Theories of Psychotherapy Series
Existential–Humanistic Therapy
Kirk J. Schneider and Orah T. Krug
Feminist Therapy
Laura S. Brown
Relational–Cultural Therapy
Judith V. Jordan
Copyright © 2010 by the American Psychological Association. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, including, but not limited to, the process of scanning and digitization, or stored in a database or retrieval system, without the prior written permission of the publisher.
Electronic edition published 2012.
ISBN: 978-1-4338-0826-5 (electronic edition).
Published by
American Psychological Association
750 First Street, NE
Washington, DC 20002
www.apa.org
To order
APA Order Department
P.O. Box 92984
Washington, DC 20090-2984
Tel: (800) 374-2721; Direct: (202) 336-5510
Fax: (202) 336-5502; TDD/TTY: (202) 336-6123
Online: www.apa.org/books/
E-mail: order@apa.org
In the U.K., Europe, Africa, and the Middle East, copies may be ordered from
American Psychological Association
3 Henrietta Street
Covent Garden, London
WC2E 8LU England
Typeset in Minion by Shepherd, Inc., Dubuque, IA
Printer: United Book Press, Inc., Baltimore, MD
Cover Designer: Minker Design, Sarasota, FL
Technical/Production Editor: Emily Welsh
Cover art: Lily Rising, 2005, oil and mixed media on panel in craquelure frame, by Betsy Bauer.
The opinions and statements published are the responsibility of the authors, and such opinions and statements do not necessarily represent the policies of the American Psychological Association.
Library of Congress Cataloging-in-Publication Data
Brown, Laura S.
Feminist therapy / Laura S. Brown.
p. cm.
Includes bibliographical references and index.
ISBN-13: 978-1-4338-0461-8 (alk. paper)
ISBN-10: 1-4338-0461-1 (alk. paper)
1. Feminist therapy. I. Title.
RC489.F45B758 2010
616.89'14—dc22
2009017970
British Library Cataloguing-in-Publication Data
A CIP record is available from the British Library.
Printed in the United States of America
First Edition
To Hannah Lerman, PhD
And in memory of Adrienne J. Smith, PhD (1934–1992), pioneers of feminist therapy theory
Contents
Series Preface
1. Introduction: Feminist Therapy—Not for Women Only
2. History
3. Theory
4. The Therapy Process
5. Evaluation
6. Future Developments
7. Summary
Glossary of Key Terms
Suggested Readings
References
About the Author
Series Preface
Some might argue that in the contemporary clinical practice of psychotherapy, evidence-based intervention and effective outcome have overshadowed theory in importance. Maybe. But, as the editors of this series, we don’t propose to take up that controversy here. We do know that psychotherapists adopt and practice according to one theory or another because their experience, and decades of good evidence, suggests that having a sound theory of psychotherapy leads to greater therapeutic success. Still, the role of theory in the helping process can be hard to explain. This narrative about solving problems helps convey theory’s importance:
Aesop tells the fable of the sun and wind having a contest to decide who was the most powerful. From above the earth, they spotted a man walking down the street, and the wind said that he bet he could get his coat off. The sun agreed to the contest. The wind blew and the man held on tightly to his coat. The more the wind blew the tighter he held. The sun said it was his turn. He put all of his energy into creating warm sunshine and soon the man took off his coat.
What does a competition between the sun and the wind to remove a man’s coat have to do with theories of psychotherapy? We think this deceptively simple story highlights the importance of theory as the precursor to any effective intervention—and hence to a favorable outcome. Without a guiding theory, we might treat the symptom without understanding the role of the individual. Or we might create power conflicts with our clients and not understand that, at times, indirect means of helping (sunshine) are often as effective—if not more so—than direct ones (wind). In the absence of theory, we might lose track of the treatment rationale and instead get caught up in, for example, social correctness and not wanting to do something that looks too simple.
