Counseling and Psychotherapy Theories in Context and Practice, with Video Resource Center_ Skills, Strategies, and Techniques

CHAPTER SUMMARY 331

other choice theory and reality therapy advocates little systematic research on reality therapy efficacy.
such as Wubbolding, have sought to modify reality Future research needs to focus on more tightly con-
therapy to make it more culturally sensitive. trolled studies conducted by unbiased researchers
and that focus specifically on treatment or educa-
Although some research supports choice theory tional outcomes.
concepts and reality therapy practice, there’s very

CHOICE THEORY/REALITY THERAPY KEY TERMS

Acting Power or achievement
Avoiding things Restraining anger
External control psychology SAMIC3
Feeling Seven caring habits
Five basic human needs Seven deadly habits
Freedom (or independence) Survival
Fun (or enjoyment) Ten axioms of choice theory
Getting help Things or experiences
Ideas and beliefs Thinking
Love and belonging Total behavior
People WDEP
Physiology Your quality world

RECOMMENDED READINGS AND RESOURCES

The following resources provide more information about choice theory and reality therapy.

CHOICE THEORY AND REALITY THERAPY JOURNAL

International Journal of Choice Theory and Reality Therapy

READINGS ON CHOICE THEORY AND REALITY THERAPY

Burdenski, T. K. (2010). What does the future hold for Glasser, W. (1965). Reality therapy: A new approach to
choice theory and reality therapy from a newcomer’s psychiatry. New York, NY: Harper & Row.
perspective? International Journal of Choice Theory and
Reality Therapy, 29(2), 13–16. Glasser, W. (1998). Choice theory: A new psychology of
personal freedom. New York, NY: HarperCollins.

332 CHAPTER 9 CHOICE THEORY AND REALITY THERAPY

Glasser, W. (2000). Reality therapy in action. New York, Wubbolding, R. E. (2011). Reality therapy. Washington,
NY: HarperCollins. DC: American Psychological Association.

Glasser, W. (2002). Unhappy teenagers: A way for parents and Wubbolding, R. E., Brickell, J., Imhof, L., Kim, R. I.,
teachers to reach them. New York, NY: HarperCollins. Lojk, L., & Al-Rashidi, B. (2004). Reality therapy:
A global perspective. International Journal for the
Glasser, W. (2003). Warning: Psychiatry can be hazardous Advancement of Counseling, 26(3), 219–228.
to your health. New York, NY: HarperCollins.

Robey, P. A. (2011). Reality therapy and choice theory: An
interview with Robert Wubbolding. Family Journal, 19(2),
231–237.

TRAINING ORGANIZATIONS AND WEBSITES

The William Glasser Institute (www.wglasser.com) Center for Reality Therapy (www.realitytherapywub.com)

VIDEOS/DVDs Cognitive-Behavioral. North Amherst, MA: Micro-
training Associates.
Carlson, J., & Kjos, D. (2000). Reality therapy with Wubbolding, R. (2007). Reality therapy [DVD]. Washing-
Dr. Robert Wubbolding [Video]. Boston, MA: Allyn & ton, DC: American Psychological Association.
Bacon.

Hamann, E. (2010). Three Approaches to Counseling
One Client: Solution Focused, Reality Therapy, and

GOING FARTHER AND DEEPER

Additional choice theory and reality therapy counseling and psychotherapy resources are available at
johnsommersflanagan.com.

10CHAPTER

Feminist Theory and Therapy

With MARYL J. BALDRIDGE

THIS CHAPTER

Reviews the key figures and historical factors contributing to the development and evolution of
feminist theory and therapy
Outlines and describes feminist theoretical principles
Describes and discusses principles and strategies associated with feminist therapy practice, including

Assessment issues and procedures
Therapy relationships
Therapist self-disclosure
Therapy focus and strategies
Provides short vignettes to demonstrate feminist therapy principles in action
Illustrates how treatment planning, outcomes assessment, and gender and cultural issues can be
integrated into a feminist therapy approach
Reviews the empirical status of feminist therapy
Offers resources for further study

