Personality Theories in the Psychodynamic Tradition 1

Theories in the Psychodynamic Tradition
Theories in the Psychodynamic Tradition

Prior to beginning work on this discussion, read chapters 1 through 6 of the textbook and the required articles listed with the theorist assigned to you for the discussion. For your initial post, you will examine the contributions of a theorist who was instrumental in developing the psychoanalytic theoretical approach based on the first letter of your last name. In addition to the required articles for your assigned theorist, research a minimum of one peer-reviewed article on your theorist’s research and work within the field of psychology. Examine and describe your theorist’s contribution(s) to psychodynamic theory. Examine the major theoretical approaches proposed by your theorist including any related research methods and/or assessment instruments associated with him or her. Evaluate any issues and cultural considerations associated with your assigned theorist. Analyze and describe how the APA’s Ethical Principles and Code of Conduct might affect the implementation of your theorist’s personality assessments. Assess the types of personality measurements and research designs associated with your assigned theorist and describe how they have evolved. Your initial post should be a minimum of 500 words. 

Please see below for your assigned theorist.

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Neo-Freudians (Karen Horney): last names beginning with O through R:

Eckardt, M. (2006). Karen Horney: A portrait. American Journal of Psychoanalysis, 66(2), 105-108. doi: 10.1007/s11231-006-9008-4

· The full-text version of this article can be accessed through the ProQuest database in the Ashford University Library.

Smith, W. B. (2007). Karen Horney and psychotherapy in the 21st century. Clinical Social Work Journal, 35(1), 57-66. doi: 10.1007/s10615-006-0060-6

Required articles

Marianne, H. E. (2006). KAREN HORNEY: A PORTRAIT1. American Journal of Psychoanalysis, 66(2), 105-8. doi:

Smith, W. B. (2007). Karen horney and psychotherapy in the 21st century. Clinical Social Work Journal, 35(1), 57-66. doi:

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


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:

Clin Soc Work J (2007) 35:57–66

DOI 10.1007/s10615-006-0060-6



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


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,


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


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


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


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


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


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


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,


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


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


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

Clin Soc Work J (2007) 35:57–66 63


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


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


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


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


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

Clin Soc Work J (2007) 35:57–66 65


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.


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.

Born over 100 years ago, Karen Horney was in

many ways a woman ahead of her time. Her ideas

about human behavior and about psychotherapy have

a remarkably contemporary feel. Her appreciation of

the impact of environment and culture on develop-

ment, long a staple of social work thinking, has ac-

quired more and more currency in analytic circles. Her

optimistic view of the plasticity of development and the

unending human potential for growth is supported by

recent and current brain and infant research. Perhaps

the most impressive aspect of Karen Horney’s work is

that it was conceived and propounded by a woman in a

time and place that were professionally and culturally

steeped in a male-dominated paradigm. To think these

thoughts and then to proclaim them publicly were

extraordinary acts of imagination and courage.


Danielian, J. (1988). Karen Horney and Heinz Kohut: Theory and the repeat of history. American Journal of Psycho- analysis, 48, 1.

Eckardt, M. H. (1984). Karen Horney: Her life and contribution. American Journal of Psychoanalysis, 44, 3.

Feiring, C. (1983). Behavioral styles in infancy and adulthood: The work of Karen Horney and attachment theorists col- laterally considered. American Journal of Psychoanalysis, 44, 2.

Horney, K. (1926). The flight from womanhood. In K. Horney (Ed.), Feminine psychology. New York, NY: W. W. Norton & Co., 1967.

Horney, K. (1933). The problem of feminine masochism. In K. Horney (Ed.), Feminine psychology. New York, NY: W. W. Norton & Co., 1967.

Horney, K. (1939). New ways in psychoanalysis. New York, NY: W. W. Norton & Co.

Horney, K. (1945). Our inner conflicts. New York, NY: W. W. Norton & Co.

Horney, K. (1950). Neurosis and human growth: The struggle toward self-realization. New York, NY: W. W. Norton & Co.

Horney, K. (1956a). Aims of analytic therapy, lecture I. In B. Paris (Ed.), Karen Horney: The therapeutic process: Essays and lectures. Yale University Press: New Haven, 1999.

Horney, K. (1956b). Understanding the patient, lecture 5. In B. Paris (Ed.), Karen Horney: The therapeutic process: Essays and lectures. Yale University Press: New Haven, 1999.

Horney, K. (1959). The quality of the analyst’s attention, lecture 3. In B. Paris (Ed.), Karen Horney: The therapeutic process: Essays and lectures. Yale University Press: New Haven, 1999.

Kelman, H. (1967). Karen Horney on feminine psychology. In K. Horney (Ed.), Feminine psychology. New York, NY: W. W. Norton & Co.

Main, M., & Solomon, J. (1985). Discovery of an insecure-dis- organized/disoriented attachment pattern. In T. B. Brazel- ton, & M. Y. Yogman (Eds.), Affective development in infancy (pp. 95–125). New Jersey: Abbey.

Natterson, J. (1966). Karen Horney: The cultural emphasis. In F. Alexander et al. (Eds.), Psychoanalytic pioneers (pp. 450– 456). New York: Basic Books.

Paris, B. (1994). Karen Horney: A psychoanalyst’s search for self- understanding. New Haven: Yale University Press.

Paris, B. (1999a). Karen Horney’s vision of the self. In A. Horner (Ed.), Visions of the self. American Journal of Psychoanal- ysis, 59, 2, 1999.

Paris, B. (1999b). Karen Horney: The therapeutic process: Essays and lectures. New Have: Yale University Press.

66 Clin Soc Work J (2007) 35:57–66


Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

  • Karen Horney and Psychotherapy in the 21st Century
  • Abstract
  • Introduction
  • Social Historical Context
  • Horney and Freud
  • Feminine Psychology
  • Horney hxx2019 s Theory of Neurosis
  • Horney hxx2019 s Conception of the Self
  • Horney hxx2019 s Schema of the Neurotic Trends
  • Horney and Kohut
  • Horney and Attachment Theory
  • Horney and Psychotherapy
  • Case examples from a Horneyan Perspective
  • Case #1: Ms. H
  • Case #2: Mr. Y

Celebrating the 120th Anniversary of Karen Horney’s Birth


Marianne Horney Eckardt

I am going to sketch for you a portrait of Karen Horney emphasizing two features: her remarkable strong sense of self-determination and the seeming happenstance of being in the right place at the right time. She collaborated with fate. She prescribed everything for it and fate facilitated opportunities.

Horney was a very private person. It is only due to our coming, after her death, upon her diaries written in her adolescence and early twenties that this remarkable young person made her appearance and shed much light on later happenings. We owe the real discovery of the diaries to my sister Renate. We had casually noted their existence. They then gathered dust on Renate’s bookshelves in Mexico, when by some magical spiritual happening she discovered them, transcribed them, had them translated, and published them. All of Karen’s early entries, beginning at age 13, be- guile with confident self-determination of her path, her actions, and her thinking. She writes, “Fate will have an easy time with me, I prescribe everything for it” (Horney, 1990, p. 19). She aims at being a doctor, even though as yet no German university is admitting women to medical school. She has no doubt that she will find a way. The word ambition does not convey her spirit. She just makes her decision and follows her mapped-out road. The diaries are never boring. She reflects on happen- ings, debates, asks big questions about religion, mores, love, morality, and truth, and declares her opinion.

1This address was given on October 23, 2005, at the American Institute for Psychoanalysis, New York, celebrating the 120th anniversary of Karen Horney’s birth.

Address correspondence to: Marianne Horney Eckardt, 3066 Via Serena South Unit A, La- guna Woods, CA 92637, USA; e-mail:

The American Journal of Psychoanalysis, Vol. 66, No. 2, June 2006 (� 2006) DOI: 10.1007/s11231-006-9008-4


0002-9548/06/0600-0105/1 � 2006 Association for the Advancement of Psychoanalysis

At age 17 she is debating the ethics of free love. The turn of that cen- tury is still steeped in Victorian morals, ready to disintegrate. As yet she has had no love experience of her own. She muses and declares that deep love is always moral greatness, because it elevates us inwardly. “It is altogether too absurd,” she writes, “to judge a person’s character exclu- sively from his or her attitude toward sex. How much more important is his or her attitude toward the truth. A woman who decides to give herself freely to a man, stands much higher on the moral scale than a woman who marries the first man just to be married” (Horney, 1990, p. 81). Her environment is full of what she recognizes or perceives as prejudices and false morals. She comes to the conclusion that one should free oneself of common conventional morality and think through the large issues for oneself and act accordingly.

At age 18 she is very impressed by the Swedish avant-garde writer Ellen Key, who also sounds the tune of true morality, rather than the false morality of convention. Karen reflects: “I took up Ellen Key again. It is like a bath in the sea in autumn, when the cold is cutting and you have to battle with wind and waves, but once out, you are refreshed and a new person” (Horney, 1990, p. 90). In her book, The Century of the Child, Key rebels against the definition of the human being as man par excellence, writing that women have to take their rightful place as wo- men because society is entitled to receive the best women have to give. She seeks a morality of love; she questions the morality of monogamy and marriage. Key’s message profoundly influenced Karen’s outlook on life.

On New Year’s Eve, age 18, she is full of New Year’s resolutions, namely, to cultivate strength of will, self-discipline, hard work. She writes: ‘‘Yes, I long for one more thing, to learn how to listen to the delicate vibrations of my soul, to be incorruptibly true to myself and fair to others, to find in this way the right measure of my own worth” (Horney, 1990, p. 102). She is her own teacher, guide, and critic.

Two personal themes emerge, which become characteristics of her way of being. One theme is not complaining to others: “Only not sympathy, she remarks, “sympathy hurts, humiliates. But if I show my suffering, it calls forth sympathy. Nobody is to know when I am suffering” (Horney, 1990, p. 62). The other theme refers to a lack of group spirit. People ac- cuse her of this lack. She ponders: Why should she be expected in dis- puted cases to join the majority? Is that a lack of esprit de corps, a real lack on her part, or is it justified? She believes that it is justified. She never developed this esprit de corps, never was a good team player, never a family person.


