The Gender Gap in Psychotherapy: Social Realities and Psychological Processes PDF
Preview The Gender Gap in Psychotherapy: Social Realities and Psychological Processes
The Gender Gap in Psychotherapy Social Realities and Psychological Processes The Gender Gap in Psychotherapy Social Realities and Psychological Processes EDITED BY PATRICIA PERRI RIEKER Harvard Medical School and Dana Farber Cancer Institute Boston, Massachusetts AND ELAINE (HILBERMAN) CARMEN University of North Carolina School of Medicine Chapel Hill, North Carolina PLENUM PRESS • NEW YORK AND LONDON Library of Congress Cataloging in Publication Data Main entry under title: The Gender gap in psychotherapy. Includes bibliographical references and index. 1. Women-Mental health. 2. Men-Mental health. 3. Sex role. 4. Feminist therapy. 5. Social psychology. I. Rieker, Patricia Perri. II. Carmen, Elaine (Hilberman), date- . [DNLM: 1. Identification (Psychology). 2. Psychology, Social. 3. Psychotherapy. WM 420 G3255] RC451.4.W6G46 1984 362.2 84·11511 ISBN-13: 978-1-4684-4756-9 e-ISBN-13: 978-1-4684-4754-5 DOl: 10.1007/978-1-4684-4754-5 © 1984 Plenum Press, New York Softcover reprint of the hardcover 1st edition 1984 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part d this book may be reproduced, stored in a retrieval system, or trarmnitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher For Pasquale and Mollie who taught us to see the world from odd angles For there is no creature whose inward being is so strong that it is not greatly determined by what lies outside it. George Eliot Middlemarch Contributors JANET R. ALLISON, PH.D. • Bitterroot Psychological Services, Missoula, Montana 59801 MICHAEL BERGER, PH.D. • Department of Psychology and Family Study Center, Georgia State University, Atlanta, Georgia 30303, and Intra mural Training, Atlanta Institute for Family Studies, Atlanta, Geor gia 30309 MARLENE (BosKIND-LODAHL) BosKIND-WHITE, PHD. • Gannet Mental Health Section, University Medical Services, Cornell University, Ith aca, New York 14853 ELAINE (HILBERMAN) CARMEN, M.D. • Department of Psychiatry, Uni versity of North Carolina School of Medicine, Chapel Hill, North Carolina 27514 VIRGINIA DAVIDSON, M.D. • Department of Psychiatry, Baylor College of Medicine, Houston, Texas 77030. Present address: 4101 Green briar, Houston, Texas 77098 NANETIE GARTRELL, M.D. • Department of Psychiatry, Harvard Medical School and Beth Israel Hospital, Boston, Massachusetts 02215 SEYMOUR L. HALLECK, M.D. • Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27514 RACHEL T. HARE-MUSTIN, PH.D. • Counseling and Consulting Psychol ogy, Harvard University, Cambridge, Massachusetts 02138 JUDITH HERMAN, M.D. • Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02215 LISA HIRSCHMAN, ED.D. • University of California Medical School, San Diego, California 92037 ROSABETH Moss I<ANTER, PH.D. • Yale University, New Haven, Con necticut 06500, Harvard Law School, Cambridge, Massachusetts 02138, and Goodmeasure, Inc., Cambridge, Massachusetts 02138 ALEXANDRA G. KAPLAN, PH.D. • Stone Center for Developmental Ser vices and Studies, Wellesley College, Wellesley, Massachusetts 02181 HARRIET E. LERNER, PH.D. • The Menninger Foundation, Topeka, Kan sas 66601 vii viii Contributors ROBERT A. LEWIS, PH.D. • Child Development and Family Studies, Pur due University, West Lafayette, Indiana 47907 SHARON S. MAYES, PH.D. • Divorce Counseling Research Project, Chil dren's Hospital of San Francisco, Department of Psychiatry, San Francisco, California 94118 JEAN BAKER MILLER, M.D. • Department of Psychiatry, Boston Univer sity School of Medicine, Boston, Massachusetts 02215 TRUDY MILLS, PH.D. • Department of Sociology, University of Arizona, Tucson, Arizona 85721 JOSEPH H. PLECK, PH.D. • The Wellesley College Center for Research on Women, Wellesley, Massachusetts 02181 PATRICIA PERRI RIEKER, PH.D. • Dana-Farber Cancer Institute and Har vard Medical School, Boston, Massachusetts 02115 NANCY FELIPE Russo, PH.D. • Women's Programs, American Psycholog ical Association, Washington, D.C. 20036 ALAN A. STONE, M.D. • Faculty of Law and Faculty of Medicine, Har vard University, Cambridge, Massachusetts 02138 St., ELIZABETH A. WAITES, PH.D. • 206 South Main Ann Arbor, Michigan 48107 Preface This collection of readings is designed to clarify the relationship between social structures and psychological processes. Our awareness of the need for such a book derives from our extensive experiences in teaching a for mal course for mental health professionals on gender and psychother apy. The material in this anthology emphasizes the clinical implications of the new research and knowledge that has changed our understanding of the psychological development of women and men. Throughout the book, we present ideas that challenge conventional explanations of psy chological distress in women and men and suggest alternative concep tualizations of these processes. As will be evident, our work is informed by and contributes to the growing field of knowledge produced by feminist scholars over the last decade. That this book on gender has more to say about women reflects the existence of a substantial body of research that reconceptualizes women's psychology. The corresponding research on men is still in its formative stages, due in part to the later development of a men's move ment. Although many of the chapters focus on women, we have attempted in our discussion to consider the implications for men. We believe that the fundamental processes explored in this book are relevant to the understanding of both women and men. We recognize that neither men nor women can be seen as a homo geneous group. Categorizing people by gender alone serves to highlight certain common experiences while masking important differences. We know that psychological development and social identities are differen tially affected by race, ethnicity, social class, sexual preference, and sim ilar factors. While we have chosen not to focus on the confounding effects of gender with, for example, age, race, ethnicity, or income, we encourage the reader to take account of the way in which these and other factors interact with