If the world has had a historical blindness to lesbian mothers, it also has a blindness to the problems they face as parents.

     That’s the view of Elisabeth Young-Bruehl, Ph.D., a psychoanalyst on the faculty of the New School for Social Research, who has treated a number of lesbian parents in private practice. She spoke at the Chicago Psychoanalytic Society’s conference on "Clinical Issues with Lesbians and Gay Men" in March.

According to Young-Bruehl, lesbian parents fall into two major categories with distinct sets of problems. The first category includes women who had children in a heterosexual relationship. After a divorce or separation, these mothers are raising their children with lesbian partners. Often women in these relationships go into treatment to address concerns about coming out or difficulties managing relationships with ex-husbands and ex-boyfriends.

While difficult, the problems they face are far less complex than those of the second group: lesbian parents who set out to have a baby together. From the start, they face a staggering set of decisions that have long-term consequences for the child and the relationship. Should they adopt or have a child themselves? If they elect to have their own, who will bear the child? Who is healthier or has the better genes?

"The amount of discussion is off the map" in comparison with heterosexual parents, Young-Bruehl said.

The questions not only trigger profound emotional reactions, but serious legal issues as well. With the exception of a handful of states, most courts recognize only the rights of biological parents. That leaves nonbiological parents in a vulnerable position. In difficult times, they may be unwilling to assert themselves for fear of losing access to the children.

Even when the courts resolve the problem, the emotions don’t necessarily change, said Karen Martin, L.C.S.W., a candidate at the Chicago Institute for Psychoanalysis. Despite the fact that a court had allowed one of her clients to adopt the child her partner had given birth to, she never felt she had the same stature as the birth mother.

"She did not feel internally as though she had the same rights to the child as the partner did. Nor did the partner feel like the other person had the same rights," Martin said. "I think neither one of them could quite get to the place where they could feel that the nonbiological parent was actually a parent."

The second group that Young-Bruehl sees is characteristically made up of women in their 30s and 40s and is rapidly outgrowing the first. The primary reason is the development and availability of reproductive technologies. Artificial insemination and in vitro fertilization have enabled a whole generation of women to conceive in nontraditional ways, and has, according to Young-Bruehl, created a "unique possibility to play out scenarios of love and hate. That is one of the most important things [for therapists] to bear in mind," she said.

To illustrate, Young-Bruehl described a patient who viewed pregnancy and childbirth as an assault and, in what Young-Bruehl called an act of unrecognized hostility, insisted her partner bear their second child. The demand caused immense problems in the relationship because her partner was terrified of being pregnant and ended up carrying twins.

Joan A. Lang, M.D., the chair of the department of psychiatry at St. Louis University School of Medicine, said lesbian parents also face disappointment, much as heterosexual parents do, with parenthood itself. Many have "deep fantasies. . .[that they] will establish a safe haven where total understanding is possible," Lang said, but find it is not so.

Making matters worse, their relationships in the lesbian community are often disrupted, as they are drawn more and more into a child-centered heterosexual world. Childrearing "marks a transition back into the heterosexual world," Young-Bruehl said. In that world of soccer games and children’s birthday parties, partners find themselves closer to heterosexual mothers than lesbian friends without children.

Despite the complications, Young-Bruehl has seen many successful examples of lesbian parenting.

Where the egos of the partners are strong, where there are not "exaggerated needs for children to be a certain way," and when the partners understand each other’s weaknesses and are flexible in the roles they play, lesbian parents can be tremendously successful at raising healthy, happy children, she said.