described in the following sections.

Horney and Kohut

In 1988, Jack Danielian published a fairly thorough-

going analysis of the differences and similarities be-

tween Kohut and Horney (Danielian, 1988). He points

to the ‘‘remarkable resemblance’’ between Horney’s

trends and the three selfobject transferences of ideal-

izing, mirroring, and twinship. The wish to merge with

the idealized parent or analyst selfobject is much like

the compliant or self-effacing solution. The mirroring

transference, in which the grandiose-exhibitionistic self

is mobilized, is comparable to the expansive solution.

And the twinship/alter ego transference, requiring ego

alikeness and conveying a sense of anonymity in the

midst of loneliness, has elements of the solution of

resignation.

Danielian also highlights the similarity between

Kohut’s concept of empathic immersion (as an appli-

cation of vicarious introspection) and Horney’s view

that the analyst must embody ‘‘wholeheartedness’’ in

his approach to the patient. I will discuss this further in

a section below on the analyst’s role. Both Kohut and

Horney recognize self-healing or curative forces within

the human psyche, but where Horney suggests that

once obstructions to self-realization have been dimin-

ished, growth can and will continue, Kohut returns to a

‘‘mechanistic meta-psychology, namely that the child

does not grow by unfolding his potentialities, but ra-

ther by internalizing external qualities’’ (Danielian,

1988, p. 12). Another difference between the two is

that Horney’s theory is conflict-based, whereas Kohut’s

is a deficit model in which there must be restoration or

structure-building, as opposed to resolution of conflict.

Horney and Attachment Theory

Attachment theory is increasingly in the foreground of

psychological and psychoanalytic thinking. It draws on

ethology, evolution theory, cognitive psychology, and

60 Clin Soc Work J (2007) 35:57–66

123

object relations theory, and it emphasizes the primary

status and biological functions of the intimate emo-

tional bonds between people from birth forward. As I

have noted, Karen Horney also accorded centrality to

human relationships, especially those in the family, as

fundamental shapers of motivation, behavior and, in-

deed, character structure. An ethological basis can be

seen for her formulation of the strategies of aggression,

withdrawal, and compliance, which are as noted by

Paris (1994) complex human versions of the basic

mechanisms of defense in the animal kingdom: fight,

flight, and submission.

Attachment theory suggests that individuals orga-

nize their behavior and their self and world views

(internal representations) in relation to their experi-

ence of the early caregivers in their lives. These char-

acteristic views and behaviors become enduring and

have continuity. Like Horney’s trends or solutions,

they tend to lose flexibility: in both theories, what be-

gins as an adaptive response becomes a characteristic

of the person.

It is true that Horney, whose theories emerged from

her clinical observations, observed adult neurotics,

whereas attachment theory grew out of observations of

infants and their caregivers. Interestingly, the strate-

gies described in both theories have remarkable cor-

respondence, and in both, the goal of the strategy is

security. In both systems, healthy development de-

pends on the ability to use the full range of strategies.

In attachment theory, this translates as being able to

use the secure base and being able to explore the

environment apart from the base (Feiring, 1983).

The child with a secure attachment (Group B in the

literature) may belong to any of four subtypes, from

those with most ability to explore and least need for

proximity to those needing the most proximity and

having least ability to explore comfortably. Although

most of the securely attached would not be considered

neurotic in Horney’s schema, this last group at the

edge of the range and moving toward being overly

compliant might be close to demonstrating a self-

effacing solution.

Group C, those with anxious resistant attachments,

sound much like individuals who employ Horney’s

expansive solutions—that is, moving against people.

They are ambivalent about the caregiver, distressed by

separation, and yet not comforted by contact. They

may be hostile and controlling, and are conflicted in

their longings.

Group A, those with avoidant attachments, are

clearly similar to Horney’s solution of detached resig-

nation. They avoid proximity or interaction with the

caregiver, exploring the world, but moving away from

people. They expect little from others, choosing to

avoid conflict rather than to experience or resolve it.

What might we say about Group D, those with a

disorganized, disoriented attachment pattern, in rela-

tion to Horney’s model? The attachment theorists re-

gard these as individuals who cannot develop a

coherent strategy (Main & Solomon, 1985), so no one

strategy can be said to predominate. Unable to use any

of the strategies successfully, they can find no real

solution. They can neither form relationships, nor

avoid them entirely. They may be hypervigilant and

compulsively compliant, so in some senses self-efface-

ment may be dominant, yet avoidance and attempts to

be invisible interrupt these behaviors. Such people

probably cannot construct an ideal self in any direction:

they flail.