Her strength of character was certainly the major factor in shaping her great career, but fate also facilitated her development. She repeatedly seemed to be in the right place at the right time. High schools and uni- versities opened their doors for women just when she was at the right age. She came to Berlin in 1910, just when Abraham started his first psy- choanalytic seminars. She became a psychoanalyst in Berlin, not in Vien- na. The atmosphere in Berlin was very different from Vienna. In spite of economic and political turmoil, the period between 1920 and 1930 was a cultural phenomenon. One cannot appreciate the spirit or the soul of the early Berlin psychoanalytic pioneers detached from this unique exu- berant atmosphere of the Weimar Republic, when cultural energy ex- ploded, sparkled, vibrated, and, for 10 years, nourished the arts and lives of people and made Berlin the Mecca of attraction. What happened in Berlin influenced art and cultural happenings in the Western world for the rest of that century. It was this spirit that gave the Berlin psychoana- lytic community its very special flavor, very distinct from the atmosphere in Freud’s Vienna, where the psychoanalytic community was much di- rectly influenced by the giant shadow of Freud. The enthusiastic Berlin community embraced psychoanalysis as a young science challenging its members toward further creative contributions. The spirit of the time em- braced breaking traditions and conventions, and the Berlin analysts, too, viewed psychoanalysis as a force that would free the human potential and allow it to unfold. The soil did not favor orthodoxy. Karen Horney would never have flourished as well in Vienna.

She had the good fortune to be asked by Franz Alexander in 1932 to join him in Chicago to codirect the first American Psychoanalytic Institute. Because of her theoretical differences with Alexander, she left Chicago for New York after two years. She joined the New York Psycho- analytic Institute. She was also invited to teach at the New School of Social Research, a school that established a reputation for attracting the best minds of European immigrants who escaped Hitler. The New School provided the setting for the development of her own novel psychoanalytic notions. Her lectures were sought after, extremely successful, and evolved into her first two books, The Neurotic Personality of Our Time and New Ways in Psychoanalysis. Her teaching did not find approval at the New York Psychoanalytic Institute. Her direct challenge of Freud led to a break and the well-known walk-out of Karen Horney, Clara Thompson, Sarah Kelman, Saul Ephron, and Bernard Robbins, singing, “Go Down Moses, Let My People Go,” the spiritual that celebrates the liberation of the Jews from the tyranny of the Pharaoh. The break led to the formation of the American Institute of Psychoanalysis. Fourteen candidates of the New York Psychoanalytic resigned at the same time.


Again the time was right for favoring secessions. Sandor Rado, Abraham Kardiner, John Millet, George Daniel, Phyllis Greenacre, David Levy, and others at the New York Psychoanalytic Institute were also developing plans for a new institute. They favored an association with a university and a few years later founded the Association for Psychoana- lytic and Psychosomatic Medicine and an institute at Columbia Univer- sity. Alexander in Chicago set a liberal course. Splits began occurring in Washington, D.C., Detroit, Boston, and Los Angeles.

While the new constitution of the new American Institute for Psycho- analysis was a hymn to freedom of thought and encouraging diversity, in retrospect it seems inevitable that Horney would create her own institute. Beginning in the mid 1930s she had the foundation and outline for a new system of psychoanalytic thought and worked steadily from then on, allowing it to grow, with the new insights ever nourishing her creativity. This was her task, goal, and sole interest. Like Berlin in the 1920s, the 1940s began a very creative period in American psychoanalysis, and Karen Horney was a major player, opening the field for ongoing creative development.

We all are fortunate beneficiaries of her remarkable spirit.


Horney, K. (1980). The adolescent diaries of Karen Horney. New York: Books, Inc.


Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

This is the classroom book regarding Karen Horney

Cloninger, S. (2013). Theories of personality: Understanding persons. Upper Saddle River, NJ: Pearson.Constellation TM course digital materials (CDM) title.

Karen Horney’s theory is popular for its insights into gender. It confronted the male bias of the earlier generation of psychoanalysts. Asan icon of femininity in twentieth-century American popular culture, Marilyn Monroe portrays a person trapped in the gender role ofher time, and so she can be understood from the perspective of Horney’s interpersonal theory and of the subsequent relational theorythat further develops these ideas.

Although she has been dead since 1962, the movie actress Marilyn Monroe is a timeless embodiment of the image of femininity. Sheepitomizes sexual beauty; her picture on a nude calendar was admired by many men and envied by many women. She also had a tragicside, arousing sympathy for the helpless victim.


Marilyn Monroe

Born in Los Angeles, California, in 1926, Norma Jeane Mortenson (her birth name) wasnot told the truth about her paternity, the product of an extramarital affair. She grewup without a father or mother. Mental illness ran in her family, and her mother andgrandmother were institutionalized (Steinem, 1986). After living in several fosterhomes and an orphanage and having no other stable home, Norma Jeane married atage 16 (a marriage that lasted 4 years). With her husband off to war, she worked in afactory until a photographer taking pictures to boost the troops’ morale discovered herthere. She quickly became a model, on her way to becoming a movie actress, under thename of Marilyn Monroe. Along the way, she posed as the first Playboy magazinecenterfold, married baseball star Joe DiMaggio (a union that lasted only 8 months), andthen married playwright Arthur Miller (for 4 years). She also was the lover ofPresident John F. Kennedy (among others). Marilyn Monroe had many lovers andthree, possibly four, husbands. As much as she sought love, her longest marriage lastedonly 4.5 years. She loved children but never raised her own. Many were conceived;reportedly she had over a dozen abortions. (She reported that she bore an illegitimatechild as a teenager, but it is unclear whether this is fact or imagination.) Whenmotherhood was acceptable, as Arthur Miller’s wife, she miscarried.

Throughout adulthood, Monroe took high doses of barbiturates and attempted suicideon several occasions. It is likely that her death was either an intentional suicide or anaccidental overdose. Theories of murder are favored by some, who argue that the FBI,the Kennedys, and the Mafia all had reasons to be involved in her death. Whatever thecircumstances, her death occurred on the fifth anniversary of her much-mournedmiscarriage.


Karen Horney’s theory emphasizes childhood parental love as essential for healthy development, whereas neglect produces afundamental conflict that endures. Conflict is between basic anxiety (fear of not being loved or lovable) and basic hostility (anger aboutthe lack of love).

Marilyn Monroe was neglected by her parents. She did not know her father. Her mother suffered serious depression and wasinstitutionalized when Monroe was 7 and for most of her life thereafter. Monroe then grew up in foster homes and an orphanage, neverexperiencing a stable, loving family that would help her establish healthy interpersonal relationships. This insecure beginning, accordingto Horney’s theory, would leave her with lifelong unconscious feelings of being unloved and angry.


Horney’s interpersonal psychoanalysis and subsequent theories of object relations emphasize that the most important aspect ofpersonality is the relationships we have with other people. If they are not secure, then no amount of fame or success can replace them.Personality is described in terms of relationship styles. Some people have a style of an exaggerated need for love and acceptance(“moving toward” style). Others have exaggerated needs for competition or aggression (“moving against” style). A third style is anexaggerated need for isolation (“moving against” style).

Of these styles, Marilyn Monroe clearly had an exaggerated need for love. In her case, this need took the form of seeking sexual love andadmiration for her physical beauty. She had a childlike innocence in her physical appearance and also a childlike hunger for love withoutthe stabilizing anchor of mature self-esteem. Her childlike persona elicited love and protective impulses in others. Like many “movingtoward” women, she chose for her male partners powerful men (including baseball player Joe DiMaggio, playwright Arthur Miller, andPresident John Fitzgerald Kennedy). Gloria Steinem describes her as “the child-woman who offered pleasure without adult challenge; alover who neither judged nor asked anything in return” (1986, p. 22).


Mental health requires healthy interpersonal relationships, not immature relationships based on inadequate childhood experiences inobject relations theory, and not limited in Horney’s earlier theory to only one or two of the three interpersonal styles listed above. Apoorly adjusted person creates a defensive idealized self that resists awareness and does not permit flexibility. A person whose idealizedself demands always being loved will not be able to move against others by appropriate assertive behavior or to move away from themto be alone when that is needed. A variety of defense mechanisms maintain this style, defending against any unconscious impulses forthe repressed material to emerge—in this case, for repressed anger that could lead to competitiveness or assertiveness.

Physical beauty can be a way of ensuring love; it therefore takes on great value for those with a neurotic need for affection (Horney,1950, p. 138). Monroe’s exhibitionist tendencies trace back to childhood (Steinem, 1986). Horney (1937/1967d, pp. 256–257)suggested that a neurotic need for love can also be expressed as a series of sexual relationships, surely characteristic of Monroe, whosepromiscuity was legendary.

In people who have adopted this pattern of a neurotic, compulsive need for love, hostility is repressed, to avoid anxiety and the risk ofbeing unlovable. One anecdote strongly suggests how much suppressed hostility must have pervaded Monroe’s lovemaking. At a party,where a game required disclosing personal fantasies, “she said she imagined disguising herself in a black wig, meeting her father,seducing him, and then asking vindictively, ‘How do you feel now to have a daughter that you’ve made love to?’” (Steinem, 1986, p. 144).How clearly this says that she thought her father’s love could only be obtained by trickery, and she was mad about it. From an objectrelations theory point of view, this fantasy discloses an unhealthy pattern of relationships, and we would expect the fantasy to alsocontaminate her lovemaking.


As in other psychoanalytic theories, both object relations theories and Horney’s theory describe defense mechanisms that distortthinking and interfere with accurate self-perception. Some of these defense mechanisms (e.g., repression) are the same as thosedescribed in previous chapters, whereas others (e.g., blind spots and externalization) are first described by Horney.

Marilyn Monroe showed an exaggerated concern for the suffering of animals and even plants that can be interpreted as a defensemechanism (externalization) that distorted accurate self-perception. She externalized her own sense of being unloved and helplessnessin a hostile world, not realizing it was she herself who felt the need to be rescued. For example, when she found boys trapping pigeons tosell in New York City, she bought the birds every week and set them free. Another rather bizarre externalization occurred when she sawnasturtiums cut by a lawn mower. As her husband, Arthur Miller, tells it, “crying as if she were wounded,” Marilyn demanded that theystop the car as they drove past. “Then she rushed about picking up the fallen flowers, sticking the stalks back into the ground, to see ifthey might recover” (Summers, 1985, p. 200).


Horney’s most important contribution to psychoanalysis was her recognition that culture contributes significantly to mental healthproblems by encouraging certain neurotic tendencies. By relegating women into society’s accepted gender roles, culture producesunconscious conflict and neurosis. Early psychoanalysts did not recognize this, and so their supposed expertise had the unfortunateeffect of endorsing the unhealthy gender messages of society. Freud’s theory describes masochism as part of normal femininedevelopment, whereas Horney said this trait is a product of culture. It is not inevitably part of being a normal female, and it is nothealthy.

