Systems of Psychotherapy:A Transtheoretical Analysis

Chapter 12. Gender-SensitiveTherapies

A Sketch of Sociopolitical Forces Modern psychotherapy created by

White men in their own image and acc to their own values

Gilligan’s In A Different Voice illuminated sexist bias in psychology

Rise of feminism (commitment to equal social, economic, & political rights for men and women) in the 60’s and 70’s

Women denied equal rights and an equal voice in mental health care

N single person responsible for feminist tx; a collaborative effort

Feminist Theory of Personality

Identity is influenced by prevailing environment, including social learning and gender roles

Gender roles and discrimination influence cognitive structures and behavior patterns

Differences between gender due in part to women primarily raising children (Chodorow)

Children bombarded with messages of gender expectations

Gender roles deeply ingrained in personality

Theory of Psychopathology

Psychological distress is often environmentally induced and culturally determined

Many disorders (e.g., self-destructive behs) are coping efforts in oppressive, inescapable environment

Disorders caused by Sex-role stereotyping Gender-role expectations Role strain and conflict Sexual trauma 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

Sexual Trauma

Major contributor to psychopathology Approx ¼ of American women have

experienced childhood sexual abuse About 60% of rapes are

acquaintance rapes & only 30% of rapes are reported

Rage related to sexual abuse manifests itself in pathological symptoms

Gender-Related Economics Women clustered in lower paying, lower

status occupations Divorced women and their children

constitute an increasing proportion of the poor

Average woman worker with same education receives 76¢ to a dollar for a man

40 to 90% of working women have been sexually harassed

Professional women assigned to “mommy track” or hit the “glass ceiling”

Feminist Theory of Therapeutic Processes

Consciousness raising: one's suffering due to gender restrictions & discrimination

Choosing: can be achieved even within a patriarchic society

Social liberation: increasing alternatives for equality; “the personal is political”

Guidelines for Therapy with WomenTherapist should: Be free of gender-defined roles & stereotypes Recognize reality and variety of sex discrimination and

facilitate options for clients Be knowledgeable about current research Not use derogatory labels Not reinforce stereotypic dependency of women Respect the client’s assertive behavior Recognize that abused or assaulted clients are victims of

crimes Recognize the client’s right to define sexual preference

Therapeutic Relationship

Characterized by 2 E’s: empowerment and egalitarianism

Empowerment: therapist helps instill power, both social and individual, in client

Egalitarianism: comparatively equal relationship between therapist & client

Tx goals are mutually generated

A Major Alterative: Male-Sensitive Psychotherapy

Traditional therapy designed by men to treat primarily women

Psychotherapy for men based on an accurate understanding of male personality development

Men are negatively effected by gender role expectations and suffer from role stain (as do women) No sissy stuff: avoid anything “feminine” The big wheel: must be successful, respected,

family breadwinners The sturdy oak: exude confidence, strength, self-

reliance Give ’em hell: behave aggressively and daringly

Gender-Role Expectations Men must achieve or exceed masculine

standards or accept “failure” Men hide feelings behind façade of

toughness, resistance, and 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)

Systems of Psychotherapy:A Transtheoretical Analysis

Chapter 13.Multicultural

Therapies

A Sketch of Multicultural Therapy Psychotherapy developed by upper-

class, white heterosexuals in western Europe

Therapy originally and erroneously envisioned as transcultural

Traditional therapies are increasingly inappropriate for addressing the problems of minority and oppressed groups

Changing demographics signal need for cultural awareness & competence

100 Person World Village

57 Asians 21 Europeans 14 from Western Hemisphere 8 Africans 70 non-white 70 non-Christian 50% of world wealth would be in

hands of 6 Americans

Theory of Personality

Culture is a major determinant of personality

Culture is constellation of human knowledge, belief, & behavior passed down from earlier generations

No single theory of personality for multicultural tx; we require multiple perspectives rooted in particular cultures

