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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 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 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 selfhatred 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