The particular style of femininity that Marilyn Monroe epitomized, the sex goddess of her age, was a product of her culture. MarilynMonroe paints, in bold strokes, themes that typify the feminine personality of her time, in her culture, suggests Gloria Steinem (1986).Her self-doubt and need to be loved, her inability to express anger appropriately, were widespread issues for women of that era. MarilynMonroe was treated by a Freudian analyst Ralph Greenson, a psychiatrist internationally known for his scholarly publications and aformer close friend of the Freud family. However, her therapist missed this opportunity to put her on a less dependent, healthier track(Steinem, 1986). Rather than challenging her need for love as neurotic, apparently he played along, at times even taking the patient intohis home. He also intervened in her movie roles and other extra-therapy aspects of her life, to an extent that violated even his ownteachings about proper therapy techniques (Kirsner, 2007). Of course, it is unfair to judge analysis from a distance; but if the therapy didnot get beneath the neurotic need for affection, it was not addressing the core neurosis and could not hope to achieve a personalityreconstruction. One suspects that Horney would even criticize the therapist for allowing “morbid dependency” in the doctor–patientrelationship (cf. Horney, 1950, p. 243). Cultural assumptions can blind even the experts.


Although Horney added a cultural component to psychoanalytic theory, she did not deny the underlying assumption that biologyprovides the energy for personality. Thus she suggested that physical as well as psychological symptoms can be produced by unresolvedunconscious conflict. She also realized that some people turn to physical substances to alleviate psychological suffering.

Marilyn Monroe tried to drown her hostility and anxiety with drugs. Horney (1950, p. 152) proposed that drug use stems from theunderlying problem of self-contempt. Even Monroe’s physical difficulties are consistent with Horney’s theory. Monroe suffered extrememenstrual pain. She was reportedly frigid, compulsively seeking intercourse but not experiencing orgasm. If Horney’s paper had notoriginally been published in 1926, we might have thought Horney had Marilyn Monroe in mind when she observed “that frigid womencan be even erotically responsive and sexually demanding, an observation that warns us against equating frigidity with the rejection ofsex” (Horney, 1926/1967c, p. 74). Horney reported that frigid women may convert their sexual functioning into a variety of menstrualdisorders, including pain and miscarriage.


It took a woman, Karen Horney, to see cultural bias in misunderstanding women in the psychoanalytic theory that she otherwiseadmired and practiced. Her insights help us understand the psychological flaws of Marilyn Monroe, not simply to admire or desire her.The core conflict, in Horney’s theory, stems from inadequate parental love. We may defend against that conflict in culturally driven ways,varying from one century to the next and from one subgroup within society to another, but our basic needs are the same.


The emphasis on society that Adler and Erikson contributed to psychoanalytic theory continued into the next generation of analysts,including Karen Horney. Like traditional Freudian psychoanalysts, Horney firmly believed that the unconscious is a powerful determinant ofpersonality and that childhood conflicts are important. However, she questioned Freud’s emphasis on sexual conflict. According to Horney,the most important conflicts are based on unresolved interpersonal issues. She argued that cultural forces must be considered and thepersonality differences between men and women are influenced more by society than by anatomy.

Table 6.1 Preview of Horney’s Theory and Object Relations Theory

IndividualDifferencesIndividuals differ in the way they define themselves in relationships. Horney described a balance among threeinterpersonal orientations: moving toward, moving against, and moving away (from people). People have differentidealized selves and use different ways of adjusting to anxiety.
AdaptationandAdjustmentHealthy interpersonal relationships are a key to adjustment, and they are based on acceptance of the true self instead ofsome defensive idealized self. Horney provides full descriptions of neurotic trends. Therapy focuses more on the presenttime and on interpersonal relationships than on the past and libidinal conflict (contrasting with Freud’s theory).
CognitiveProcessesBlind spots and other defense mechanisms limit insight, but courageous self-examination can lead to growth.Developmental and object relations theorists are studying specific cognitions, such as those related to emotion.
CultureCulture is very important in shaping personality, especially through gender roles.
BiologicalInfluencesBiology is far less important than orthodox psychoanalysis claims.
DevelopmentLove and nurturance are key to a child’s development. In Horney’s theory, basic anxiety and hostility are thefundamental emotions of childhood. Without adequate parental love, the child develops unhealthy interpersonal modesand a defensive sense of self. Few major changes in personality occur after childhood (except through therapy).

The interpersonal emphasis that Horney advocated has been the foundation of other psychoanalytic theories, as well. The relational approachdraws from many of these theoretical developments and has forged connections with advances in developmental and social psychology. Thisapproach, which has too many contributors to single out one “great name” with which to label it, is presented in this chapter.


Karen Danielson was born near Hamburg, Germany, on September 15, 1885. She was the second child in an unhappy marriage of an often-absent Norwegian sea captain and his beautiful, somewhat higher-class wife. Danielson and her older brother Berndt were disciplined strictlyby their tyrannical Lutheran father when he was home from long sea voyages around Cape Horn to the Pacific coast of South and CentralAmerica. She retained a strongly independent character, regarded her father’s outspoken religious attitudes as hypocritical, and questionedthe fundamentalist teachings of her church.

This was a time of social change in Germany, opening opportunities for women. Young Danielson entered the University of Freiburg in 1906,in a class of 58 women and 2,292 men. There she studied medicine, was popular, and married one frequent companion, Oskar Horney, in1909. They moved to Berlin, where she continued her medical studies and he began a business career.

Karen Horney was a psychoanalytic patient of the Freudian analyst Karl Abraham. This was an avant-garde interest at that time. It wascharacteristic of her to explore new ideas, but she sought relief from personal problems as well: depression, fatigue, and dissatisfaction withher marriage. Her father died about this time, and she had ambivalent feelings toward him to sort out: anger because of the unhappiness ofher parents’ marriage, but also more fondness for him than she admitted. The demands of combining a medical education with family life,without much encouragement from her husband, also required coping.


Karen Horney

After receiving her psychiatric degree in 1915, she dared to lecture on the controversialFreudian theory and to defend it against critics including, interestingly, Adler and Jung(Quinn, 1988, p. 151). Her own challenges to the theory were still brewing. Unlike manypsychoanalysts of this time, she did not visit Freud and so did not know him personally(Quinn, 1988). Freud did, however, chair a session in 1922 in which Horney presented apaper, “The Genesis of the Castration Complex in Women” (O’Connell, 1980).

Karen and Oskar Horney had three daughters. (One, Marianne Horney Eckardt, became aHorneyan analyst.) But the couple continued to have a troubled marriage and finallyseparated. Horney poured increasing energy into her career. She became one of thefounding members of the Berlin Psychoanalytic Institute in 1920 and published severalpapers on male and female development, relationships, and marriage. Her 14 papersbetween 1922 and 1935 outlined a theory of female psychology that was clearly critical ofFreud’s theory. Horney’s first suggestions were presented in a spirit of intellectual debatewithin classic Freudian theory, the sort of challenge that fosters the development of anyscience. The psychoanalytic community, however, dismissed her points and attacked hermotivations. Freud is reported to have said of her, “She is able but malicious—mean”(Quinn, 1988, p. 237). He accused her of an inadequate analysis, saying that she did notaccept her own penis envy (Symonds, 1991).

Given this hostile environment in Germany, it is no wonder that Horney accepted aninvitation to become associate director of a new Institute for Psychoanalysis in Chicago,under Franz Alexander, in 1932. Then, in 1934 she moved to New York. Ironically, the same sort of professional debates over theoreticalorthodoxy that had impelled her to leave Germany divided the New York Psychoanalytic Institute, which in 1941 voted to remove her fromher role as a teacher and clinical supervisor, demoting her to instructor.

Horney and her followers quickly formed a new organization, the Association for the Advancement of Psychoanalysis, and founded the American Journal of Psychoanalysis. The announcement of the new training institute contained a statement of commitment tononauthoritarian teaching:

Students are acknowledged to be intelligent and responsible adults…. It is the hope of the Institute that it will continue to avoid conceptualrigidities, and to respond to ideas, whatever the source, in a spirit of scientific and academic democracy. (cited in Quinn, 1988, p. 353)

It was not only the orthodox Freudians who were suspicious of her. The Federal Bureau of Investigation (FBI) kept a file on her because of heralleged communist sympathies, and she was for a while denied a passport (Quinn, 1988). She was ultimately granted the passport, and inJapan she stayed at several Zen monasteries (O’Connell, 1980). In Zen Buddhism, Horney found support for the idea of a striving, healthy realself within the individual that Freudian theory did not offer (Morvay, 1999). On December 4, 1952, within months of her return from Japan,she died of previously undiagnosed abdominal cancer.

As a person, Karen Horney seems to have had a capacity for enjoying life, despite the seriousness of her career and the disappointments ofher marriage. She liked fine dining, concerts, and parties. She enjoyed relationships with men and had several affairs (Quinn, 1988). DuringProhibition, she at least once spiked the punch by writing her own prescription for “medicinal” alcohol (Quinn, 1988).

Horney challenged Freud’s claim that he had discovered universal developmental conflicts. Instead, she argued that personality and itsdevelopment are influenced by culture and vary from one society to another. This energetic and nontraditional woman proposed newunderstandings of women, and of men, which today are more widely accepted than the classical Freudian theory she challenged. She ispraised as an important role model for women and her writings had a major influence on feminist theory (Gilman, 2001O’Connell & Russo,1980).


Infants and young children are highly dependent on their parents for psychological security as well as physical survival. In the ideal case, theinfant senses that he or she is loved and protected by the parents and therefore is safe. Under less-than-ideal circumstances, the child feelsintensely vulnerable, experiencing  basic anxiety,  which Horney (1945, p. 41) described as “the feeling a child has of being isolated andhelpless in a potentially hostile world.”

basic anxiety

feeling of isolation and helplessness resulting from inadequate parenting in infancy

Parental neglect and rejection make the child angry, a condition Horney called  basic hostility.  However, expressing the hostility would resultin punishment or loss of love, so instead it is repressed, which increases anxiety. The neurotic, then, develops a basic conflict between“fundamentally contradictory attitudes he has acquired toward other persons” (Horney, 1945, pp. 40–41). On the one hand, the child needsthe parents and wants to approach them but, on the other hand, hates them and wants to punish them. This is the driving force behindneurosis: an interpersonal conflict, in contrast to Freud’s libidinal conflict between sexual desire and the restricting forces of society.

basic hostility

feeling of anger by the young child toward the parents, which must be repressed


What is the child to do? Three choices are available: accentuate dependency and move toward the parents, accentuate hostility and moveagainst them, or give up on the relationship and move away from them. The young child resolves the conflict with the parents by usingwhichever of these strategies seems best to fit his or her particular family environment. This choice becomes the person’s characteristicinterpersonal orientation.

