ABSTRACT
The patients who concern me here have, like me, had to recognize that, although they now very much want to bear children, they will never do so. They must also recognize that not having children is a consequence of their own psychic realities and the behaviors that these realities generated. Our role as analysts is to mitigate psychological suffering and promote self-understanding and self-acceptance. Yet we are drawn to case reports with fairy tale endings: "When we terminated, Mrs. A was enjoying her work, was sexually responsive to her husband, and was pregnant." In one important respect, such an external fairy tale ending cannot happen for the women I am discussing, as we recognize the biological clock and the ending of possibility; but my experience has been that it is particularly difficult for these women to mitigate their guilt and self-blame. The challenge, then, is to help a woman in this situation to get beyond feeling that her lack of motherhood is her fault and that she has damaged not only herself but others in the process. For the analyst, perhaps particularly if the analyst is a woman whose maternal identity is powerful and who really does feel, deeply and profoundly, that there is no substitute for motherhood (I refer to myself), there are also strong countertransference feelings: it is difficult not to agree with the patient that on some level there is something absolute and irretrievable in her situation.