Horney and Psychotherapy

However contemporary her understanding of the

interpersonal and intrapsychic underpinnings of human

behavior, Horney’s views on the psychotherapeutic

enterprise are no less so. Her conception of the ther-

apeutic relationship and the analyst’s role within it are

so compatible with current intersubjective and rela-

tional views as to make one wonder why she is not

taught and spoken of regularly and with respect today

in training institutions.

Horney’s ideas about therapy were based on her

understanding of the cultural/interpersonal contribu-

tions to neurosis, the continuing nature of develop-

ment, and the nature and functions of the patient’s

current defensive strategies as displayed in the inter-

action with the therapist. The purpose of therapy, she

suggested, was to lessen the patient’s anxiety to the

extent that he or she is able to give up the neurotic

trends and abandon the drive to actualize the idealized

self, thus permitting further self-realization and growth

to take place (Paris, 1999b).

She placed great importance on self-realization and

growth. Freud had emphasized the removal of neurotic

symptoms and increasing the capacity for enjoyment

and work. Sullivan’s goal was to help the patient to

establish good human relationships. Horney added to

these the improvement of relations not only with oth-

ers but also with the self, as well as greater freedom,

inner independence, and self-realization in every way

(Horney, 1956a).

The patient’s motivation—the desire to suffer less

and to unfold one’s true potential—is crucial: the

therapist must foster the patient’s initiative and

resourcefulness in an ‘‘exquisitely cooperative enter-

Clin Soc Work J (2007) 35:57–66 61

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prise’’ (Horney, 1946 in Paris, 1999b). The patient’s

tasks are to express him/herself as completely as pos-

sible, to become aware of unconscious driving forces

and their effects, and to change those patterns of

behavior that disturb the patient and others (Paris,

1999b). The unconscious forces, in a Horneyan sense,

have less to do with repressed drives from early

childhood, and much more to do with conflicts between

neurotic trends pressing for dominance (Paris, 1994).

Transference and countertransference likewise arise

from and are expressions of character structure and, as

such, can provide insight into the nature of the person’s

defenses and conflicts (Horney, 1939). Symptoms are

seen as arising from the character neurosis, which is the

focus of attention and treatment (M.H. Eckardt,

unpublished).

Horney describes the therapist’s tasks as observa-

tion, understanding, interpretation, help with resis-

tances, and something called ‘‘general human help,’’ a

phrase that refers to an attitude of friendliness and

serious interest that helps the patient to regard his/her

own growth as important and to accept his/her less

than perfect self (Paris, 1999b, p. 80). Horney includes

interpretation as an analytic task, but she is referring

more to the interpretation of the unconscious aspects

of the neurotic character or patterns than to interpre-

tation of transference or dreams, which are rarely

mentioned (M.H. Eckardt, unpublished).

In a paper entitled ‘‘What Does the Analyst Do?’’

(Horney, 1946 in Paris, 1999b), Horney comments on

the analyst’s stance in a way that can only have been

revolutionary at the time and provides a dramatic

illustration of her ability to think outside the analytic

box. She describes the special nature of the analyst’s

attention: it must be wholehearted. ‘‘...It can be pro-

ductive only if he enters into the task completely and

without reservation... letting his own emotional reac-

tions come into play.’’ She goes on to argue that ana-

lysts should not try to suppress their emotions because

they play an important role in the therapeutic process;

indeed, analysts’ feelings are ‘‘the most alive part’’ of

themselves (p. 98). This is quite a different picture

from the so-called ‘‘blank screen’’ and sounds much

more like contemporary relational analysts.

There is, today, greater attention to affect, in both

patient and analyst, than there was when Horney lived

and wrote. Yet she includes affect explicitly in her

description of the analyst’s role, discussing it as an

aspect of optimal analytic behavior. Perhaps this re-

flected an implicit recognition of the need for full or

complete participation by both members of the dyad if

therapeutic healing is to occur.