Ideally, a healthy person should be able to  moved toward  people,  move against  them, or  move away  from them, flexibly choosing thestrategy that fits the particular circumstances. In contrast to healthy flexibility, neurotics are imbalanced in their interpersonal behavior.Some choices cause so much anxiety that they simply are not options. The young child who was never permitted to express any criticism ofthe parents, for example, is unlikely to be able to compete wholeheartedly against others in adulthood. The rejected child will continue tohave difficulty depending on people.

moving toward

interpersonal orientation emphasizing dependency

moving against

interpersonal orientation emphasizing hostility

moving away

interpersonal orientation emphasizing separateness from others

Horney said that neurotics who emphasize moving toward people adopt the  self-effacing solution  to neurotic conflict, seeking love andminimizing any apparently selfish needs that could interfere with being loved. Neurotics who emphasize moving against people adopt the  expansive solution  to neurotic conflict, seeking mastery even if it impedes close relationships with others. Finally, neurotics who emphasizemoving away from people adopt the  resignation solution,  seeking freedom even at the expense of relationships and achievement (see Table6.2).

self-effacing solution

attempting to solve neurotic conflict by seeking love; moving toward people

expansive solution

attempting to solve neurotic conflict by seeking mastery; moving against people

resignation solution

attempting to solve neurotic conflict by seeking freedom; moving away from people

A measure of Horney’s three interpersonal orientations, the Horney-Coolidge Type Indicator (HCTI; Coolidge et al., 2001) assesses threefacets of each orientation, based on factor analysis (see Table 6.3). In a study of normal adults (Coolidge et al., 2004), scores on a scalemeasuring personality disorders were correlated with HCTI scores. Those with higher Cluster A (eccentric) scores, comprising the paranoid,schizoid, and schizotypal personality disorder scales, scored higher on the Detachment scale and, to a lesser extent, the Aggression scale.Those with higher Cluster B (emotional) scores, comprising the antisocial, borderline, histrionic, and narcissistic personality disorder scales,scored higher on the Aggression scale. People with higher Cluster C (fearful) scores, reflecting avoidant, dependent, and obsessive-compulsivepersonality disorders, scored higher on the Detachment and Compliance scales. These results are consistent with Horney’s view thatimbalanced interpersonal orientations are maladaptive, although the research needs to be replicated among clinically diagnosed individuals.Interestingly, the Malevolence facet of the Aggression scale was positively correlated with all three clusters of personality disorders, which,according to the researchers, “captures the maladaptive relational aspect of the personality disorders and suggests that underlying thediffering relational postures of Horney’s theory is a basic belief that people hurt other people and cannot be trusted” (Coolidge et al., 2004, p.372). Other research using this questionnaire examines its relationships to biological factor models of personality (see Chapter 9), suggestingthat the Compliant scale is related to Eysenck’s Neuroticism measure, and the Aggressive and Detached scales to his Psychoticism (orantisocial) scale (Shatz, 2004).

Table 6.2 Horney’s Three Neurotic Solutions

1. Self-Effacing Solution: The Appeal of Love (“The Compliant Personality”)
“Moving toward” people
Morbid dependency: the need for a partner (friend, lover, or spouse)
“Poor little me”: feeling of being weak and helpless
Self-subordination: assumption that others are superior
Martyrdom: sacrifice and suffering for others
Need for love: desire to find self-worth in a relationship
2. Expansive Solution: The Appeal of Mastery (“The Aggressive Personality”)
“Moving against” people
Narcissistic: in love with idealized self-image
Perfectionistic: high standards
Arrogant-vindictive: pride and strength
Need to be right: to win a fight or competition
Need for recognition: to be admired
3. Resignation: The Appeal of Freedom (“The Detached Personality”)
“Moving away from” people
Persistent resignation and lack of striving: the aversion to effort and change
Rebellious against constraints or influences: the desire for freedom
Shallow living: an onlooker at self and life, detached from emotional experiences and wishes
Self-sufficient and independent: uninvolved with people
Need for privacy: keeping others outside the magic circle of the self

Source: Adapted from Horney, 1945, 1950.

Table 6.3 Horney-Coolidge Measure of Interpersonal Orientations: Facets and Sample Items

1. Compliance Scale
Altruism“I like to help others.”
Need for Relationships“I feel better when I’m in a relationship.”
Self-Abasement“I am self-sacrificing.”
2. Aggression Scale
Malevolence“Beggars make me angry.”
Power“I like to be in command.”
Strength“I test myself in fearful situations to make myself stronger.”
3. Detachment Scale
Need for Aloneness“I prefer to be alone.”
Avoidance“I avoid questions about my personal life.”
Self-Sufficiency“I don’t really need people.”

Source: Prepared from information in Coolidge et al., 2001; and Coolidge et al., 2004.

Moving toward People: The Self-Effacing Solution

Some people turn to others for the love and protection lacking in their early life and must be careful to do nothing to alienate others. Horney(1945) referred to these as compliant types. Some are dominated by a need for affection, living as though their motto were, “If you love me,you will not hurt me” (Horney, 1937, p. 96). Others are characterized by their submissive attitude, as though they felt, “If I give in, I shall notbe hurt” (p. 97).

To be lovable, a person will do things to endear others: becoming sensitive to their needs; seeking their approval; and acting in unselfishways, generous to a fault. The need for love may be expressed in an exaggerated need to be “in love” or involved in sexual relationships inwhich the partner takes control.

The compliant type of person makes few demands on others, instead playing a “poor me” role that emphasizes helplessness andsubordination. This produces low self-esteem. Such a person “takes it for granted that everyone is superior to him, that they are moreattractive, more intelligent, better educated, more worthwhile than he” (Horney, 1945, pp. 53–54).

Moving against People: The Expansive Solution

A second strategy for resolving the conflict over unmet early needs is to emphasize the mastery of tasks and power over others, which seemto offer protection from the vulnerability of being helpless. Horney (1945) refers to those who adopt this strategy as aggressive types, whoseem to live by the motto, “If I have power, no one can hurt me” (Horney, 1937, p. 98). Less subtle domination over others, or more subtlepower through competitive mastery, both achieve the desired protection against humiliation.

Career competitiveness and perfectionism tap this trend. In politics, the expansive solution can lead to vigorous campaigning or it can makemilitary action seem more appealing (Swansbrough, 1994). From her clinical experience, Horney noted that patients of this type seem to haveparticular difficulty when they begin to come close to other people in love or friendship.

Moving away from People: The Resignation Solution

A third strategy for resolving childhood conflicts is epitomized by the fox in Aesop’s fable who could not reach the grapes hanging over hishead. After all attempts to reach them failed, the fox finally gave up, avoiding disappointment by telling himself that the grapes were probablysour anyway. In Horney’s theory, some people try to do without other people, having given up on solving the problem of basic anxiety throughlove or power. Horney (1945) refers to these as detached personality types and says they seem to live by the motto, “If I withdraw, nothing canhurt me” (Horney, 1937, p. 99). In the effort to be self-sufficient, detached types may develop considerable resourcefulness andindependence; Horney cites the example of Robinson Crusoe. Or they may restrict their needs and protect their privacy. Creative people areoften detached types.

Healthy versus Neurotic Use of Interpersonal Orientations

Harmonious interpersonal relationships are an important source of life satisfaction cross-culturally, although to a greater extent in somecultures than others (Kwan, Bond, & Singelis, 1997). How do we achieve this? The healthy person adopts, when appropriate, any of the threeorientations toward people because each is adaptive in certain situations. The neurotic individual is limited in using these orientations.Consider aggression. Although it is pathological to be aggressive toward everyone, the healthy person must be capable of “adequateaggressiveness,” by “taking initiative; making efforts; carrying things through to completion; attaining success: insisting on one’s rights;defending oneself when attacked; forming and expressing autonomous views; recognizing one’s goals and being able to plan one’s lifeaccording to them” (Horney, 1935/1967e, p. 228). The current term would be assertiveness rather than aggressiveness. Similarly, althoughexcessive dependency (moving toward) is neurotic, the inability to ask for appropriate help (a deficit in the moving-toward orientation) isalso maladaptive (cf. Bornstein, 1992).

Interpersonal orientations also influence physical health. Horney reported that repressed hostility may cause physical symptoms, such asheadaches and stomach problems (1945, p. 58). Research confirms that high levels of hostility (“moving against” orientation) contribute tocoronary heart disease (Miller et al., 1996Roemer, 1987). Excessive dependency, too, puts people at increased risk for many physicaldiseases, including ulcers, asthma, epilepsy, and heart disease—perhaps in part because unmet dependency needs arouse anxiety, whichimpairs the immune system (Bornstein, 19982000). If these relationships were found only after people became ill, we might dismiss them asonly indicating that sick people become dependent. The fact that the relationships are also found in prospective studies (i.e., that earlierdependency predicts later illness) indicates that the dependency–illness relationship is not simply an artifact of the sick role. On the positiveside, Robert Bornstein (2000) points out that dependency can have a protective effect, too, when it stimulates people to seek early treatmentand to comply with medical instructions.


To solve conflicts over basic anxiety, an individual adopts defense mechanisms, including many of the defense mechanisms that previousanalysts had described, such as repression, and Horney’s expanded list of defensive maneuvers. All neurotics use some combination of fourmajor strategies for resolving the basic conflict between helplessness and hostility. These strategies do not solve the conflict or lead togrowth, but they may allow a person to adapt sufficiently to cope with daily life.

Eclipsing the Conflict: Moving toward or against Others

First, the neurotic may “eclipse part of the conflict [between helplessness and hostility] and raise its opposite to predominance” (Horney,1945, p. 16). Some eclipse hostility and emphasize helplessness, seeking nonconflictful interactions and moving toward others. This stylerequires low self-esteem in order to avoid the distress that would otherwise result from holding back one’s self-assertion (Robinson &Wilkowski, 2006). Others eclipse helplessness and emphasize hostility against other people. These constitute two of the basic interpersonalorientations: moving toward and moving against people.

Detachment: Moving away from Others

A second major adjustment strategy is to become detached from others. Because the conflicts are inherently interpersonal, simply movingaway from people reduces the experience of conflict. If this tendency is much stronger than eclipsing, it leads to Horney’s third interpersonalorientation, moving away from people.

