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An Exploration of How Childlessness and the Decision An Exploration of How Childlessness and the Decision Whether to Become a Parent is Understood by Psychoanalytic Practitioners By Sheila Marie O’Sullivan A Thesis submitted for the Degree of PhD Department of Psychoanalytic Studies University of Essex 2016 1 ABSTRACT Voluntary childlessness (VC) is a growing phenomenon in the 21 st Century in western societies with the Office of National Statistics (ONS) in 2013 showing that one-fifth of women are childless at the age of 45. Sociological literature highlights how VC is a complex, multifaceted phenomenon and is often difficult to define. However, since its inception, psychoanalysis has made an inextricable link between femininity and motherhood thus psychoanalytic theory views motherhood as normative and it is often seen as a developmental stage. This thesis explores how psychoanalytic practitioners understand, conceptualise and respond to VC in the clinical setting. Four psychoanalytical practitioners were interviewed and three main themes arose as a result of the Interpretative Phenomenological Analysis (IPA) of the data collected. The first finding highlighted the biopsychosocial pressures that the participants felt their patients experienced. Some participants spoke of the professional pressure they experienced from within the psychoanalytic field as a result of the theory that links motherhood and femininity. The second finding highlighted the ethical dilemmas faced by some patients with regards to whether to become a mother, such as a VC choice might be the result of difficult childhoods, immaturity, or because their mental health issues precluded them from motherhood or they feared motherhood might induce mental illness. The final finding highlighted that working with childless patients was both complex and conflictual. The practitioners discussed both their personal professional responses to childlessness in general. This research is important for highlighting how psychoanalytical practitioners are influenced by the competing discourses in society surrounding motherhood. Finally, the thesis critically evaluates the research, makes suggestions for future enquiries and reflects on the clinical implications of the findings. 2 CONTENTS PAGE Chapter 1 – Introduction 1.1 The Starting Point 7-11 1.2 Research aim and question 12 1.3 Outline of thesis 13-16 Chapter Two – Critical Literature Review 2.1 Introduction 17-20 2.2 Psychoanalytic Explanations of Voluntary Childlessness in 20 Women 2.2.1.Psychosexual development 20-21 2.2.2 A Woman’s Desire for a Penis 21-28 2.2.3 Parenthood as a developmental stage 28-30 2.2.4 Why do Women Choose to be Childless? 30-32 2.2.5 Alternative Forms of Female Expression: the 32-34 Womb as a Symbolic Space 2.2.6 Maternal Ambivalence 34-35 2.2.7 The Influence of the Mother on Voluntary 35-36 Childless Women 2.2.8 The role of the father 36 2.3 The stigmatisation of the voluntary childless 37-38 2.4 Motherhood, childlessness and countertransference 38-40 2.5 Contributions from psychologists, psychotherapists and 40-43 health professionals 2.6 Sociological perspectives on Voluntary Childlessness in Women 2.6.1 Introduction 43 2.6.2 The influence of cultural discourse and 44-48 Pronatalism 2.6.3 Reasons for childlessness from a sociological 48-50 perspective 2.6.4 Characteristics of childless marriages 51-52 2.6.5 Managing stigmatization 52-56 2.7 Feminist perspective on voluntary childlessness in women 56 2.7.1 Feminist criticism of psychoanalysis 56-57 2.7.2 Childlessness and postmodernity 57-58 2.8 Conclusion 58-60 2.9. Research Question and aims 60-61 3 Chapter Three - Methods and Methodology 3.1 Introduction 62 3.2 Production of knowledge 63 3.3 Qualitative research 63-64 3.3.1 Overview of qualitative research in psychotherapy 64-65 3.3.2 Different types of qualitative research 65 3.3.3 Discourse Analysis 65-67 3.3.4 Grounded theory 67-69 3.4 Psychoanalytic Research 69-74 3.5 Similarities and differences between Psychoanalytic 74-76 research and IPA 3.6 Interpretative Phenomenological Analysis (IPA) 76-77 3.6.1 The theoretical underpinnings of IPA 77 3.6.2 Hermeneutics 77-79 3.6.3 Philosophical underpinnings of IPA 79-81 3.7 Researcher’s Position 81-87 3.8 Research Design 87 3.8.1 Ethical approval 87-88 3.8.2 Pilot Study 88-89 3.8.3 Procedures and participant selection 89-90 3.8.4 Sample characteristics 91 3.8.5 Preparation and design of the Interview 91-92 3.8.6 Data Analysis 92 3.8.7 Table of master themes 93 3.8 8.Ensuring Quality, validity and rigour 93-97 3.9 Conclusion 97-98 Chapter four - superordinate theme one - Biopsychosocial and professional Pressure 4.1 Introduction 99-100 4.2 Findings – Subordinate theme 1 – The Biological Urge 100-105 