Horney defined understanding as a ‘‘process of

moving toward another person’s position while still

maintaining our own’’ (Horney, 1956b). This suggests

that the analyst, in the optimal situation, is able to

‘‘feel into’’ the other person with all of his/her own self

(p. 199). She might be regarded as a conservative in-

tersubjectivist in that she clearly acknowledges the

presence, importance, and irreducibility of the two

subjectivities in the room; yet, for her they remain

separate. A more radical intersubjective view assumes

a continuously coconstructed reality—one in which,

while the analyst’s subjectivity is subordinated to the

needs of the patient, there is always some measure of

contribution by both, instead of an immersion by only

one party, the analyst, into the patient’s reality.

Case examples from a Horneyan Perspective

Case #1: Ms. H

When she came for treatment, Ms. H was a single, 26-

year-old woman of English and Scottish descent. She

grew up in a middle-class suburb of San Diego and

moved to Los Angeles in her early twenties to pursue a

retail business opportunity. She was a middle child and

only girl, with a brother 9 months older and a brother

1 year younger. Ms. H was a strikingly attractive young

woman of above-average intelligence who finished

1 year of college before deciding it was not for her. She

was successfully working in a retail business with plans

to open a business of her own in the future.

Ms. H’s reasons for seeking treatment were problems

in a love relationship, lack of self-confidence, difficulty

with confrontation, family issues, and intense negative

feelings about her own body. I saw her for 3 years,

initially twice a week and then three times per week.

Ms. H’s mother, described as immature and mer-

curial in mood, was divorced when Ms. H was 5 years

old. Her father sought the divorce; the mother was

both devastated and enraged. She remarried 3 years

later, but her bitter competitiveness with her ex-hus-

band regarding the affections of the three children

continued. Father had an active social life until he

remarried 10 years later; during his single years, he was

an inattentive and erratic parent.

Stepfather, by contrast, was deeply but destructively

involved with the children, on the one hand spending

enjoyable time with them, and on the other, physically

and verbally abusing the boys, and sexually abusing

Ms. H from the time she was 8 until he and her mother

divorced when Ms. H was 13. Mother remarried twice,

62 Clin Soc Work J (2007) 35:57–66

123

and had at least two other engagements. She was

preoccupied with her love relationships or depressed

and isolated in her room, on one occasion overdosing

on pills while the children were in the house. Between

men, she could be a sporadically involved or demon-

strative mother, but more frequently was angry,

unhappy, or simply not present. When in their mid-

teens, the children chose to live with their father and

his new wife. Mother fought this in court and lost.

Following the change of custody, mother refused all

contact with the children for years.

During childhood and early adolescence, Ms. H

successfully repressed awareness of her stepfather’s

molestation of her; after moving to her father’s home,

however, troubling dreams led to the therapy that re-

sulted in a report to the authorities. The stepfather was

fired from his job, but the case was not prosecuted, as

Ms. H’s mother stated she would be a hostile witness.

The police told my patient it would be a matter of her

word against his and was likely to be a very difficult

experience.

As an infant, Ms. H entered a problematic world.

She had two siblings so close in age that her mother

barely had time to recover from one pregnancy and

childbirth before the next, and none of the children had

a period of being alone with her. That marriage was

unhappy, and it ended unhappily. It is likely that the

needs of three very small children overwhelmed the

recently divorced mother. The ‘‘basic anxiety’’ of Ms.

H’s life was intense from the moment of birth, perhaps

from conception. What gifts she had could not possibly

blossom in an environment in which, in Horney’s

terms, her parents were too wrapped up in their own

neuroses to love her or even to conceive of her as the

person she was (Horney, 1950). In addition, her step-

father, experienced by her as the most attentive of her

parents, invaded and abused her over a period of years.

What was Ms. H’s ‘‘solution’’ to the powerful anxi-

eties generated by the circumstances of her childhood?

What became of her ‘‘real self’’? It is unlikely that she

had the requisite space and care to begin the devel-

opment of her real self in early childhood. The lack of a

dependable source of care and response compromised

her development from the outset. She could not begin

to construct any confidence, in herself or in others, and

the world must have seemed indifferent at best. It

would soon become hostile and dangerous.

Ms. H was encouraged early on to concentrate on

her feminine and body attributes. Her appearance was

the aspect of her that her mother, father, and stepfa-

ther paid most attention to, and was, in fact, what

differentiated her from her brothers. She was con-

stantly reinforced for her cuteness, prettiness and later

her lovely skin and body. Stepfather told her, even as

he made use of her, ‘‘Your mother is jealous of your

body.’’ This was both exhilarating and alarming, pro-

viding fertile ground for the development of her own

body preoccupations. A strong component of Ms. H’s

idealized self has to do with bodily perfection and the

striving to obtain it through exercise and diet. Horney

(1950) points out that the difference between healthy

strivings and neurotic drives for glory is the difference

between spontaneity and compulsion, between wanting

to and having to.