The Idealized Self: Moving away from the Real Self

The third major neurotic adjustment strategy is to turn away from the real self toward some seemingly better (less helpless, less angry)  idealized self.  The  real self  is “the alive, unique, personal center of ourselves” (Horney, 1950, p. 155) and is involved in healthy psychologicalgrowth. It is the self that would have developed if we had been nurtured properly as we were developing or that we may become once weovercome our neurosis (Paris, 1999).

idealized self

an image of what a person wishes to be

real self

the vital, unique center of the self which has growth potential

A healthy adult who is neglected or rejected can turn to other relationships, confident in his or her own self-worth, but the young child doesnot have the resources to do so. Consequently, the sense of self, which is just in the process of developing, emerges already wounded. Thechild develops a low self-esteem. The person may feel like a counterfeit, having “lost touch with essential aspects of self,” that is, alienatedfrom the true self (Ingram, 2001). Instead, the neurotic turns to an imagined idealized self, which would not be despised. The idealized selfvaries depending on the interpersonal orientation of the individual. “Perhaps if I am very, very good and kind, I will be lovable,” thinks onechild. “Or,” imagines another, “if I impress people with my achievements and power, they will not be able to hurt me, and they may evenadmire me.” “Or,” muses a third, “maybe I don’t need people after all; I can manage alone.”

The profoundly disturbing consequences of turning from the real to the idealized self are suggested by the comparison Horney (1950) makes.The process corresponds to “the devil’s pact…the selling of one’s soul” (p. 155). The healthier choice is to turn away from false pride andinstead to accept the “ordinariness” of one’s real self (Horner, 1994).

However, neurotics try instead to strengthen the idealized self and avoid painful confrontation with the repressed real self. “I should be kindto everyone” or “I should not have to depend on other people.” Horney called these sorts of demands the  tyranny of the shoulds.  They urgeus ever closer to the idealized self but at the expense of increased alienation from the real self. Perfectionism can produce the sort of highperformance that many jobs reward, but the cost is great, including emotional disorders and an elevated risk of suicide (Bieling et al., 2004Blatt, 1995Chang, 1998Flett et al., 1998Hewitt, Flett, & Ediger, 1996Hewitt et al., 1997Minarik & Ahrens, 1996Orbach, 1997Shafran &Mansell, 2001). Even if they succeed, perfectionists may feel like “impostors” (Henning, Ey, & Shaw, 1998). Bernard Paris (1999, p. 165)conveys wise advice: “Horney recognized that the absolute best is the enemy of the good, that we must not disregard our accomplishmentsbecause we have failed to attain perfection.”

tyranny of the shoulds

inner demands to live up to the idealized self

Externalization: Projection of Inner Conflict

In the fourth major adjustment strategy, the neurotic projects inner conflicts onto the outside world, a process Horney called  externalization.  Externalization refers to “the tendency to experience internal processes as if they occurred outside oneself and, as a rule, tohold these external factors responsible for one’s difficulties” (Horney, 1945, p. 115). It includes the defense mechanism of projection, astraditional psychoanalysis understands it, in which our own unacceptable tendencies (such as anger or sometimes ambition) are perceived ascharacteristic of other people but not ourselves. In one case study, for example, a woman was interpreted to have selected her ambitious butnarcissistic husband because she could externalize onto him “power, competence, and a capacity for success” that she could not see in herself(Horwitz, 2001). This defensive choice by the self-effacing wife, combined with the husband’s own expansive and narcissistic solution toconflict, led to considerable marital discord.


defense mechanism in which conflicts are projected outside

Externalization can also include our unrecognized feelings. Horney cited the example of a man unaware of his own feeling of oppression, who,through externalization, was “profoundly disturbed by the oppression of small countries” (1945, p. 116). Neurotics often externalize feelingsof self-contempt, either by thinking that others despise them (projection of the impulse) or by despising others (displacement of the object ofcontempt). Compliant types (those who move toward others) are likely to externalize in the first way, and aggressive types (those who moveagainst others) in the second way. In either case, the neurotic is unaware of deep self-contempt.

These four attempts at solution occur in all neuroses, although not with equal strength. The neurotic attempts only to “create an artificialharmony” (Horney, 1945, p. 16) rather than actually resolving the problem.


In addition to the major defensive strategies (eclipsing, detachment, the idealized self, and externalization), there are many auxiliarystrategies for reducing anxiety. Horney believed these secondary adjustment techniques, like the major adjustment techniques, do not reallysolve the neurotic problem in any lasting way, as she made clear in the title by which she introduced the concepts: “Auxiliary Approaches toArtificial Harmony” (1945, p. 131).

People are often unaware of aspects of their behavior that are blatantly incompatible with their idealized self-image. Horney (1945) cited theexample of a patient who “had all the characteristics of the compliant type and thought of himself as Christlike” but who blindly failed torecognize the aggression expressed by his symbolic murders of co-workers. “At staff meetings he would often shoot one colleague afteranother with a little flick of his thumb” (p. 132). Such  blind spots  prevent conscious awareness of the conflict between the behavior and ourself-image.

blind spots

secondary adjustment technique in which aperson is unaware of behavior inconsistent with the idealized self-image

Another way to prevent the recognition of conflict is by  compartmentalization,  allowing the incompatible behaviors to be consciouslyrecognized but not at the same time. Each is allowed to be experienced in a separate “compartment” of life: family or outsiders, friends orenemies, work or personal life, and so forth. For example, a person may be loving within the family but a ruthless business competitor outsidethe family.


secondary adjustment technique in which incompatible behaviors are not simultaneously recognized

Horney (1945, p. 135) called  rationalization  “self-deception by reasoning.” We explain our behaviors so they seem consistent with what issocially acceptable and with our idealized self-image. Horney provided these examples: A compliant type who is helpful will rationalize thisaction as due to feelings of sympathy (ignoring a tendency to dominate, which may also be present); an aggressive type will explain his or herhelpfulness as expedient behavior.


secondary adjustment technique in which aperson explains behaviors in socially acceptable ways

Excessive self-control  prevents people from being overwhelmed by a variety of emotions, including “enthusiasm, sexual excitement, self-pity, or rage” (Horney, 1945, p. 136). When emotions threaten to break through, people may fear they are going crazy. Rage is particularlydangerous and is most actively controlled. People using this defense mechanism typically avoid alcohol because it would be disinhibiting, andthey have difficulty with free association in psychotherapy.

excessive self-control

secondary adjustment technique in which emotions are avoided

Arbitrary rightness  “constitutes an attempt to settle conflicts once and for all by declaring arbitrarily and dogmatically that one is invariablyright” (Horney, 1945, p. 138). Inner doubts are denied, and external challenges are discredited. The rigidity of these people makes them avoidpsychoanalysis, which challenges a person’s core defensive beliefs.

arbitrary rightness

secondary adjustment technique in which a person rigidly declares that his or her own view is correct

Elusiveness  is quite the opposite of arbitrary rightness. These people do not commit themselves to any opinion or action because they “haveestablished no definite idealized image” (Horney, 1945, p. 139) to avoid the experience of conflict. The person who is elusive does not stickwith a conflict long enough to really work at resolution. “You can never pin them down to any statement; they deny having said it or assureyou they did not mean it that way. They have a bewildering capacity to becloud issues” (p. 138). They are reminiscent of the joke about theneighbor who, asked to return a borrowed bucket, says he did not borrow it, and besides it was leaking when he borrowed it, and besides healready returned it.


secondary adjustment technique in which aperson avoids commitment to any opinion or action

Cynicism  avoids conflict by “denying and deriding… moral values” (Horney, 1945, p. 139). A Machiavellian-type person is consciously cynical,seeking to achieve his or her goals without moral qualms. Others use cynicism unconsciously; they consciously accept society’s values but donot live by them.


secondary adjustment technique in which the moral values of society are rejected


Horney stressed cultural determinants of personality and neurosis, in addition to orthodox Freudian biological forces. Specific familyexperiences, such as having domineering or self-sacrificing mothers, only occur under particular cultural conditions (1937, p. viii). ForHorney, even the Oedipal complex is not universal. Psychoanalysts have noted that family ties are closer and more central to the patients’sense of self in Asian countries influenced by Confucian values, including China, Japan, Korea, and Vietnam (Slote, 1992).

Horney (1937, p. 62) argued that sexual conflict was becoming less important as a source of anxiety at the time she wrote than in Freud’ssomewhat earlier era, and the conflict between competitiveness and love was becoming more important. “In our culture,” she wrote, “themost important neurotic conflict is between a compulsive and indiscriminate desire to be the first under all circumstances and thesimultaneous need to be loved by everybody” (1937/1967d, p. 258). This conflict is exacerbated by the feminine role. Because cultures canchange, Horney’s emphasis on culture appeals to feminists and others who advocate change.

Gender Roles

Whereas biology determines sex (male or female), it is culture that defines the accepted traits and behaviors for men and women. Torecognize that we are discussing cultural rather than biological phenomena, it is customary to use the terms masculine and feminine insteadof male and female and the term gender instead of sex. According to social role theory, cultures define what is masculine and what is feminine(Eagly, 1987Eagly & Wood, 1991). For example, contrast the traditional value of machismo to the masculine identity of Chicano men (Segura& Pierce, 1993) with the high levels of dependency among males in China (Dien, 1992).


Horney’s description of gender roles concerning achievement stimulated later research. Women, she claimed, are especially likely to becomecompliant types who do not risk achievement because “our cultural situation… stamps success a man’s sphere” (1937, p. 204). In her time,Horney (1939, p. 181) noted that a woman who sacrificed her own career for her husband’s career was considered “normal,” even if the wifewas more gifted. Women may even develop a “fear of success” (pp. 210–214) that comes from a conflict between competition and the needfor affection, leading her to believe that if she succeeds, she will lose her friends. Fear of success is measured for research purposes by aprojective test (Horner, 1972), which has been used in many studies.


Traditionally, gender roles prescribe dominance or power for males and submissiveness or nurturance for females. This is true to such anextent that the short form of the Bem Sex-Role Inventory “masculine” scale is virtually identical to a scale derived by factor analysis calledInterpersonal Potency, and the Bem “feminine” scale is virtually identical to an Interpersonal Sensitivity scale (Brems & Johnson, 1990).