What exactly is theory? The APA Dictionary of Psychology defines theory as “a principle or body of interrelated principles that purports to explain or predict a number of interrelated phenomena.” In psychotherapy, a theory is a set of principles used to explain human thought and behavior, including what causes people to change. In practice, a theory creates the goals of therapy and specifies how to pursue them. Haley (1997) noted that a theory of psychotherapy ought to be simple enough for the average therapist to understand but comprehensive enough to account for a wide range of eventualities. Furthermore, a theory guides action toward successful outcomes while generating hope in both the therapist and client that recovery is possible.
Theory is the compass that allows psychotherapists to navigate the vast territory of clinical practice. In the same ways that navigational tools have been modified to adapt to advances in thinking and ever-expanding territories to explore, theories of psychotherapy have changed over time. The different schools of theories are commonly referred to as waves, the first wave being psychodynamic theories (i.e., Adlerian, psychoanalytic), the second wave learning theories (i.e., behavioral, cognitive–behavioral), the third wave humanistic theories (person-centered, gestalt, existential), the fourth wave feminist and multicultural theories, and the fifth wave postmodern and constructivist theories. In many ways, these waves represent how psychotherapy has adapted and responded to changes in psychology, society, and epistemology as well as to changes in the nature of psychotherapy itself. Psychotherapy and the theories that guide it are dynamic and responsive. The wide variety of theories is also testament to the different ways in which the same human behavior can be conceptualized (Frew & Spiegler, 2008).
It is with these two concepts in mind—the central importance of theory and the natural evolution of theoretical thinking—that we developed the APA Theories of Psychotherapy Series. Both of us are thoroughly fascinated by theory and the range of complex ideas that drive each model. As university faculty members who teach courses on the theories of psychotherapy, we wanted to create learning materials that not only highlight the essence of the major theories for professionals and professionals in training but also clearly bring the reader up to date on the current status of the models. Often in books on theory, the biography of the original theorist overshadows the evolution of the model. In contrast, our intent is to highlight the contemporary uses of the theories as well as their history and context.
As this project began, we faced two immediate decisions: which theories to address and who best to present them. We looked at graduate-level theories of psychotherapy courses to see which theories are being taught, and we explored popular scholarly books, articles, and conferences to determine which theories draw the most interest. We then developed a dream list of authors from among the best minds in contemporary theoretical practice. Each author is one of the leading proponents of that approach as well as a knowledgeable practitioner. We asked each author to review the core constructs of the theory, bring the theory into the modern sphere of clinical practice by looking at it through a context of evidence-based practice, and clearly illustrate how the theory looks in action.
There are 24 titles planned for the series. Each title can stand alone or can be put together with a few other titles to create materials for a course in psychotherapy theories. This option allows instructors to create a course featuring the approaches they believe are the most salient today. To support this end, APA Books has also developed a DVD for each of the approaches that demonstrates the theory in practice with a real client. Some of the DVDs show therapy over six sessions. Contact APA Books for a complete list of available DVD programs (http://www.apa.org/videos).
In this book, Dr. Laura Brown clearly illustrates how feminist psychotherapy is a model that takes into account cultural identities and the sociopolitical realities of clients to provide an effective psychological practice. Dr. Brown chronicles how feminist psychotherapy has evolved from an outside critique of mainstream psychological theory and practice to a stand-alone model of psychotherapy for both women and men that is widely accepted and taught. Dr. Brown draws upon her own knowledge as one of the original feminist theorists and her vast experience as a practicing psychotherapist to provide a clear and concise delineation of the theory and practice of feminist psychotherapy. The numerous case studies help the reader to gain familiarity with the theory by reading about it in practice.
—Jon Carlson and Matt Englar-Carlson
REFERENCES
Frew, J., & Spiegler, M. (2008). Contemporary psychotherapies for a diverse world. Boston: Lahaska Press.
Haley, J. (1997). Leaving home: The therapy of disturbed young people. New York: Routledge.