We can see in Ms. H the presence of all three of the

Horneyan strategies—moving toward, moving against,

and moving away from people. Her predominating

strategy is the ‘‘self-effacing solution,’’ or compliance

and moving toward. Her longing for love and protec-

tion are expressed in her attempts to please the sig-

nificant others in both her early and current life. She

has difficulty with assertiveness and aggression; prob-

lems with confrontation had been one of her expressed

presenting problems.

Her relationships with men are characterized by the

attention she and they pay to her idealized self—if she

looks perfect enough, the man will/does love her, and

she feels confident and worthwhile. If she does not look

good enough, she feels guilty, inferior, or contemptible.

It is worth noting that what she regards as her out-of-

shape self would look to anyone else like a physical self

to be admired.

There are also elements of withdrawal and resigna-

tion, or moving away. Ms. H struggles with a tendency

to self-isolate, spending many weekends alone in her

apartment, avoiding social contact. The idea of not

needing or depending on anyone is appealing to her, as

her disappointments have been manifold. She similarly

fears investing herself in new achievements; she be-

haves as if she can protect herself from pain only by

avoiding longing for anyone or anything. This repre-

sents a further restriction of her real self in favor of a

desired totally self-sufficient self.

Traces of the expansive solution are less apparent,

but may make more of an appearance as Ms. H’s angry

feelings emerge more fully. The neglect and brutality

of some of her childhood experiences are bound to

have engendered considerable rage. Her femaleness is

bound up with interpenetrating strategies as well, in

that it was a source of inferiority (to her brothers) and

vulnerability as well as a source of potential perfection

and power. Ms. H provides a good illustration of

Horney’s view that the familial and cultural views

of gender play crucial roles in determining the meaning

of sex, one’s sexual equipment, one’s sexual role. Ms.

H reported wanting a penis when she was little; in her

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family, being a boy looked safer and freer. It would

have protected her from the way in which she was

defined and exploited. At the same time, she feels that

being female is her most important advantage.

The Horneyan therapeutic goals with Ms. H would

involve reducing the anxiety over safety and security so

that she can relinquish her compulsive focus on bodily

perfection as a substitute source of security. Because

her self-effacing trends (longing for love via compli-

ance) are in conflict with her expansive trends (longing

for mastery via grandiose triumphs), the expansive and

aggressive aspects have been subordinated. The

reduction of the need to quash all aggressive feelings

should permit a less rigid reliance on self-effacement.

The relaxation of the drive to actualize her idealized

self through physical perfection could make room for

her real self to emerge and unfold, in turn allowing for

the development of goals and relationships that reflect

her inner longings and abilities rather than more rigidly

adopted stereotypically feminine behaviors and modes.

Her human relations might then evolve more flexibly

so that they can comfortably include aggressive as well

as compliant aspects.

In the relationship with me, there was an unavowed

idealizing transference, tempered by fears of depen-

dency and disappointment. In Horneyan terms, my

impression was that Ms. H tried to be motionless in the

transference—moving neither toward nor away, and

certainly not against me. It was as if she were holding

herself as still as she could, watching me carefully

without seeming to watch—perhaps not even allowing

herself to know she was watching. In early life, she had

known no truly benign yet caring figures; it is unlikely

that she could conceive of me other than as an ideal-

ized fantasy of the perfect mother. On occasions when

I attempted to take this up, Ms. H could respond only

minimally; she seemed to need me not to be too real a

person.

In a lecture on ‘‘The Quality of the Analyst’s

Attention’’ (Horney, 1959), Horney gives us a pierc-

ingly sensitive admonition—one that has general

application and that in the case of Ms. H has special

relevance: ‘‘We must be careful not to let the intensity

of our attention convert a mutual analytic situation

into one where the patient is in the brilliant spotlight

on a clinical stage while we are in the darkened audi-

ence. With both of us sharing more subdued light in the

same room, we can become more open and real to one

another’’ (p. 189). A more muted exchange, necessi-

tated by Ms. H’s understandable wariness, may have

led to the problems I shall describe.

