Table Of ContentThe 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