Introduction: Feminist Therapy—Not for Women Only
Feminist therapy came into existence toward the end of the 1960s. Its appearance coincides with the second wave of feminism in the United States and reflected the concerns raised by that movement. Its early adherents were psychotherapists, primarily women, who transformed their protests against sexism in the mental health professions into the development of a viable alternative for women seeking psychotherapy, in which clients would not encounter the sexism, misogyny, and stereotyping that were ubiquitous in the mental health field until then. Feminist therapy is a theory that derives its inspiration and wisdom from an in-depth interrogation of standpoints that are unavailable to the dominant culture simply because they have been relegated to the margins—the standpoints of Euro American women; people of color; lesbian, gay, and bisexual people; gender variant people; poor people; people with disabilities; and immigrants and refugees. Feminist practice is psychology derived from the realities that lie outside, beneath, and at variance from the visions of the dominant patriarchal mainstream. It is a theory that not only listens to, but privileges, the voices and experiences of those who have been defined as “other” by dominant cultures. It is a competency-based paradigm that perceives human beings as responsive to the problems of their lives, capable of solving those problems, and desirous of change. It is also a politically informed model that observes human experience within the framework of societal and cultural realities, and the dynamics of power informing those realities.
Feminist therapy does not simply study the “other” in order to offer a neutral perspective on that experience. Rather, what is inherent in feminist therapy is the radical notion that silenced voices of marginalized people are considered to be the sources of the greatest wisdom. This is a shifting of the value of knowledge claims from those of culturally appointed experts to the expertise of the oppressed. This perspective, when made central to analysis and practice, is potentially transformative of everything about therapy as usual in dominant cultures. In feminist practice, the margins become a new center epistemically and conceptually.
In the 4 decades since therapists began to use this term to describe themselves and their work, feminist therapy has evolved significantly from its roots as a psychotherapy for women that functioned primarily as a corrective against the sexist treatment approaches of the era (Rawlings & Carter, 1977; Rosewater & Walker, 1985). It has developed into a sophisticated postmodern, technically integrative model of practice that utilizes the analysis of gender, social location, and power as a primary strategy for comprehending human difficulties (Brown, 2005). It has become a practice that encompasses work with women, men (Levant & Silverstein, 2005), children, families (Silverstein & Goodrich, 2003), and larger systems, standing in continuous challenge to all newly emerging disempowering dynamics in the culture of psychotherapy and in the larger society.
Feminist therapists, who were once exclusively women, now include men among their ranks (Levant & Silverstein, 2005). Feminist constructs of what constitutes good psychotherapy practice, such as the use of written informed consent to treatment that outlines the rights of the client (Hare-Mustin, Marecek, Kaplan, & Liss-Levinson, 1979), are no longer seen as radical challenges to therapist authority, but rather as foundational to ethical practice for all psychotherapists. Many feminist innovations have become integrated into mainstream models of client rights and psychotherapist responsibilities (Ballou, Hill, & West, 2008), although more often than not, feminist therapy’s role in instituting a phenomenon is taken for granted today, just as a signed consent to psychotherapy has become invisible.
Because of its name, feminist therapy is often misunderstood, as unfounded stereotypes, assumptions, and implicit biases about feminists and feminism arising from reactions in the popular culture against progressive social change agents abound among professionals and laypeople alike. It is not uncommon for professionals to think themselves not to be feminist therapists because of their negative associations with the concept of feminism, only to discover that their core values about how to practice psychotherapy are best defined by feminist therapy (Swing, 2007)—and to have their beliefs about feminism and feminists changed in the process.
Feminist therapy has gone through a number of significant transformations and developments on its way to its current incarnations. However, what remains as true today about feminist practice as at its inception in the midst of the social movements of the 1960s is its central focus on, and attention to, dynamics of interpersonal and personal power both in and outside the therapy office. What has also remained a constant in feminist therapy is its placement of the psychotherapy process into the broad social and political contexts informing constructions of gender, power, and powerlessness. Therapy is not construed as happening solely during the session or in the consulting room; it is linked to the events of daily life and to the politics of power, privilege, and disempowerment that are inherent, overtly and subtly, in all of the cultures in which feminist therapists practice.
Feminist therapy first emerged from the consciousness-raising (CR) groups of the Second Wave women’s movement as a commentary on women’s experiences in therapy and the implications of sexism for their psychological well-being. CR has the same place in feminist therapy that the concept of the unconscious has in psychodynamic formulations, as the core construct from which all practice has grown and around which practice continues to center.