Gender roles profoundly influence the development of social power or dominance. Masochism (the enjoyment of pain and suffering) was abiological characteristic of females, according to Freud. Horney disagreed, suggesting that “masochistic phenomena represent the attempt togain safety and satisfaction in life through inconspicuousness and dependency” (1939, p. 113).

An empirical study of couples provides evidence that social power determines interpersonal behavior. The strategies people use to influencetheir intimate partners were found to vary with the person’s structural strength or weakness in the relationship, as indicated by income,education, and age. The more powerful member of a couple was more likely to use bullying and autocratic tactics to influence the partner,whereas the weaker partner was more likely to use supplication and manipulation. This association held for both heterosexual andhomosexual couples. In the former, the more powerful partner was usually the man, but it was power, rather than sex, that best predictedbehavior (Howard, Blumstein, & Schwartz, 1986).


Horney rejected Freud’s assertion that women reject their bodies as inferior. She argued that culture, rather than anatomy, is the importantforce behind the “penis envy” Freud had postulated. Women envy the power and privilege that humans with penises have, rather than theorgan itself (Horney, 1926/1967a1923/1967bSiegel, 1982). She countered, “Is not the tremendous strength in men of the impulse tocreative work in every field precisely due to their feeling of playing a relatively small part in the creation of living beings, which constantlyimpels them to an overcompensation in achievement?” (quoted in Gilman, 2001). This argument, well known by the catchy term  womb envy ,questions the assumption that men have the enviable position.

womb envy

men’s envy of women’s reproductive capacity (the complement of Freud’s penis envy)

Other supporters of women’s roles emphasize the value of interpersonal connectedness and relationship-oriented values like nurturance andempathy (Gilligan, 1982Lang-Takac & Osterweil, 1992Miller, 1976Symonds, 1991). This argument has not gone unchallenged. MarciaWestkott contends that women’s valuing of relationships often takes the form of an idealized self, and that feminist theory and therapy, byaffirming relationship values, unwittingly confirm a neurotic idealized self and perpetuate a cultural expectation that women should take careof men (Westkott, 1986a1986b1989). For example, when feminine nurturant values are emphasized, family members of alcoholics mayinadvertently enable the alcoholic to continue drinking by taking care of the problems that the addiction creates, which is unhealthy for boththe alcoholic and the codependent family member (Haaken, 1993).


In the past, the prevailing view among psychologists was that women who work and have professions suffer personality disturbances(labeled “penis envy” or otherwise) and that traditionally feminine women were psychologically healthier. Research does not support thisview (Helson & Picano, 1990Yogev, 1983). Psychological “masculinity” (as measured on sex-typing instruments such as the Bern Sex-RoleInventory), which reflects such qualities as assertiveness, is associated with better mental health in both men and women. Calling suchhealthy traits “masculine” reflects a cultural viewpoint.

Traditional gender roles bring a price. In women, they discourage assertiveness and individual development. People who overemphasizeother people’s needs compared to their own, in a pattern called unmitigated communion, are prone to later psychological maladjustment,such as depression (Aubé, 2008). The finding applies to both women and men, though gender roles make this style more common amongwomen. In men, traditional gender roles contribute to defense mechanisms such as restrictions in emotionality (Mahalik et al., 1998) and togender-related problems, including violence, fear of homosexuals, detached fathering, and neglect of health needs (Levant, 1996).

Cross-Cultural Differences

The emphasis on individual achievement is, as Horney hinted, particularly characteristic of Western culture. Harry Triandis and hiscolleagues have studied cultural differences in  individualism,  a value that emphasizes individual accomplishments and privileges. TheUnited States and Britain are particularly high in individualism (Triandis, McCusker, & Hui, 1990). In contrast, countries that are less affluent,in which people depend on cooperation to share resources, are characterized by  collectivism,  which values the relationships between peopleand their shared goals and mutual responsibilities (Triandis, 1996). Collectivist cultures, like those in Africa, Asia, and Latin America,emphasize conformity, social harmony, group tasks, and family obligations.


values, predominant in many Western cultures, of individual goals and achievement (in contrast to shared groupgoals and cooperation)


values, predominant in some cultures, of social cooperation and group goals

The assumption that the self is separate rather than connected to others pervades Western thought and psychological theory and treatment,reflecting the individualistic values of its cultural founders. Having harmonious relationships with other people is less important as a sourceof life satisfaction in the United States, an individualistic culture, than in (for example) Hong Kong (Kwan, Bond, & Singelis, 1997).Individualistic cultures encourage Horney’s moving-against orientation, emphasizing achievement and accepting aggressive behavior.Collectivist cultures are more supportive of a mov-ing-toward orientation. For therapists dealing with clients from other cultures, it isimportant to not misperceive people whose behavior may reflect their different cultural values, rather than individual problems. Fortheorists, it’s important to realize that our assumptions about what is healthy may be limited by our cultural vision, and that other culturesmay provide correctives to cultural myopia.


In criticizing Freud’s patriarchal biases, Horney set a model for later clinicians to question whether therapists could also fail to understandpatients because of their own limited experience of race, sexual orientation, or other factors. Horney opened the door for realizing that thetherapist, too, is influenced by culture, bringing perhaps biased assumptions to the understanding of the client (Miletic, 2002).

Although orthodox in her acceptance of the importance of childhood experience in developing personality, Horney did not believe allpsychoanalytic treatment required delving into childhood recollections. Horney criticized the Freudian overemphasis on the exploration ofchildhood origins of neurosis, although she would doubtless agree that interpersonal relationships based on faulty parent–child interactingcan be mended in therapy (Morgan, 1997). Horney advised the therapist to keep bringing the patient back to the present, seeing how neurotictrends influence current life.

Inevitably, the patient’s idealized image must he challenged, but this must be done carefully and slowly because it is the basis for thepersonality, wounded but not destroyed, that the patient brings to analysis. Eventually, the idealized image must be replaced by a morerealistic self-concept. The term shrink, applied to the analyst, seems particularly fitting for this function.


Neurotic problems begin early in life, within the family, where the “basic evil is invariably a lack of genuine warmth and affection” (Horney,1937, p. 80). Parental behavior that undermines a feeling of safety will lead to neurotic development. This includes parental neglect,indifference, and even active rejection of the child.

One of the goals Horney described for psychoanalysis was to advise parents how to raise healthy youths, thus breaking the repeating cycle ofneurosis through each generation. Psychoanalysts exploring these issues suggest it is important for parents to pay attention to their infants’emotional experiences. This requires that the mother (or other caregiver) be able to understand the infant’s emotion and to respondappropriately, for example, by mirroring an infant’s distress or joy. If this experience is deficient, the child will develop with deficits inaffective regulation (Glucksman, 2000).

Research supports her ideas. The trait of neuroticism in parents contributes to their abuse of children, apparently by making the parents lessable to tolerate the negative emotions that come from stressful interactions with their children (Belsky, 1993McCrae & Costa, 1988).Longitudinal research shows that parental acceptance and nonauthoritarian punishment in childhood predict higher ego development at age30, particularly for women (Dubow, Huesmann, & Eron, 1987). One particularly impressive study, using a longitudinal design, correlatedparental behavior during preschool and the children’s development as young adults. Fathers and mothers were evaluated according to the“poisonous pedagogy” formulation of psychoanalyst Alice Miller, whose ideas are similar to those of Karen Horney. As predicted, parents whotreated their children with criticism and excessive control produced anxious, poorly adjusted children; parents who expressed affection andencouraged their children produced warm and socially well-adjusted young adults (Harrington, 1993). Other studies of parenting stylesconfirm that neglectful parents have children who have greater difficulties. Authoritative parents, who provide both direction and acceptance,rear better adjusted children (Lamborn et al., 1991).


Theories build on earlier theories. In contrast to Freud’s emphasis on the unconscious and intrapsychic conflict, many of his successors todaystress disturbances in the relationships that people have developed, beginning with early family experience, a theme that Horney and othersemphasized (see Table 6.4). The relational model was presented as an alternative to Freud’s drive model (Greenberg & Mitchell, 1983Mitchell & Aron, 1999), and it influences even many therapists who were trained in the Freudian tradition (Sudak, 2000).

The  relational approach  emphasizes interpersonal relationships, especially the impact of early relationships with parents (Greenberg &Mitchell, 1983). The mother is more important in this approach, in contrast to Freud’s emphasis on the father (Grotstein, 1993). Earlyrelationships are particularly influential because the very young do not yet have a sense of themselves as separate persons. Earlyrelationships are the basis for developing internal representations of self and others that will guide relationships throughout life, and thatprepare us to expect love or rejection, nurtur-ance or disappointment, from people. Whether people seek support from others in adulthoodor avoid doing so and dwell on depression and self-criticism is related to the way they describe their parents, even though they are oldenough to have moved on to new relationships (Mongrain, 1998). A relationship with an empathic, nurturant parent begins this process in ahealthy way. But rejecting or abusive parenting sets the stage for internalizing much more negative images of others and of the self.

relational approach

approach in modern psychoanalysis that emphasizes interpersonal relationships

Table 6.4 Important Persons in the History of the Relational Approach

TheoristTheoretical Ideas
MelanieKleinYoung children are very needy; they relate to “part objects” (such as the breast) instead of the whole parent; theirambivalent feelings cause guilt about their negative feelings about their parents.
W. R. D.FairbairnPeople have a fundamental need for relatedness. Maternal indifference and lack of love for the child contribute to thedevelopment of child pathology. The child defensively splits the rejecting mother (which is internalized) from the hoped-forloving mother, which impedes development from immature to mature dependency.
HarryStackSullivanChildren attempt to avoid anxiety in interpersonal relationships by constructing an understanding of self that includes a good me, a bad me, and a not me.
OttoKernbergBorderline and psychotic patients suffer disturbed identity and interpersonal relationships. Early severe frustration leadsto unmanageable aggression and narcissistic personality disorders. Especially in borderline personality disorder,narcissistic frustrations lead to a splitting of the “good” and “bad” self and object relations, which are kept isolated fromone another, and a grandiose self is defensively formed.
HeinzKohutgrandiose self is part of normal, healthy development, based on a desire for merger with omnipotent caretakers, whoseadmiration is sought. A healthy, integrated self structure will be formed if the adults respond empathically to the child. Ifless-than-optimal parenting is available, the child will construct an idealized parental imago to support the grandiose self.
MaryAinsworthand JohnBowlbyInfants develop secure attachment, in which they derive comfort from the presence of the mother (or substitute); orinsecure attachment, in which they are not comforted.
NancyChodorowChildren’s gender development is influenced by the different roles that the mother and father play in caring for children (incontrast to Freud’s proposed anatomical determinants of gender).

