Gender and power in our therapy room

In the current socio-cultural context, there has been a shift toward equality and away from sex discrimination; however, differences between sexes are being rediscovered. Gender is considered the primary determinant of how individuals experience the world and how the world perceives them (Reibstein & Richards, 1992). It is "deeply embedded in our psyches and in the politics of family life" (Goldner et al., 1990). People are influenced by broader cultural and gender role expectations (Vetere & Dallos, 2003). It is important to recognise that theories and models of therapy have developed within a patriarchy and to understand that individual family members may be held accountable for "culturally determined attitudes and interactions" (Urry, 1990). Failing to work toward gender equality can lead to greater symptomatology (Knudson-Martin & Mahoney, 2005).
 

Considering that power is "a characteristic of interpersonal dynamics and an inherent component of social interaction" (Millar & Rogers, 1988), it is crucial for therapists and individuals to connect positively with others and respect their positions without assuming a higher moral ground.

Therapists must self-regulate and monitor power dynamics in treatment. A client's transference of powerful feelings can make the therapist feel powerful. There may be times when therapists exercise "expert power" by defining the patient's reality and privileging some information over others (Cormack & Mitchell, 1998; White, 1995). The goal in therapy should be to promote respectful dialogue and recognise differences in personal, professional, and cultural backgrounds, thus striving to provide anti-discriminatory practice (Waite, 1995).

I saw the parents and their grown-up daughter Liz, who suffered from a chronic illness for family therapy. In the first session, the family courageously discussed powerful and hurtful feelings in front of each other. The mother expressed her willingness to do anything to help her daughter get better and explained that her cultural background influenced her ability to "lower her defenses to express herself." Liz had complained that her mother's communication style was deeply hurtful.

The reflecting team, joining me as the therapist in the room, pointed out that the mother’s justification seemed like an "excuse to be unkind and cruel" towards her daughter. The mother felt "shocked and distraught" and shared her dismay at this "superficial comment which misrepresented her position as a mother" and exemplified "professional tyranny." A shift in the mother’s body language was observed, from a confident and proud demeanour to one of distress.

It was noted that the parents, particularly the mother, seemed to take responsibility for their children's successes and failures. Liz had been unable to transition to independence due to her illness.

There was concern about the mother’s safety as she had expressed suicidal ideation. While threatening suicide could be seen as a form of controlling intimidation, it was considered that her unkind communication might mask her suffering while being challenged. There was uncertainty about whether the mother would feel able to express herself in future sessions, but she did.

Gender issues were overlooked, failing to recognise that the mother, as a female, might have been punished through therapy, attacking core female qualities and her role in motherhood as primarily responsible for child-rearing (Gilligan, 1979; McGoldrick, 1989). The team saw the mother as the problem, missing the male cruelty shown by the father’s avoidance and the brother’s withdrawal. The women in the team felt unable to address cruelty, whether exhibited by males or females in the family.

Reflecting on these experiences has emphasised the importance of being mindful of gender and power in therapy practice, teams, and broader cultural contexts.

Dr Cristina López-Chertudi is an esteemed consultant clinical health psychologist and systemic family psychotherapist. You can schedule an appointment with Dr López-Chertudi on her Top Doctors profile.
 

References

Cormack, M. & Mitchell, A. (1998). Power in treatment. Therapeutic Relationships in Complimentary Care, pp 91-107. Edinburgh; New York: Churchill Livingstone. 

Gilligan, C. (1979). Woman’s place in a man’s life cycle. Howard Educational Review, 49, (4), 431-446. 

Goldner, V., Penn, P., Sheinberg, M. & Walker, G. (1990). Love and violence: gender paradoxes in volatile attachments. Family Process, 29, 343-364. 

Knudson-Martin, C. Mahoney. A. (2005). Moving beyond gender: processes that create relationship equality. Journal of Marital and Family Therapy, 31 (2), 235-246. 

McGoldrick, M. (1989). Women through the family life cycle. In M. McGoldrick, C.M. Anderson, & F. Walsh (eds.), Women in Families. New York: Norton. 

Millar, F.E. & Rogers, L.E. (1988). Power dynamics in marital relationships. In P. Noller & M.A. Fitzpatrick (Eds), Perspectives on marital interaction, pp. 79-97. Philadelphia: Multilingual Matters Ltd. 

Reibstein, J. & Richards, M. (1992). Sexual arrangements. Marriage and affairs. London: Henemann. 

Urry, A. (1990). The struggle to a feminist practice in family therapy: premises. In R. J. Perelberg & A. C. Miller (Eds), Gender and power, pp. 104-117. London & New York: Tavistock/Routledge. 

Vetere, A. & Dallos, R. (2003). Working systemically with families: formulation, intervention and evaluation. London: Karnac. 

Waite, D. (1995). Rethinking instructional supervision. Notes on its language and culture. London: Falmer Press. 

White, M. (1995). Reflecting teamwork as definitional ceremony. In White, M. (ed), Re-authoring lives: interviews and essays, pp 172-198. Adelaide: Dulwich Centre Publications.