At the time I wrote (and presented) an earlier ver-

sion of the paper, Ms. H was deeply engaged in the

treatment. Some months later, Ms. H changed jobs and

reduced the frequency of her appointments to two

sessions/week because of her new work schedule. After

several months at this job, Ms. H decided to change

careers, from retail sales to becoming a physical trai-

ner, again an indication of the high valuation of the

body and its appearance and properties. As the train-

ing required was costly, she moved in with a friend’s

family in an informal au pair arrangement. The family

lived much of the time in a community some distance

away; Ms. H withdrew even further from therapy,

coming in only once each week, and eventually dis-

continuing altogether.

Ms. H’s departure from therapy was both more

complicated, and from my point of view, more pre-

cipitous, than these facts suggest. During the course of

the therapy, Ms. H had explored and experimented

with her relationship with her mother. When she began

therapy, there had been no contact for many years;

about 1 year into the therapy she made telephone

contact, and followed that with sporadic additional

phone calls, many of which were disappointing to her

because of her mother’s substantial self-involvement.

Her mother wanted very much to have a photograph of

her, yet showed no real desire to actually meet or be

with her. The pain of her mother’s preoccupations

during early life reverberated again. I too had a pow-

erful reaction to her mother’s renewed, but apparently

limited interest in a real relationship with her, and

probably unconsciously conveyed to her my own sense

of disappointment and anger, putting more psycho-

logical burden on her.

Horney believed that repressed hostility was the

early affect which we most fear and most need to con-

tact (Paris, 1994). Ms. H’s rage, which emerged pow-

erfully in her dreams, had begun to surface more

consciously during the last year of her treatment.

Shortly before discontinuing therapy, Ms. H had what

she described as a ‘‘wonderful’’ telephone conversation

with her mother, in which they were able to talk openly

about some of the events of Ms. H’s childhood and

adolescence. She then told me, with considerable anger,

that I had failed to push her strongly enough to rec-

oncile with her mother. Indeed, I had not pushed in this

direction. I had told myself that this was a path which

must be traveled as it unfolded and that I could not/

should not influence it. After the fact I could recognize

that not doing something is also a way of influencing

events and behavior. It is likely that my unspoken dis-

approval of her mother’s abandonment did play an

unrecognized part in the intersubjective unfolding of

events. While I may have internally, as Horney sug-

gests, been letting my ‘‘own emotional reactions come

64 Clin Soc Work J (2007) 35:57–66

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into play’’ (Horney, 1946 in Paris, 1999b), I had not

fully recognized what they were and how they might be

entering into the encounter. As a result, Ms. H may

have felt me to be inattentive to her true needs and

feelings, much as her mother had been. She may have

fled from me much as she fled her mother at age 16.

In Horneyan terms, the compliant solution had

weakened its neurotic grip enough to make way for her

repressed aggression, which now rose to the fore. In a

more grandiose state perhaps, she no longer needed

me and could be in control of our situation. Unfortu-

nately, the work was interrupted before the events and

responses could be analyzed and understood, and a

true flexibility of responses achieved.

Case #2: Mr. Y

Mr. Y, a 40-year-old accountant, came in for couples

therapy with Ms. X, his live-in girlfriend of 5 years who

had been in treatment with another therapist for many

years. His girlfriend’s real wish was that Mr. Y have

individual therapy, but while he was (barely) willing to

have couples therapy, he had no desire at all to come

on his own. I saw the couple weekly for several months.

When their relationship had begun, both had needed

considerable distance. Ms. X had progressed in her

own therapy and development to the point where she

longed for greater communication and closeness, but

Mr. Y was as closed off as he had always been and their

lives were more parallel than emotionally interwoven.

In the joint sessions, Ms. X spoke at length about her

feelings, but Mr. Y was almost completely unable to do

so. She could not tolerate the snail-like pace of the

conjoint therapy and wished Mr. Y to continue on his

own. Despite deep ambivalence, Mr. Y correctly

sensed that his relationship with her depended on his

doing this, and so he began individual therapy.

After the first few months of individual sessions,

during which Mr. Y related to me in a most guarded

fashion, he began to open up, remembering and

speaking about intensely painful and isolating experi-

ences of his childhood for the very first time in his life.