Today, feminist therapy continues to be founded theoretically in a close and careful analysis of the meanings and contributions of gender and other social locations such as culture, phenotype, social class, sexual orientation, and age, both to normative identity development and life trajectories as well as to the etiologies of distress and dysfunction. Consciousness continues to be raised by feminist practice, although the strategies for doing so in the therapeutic context may little resemble those of the CR groups of the 1960s, just as psychodynamic practitioners are not likely to use abreaction as the road to uncovering of unconscious material as did Freud in his first years of developing psychoanalysis. However, as a theory, the most important change that has occurred in four decades is that feminist therapy has moved from a sole focus on women and gender to become a more inclusive model of practice for work with all people.
Feminist therapy can be defined as:
The practice of therapy informed by feminist political philosophies and analysis, grounded in multicultural feminist scholarship on the psychology of women and gender, which leads both therapist and client toward strategies and solutions advancing feminist resistance, transformation and social change in daily personal life, and in relationships with the social, emotional and political environments. (Brown, 1994, pp. 21–22)
Each part of this definition is important. The insistence on the use of culturally competent knowledge claims, the centering of feminist therapy and theory in feminist politics, the attention to the transformative effects of the therapeutic process both on clients and on therapists, and the shared and separate contexts for those parties—each is a necessary component of engaging in a psychotherapy that is feminist. The project of feminist therapy is one of subversion as a strategy for effecting growth and healing for people in distress (Brown, 1994, 2004, 2005, 2007, 2008). Subversion is a concept that broadly represents the psychotherapeutic strategies by which therapist and client, working together collaboratively, use the tools of psychotherapy to undermine the internalized and external patriarchal realities that serve as a source of distress and as a brake on growth and personal power for all humans. In the feminist lens, psychotherapy is itself construed as a potential component of systems of oppression, with therapy as usual operating in the absence of an analysis of gender and power, practiced in ways that can actively or inadvertently uphold problematic status quos and reinforce hierarchies of value inherent in dominant cultures. Consequently, in feminist therapy, almost every taken-for-granted aspect of business as usual for a therapist, from where the office is located to how diagnosis is done to how therapist and client relate, is analyzed, questioned, and challenged with the tools of feminist theory, with the goal of making psychotherapy not only nonoppressive but actively liberatory.
Patriarchies are the near-universal hierarchical social systems in which attributes associated with maleness are privileged and those attributed to women are denigrated (Lerner, 1993), no matter the sex of the individual in whom these qualities are found. Patriarchal systems are identified by feminist therapy and theory as the primary sources of human distress, including those kinds of distress that are organized into diagnostic categories and labeled psychopathology by the mental health disciplines. The actual distress or dysfunction about which an individual initiates therapy is thus seen not as pathological per se, no matter how much it impairs a person’s functioning, but most likely a response to being immersed in toxic patriarchal realities. Such toxic social hierarchies of value are construed inherently inimical to personal power and healthy functioning for all people, even those apparently privileged by patriarchal norms of dominance and hierarchy. Feminist therapy, while viewing all psychotherapies as inherently political due to their participation in sustaining such oppressive norms (even via passive disengagement from an analysis of those norms), actively positions itself as having a political impact in the direction of social change.
By this, feminist therapy means that its practitioners actively seek first to understand and then to undermine the intrapsychic representations of patriarchal systems in human consciousness. Feminist therapists accomplish this overarching goal of psychotherapy as a tool for social change at the individual level by analyzing gender, power, and social locations/multiple identities as strategies for comprehending how and why a person feels distress or behaves in dysfunctional ways. This analysis is also integrated into the psychotherapeutic process itself, so that every component of therapy contains a challenge to patriarchal norms of valuing and relationships.
