Systems of Psychotherapy A Transtheoretical Analysis Chapter 13

Systems of Psychotherapy: A Transtheoretical Analysis Chapter 13. Gender. Sensitive Therapies

A Sketch of Sociopolitical Forces ♦ Modern psychotherapy created by White men in their image & according to their values ♦ Rise of feminism (commitment to equal social, economic, & political rights) in 60’s & 70’s ♦ Gilligan’s In a Different Voice illuminated sexist bias in psychology research and practice ♦ Women denied equal rights & equal voice in mental health care ♦ No single person responsible for feminist therapy; a collaborative effort

Feminist Theory of Personality ♦ No single or consensual theory of personality ♦ Identity is influenced by prevailing environment, including social learning & gender roles ♦ Gender roles & discrimination influence cognitive structures & behavior patterns ♦ Differences between gender due in part to women primarily raising children (Chodorow) ♦ Gender message and roles deeply ingrained in personality

Theory of Psychopathology ♦ Psychological distress is often environmentally induced and culturally determined ♦ Occurs when social structure is rigidly defined and people are not permitted to grow ♦ Many disorders are coping efforts in oppressive, inescapable environments ♦ Disorders caused in part by: Sex-role stereotyping, gender-role expectations, role strain and conflict, sexual trauma, and gender-related economics

Role Strain & Conflict ♦ Strain: multiple demands of different roles ♦ Conflict: clashing or conflicting roles ♦ Women subscribing to traditional sex role have higher incidence of depression & anxiety as well as lower self-esteem ♦ Stress created by society’s antagonism toward changing roles and power

Sexual Trauma ♦ Major contributor to psychopathology ♦ Approx ¼ of American women and �men have experienced childhood sexual abuse ♦ About 60% of rapes are acquaintance rapes & only 30% of rapes are reported ♦ Rage related to sexual abuse can manifest itself in pathological symptoms

Feminist Therapeutic Processes ♦ Consciousness raising: suffering due to gender discrimination, not individual deficits ♦ Choosing: can be achieved even within a patriarchic society ♦ Counterconditioning: healthy opposites applied to gender-linked distress ♦ Social liberation: increasing alternatives for equality; “the personal is political”

Guidelines for Therapy with Women Therapist should: ♦ Be free of gender-defined roles & stereotypes ♦ Recognize reality & variety of sex discrimination ♦ Facilitate options for clients ♦ Not use derogatory labels ♦ Inform clients about therapy practices (informed consent)

Guidelines for Therapy with Women (cont. ) Therapist should: ♦ Realize that privilege belongs to client (not family or spouse) ♦ Not reinforce stereotypic dependency of women ♦ Respect the client’s assertive behavior ♦ Recognize that abused clients are crime victims ♦ Recognize the client’s right to define sexual orientation

Therapeutic Content Intrapersonal Conflicts ♦ Anxieties & defenses ♦ Self-esteem ♦ Responsibility Interpersonal Conflicts ♦ Intimacy & sexuality ♦ Communication ♦ Hostility ♦ Control

Therapeutic Content (cont. ) Indivduo-Social Conflicts ♦ Adjustment versus transcendence Beyond Conflict to Fulfillment ♦ Meaning of life ♦ Ideal individual

Therapeutic Relationship ♦ Characterized by 2 E’s: Empowerment & Egalitarianism ♦ Empowerment: therapist helps instill power, both social & individual, in client ♦ Egalitarianism: comparatively equal relationship between therapist & client ♦ Treatment goals are mutually generated

Practicalities of Feminist Therapy ♦ Consumer-oriented: clients encouraged to shop around for therapist ♦ Lower-cost sessions common ♦ Empowered consent regarding risks & benefits of psychotherapy ♦ Non-hierarchical leadership to group treatment & community organizations ♦ Mostly, but not always, women therapists

Practicalities of Feminist Therapy (cont) ♦ Length of treatment determined by patient ♦ Treatment length increases when client pursues more ambitious goals ♦ Feminist consciousness takes considerable time ♦ Successful feminist action takes even longer

A Major Alterative: Male-Sensitive Psychotherapy ♦ Traditional therapy designed by men to treat primarily women ♦ Therapy for men based on accurate understanding of male personality and development ♦ Men are negatively effected by gender role expectations & suffer from role strain (as do women)

4 Stereotypes of “True Masculinity” ♦ No sissy stuff: avoid anything “feminine” ♦ The big wheel: must be successful, respected breadwinners of the family ♦ The sturdy oak: exude confidence, strength, self-reliance ♦ Give ’em hell: behave aggressively & daringly

Gender-Role Expectations ♦ Men must achieve or exceed masculine standards or accept “failure” ♦ Men hide feelings behind façade of toughness, resistance, & violence ♦ Male problems (e. g. , aggression) are often byproducts of typical socialization ♦ Men find it difficult to seek help; seen as admission of weakness ♦ Men often genuinely unaware of their emotions (normative male alexithymia)

Practicalities of Men-Affirming Psychotherapy ♦ Treatment formats more flexible than conventional therapy ♦ Group therapy is powerful & common ♦ Humor is frequent means to begin conversations about serious issues ♦ Initially, therapist may avoid open- ended questions about feelings; focus on practical matters

Gender Non-Conforming Psychotherapy ♦ Psychotherapy long maintained a cisgender bias (assuming person in accord with assigned gender) ♦ Nonconforming individuals’ need for services often exacerbated by feelings of isolation, shame, & discrimination ♦ Gap exists between the need for trans-affirmative therapy and current treatment resources ♦ Therapeutic processes employed in feminist and male-sensitive therapies transfer here

Effectiveness of Gender-Sensitive Therapies ♦ No randomized controlled studies on effectiveness of feminist therapy ♦ Increased satisfaction commonly observed in same-gender therapy dyads ♦ But no consistent benefit of patient-therapist gender matching on outcome ♦ More difficult to test by traditional means because results are not limited to symptom remission

Criticisms of Gender-Sensitive Therapies ♦ From a Psychoanalytic Perspective (source of problems are within the person not society) ♦ From a Cognitive-Behavioral Perspective (change principles are universal across gender, lack of research) ♦ From a Humanistic Perspective (feminism may be promoting censorship rather than diversity) ♦ From an Integrative Perspective (prioritizing gender over everything goes too far, only considers adult women)

Future Directions ♦ Future demands cultural competent, gendersensitive therapies ♦ Will more fully address inclusiveness, e. g. , age, SES, disabilities ♦ Need for controlled outcome research ♦ More gender-sensitive training in graduate programs & continuing education

Key Terms alexithymia androcentric androgyny Bibliotherapy cisgender consciousness-raising groups cultural competence culturally determined egalitarianism empowered consent empowerment feminism feminist therapy feminization of poverty fundamental attribution error gender identity paradigm gender nonconforming gender role strain paradigm gender socialization glass ceiling internalized oppression male-sensitive therapy mother blaming power analysis groups Relational-Cultural Theory role conflict role strain social liberation “the personal is political”

Recommended Websites ♦ Feminist Therapy Institute: www. feminist-therapyinstitute. org ♦ Men. Web: www. menweb. org ♦ Society for the Psychological Study of Men & Masculinity: http: //division 51. net ♦ Society for the Psychology of Women: www. apa. org/divisions/div 35/ ♦ Stone Center/Wellesley Centers for Women: www. wcwonline. org ♦ Website of Dr. Laura Brown www. drlaurabrown. org