Mr. Y was the youngest, by several years, of four

children from a depressed industrial town in the Pacific

Northwest. Both parents were alcoholics, and an older

sister who also became alcoholic committed suicide

when Mr. Y was a young adult. The family was poor,

requiring welfare at times, and marginal at best. Family

life was chaotic and emotionally barren. Mr. Y’s par-

ents fought frequently and violently, and divorced

when Mr. Y was in junior high school. After the di-

vorce, contact with father was sporadic and, when it did

occur, had a dead quality. Mr. Y’s mother remarried,

but her alcoholism and resulting arguments continued

in the new marriage. The stepfather was somewhat

more available to Mr. Y than his own father had been.

Due to the unpredictable and highly charged

atmosphere at home, Mr. Y’s siblings were out as often

as possible, and all three left home by late adolescence.

Mr. Y recalls a childhood lived largely by himself, ei-

ther at home alone while parents were out drinking or

lying still in his room, hoping they would not fight. He

spent his adolescence experimenting with drugs, up to

and including IV drugs. His one great strength was his

intelligence, and he resolved to leave home and attend

college—the only member of his family to do so.

Mr. Y provides a poignant example of the strategy

of withdrawal from the battlefield of human emotions

and relations. Though he maintained formal social and

work relations, he never spoke of his feelings to other

people. He wanted neither to be touched nor to touch

others, and cultivated as much detachment as he could.

His relationship with Ms. X had been possible for him

only because she too had been incapable of intimacy

when he met her. The couple shared a house and social

engagements, but nothing else—not money, not meals,

not communication, very little sex.

Mr. Y’s idealized self was one that needed no one

and never felt anything. He tried not to be aware of his

own conflicts, and concerned himself as entirely as

possible with material things. He focused on cars,

sports, recreational activities, did a fair amount of

drinking, and had the most minimal contact with family

members.

A conflicting trend for Mr. Y, however, is moving

against people—he would be deeply troubled at mo-

ments when he felt the surfacing of the rage and hos-

tility within. This occurred in traffic, sometimes at

work, occasionally in relationship to Ms. X. Indeed,

Mr. Y’s deep anger, and his fear of exploding unpre-

dictably and uncontrollably as people in his family so

often did, contend powerfully with his longing to feel

nothing.

The squelching of the more expansive angry trends

resulted, in the treatment, in the tight, flat quality of

relating that so frustrated his girlfriend. It was only

marginally less frustrating in the consulting room. His

early transference to me was indicative of both avoi-

dant and combative trends. Sometimes he appeared to

feel utterly neutral, while I struggled to locate some

affect in the room. At these times I felt it was all I

could do to maintain some feeling of connectedness to

Mr. Y. At other times, it seemed as if he experienced

me as an enemy at the gate, threatening to attack him.

In both modes, the atmosphere was deadening,

reflecting his need to render the environment less

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dangerous to him. For me, the struggle was between

fully experiencing the deadness (surrendering to or

weathering it) and provoking some contact just to feel

more alive in the room.

After some months, he began to arrive in a more

open state, having thought about something he actually

wanted to talk about. His basic anxiety had diminished

to the point where I could be experienced as a benign

presence who would maintain an even and predictable

attentiveness to his process. In his relationship with

Ms. X, who of course has an agenda and needs of her

own, his comfort in sharing has come much more

slowly. The couple shares more time and more varied

mutual experiences than when they first came to see

me, and Mr. Y has developed greater range of feeling

and expression. He now welcomes his awareness of his

inner state, where before he tried to be as far removed

from it as possible.

Conclusion

There are many alternative ways to describe both Ms.

H and Mr. Y psychologically: one might speak of

internalized bad objects and the compromises neces-

sitated by the unavoidable splitting, managing, and/or

projecting of these internalizations. One could discuss

the anxious attachment resulting from Ms. H’s early

mother–infant experiences or the avoidant attachment

pattern of Mr. Y. One could discuss the selfobject

functions desperately needed by Ms. H, and the ide-

alizing transference, followed by the devaluing trans-

ference which accompanied her exit from treatment.

Certainly, one could discuss Mr. Y’s problems in affect

regulation, and the sparsity of his internal life.

What Karen Horney offers us is a glowingly human

set of constructs—constructs that allow us to situate

our patients in relation to their inner and outer worlds

within a positive, growth-minded and open system. Her

conception of the person affords the individual his or

her unique, even if yet unrealized qualities, while rec-

ognizing the more common ways in which people ar-

range themselves to accommodate otherwise shattering

experiences in early life.