Feminist therapy’s theoretical origins can be found in several political movements that are all subsumed under the rubric of feminism. It situates philosophically within the larger rubric of critical psychology (Fox & Prilleltensky, 1997), which includes a group of theories, such as liberation psychology (Duran, Duran, Brave Heart, & Yellow Horse-Davis, 1998; Martin-Baro, 1986, 1994), multicultural psychology (Comas-Díaz, 2000, 2007, 2008), and narrative therapy (White & Epston, 1990). All of these theories are located epistemologically and methodologically at the margins of mainstream psychology and critique those professional cultures’ assumptions about health, distress, normalcy, and the nature of the therapist-client relationship. The scientific scholarship of feminist psychology, which has developed in tandem with the creation of feminist practice, has, over time, become an important source of information informing feminist theory and practice. That science is itself a challenge to normative assumptions about the creation of knowledge claims, relying on multiple methodologies in which the voices and experiences of participants as knowers of experience are privileged (Ballou, 1990). Feminist practice also draws upon knowledge sources not always valued in the world of psychology, including autobiography, literature, and social sciences concerned with understanding cultural and historical roots of patriarchy. Feminist psychotherapy practice is interdisciplinary, encompassing the work of women and men from all of the disciplines delivering care for people’s psychological well-being. It continues to be influenced by developments in the social justice movements for women’s and human rights from which it originally sprang.
Because the word feminist is assumed by many persons to apply only to women, professionals and laypeople alike frequently think of feminist therapy to be both by and for women only, or even for feminist women only. In its original incarnation, this would have been an accurate appraisal, as almost every initial adherent to this model was a woman, and the early years of feminist therapy are marked entirely by an attention to women’s special needs in psychotherapy (Greenspan, 1983; Rawlings & Carter, 1977; Rosewater & Walker, 1985). This is no longer the case: Feminist therapy is practiced by people of all genders, with every possible type and configuration of client (Ballou, Hill, & West, 2008; Brown, 2005; Enns, 2004; Levant & Silverstein, 2005).
Feminist therapy, unlike many other theories of therapy, does not have an identifiable founding parent or parents who created it. It is a paradigm developed from the grassroots of many different feminists practicing psychotherapy, and its beginnings occurred in the context of many people’s experiences and interactions in personal, political, and professional settings. Because there is no central authority, accrediting body, or founder, those who identify as its practitioners do not always agree on the boundaries of what constitutes feminist therapy. However, in recent years some core theoretical precepts appear to have gained consensus support, even as feminist therapies that reflect different flavors of understanding of those precepts and integration with a number of other strains of psychotherapeutic thought continue to emerge. Feminist therapy is an immensely diverse field, with its different flavors reflecting the multiplicity of trajectories by which each feminist therapist and feminist therapy theorist has arrived at her or his version of the theory.
This volume represents an attempt to synthesize feminist therapy’s heritage and roots, theory, and modes of practice as they stand in the early 21st century. As a psychologist, my standpoint on feminist therapy is largely from within my own discipline, and this volume will likely not adequately represent the work of feminist therapists who are social workers, psychiatrists, nurses, and counselors, even though members of each of these professions have contributed to the discourse on feminist therapy practice. My training as a clinical psychologist also affects my standpoint, which is different than that of those trained in other disciplines of psychological practice. Because it is being addressed in a separate volume in this series, this book will not include an in-depth discussion of a particular school of feminist practice, relational–cultural therapy (Jordan, 1997), which has developed separately from and in parallel with other major streams of feminist therapy thought and practice. The model of feminist therapy described here is strongly influenced by multicultural and global feminism and by the politics of the social justice movements of feminism, multiculturalism, and other similar movements working to transform society.
History
ORIGINS OF FEMINIST THERAPY
Feminist therapy has its clinical roots in the humanistic psychotherapies that were practiced by many of its initial adherents prior to their engagement with the Women’s Movement at the end of the 1960s. The “third force” psychotherapies that emerged strongly during the 1960s were experienced by many women practitioners as offering a viable alternative to what was seen as the determinism and misogyny of psychoanalysis and the mechanistic view of humans that then defined behaviorism. Carl Rogers’s (1957) then-radical notion that a therapist ought to be seeing the person across the room as a prized fellow human rather than a specimen of a particular diagnosis, as well as his emphasis on the quality of relationship between therapist and client, opened a theoretical door. Feminist therapy followed through that door when practicing psychotherapists began to notice how much of the reification of clients by psychotherapists mirrored the reification and objectification of women in the culture surrounding them.