4.3 Myth of maternity and social expectations 105-116 4.4 Discussion 4.4.1 The biological urge 116-121 4.4.2 Implications for practice 121 4.4.3 Myth of Maternity and social and professional expectations 122-131 4.4.4 Implications for practice 132 4.5 Conclusion 132-137 4 Chapter five – superordinate theme two - Ethical Dilemmas and Fitness to Parent 5.1 Introduction 138-139 5.2 Findings 5.2.1 Subordinate theme one - The terrible dilemmas of having 139-145 a genetic illness 5.2.2 Subordinate theme two - VC and IVC is a result of having 145-158 difficult childhood experiences 5.2.3 Subordinate theme three - Some individuals are too 158-167 psychologically immature to become parents 5.2.4 Subordinate theme four - Mental health problems render 167-172 some individuals unfit to parent 5.3 Discussion 5.3.1 Subordinate theme one – The terrible dilemmas of having 172-179 a genetic illness 5.3.2 Implications for practice 179-181 5.3.3 Subordinate theme two - VC and IVC is a result of having 178-185 difficult childhood experiences 185-190 5.3.4 Implications for practice 5.3.5 Subordinate theme three - Some individuals are too 190-203 psychologically immature to become parents 5.3.6 Implications for practice 203-208 5.3.6 Subordinate theme four - mental illness and fitness to 208-213 parent debate 5.3.7 Implications for practice 213-215 5.4 Conclusion 215-220 Chapter six - Superordinate theme three - Working with Childlessness is Complex and Conflictual. 6.1 Introduction 221-222 6.2 Findings 6.2.1 Subordinate theme one – the practitioner’s role is complex 223-233 and the need to attune to the patients’ unconscious. 6.2.2 Subordinate theme two - Personal views versus 233-239 professional views 6.2.3 Subordinate theme three – Managing countertransference 239-242 6.3 Discussion 6.3.1 Subordinate theme one - Working with Childlessness is 242-250 complex and conflicting 5 6.3.2 Implications for practice 251-254 6.3.3 Subordinate theme two - The personal self and the 255-257 professional self. 6.3.4 Implications for practice 257-258 6.3.5 Subordinate theme three – Understanding 258-263 countertransference and managing counter-reaction 6.3.6 Implications for practice 263-264 6.4 Conclusion 265-268 Chapter seven – Conclusion 7.1 Introduction 269 7.2 Research question 269-272 7.3 Subsidiary question 272-274 7.4 Aims 274-276 7.5 Summary of findings 276-277 7.6 Contributions to knowledge 277-279 7.7 Implications of findings 279-283 7.8 Quality, validity and rigour 283-286 7.9 Critical reflections 286-292 7.10 Suggestions for future research 292-293 7.11 The End Note 294 6 An Exploration of How Childlessness and the Decision Whether to Become a Parent is Understood by Psychoanalytic Practitioners CHAPTER ONE – INTRODUCTION 1.1 The starting point The primary question of this thesis is to explore how psychoanalytic practitioners understand, conceptualise and respond to voluntary childlessness (VC) in the clinical setting. This research has been carried out from an Interpretative Phenomenological Analysis (IPA) perspective and it is the first thesis at the time of submission that focuses on how psychoanalytic practitioners make meaning of VC in the clinical setting. There are a very small number of IPA studies into VC from a psychological perspective, however there is more sociological literature to be found on this subject. The origins of this thesis were as a result of my own life experiences as a psychotherapist and as an involuntarily childless (IVC) woman. In my clinical practice clients were presenting with difficulties in coming to terms with a diagnosis of infertility, but there were also women who had not made a conscious decision about whether or not to have children. Neither did they feel under pressure with the ‘ticking of the biological clock’. The process of trying to make meaning both in my personal life and in the clinical setting set me off on this particular journey. I was struck by the lack of literature on VC from a psychoanalytic perspective, noting that, following Sartre, ‘interest in what is missing is as is important as what 7 is present’ (Sartre, 1943/ 1956 p.42). This thesis, therefore, while concentrating mainly on psychoanalytic ideas, also draws on a variety of sociological and feminist perspectives in order to provide a broad understanding on the subject of VC. Each of these perspectives will produce a different form of knowledge based on their unique understanding of the human subject. It is curious that there has not been more contemporary psychoanalytic research into VC, bearing in mind the following statistics. The most recent statistics on childlessness recorded by the Office of National Statistics (ONS) in 2013 showed that one-fifth of women are childless at the age of 45.
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