Some psychoanalysts argue relational theorists do not give Freud the credit he deserves for his insights about relationships. Besides thetransference, Freud proposed that in seeking a marriage partner men seek someone similar to their own mother, and women seek someonelike their father. This prediction finds some research support. A widely used test of personality (the Five Factor Inventory) was administeredto participants (mostly college students) and to their parents, and on several traits, the participants’ opposite-sex parent had a personalitysimilar to their chosen romantic partner (Geher, 2000).

Relationships are often referred to as  object relations  in psychoanalysis, based on Freud’s idea that other people serve as the objects thatcan satisfy libidinal desire. The relational approach considers the cognitive and affective processes that allow people to form healthyinterpersonal relationships or that impede such relationships. For example, sociopaths have defective object relationships in that they exploitothers for their own selfish purposes. People suffering from borderline personality disorder have another kind of disturbed objectrelationship pattern: They manipulate others and may quickly become intensely attached to someone who is not suitable to meet thisirrational need (Westen, 1991). Borderline personality disorder is associated with such a fundamental sensitivity to rejection that a brainarea that reacts to such emotion, the amygdala, is activated by facial expressions that the general population sees as neutral (Westen,Gabbard, & Ortigo, 2008).

object relations

term used in psychoanalysis for relationships with people, based originally on the idea that people serve as objectsto satisfy libidinal drives

Emotions triggered in interpersonal situations are especially important in object relationships, as we might expect given the role of infantileanxiety and hostility that Horney described. Others may calm us when we are distressed or arouse anxiety when we are not. This effectdepends on experience with early relationships. The emotions we expect from relationships can be measured by projective tests as well as byinterview measures (Barends et al., 1990). By providing ways of measuring individuals’ capacity for healthy relationships—methods that aremore systematic than clinical impressions and can also be used to study people who are not in therapy—researchers are contributing to thedialogue between clinical and research-oriented psychologists (see Table 6.5).

Drew Westen and his colleagues have developed an instrument to measure affect regulation styles, using a Q-Sort technique in which clinicaljudges sort statements describing each patient’s emotions into nine piles, according to how well they describe the person: the AffectRegulation and Experience Q-Sort (the AREQ). They suggest that psychological problems are more severe among people who have difficultyregulating strong negative emotions (Westen et al., 1997).

In a cross-sectional study of children, Westen and his colleagues (Westen et al., 1991) report evidence for increasing maturity from grade 2 tograde 5 (about age 8 to 11 years) on three dimensions of relationships: complexity of representations, capacity for emotional investment, andunderstanding social causality. These results show that object relationships are not so fixed in the preschool years as Freud theorized, butinstead they continue to develop for many years thereafter.

Table 6.5 Measurement of Object Relations from TAT Stories

ScaleDescriptionDescription of LowScoreDescription of High Score
ComplexityComplexity, differentiation, andintegration of representations ofpeoplePoor differentiationbetween peopleComplex, multifaceted, integratedrepresentations of people’s subjectiveexperience and enduring dispositions
Affect-tone of relationshipparadigmsExpectation that relationshipswill be safe and enriching ordestructive and threateningExpectation thatrelationships will bedestructive andthreateningExpectation that relationships will be safeand enriching
Capacity for emotionalinvestment inrelationships and moralstandardsEmotional orientation that isselfish, or that unselfishly investsin people, values, and idealsInvestment in one’sown need gratificationand desiresCommitment to values and relationshipsthat acknowledge needs of self and others
Understanding of socialcausalityLogic, complexity, accuracy, andpsychological mindedness ofattributionsAbsence of causalunderstandingComplex understanding of the rolemental events play in social causation

Source: Adapted from information in Westen et al., 1991.


Our sense of self is rooted in relationships. Early disturbances, coming from relationships with inadequate parents, leave a person with aweakened or enfeebled sense of self (Kohut, 1984). In terms of relational theory, disturbed interpersonal relationships stem from earlyexperience in which parents do not properly “mirror” the baby’s experience and emotions, failing to provide the experience needed todevelop a healthy sense of self. Thus the developing person lacks accurate awareness of his or her own self, identity, and emotions, producingunhealthy interpersonal behavior later in life (e.g., Vanheule & Verhaeghe, 2009). The sense of self is central to the understanding of defensemechanisms in relational theory. Defenses serve to protect self-esteem (Cooper, 1998).

Children who have not been adequately nurtured or loved develop a belief (which may be unconscious) that they are not worthy, and thisimpaired self is at the heart of much pathology. Patients diagnosed with borderline personality disorder report what Westen and hiscolleagues call “malevolent” early memories, in which people were injured (e.g., being pushed to the ground in an early school experience)and little help was given (Nigg et al., 1992). In contrast, adolescents who describe their parents as warm and fostering independence, as“ideal parents,” are less likely to suffer from a variety of personality disorders than those who recall less benign parenting (Brennan & Shaver,1998).

Relational theorist Stephen Mitchell (1970/1999) suggests that the early parent–child relationship is one in which parents’ more or lessdistorted views of themselves and their child set up a distorted, grandiose self-image in the child. For example, the parents might create anunrealistically good and obedient image of their child, which is too limiting for a real child to have room to develop his or her full personality.Object relations theorist Fairbairn (Celani, 1999) describes the defense mechanism of “splitting” as a result of inadequate parenting. Theparental object is seen as two separate objects: the bad object that has been rejecting or abusive and the good object that the child longs toplease. The child develops both a despised self that in a warped sense justifies the parental rejection or abuse and a grandiose good self thatcould ideally be the basis for earning parental respect and love. These ideas are quite similar to Horney’s description of the despised real selfand the grandiose self, and in both theories, the split stems from bad parenting.

Our role relationships with other people throughout life are based on early relationships, and they recapitulate the weaknesses and thedefective sense of self that are the legacy of the past. People whose early object relationships are unhealthy because of early physical, sexual,and emotional abuse or other mistreatment are vulnerable to self-destructive behaviors, including suicide (Twomey, Kaslow, & Croft, 2000).They remain in relationships that seem obviously unhealthy. Why would this be? The need to maintain a relationship with an importantobject, such as the parent, is so strong that extreme measures are taken to maintain the relationship, including blaming oneself (Grand &Alpert, 1993Westen, 1991).


Too much focus on the self can get in the way of healthy relationships. An unhealthy self-focus and self-admiration constitutes  narcissism.  Inless than 1 in 100 people, narcissism is severe and impairs the person so much that it can be diagnosed as a mental disorder, narcissisticpersonality disorder (American Psychiatric Association, 1994). People who suffer from this disorder are extremely self-focused; they do nothave much empathy for other people’s experience. Their sense of being special, that they deserve attention and admiration, leads them to useother people as admiring audiences and supporters instead of as separate individuals. When undergraduates who score high on a measure ofnarcissism are asked to describe a shameful early memory (a manipulation theorized to confront the early basis of their narcissism), theysubsequently express considerable hostility on an ambiguous projective picture of a child; but those in the experimental group asked to recalla positive memory projected much less hostility onto the picture. Nonnarcissists did not show these effects, which supports the interpretationthat narcissists’ hostility is tied to early shameful experiences (Heiserman & Cook, 1998). It is easy to see why narcissism, which is based ondisturbed relationships, may lead to domestic violence (Zosky, 1999), and why narcissists sometimes react very strongly when they areinsulted (Horton & Sedikides, 2009).


unhealthy self-focus that impairs the ability to have healthy, empathic relationships with other people

The insight that a disturbed sense of self is closely related to disturbed relationships with others helps us understand puzzling findingsreported by researchers. High self-esteem, that is, thinking you are a worthwhile person, is generally a healthy characteristic. High self-esteemhas its downside, though. For one thing, people with high self-esteem sometimes take on tasks that are too difficult, apparently trying toprove how much they can do (Baumeister, Heatherton, & Tice, 1993). They also may persist too long at tasks that cannot be finished and areprone to other self-defeating behaviors (Baumeister, 1997). Surprisingly, it has also been found that people with high self-esteem may also bemore aggressive than other people (Baumeister, Smart, & Boden, 1996), at least under some circumstances—specifically, when they are alsonarcissists and they are insulted (Bushman et al., 2009).

Why? One factor to consider is that “self-esteem” is operationally defined as a person’s score on a self-report measure. Some people whoscore high on such measures truly accept who they are, but others have a fragile, grandiose image of themselves hiding a deeper self-doubt.For them, high self-esteem scores are not so much accurate as they are defensive statements. When challenged, they feel vulnerable and somay behave aggressively in an effort to bully their way to being seen as worthwhile. That interpretation suggests that narcissism, not trueself-esteem, leads to aggression when a person is insulted or provoked. This interpretation is supported by experimental evidence. Subjectswho score high on a test of narcissism behave aggressively toward someone who has insulted them by criticizing essays they had written.When given the opportunity to do so in a laboratory setting, narcissists blast the other person with a loud noise in a computer game(Bushman & Baumeister, 1998). Narcissistic people are readily angered (Rhodewalt & Morf, 1998). Their self-esteem is insecure, subject tothe supports and attacks of life’s transient events (Rhodewalt, Madrian, & Cheney, 1998), and so they defend their self-worth aggressively.


Whether we turn to relational theorists, Horney, or even Freud, experts continue to point to the importance of early relationships betweenparents and children as a foundation for personality and relationships throughout life.

Infant Attachment

Infants develop bonds of affection with their mother, called  attachment  (Ainsworth et al., 1978Bowlby, 1988). Attachment is based on aninstinct (Eagle, 1996) that functions, in an evolutionary sense, to ensure children’s survival by keeping them near to their parents, on whomthey depend for survival. In historic observations, René Spitz (1945) observed that orphanage babies deprived of human touch and lovebecame ill and even died, despite adequate food and medical care.


bonds of affection in which an infant turns to the mother or other caretaker for comfort and security; by extension,close interpersonal styles in adulthood

Mary Ainsworth (1972Ainsworth et al., 1978) studied infant attachment to the mother (as the primary caretaker) by observing infants’responses to strangers. The development of a secure attachment between infant and parent provides a basis for emotional health and copingin later life. It facilitates cognitive development in childhood, presumably because the securely attached child has self-confidence toinvestigate the world (Jacobsen, Edelstein, & Hofmann, 1994). Later love relationships are also healthier when they build on secureattachment.