Yet many of the women who created feminist therapy eventually found the humanistic psychotherapies to be insufficient as a framework for understanding their experiences, particularly as those women joined feminist consciousness-raising (CR) groups and began to critique gender relations in the humanistic psychotherapy movements. The intersection of CR with the lives of psychotherapists was the catalyst for the emergence of a specifically feminist commentary on the practice of psychotherapy (Rawlings & Carter, 1977). In CR groups, women met without a leader and shared personal experiences of their lives, including experiences of discrimination. The only authority in a CR group was the woman speaking; CR groups became a place in patriarchy where a woman’s voice could be heard and valued, rather than dismissed and denigrated as “anecdotal evidence” or mere gossip. In these groups, the original feminist therapists who were themselves participants began to notice themes and trends common to many women’s lives and, in particular, common to the experiences of being trained as a psychotherapist and being a client in psychotherapy. In parallel with raised consciousness about sexism and misogyny in the culture at large, an awareness of these pervasive biases in the psychotherapy profession emerged. Because they were listening to other women describe parallel experiences, feminists in the psychotherapy professions began to feel less alone, less crazy, and more empowered to take steps to change their own disciplines (Rosewater & Walker, 1985).
As a separate model of psychotherapy, feminist therapy in psychology has its most traceable conceptual origins in three documents, two of which were written by psychologists active in the Women’s Movement and one of which reflects feminist questions and sensibilities but was framed in the language, and published in the context, of scientific psychology. These documents can be said to have functioned as large-scale consciousness-raising tools for the psychotherapists who read them; many of the first generation of feminist therapists mark the moment of their epiphanic association with feminist therapy to reading one or more of these pieces (Brown, 1994; Chesler, Rothblum, & Cole, 1995; Kaschak, 1992).
These three pieces were Phyllis Chesler’s book Women and Madness (1972), Naomi Weisstein’s essay Kinder, Kuche, Kirche as Scientific Law: Psychology Constructs the Female (1968), and the 1970 journal article “Sex Role Stereotypes and Clinical Judgment of Mental Health,” by Broverman, Broverman, Clarkson, Rosenkrantz, and Vogel. These three works will be discussed in detail in this chapter. Each of these documents presaged developments to follow in the emergence of feminist therapy’s theory and practice. For their readers, these writings had the effect of initiating the first step in any process of feminist therapy, which is the arousal of feminist consciousness in the individual, a consciousness without which feminist practice cannot occur.
What is feminist consciousness? Historian Gerda Lerner (1993) defines it as the development of awareness that one’s maltreatment is not due to individual deficits but to membership in a group that has been unfairly subordinated, and that society can and should be changed to give equal power and value to all. Specifically as to feminism within the psychotherapy professions, this consciousness took the form of realization that almost all of what had been written about women up to that time was distorted by the sexist biases inherent in the mental health professions. Feminist consciousness-raising highlighted the reality that the very practice of psychotherapy itself was imbued with oppressive norms and values that were harmful to women because of how those norms replicated barriers to women and associated noncompliance with those barriers with inadequate mental health. In many instances this epiphany was accompanied by a cognitive reappraisal of personal experiences with sexist and misogynist psychotherapy and/or professional relationships in which the difficulties encountered therein were reinterpreted as reflecting the sexism of the other person or the situation, rather than one’s own inadequacy as a woman. Feminists who were psychotherapists noted the powerful effects of this raised consciousness on their own well-being.
Feminism teaches that “the personal is political.” For this group of early feminist therapists and feminist psychologists, the development of feminist consciousness and politics arose from their own experiences as graduate students, therapists, and sometimes clients within the patriarchal system of psychotherapy as practiced universally prior to the early 1970s (Baker & Welch, 1995; Bernardez, 1995; Caplan, 1995; Chesler, Rothblum, & Cole, 1995; Denmark, 1995; Gartrell, 1995; Greenspan, 1995). For Phyllis Chesler and Naomi Weisstein, those experiences of sexism and discrimination in their professional settings were the genesis of two of feminist therapy’s founding documents.