Sex Role Stereotyping and Clinical Judgments of Mental Health: Science Supporting Politics

This next founding document, authored by clinical psychologists Broverman, Broverman, Clarkson, Rosencrantz, and Vogel (1970) reported the findings of a study in which experienced practicing psychotherapists, both women and men, from the range of mental health disciplines were asked to describe three people on a 102-item scale of bipolar adjectives (e.g., “Functions well in a crisis vs. Does not function well in a crisis”) separated by a 100-point continuum. Presented in random order, the persons to be described were the Mentally Healthy Adult Male (MHAM), the Mentally Healthy Adult Female (MHAF), and the Mentally Healthy Adult (MHA).

The authors’ findings constituted early empirical support for what Chesler and Weisstein had asserted in their critiques and validated the realities of women psychologists participating in consciousness-raising groups. The MHAM and the MHA were essentially the same constructs, and both constructs constituted ways of being human that were highly socially desired. The MHAF was significantly different from both the MHAM and, importantly, the MHA; this construct was also significantly less socially desirable. Women, not those diagnosed with disorders but seen as exemplars of good function, were being held to a different standard of functioning than were men. The mentally healthy adult woman was not, in fact, an adult; in the eyes of the typical psychotherapist of the time, she was a lesser being whose attributes were less socially desirable.

CLINICAL CONTRIBUTIONS TO THE DEVELOPMENT OF FEMINIST THERAPY

At the same time that these documents were published, women therapists began to gather at conferences and professional meetings to discuss their feminist concerns, moving out of their CR groups and into action within their disciplines. Several veteran feminist therapists have described these encounters with other women at national conferences, including the groundswell of anger that led to a feminist takeover of the APA Council of Representatives meeting in August 1969, an action that set the stage for the founding of the Association for Women in Psychology (AWP) and the Society for Psychology of Women (SPW; Division 35 of the American Psychological Association [APA]). The Women’s Institute of the Orthopsychiatric Association, organized in 1978 by feminist psychiatrist Jean Baker Miller (who went on to found the relational–cultural school of feminist therapy), became a home to feminists in social work and psychiatry, the disciplines that then constituted the majority of the parent group’s membership. In 1981, AWP members under the leadership of Adrienne Smith, one of the first openly lesbian feminist therapists, and Lenore Walker, the developer of the construct of Battered Women’s Syndrome, proposed a meeting for experienced feminist therapists, which grew into the Feminist Therapy Institute, an interdisciplinary group that has met for intensive institutes since 1982. The bulk of scholarship in feminist therapy’s first 2 decades emerged from the meetings and publications of these three organizations, with a largely clinical and qualitative body of knowledge being created by feminist therapists in the context of discussions and paper sessions by practitioners who were calling themselves feminist therapists. The peer-reviewed journal Women & Therapy, founded in 1983, has been the publication home for much of this clinically oriented work.

A clinical science of feminist therapy has been slow to develop, although the clinical science of the psychology of women and gender has grown exponentially since the early 1970s, with such journals as Psychology of Women Quarterly, Feminism and Psychology, and Sex Roles laying the foundation for a robust research literature. This slow growth of feminist clinical science appears to reflect several trends both inside feminist psychology and in hiring and promotion patterns in academic psychology departments. Because so-called science had been misused to oppress women in prefeminist psychotherapies, there was an initial hostility and resistance to putting feminist therapy under a microscope, with fears expressed that information about women’s experiences of distress would be misused against them, as “proof” of women’s incapacity to do one role or another. Although feminist psychological scientists were studying girls and women, little of their work was on therapy process and outcome. Feminist psychologists with interests in developing an evidence base of practice were often marginalized in the academy and actively discouraged from identifying themselves as feminists to protect the possibility of tenure, making it more difficult to develop the sort of long-term work needed to establish information about effectiveness and efficacy of an approach to treatment. A result has been a practice whose evidence base remains largely in the realm of clinical and qualitative materials and via extrapolation from knowledge about those common factors of good psychotherapy that are prominent and central to the feminist therapy paradigm.

STAGES OF CONCEPTUAL DEVELOPMENT IN FEMINIST THERAPY

I have somewhat arbitrarily divided the development of feminist therapy into four periods, each described by the theoretical and political theme informing its practitioners. Within each era is a range and diversity of practice that a volume such as this cannot capture; readers are encouraged to seek out the primary sources cited for more in-depth understanding of the full range of feminist therapy practices. These four stages, which each lasted roughly a decade, reflected both the Zeitgeist of research and practice in psychology in general and the Zeitgeist of feminism as propounded primarily in the United States. I define these stages as:

No-difference feminism (1960s–early 1980s) Reformist feminist Radical feminist

Difference/cultural feminism (mid-1980s–mid-1990s)

Difference with equal values feminism (mid-1990s–present)

Multicultural, global, and postmodern feminisms (the 21st century)