Table 6.6 Ainsworth’s Description of Infant Temperament Types Compared with Horney’s Model of Interpersonal Orientations

Infant TypeInfant BehaviorHorney’s Interpersonal Orientation
Type A•Resists being comfortedMoving Away
Type B1•Securely attached•Comforted by mother•Explores new environmentBalance of the three Interpersonal Orientations
Type B4•Securely attached•Stays near mother for comfortMoving Toward
Type C•Ambivalent toward mother•Shows anger toward strangerMoving Against

Source: Adapted from Feiring, 1984.

In the infant attachment studies, researchers observed how infants behaved when in the presence of a stranger. Some infants were frightened;others seemed comforted by their mothers’ presence. The various attachment patterns can be interpreted as confirming Horney’s patterns ofmoving toward, against, or away from people (Feiring, 1984). One type (Type B1) has the balanced interpersonal mode that Horney regardedas most healthy (see Table 6.6).

We should be cautious about blaming the parents entirely for attachment disturbances. Their ability to provide their children with warmthand support may be influenced by their own circumstances, including social position (Stansfeld et al., 2008). Furthermore, childhoodtemperament, produced by genetics, is partly responsible for the greater security of one child compared to another. The same parentalbehavior that is adequate for the average child may leave a temperamentally vulnerable child anxious about attachment. Fortunately, researchon interventions shows that training parents how to be more responsive to their young children can improve attachment (Lyons & Sperling,1996). And we know that attachment is mutual: babies’ smiles influence the mother’s brain activity in a unique way, different from herreactions to other infants (Strathearn et al., 2008).

Adult Attachments and Relationships

Attachment styles continue after infancy (Hazan & Shaver, 1994). Attachment in adulthood helps regulate emotion and reduce stress (Feeney& Kirkpatrick, 1996; Silverman, 1998). Securely attached adults feel more trust toward their partners than do those without secureattachment (Mikulincer, 1998b) and are able to resolve conflicts within relationships more maturely (Corcoran & Mallinckrodt, 2000).Adolescents hospitalized for psychiatric disorders are reported to be insecurely attached, as are their mothers (Rosenstein & Horowitz,1996).

Various kinds of adult attachment resemble infant attachment styles. A person who falls in love, marries, and stays in a stable relationshipthroughout adulthood exemplifies secure attachment. Another who is hesitant about love, marries, but divorces not long after and thereafteravoids long-term relationships illustrates an avoidant attachment style (Klohnen & Bera, 1998). Laboratory research that asked collegestudents to recall what they heard about a woman describing her relationships, suggests that avoidant people don’t pay as much attention tosuch information as others (Fraley & Brumbaugh, 2007). Another type of insecure adult attachment is “desperate love,” a style of love withhigh anxiety and the desire to be excessively close to the loved one (Sperling & Berman, 1991). Unhealthy attachment styles leave coupleswith the risk of being overly intrusive toward their partner (Lavy, Mikulincer, & Shaver, 2010).

Sperling and his colleagues have suggested a model of four types of adult attachment that emphasizes both dependence and anger. Theirmodel corresponds well to Horney’s three interpersonal styles, with an additional category reflecting ambivalence between moving towardand moving against (Sperling, Berman, & Fagen, 1992) (see Table 6.7).

Table 6.7 A Model of Adult Attachment Styles

High AngerLow Anger
HighDependencyResistant-ambivalent attachment style (compare to Horney’s description ofconflict between achievement and love, that is, moving against and movingtoward)Dependent attachment style (compareto Horney’s moving towardorientation)
LowDependencyHostile attachment style (compare to Horney’s moving against orientation)Avoidant attachment style (compareto Horney’s moving away orientation)

Source: Adapted in part from Sperling, Berman, & Fagen, 1992. The comparisons with Horney’s theory are added.

Other researchers have adopted a three-category model of adult attachment, corresponding to the infant research (see Table 6.8). It is notonly simpler but more optimistic in that it includes a “secure” category (Hazan & Shaver, 1987). Personality tests show securely attachedadults to be higher on extraversion and lower on neuroticism than anxious and avoidant adults (Shaver & Brennan, 1992). Securely attachedadults are also less prone to anger and deal with it more constructively (Mikulincer, 1998a). Adults who are not securely attached havedifficulty expressing anger toward their romantic partners; those who are securely attached, in contrast, can express anger appropriately andmaintain the relationship (Sharpsteen & Kirkpatrick, 1997). Securely attached college students, as yet unmarried, look forward to havingmore children and are more confident about their ability to be effective parents, compared to insecurely attached college students (Rholes etal., 1997). In one study, anxiously attached male undergraduates wrote TAT stories describing violence of men toward female victims morethan seven times as often as the secure group, perhaps reflecting the frustrations of anxiously attached men about intimacy (Woike, Osier, &Candela, 1996).

Longitudinal Studies of Attachment

Longitudinal studies of attachment verify that mothers’ caregiving at 18 months predicts attachment in adulthood (Zayas et al., 2011).Furthermore, disturbed attachment relationships from early life carry over to adulthood. One study tracked down college students up to 31years later when they were in their early 50s. In middle age, the women selected one of several paragraphs that best described them, allowingresearchers to classify their attachment style. Those classified as “avoidantly attached” had already expressed more ambivalence aboutmarriage and family when they were in college. As the years passed, they were less likely to marry than the securely attached group and morelikely to be divorced if they had married. Researchers described the avoidantly attached as less interpersonally close, more defensive andrepressive, and less tolerant to stress from college onward, compared to those who were securely attached (Klohnen & Bera, 1998).

Table 6.8 Three Adult Attachment Styles

Secure Attachment Style
I find it relatively easy to get close to others and am comfortable depending on them and having them depend on me. I don’t often worryabout being abandoned or about someone getting too close to me.
Avoidant Attachment Style
I am somewhat uncomfortable being close to others; I find it difficult to trust them completely, difficult to allow myself to depend onthem. I am nervous when anyone gets too close and often love partners who want me to be more intimate than I feel comfortable being.
Anxious-Ambivalent Attachment Style
I find that others are reluctant to get as close as I would like. I often worry that my partner doesn’t love me or won’t want to stay with me.I want to merge completely with another person, and this desire sometimes scares people away.

Source: Based on Hazan & Shaver, 1987.

Attachment difficulties are passed down from one generation to the next. For example, in a study of mothers who had a child born with aserious illness such as congenital heart disease, those mothers who were avoidantly attached had worse emotional and psychologicaloutcomes in the coming 7 years for both themselves and their children (Berant, Mikulincer, & Shaver, 2008). In another study, which gathereddata on subjects for 70 years of their lives, subjects whose parents had divorced (a major disruption of attachment relationships for a child)were adversely affected. They were more likely to become divorced themselves, and they were more likely to die earlier, at least in partbecause stable marriage tends to increase longevity (Tucker et al., 1997).

A representative sample of U.S. adults finds adults were less likely to be securely attached if, in childhood, their parents had suffered variousforms of psychopathology (including depression, anxiety, and substance abuse), committed suicide, died, or were absent for long periods oftime. Other traumas and hardships also were related to insecure attachment: physical and sexual abuse, neglect, accidents, natural disaster,financial adversity, and other distressing events (Mickelson, Kessler, & Shaver, 1997). Securely attached adults marry other securely attachedadults; those insecurely attached also tend to marry people with similar attachment problems, which bodes ill for their ability to provide asecure relationship for their children (van Ijzendoorn & Bakermans-Kranenburg, 1996).


The relational approach to therapy contrasts with Freud’s classic drive model by acknowledging a more significant role of the therapist’sbehavior as an influence in what happens in therapy sessions. In contrast to the traditional psychoanalytic drive model which emphasizes thepatient’s unconscious and defense mechanisms as the “one person” determinant of the sessions, the interaction with the therapist itself isinfluential (Altman, 1994).

Relational therapists suggest that the patient–therapist relationship provides an opportunity for transformation of old maladaptiverelationship patterns to new healthy ones. The transference relationship should be similar enough to old patterns to put these disturbancesin the arena of therapy, even if the old relationships were unhealthy, but different enough to stimulate change (Greenberg, 1986/1999).Paradoxically, a patient may need to cast the therapist in the role of the bad parent to experience that warped attachment—for example,acting out anger against a therapist perceived as hostile and rejecting like the patient’s parent, before being able to move on to healthierrelationships (Knight, 2005).

Looking back to the founder of psychoanalysis, it would seem that analysis has moved far away from the biological model that Freudproposed. Yet interpersonal relationships in the attachment approach can be understood from the perspective of a parent–child bond thatbegins with very physical connections, with attachments serving healthy development by a mirroring of the infant’s physical experience inthe responses of the other. Adult sexual relationships can provide, again, an echo of inner physical experience in the responses of the other(Fonagy, 2008Fonagy & Target, 2007). And so interpersonal approaches in psychoanalysis, as this theoretical and therapeutic approachdevelops, may have more connections with Freud’s early suggestions than we appreciated, after all.


· Karen Horney revised psychoanalytic theory to emphasize interpersonal factors, and this theme has been expanded by later relationaltheorists.

· The child experiences basic anxiety as a result of parental rejection or neglect.

· This anxiety is accompanied by basic hostility, which cannot be expressed because of the child’s dependence on the parents.

· The child attempts to resolve the conflict by adopting one of three interpersonal orientations: moving toward people (the self-effacingsolution), moving against them (the expansive solution), or moving away from them (the resignation solution).

· The healthy person can flexibly use all three orientations, but the neurotic person cannot.

· Horney described four basic strategies for resolving neurotic conflict: eclipsing the conflict, detachment, the idealized self, and externalization.

· The neurotic individual turns away from the real self, which has the potential for healthy growth, to an idealized self. The tyranny of theshoulds supports the idealized self.

· In addition, Horney described several secondary adjustment mechanisms: blind spots, compartmentalization, rationalization, excessive self-control, arbitrary rightness, elusiveness, and cynicism.

· Horney emphasized the cultural determinants of development. Parenting patterns vary from society to society; even the Oedipus complexis not a universal human experience in her theory.

· Horney discussed gender roles as developments shaped by particular cultures, which can change if cultures change.

· Horneyan therapy seeks to uncover unconscious conflicts originating in childhood but emphasizes their implications for present life.

· Relational theorists (a newer approach than Horney’s theory) also emphasize early parent–child relationships and their implications for asense of self and for interpersonal relationships throughout life.

· Disturbances in object relationships contribute to many disorders, including narcissism, and to disturbed relationships in adulthood.

· In addition to contributors from psychoanalysis, developmental researchers investigating attachment have contributed to ourunderstanding of object relations.

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