gender in our daily lives. It was not our intent to make this a comprehensive book. Rather, we selected articles to illustrate how structures of inequality set into motion psychological processes that affect women and men differently. The material in this book is presented within a framework that integrates sociological and psychological explanations of behavior. Although the ix x Preface articles are sequenced to form a coherent curriculum, each section can be read separately. Thus, the book can be used as a text either for teaching or for self-education. Each section of readings is introduced by a narra tive that analyzes how subjective experiences are determined by a wider social reality and discusses the implications of this perspective for psychotherapy. The perspective implicit in the organization of this book views psy chological distress as an emergent process embedded in a cultural con text. It provides a framework that identifies and organizes certain socio logical concepts-disembeds them from the cultural context, so to speak-concepts that can help mental health professionals understand the nature of social change and its ramifications for individuals. For example, concepts such as socialization, social roles, tokenism, and power are used to explain how social factors shape the development, and some times the destruction, of an individual's social identity and psychological well-being. The sociological imagination that we are advocating enables the therapist to focus on the matrix of social roles and power relationships that affect how people think, feel, and behave, and to disentangle the external realities from the subjective experience of those realities. Byask ing therapists to acquire a sociological imagination, we are asking them to try another way of gaining insight-another way of interpreting data. The therapist is encouraged to step outside his or her own frame of ref erence and to see things as categories of people see them (e.g., dominants, subordinates, victims, aggressors, privileged, low status, tokens). Making the connection between individual psychological states and social con texts in which identities develop provides the therapist with alternatives for understanding the content and process of therapeutic interactions. Consider, for example, the therapeutic relationship, which practi tioners believe has a major impact on the efficacy of clinical interven tions. A psychological interpretation of this relationship focuses on the personality dynamiCS of the therapist and the patient. This intrapsychic view explains the patient's reactions to the therapist as instances of pos itive or negative transference, the patient's reaction to the psychotherapy process as regression, and the therapist's reactions to the patient as coun tertransference. A social interpretation of these same phenomena might center on the relative social positions occupied by the therapist and the patient and their impact on the therapeutic relationship. Defining the therapist-patient relationship as an example of authority relations pro duces a discussion of the interaction based on the differential distribu tion of power. As a psychiatrist / sociologist team, we are convinced that mental health professionals and sociologists have much to say to one another. This is a book about just that-about the relationship of inner life to Preface xi outer reality in terms of a rapprochement between two fields that, until now, have been "scientifically" studying human behavior by focusing on just one of these aspects. Nonetheless, we continue to be impressed with the power of some psychological theories to exclude the social context altogether. Such explanations have dominated the training of psychia trists as well as other mental health professionals. But even more prob lematic, trainees are not taught that there are alternative explanations of behavior or that all intellectual perspectives contain implicit value assumptions that affect the therapeutic process. Since the professional identity of most clinicians rests, in part, on the intellectual perspectives acquired during training, there is often considerable resistance to chang ing them. This book attempts to provide some insight into the disquiet ing process of change while demonstrating the potential clinical advan tages of examining one's own gender values. Since we have been asking clinicians to examine the values con cealed in their theories and practices, we think it is appropriate to make some of our most basic assumptions more explicit: 1. Intrapsychic explanations alone are insufficient for understand ing psychological distress. 2. The elimination of sexism from the psychotherapies can only improve outcomes. 3. It is especially important to identify those taken-for-granted gen der norms (for example, sex-role stereotypes, homophobia, and patriarchal ideologies) shared by patients and therapists that, if left unexamined, will negatively affect outcomes. 4. All modes of psychotherapy are limited in their ability to change the gender inequality that contributes to psychological distress; inevitably, change of that magnitude requires political action. 5. The myth of value-free psychotherapy is no less pervasive than the myth of value-free sociology-both positions derive from the more general myth of value-free science. 6. The continuous self-monitoring of personal and professional val ues as they influence clinical performance is hard work; mental health training programs must teach value clarification methods in addition to new knowledge and skills. 7. Although there are differences between male and female thera pists that need to be explored further, neither sex nor ideology guarantees one's skill as a clinician. Finally, as we have said elsewhere, a competent therapist has the ability to stand outside the self, to observe the cognitive-value interac- xii Preface tion, and to question her or his values and intellectual framework with out paralyzing fear of personal or professional annihilation. Elaine (Hilberman) Carmen Patricia Perri Rieker Chapel Hill, North Carolina and Boston, Massachusetts
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