No-Difference Feminism and Feminist Therapy

No-difference feminism asserts that there are no actual differences between women and men and that any apparent differences either are due to learned/unlearnable processes or represent artifacts of unequal treatment. It asserts that women should not be excluded from any profession or occupation simply because of sex, because talents and capacities are equally distributed between females and males with differences being individual rather than sex-based. It was one direct feminist psychology response to the obvious cultural manifestations of sexism of the era, which justified differential and lesser treatment of women on the grounds of allegedly inherent sex differences. The feminist psychological scholarship of this period is marked by many studies that attempted to challenge the concept of essential differences between the sexes or that identified what few differences did exist and then downplayed their meanings for people’s capacities to function day to day. The initial body of research on women’s psychology was done during this period, which can be seen as encompassing the years from 1969, when feminists in psychology first coalesced as a group, into the early 1980s. During this time the first journals addressing empirical research on women and gender were founded, Psychology of Women Quarterly and Sex Roles.

Within the psychotherapy realm this strand of thought was initially represented politically by a reformist feminist model (see Enns, 1992, 2004, for in-depth reviews of the different schools of feminist political theory). Reformist feminism, then and today, has a vital interest in increasing women’s numerical representation throughout all aspects of society and in legally guaranteeing equal rights and access. However, reformist feminists do not engage in critiques of systemic sexism, misogyny, and other linked forms of oppression; nor do they call for radical social changes in cultural institutions beyond increasing the numbers of women within them. In psychotherapy practice this politic manifested as getting more women to practice as psychotherapists and making more information about women’s lives and experiences available in the training of psychotherapists.

No-difference feminist psychology also eventually became a home to radical feminist psychological thinkers, of whom Weisstein was only one. Radical feminism of this period in the late 1960s and 1970s argued that while women and men were indeed not different in their skills and capacities, simply placing female bodies in great numbers in institutions that were inherently oppressive would do nothing to transform the dominant U.S. culture into anything more just and nonsexist. Radical feminists thus worked for total—that is, “radical”—transformation of all institutions of society.

The initial emergence of a radical feminist critique in feminist therapy can be seen in early discussions of creating an egalitarian relationship in therapy (Smith & Siegel, 1985). These discussions, which have evolved into one of the cornerstones of feminist therapy in theory and practice, asserted that a woman doing therapy with a woman in the authoritarian, power-over mode typical of therapies as then practiced would not constitute feminist therapy, even if the therapist in question self-identified as feminist. This radical critique of the core structure of psychotherapy argued that for therapy to be feminist, the power dynamics of the relationship need to be interrogated and revised to create equality of power. (A detailed discussion of the egalitarian relationship will follow later in this volume.) The majority of currently practicing feminist therapists, no matter how else they define their practice, have integrated this radical feminist critique of therapy’s power structure into their definitions of feminist practice, along with radical feminism’s vision that society must be transformed to accomplish the feminist project of social change.

Feminist therapy practice during this period focused on identifying what were seen as women’s unique and special treatment needs as well as on the person of the woman therapist. There was not yet a defined theory of feminist practice separate from the political feminist notion that “the personal is political” and that all experiences consequently could be parsed in terms of women’s oppression. Some early feminist therapists rejected the notion of a theory as itself too reflective of patriarchal norms and as likely to delay women’s progress toward self-determination. Defining itself against the therapy-as-usual of its day, feminist therapy was construed as a short-term process, focused on raising women’s consciousness (Brodsky, 1973) and teaching women specific skills for better negotiating their world, such as assertiveness or sexual awareness. Women’s distress was seen as arising solely or largely as a result of oppression, and feminist therapists of the day posited that once women became aware of that oppression and learned how to respond differently, they would no longer experience that distress. A classic book of the era titled Feminism as Therapy (Mander & Rush, 1974) reflects the hopeful stance that feminist revolution per se could be curative. Therapy was postulated as a sort of “consciousness raising group of two” (Kravetz, 1978, p. 169) in which a relationship of near-equals would obtain. An excellent example of the scholarship of this stage is Miriam Greenspan’s A New Approach to Women and Therapy (1983). This work integrates and synthesizes the development of that initial stage of feminist practice and begins to move toward theory development. Some of the very early areas of emphasis of feminist therapy included women’s depression, assertiveness training, female sexuality, and, increasingly, violence against women (Brodsky & Hare-Mustin, 1980; Herman, 1981; Rosewater & Walker, 1985; Walker, 1979).

Hare-Mustin and Marecek, in their critical analysis of schools of feminist psychological thought (1990), referred to the stance of no-difference feminism as “beta bias.” They noted that one of the risks inherent in beta bias is that it ignores the realities that, even though sex differences may be small, gender as a socially constructed variable does lead to disparate life experiences arising from the gendering of society. Given the extremely early point in life at which gender roles begin to be assigned and linked to biological sex and the persistence of this gendering of infants well after feminism began to challenge the gendering of behaviors (Karraker, Vogel, & Lake, 1995), beta bias had the potential to obscure the outcomes of gender as socially constructed.