Systems of Psychotherapy: A Transtheoretical Analysis

1. Systems of Psychotherapy:A Transtheoretical Analysis Chapter 12. Gender-Sensitive Therapies

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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”

8. 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”

9. 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

10. 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

11. 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

12. 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)

13. Systems of Psychotherapy:A Transtheoretical Analysis Chapter 13. Multicultural Therapies

14. 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

15. 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

16. 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

17. 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)

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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