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Systems of Psychotherapy:
A Transtheoretical Analysis
Chapter 12. Gender-Sensitive
Therapies
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
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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
Women
Therapist 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
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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
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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 selfhatred caused by discrimination
 Problems with acculturation
 Failure to be accepted by dominant culture
Some Culture-Bound Disorders
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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