Anonymous asked: Opinions on gender in therapy as it effects therapist-client relationship
It’s only a problem if it’s a problem, y’know? Rarely do I think sex differences pose a serious problem to the therapeutic relationship. Even in cases of trauma or attention-seeking behaviors towards the opposite sex, it can be therapeutic itself for the client to sit with a therapist of the opposite sex. Are there instances where it just won’t work (at least in the beginning)? Of course. But those are relatively rare instances, in my opinion.
If a client simply does not feel prepared or ready to open up to a therapist of the opposite sex, then there’s no need to push. I would never force or pressure a client into doing something they aren’t comfortable doing. But I would definitely explore their preferences with them to see why it is they may be uncomfortable with a male/female (depending on what they are requesting).
So, this right here is the attitude in mental health that really rankles me and drives me to want to educate my colleagues.
On the first level: the question referred to gender and cognitivedefusion referred to “sex” in the reply. Sex and gender are wholly different. Furthermore, the use of binary language (“opposite sex” “male/female”) implies a belief that there are only two sexes (and likely also two genders). This mindset can be outright harmful for trans or non-binary individuals. It also indicates that there would only be “problematic” relationships when there is a difference between therapist and client sex or gender. Sex and gender identity could still play a role in client-therapist relationships even if they’re aligned between the two individuals.
On a deeper level: I believe gender differences play a major role in client therapist relationship. These dynamics should be acknowledged and explored as early and as often as possible in order to build a therapeutic relationship. Mental health professionals do not exist in a vacuum and as such are also players in the societal structure in which we exist. That is to say, what it means to be “masculine” or “feminine” is largely defined by our culture, how we were raised and our own levels of personal identification. Furthermore, therapists need to be cognizant of how their own gender identity and dynamics therein could be playing a role in therapy.
I apologize for my sloppy response. I wrote it out at 11:30 pm after being brain dead from working on my thesis all day. I agree with most of what you’re saying, but I disagree with some of that last bit. Agreements first.
I don’t see sex or gender as a binary in practice nor do I treat it as such, and I do understand the difference between sex and gender to begin with. I always leave identification to my clients and don’t assume what label they fall under (or if they even follow under one - I had one client at the university counseling center simply say they do not really prefer to identify with any kind of label). In romantic situations I use “partner” or “romantic interest” rather than assuming attraction. I have worked with individuals who identify as all sorts of different genders and sexual orientations. I’ve voiced in past posts how I just type too quick and don’t really stop to think about what I’m saying because, in my mind, I’m covering the angles of the question, but when I re-visit it later I see the holes in it. I see where you’re coming from, and that’s my fault.
That said, I disagree with the opening pieces in your last paragraph perhaps because it feels too generalized for me. Specifically, I don’t think gender differences play a major role in most therapeutic relationships, and remember I’m talking about all clients who seek mental health services. Not just those clients we specialize in, or those in our immediate geographic area, or those we are most interested in serving, but all clients across all settings.
In any given clinic, roughly 80% of the clientele are going to present with the same 20% of problems, and those problems tend to fall in the mood-anxiety-substance use spectrum. I have yet to see a study (despite many efforts) to suggest that gender/sex dynamics have any sort of significant role on outcome or the development of a therapeutic alliance for the vast majority of these clients. There’s just no data to suggest that early and often exploration of gender dynamics for most clients is necessary or an added benefit to therapeutic outcomes (open to studies if you have some, though!) If it comes up, address the hell out of it. If it poses a risk, get it out in the open. But if the question(s) are asked and nothing is there, move on to the relevant pieces unless there is some other reason to bring it up again. I’m willing to bet most clients across all therapeutic settings land in that last category.
For example, I work in a rural setting where our clinic has seen over 300 students in the last 2 years - all clients are discussed at weekly staffing meetings. From personal experience of 2-3 weekly staffings for two years, I have yet to hear any client brought up where there were sex/gender issues that required extensive attention. Again, this is anecdote, though it is rooted in a pretty large number (based on RCT standards!) And this is with a group of therapists who see each other 3-4 days per week; anything that is even slightly important comes up.
And so this brings me to my last point: the pendulum may be swinging too far in the opposite direction, depending on how you define “exploration of gender dynamics” and doing so “as often as possible,” because doing so in a rural area that is a bit more right-leaning would not pan out well as being based out of, say, NYC or a more liberal area. This is where many of our clients/families would be put-off just hearing us talk about that kind of thing beyond the question of “do you feel any discomfort with me as your therapist for any reason?”.
So, can they play a role? Sure. Can they play a major role? Of course, for some. Do they play a major role most or even a lot of the time? Not from what the research tends to suggest at this point in time. Not only that, but placing too much emphasis on it for many clients could be iatrogenic to the therapeutic relationship. It’s about finding that happy medium, I suppose.
Always open to other thoughts, though, if you feel I said anything that is mistaken or insensitive.