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CHAPTER 24 COUNSELING WOMEN Statistics on Women According to the U.S. Census 2010, there were 156,964,211 women in contrast to 151,781,326 men. Women because of society’s patriarchal structure continue to face discrimination. This chapter focuses on feminist issues. Feminism refers to efforts directed toward gender equality on social, economic, political, and other fronts. Feminist therapists believe that patriarchy contributes to women’s stress and psychological symptoms, so they focus on empowerment and strengths. Societal Pressures Women are still expected to be caregivers and are still evaluated by physical beauty. Many women are employed outside the home and now see marriage as an option. Women continue to be treated as sexual objects. There is still pressure for women to be thin, which can lead to self-esteem issues and disordered eating. Women are often socialized to meet the needs of others and take on the roles of nurture and caregiver. Discrimination, Harassment and Victimization Women continue to face sexism in professional settings. Sexual harassment continues to be prevalent. Sexual victimization and intimate partner violence disproportionately affect women. Educational Barriers Girls are underrepresented in math and science; female students receive less attention and encouragement; female students may be sexually harassed. Young women are penalized for speaking out. Economic and Employment Barriers Women continue to face barriers in many career tracks—especially math and science. Stereotypes against women inhibit their performance. Women also continue to earn only about 77% of what men earn. If a woman behaves in a task-oriented style, she may not be as likable. Women continue to be overrepresented in lower wage jobs (e.g., cashier, secretary, nurses aide, and teaching). Women leaders confront divergent expectations (e.g. assertive versus demure). Barriers to corporate women’s advancement include tokenism, old boys network, and less effective mentoring. Ageism With the emphasis on youth and sexism, older women are viewed more negatively than older men. Women increasingly outnumber men as they age (two men for every five women over the age of 75). However, post menopausal women discuss feeling more independent and self-assured (especially among welleducated women). Be aware of the various life transitions that older women go though and be prepared to provide support to them. Depression Up to 7 million women currently have depression, which is twice the rate found in men. Factors contributing to depression include poor socioeconomic status, unhealthy societal gender standards, and posttraumatic stress. Deviation from beauty standards can lead to self-doubt and poor self-image. Minority women face multiple discriminations that also contribute to depression. Gender Bias in Therapy Assess your own biases in terms of what it means to be a woman. Be aware that you may interrupt women in therapy. Gender microaggresions can reduce the effectiveness of the working alliance and decrease empowerment. Biases can exist in diagnosis (e.g., personality disorders such as borderline and histrionic). Differentiate normal menstrual issues with premenstrual dysmorphic disorder. Psychological theories are gender biased (e.g., enmeshment). Embracing Gender Strengths Affliative qualities such as being concerned with relationships, sensitivity, and nurturance can be effective at maintaining effective interpersonal relationships. Consensus building, teamwork, and cooperative efforts can help in the workplace. Implications for Clinical Practice Possess up-to-date information regarding the biological, psychological, and sociological issues that impact women; for example, knowledge about menstruation, pregnancy, birth, infertility and miscarriage, gender roles and health, and discrimination, as well as their impact on women, is important. Recognize that most counseling theories are male-centered and require modification when working with women; for example, cognitive approaches can focus on societal messages. Attend workshops to explore gender-related factors in mental health and be knowledgeable about issues related to women. Implications for Clinical Practice Maintain awareness of all forms of oppression and understand how they interact with sexism. Employ skills that may be particularly appropriate for the needs of women, such as assertiveness training, gender role analysis, and consciousness-raising groups. Assess sociocultural factors to determine their role in the presenting problem. Help clients realize the impact of gender expectations and societal definitions of attractiveness on the mental health of women so that they do not engage in self-blame. Be ready to take an advocacy role in initiating systems-level changes as they relate to sexism in education, business, and other endeavors. Assess for the possible impact of abuse or violence in all women.