Defining Race & Ethnicity

Race: category of persons related by common heredity or ancestry and whose features are perceived in terms of external traits

2 meanings of race: Social construct: (1) a way of grouping people into categories by perceived physical attributes and ancestry; (2) associated with power, status, and opportunity

All people have multiple groups, and not all members have same characteristics

Avoid the myth of uniformity (all members of a group will have the same characteristics)

Theory of Psychopathology Expression & manifestation of pathology

are often culturally determined Psychopathology is behavior that

predominant culture consensually deems unusual or maladaptive

Etiology is mix of biology, culture, & psychology

Impact of race/ethnicity due less to biological vulnerability and more to social inequality

Social Causes of Psychopathology Social, political, and economic

inequality Stress resulting from prejudice and

discrimination Internalized racism: low self-esteem

and self-hatred caused by discrimination

Problems with acculturation Failure to be accepted by dominant

culture

Some Culture-Bound Disorders In Malayan culture, Amok – sudden, wild homicidal aggression

In Western cultures, Anorexia nervosa – preoccupation with thinness and refusal to eat

In Caribbean cultures, Ataques de nervios – impulsivity, dissociation, & anxiety

In central American cultures, Susto – loss of soul causing depression and somatic symptoms

In Japanese culture, TKS – intense fear of offending other people through social awkwardness

In Algonquin Indians, Windigo –anxious, agitated, & convinced of bewitchment

4 Stages of Psychotherapy with Minorities

Reactive: effectiveness and appropriateness of traditional tx questioned

Inquisitive: conducted research to see how minorities can benefit from psychotherapy

Revisionist: examined process variables of race, gender, and culture in psychotherapy

Integrative: comprehensively addresses daily reality of minorities

Theory of Therapeutic Processes Consciousness raising:

understanding how culture has oppressed & shaped self-views

Catharsis: expressing healthy anger & recognizing that anger is normal & justified

Choosing: channeling new-found liberation and pride

Therapeutic Relationship

Empathy, regard, & collaboration are foundation

Relationship can be challenging if therapist is of different race & ethnicity

Meaning of “therapist” varies by culture Racial/ethnic matching of therapist and

patient may be preferred Therapist adapts to cultural preferences Therapist is advocate: empowers client

for social change

A Major Alternative:Psychotherapy with LGBT Clients Lesbian, gay, bisexual, & transgender

(LGBT) clients are oppressed minority group

Homophobic attitudes toward LGBT clients persist

Reparative/sexual conversion therapy attempts to “convert” clients to heterosexual orientation

Gay Affirmative Therapy celebrates and advocates for LGBT

LGBT Tx Guidelines: Attitudes Homosexuality is not indicative of mental

illness Recognize how therapist attitudes may

be relevant to tx & seek consultation or make referrals

Understand the ways social stigmatization poses mental health risks to LGBT clients

Understand how inaccurate or prejudicial views may affect client’s view

LGBT Tx Guidelines: Relationships & Families

Be knowledgeable about and respect the importance of LGBT relationships

Understand the circumstances and challenges facing LGBT partners

Recognize families of LGBT may include people not legally or biologically related

Understand how same-sex orientation impacts on clients’ real with family of origin

LGBT Tx Guidelines: Issues of Diversity

Recognize particular challenges experienced by bisexual individuals

Understand special problems and risks of LGBT youth

Consider generational differences within LGBT

Recognize challenges experienced by LGBT with disabilities

LGBT Tx Guidelines: Education

Support the provision of education & training on LGBT issues

Increase knowledge of homosexuality via education, supervision, & consultation

Familiarize self with mental health, educational, & community resources for LGBT

Effectiveness of Multicultural Therapies Conclusions of reviews on

multicultural tx tend to reflect the race of the reviewer

Many racial & ethnic minorities are underserved in mental health

Most minority clients prefer same-race therapists, but no consistent differences in outcome when so matched