Ethnic working class women's special responsibility for transmitting their heritage ties them, often painfully, to that heritage and to their traditional gender role. Psychologically, they experience a unique set of exodus stresses. When they seek psychotherapy the process can place them in a double bind in that their personal striving deeply threatens their ethnic and class ties. These women may leave treatment prematurely unless clinicians are willing to recognize the unique configuration of symptoms that derive in large part from their subcultures of origin. By challenging their own ethnic, racial and class identities, clinicians can open up new treatment possibilities to help strengthen positive group identity, enhance self-esteem and support personal striving in their patients and in themselves.