Feminist ideas are inherently radical and push floor, we offer another gender-expectation-busting
boundaries and realities of what most of us story.
are taught via the dominant social and cultural
media. This is why consciousness raising—raising At a recent American School Counselor Associa-
awareness of social and cultural influences on how tion National Conference in Seattle (2011), Georgie
we think of femaleness and maleness—is so central Bright Kunkel, a 90-year-old woman, delivered a
to the feminist perspective. With this in mind, read keynote address. She bounded onto the stage—not
the following comment by Kaschak (1992) and see looking a day over 80. She introduced herself as the
what feelings and insights it might create in you: oldest stand-up comic in Washington state (Was
there an older stand-up comic somewhere else on
For years, psychiatric journals have touted the the planet?). She proceeded to crack jokes about
salutary effects of antidepressants by printing everything from sex to . . . well . . . sex, and then sex
‘‘before’’ and ‘‘after’’ pictures showing a woman again. In the middle of her routine, she slipped in a
leaning on a mop looking despondently at her serious story that went something like this:
kitchen floor, and then happily mopping it after
taking her medication. (p. 22) I was working as a school counselor at an
elementary school. To kick off our career day, I
As you process your reactions to the image of contacted a woman friend of mine who was an
a medicated woman feeling happy mopping her airplane pilot. She agreed to land her one-person

334 CHAPTER 10 FEMINIST THEORY AND THERAPY

plane in the middle of our schoolyard. We were all people who struggle with real problems and you
very excited. We gathered the students outside and believe social forces, society, politics, hierarchies,
watched as she guided the plane down, smoothly and other paternalistic cultural factors contribute
landing on the playground. The students crowded heavily to those problems, then you should consider
around as she emerged from the tiny plane, pursuing training in feminist therapy.
helmet in hand. When it became apparent she was
a woman, a male student turned to me and asked, The uniting perspective of everyone interested
‘‘Where’s the pilot?’’ It was clearly a one-person in feminist therapy (including male feminists) is
plane, but in this boy’s mind, men were pilots and an acknowledgment that sexism, racism, classism,
women were stewardesses. This was a sad truth for and patriarchy are direct contributors to the prob-
many of our students. But what interested me lems and suffering in the world. Those engaged as
more was the impact of this event on our students’ feminist therapists take active steps toward address-
career ambitions. We had decided to take a ing these influences. Without acknowledging and
student survey before and after career day. Before addressing sexism and patriarchy, therapists will
my friend landed on our playground, exactly 0% contribute to their clients’ oppression and be com-
of our female elementary students listed ‘‘airplane plicit in pathologizing natural reactions to abuse,
pilot’’ as one of their potential career choices. denial of freedom, and denial of human rights.
After career day, about 40% of the girls listed Remembering this common thread will be useful as
airline pilot as a career to consider in the future. you read this chapter.

This is an example of a feminist working ther- Understanding feminist perspectives as a phi-
losophy that explores attitudes about gender and
apeutically to raise awareness and bring about oppression rather than thinking of it as exclusively
applying to women will help you understand its
development, change, options, and liberation. Fem- relevance to all clients. There are a number of steps
to take in the development of a feminist counsel-
inist therapy can be transformative. It was designed, ing and psychotherapy practice; it requires personal
introspection and self-knowledge, as well as socio-
in part, to break down unhelpful stereotypes and logical awareness and education about the impact
of sexism and patriarchy on society and individuals.
free all humans to fulfill their potentials.
HISTORICAL CONTEXT
Similar to exis-
Feminist theory and therapy has been and contin-
QUESTIONS FOR tential approaches, ues to be influenced by social activists outside the
REFLECTION but in contrast to counseling and psychotherapy disciplines. Conse-
quently, we begin our journey by examining recent
At this early point in many others, fem- evolutionary movements in feminist thought within
the chapter you should inist therapy is in- the United States.
try calling yourself a formed by a strong
Influences Outside Counseling and
feminist therapist. Say connection to a par- Psychotherapy: Three Feminist Waves

aloud, ‘‘I’m a feminist ticular set of phi- Themes of feminist thought have emerged, receded,
reemerged and developed further throughout his-
therapist’’ Notice how losophies or beliefs. tory. For example, Plato (c. 440 b.c.) included
consideration of women for leadership positions
that feels. What are It wasn’t developed within the ruling elite. John Stuart Mill, influenced

your gut reactions? by a single person,
What are your intellec- it doesn’t have neat
tual musings? Can you boundaries, it can’t
embrace that label? Can be easily described,
you let it embrace you? and there are many
If not, what gets in the ways to put it into
way? practice. Feminist

therapy, like femi-

nist theory, reflects the work of women and men

involved in grass-roots movements, and ideas and

concerns formulated from the ground up. It’s eclec-

tic and inclusive. If you’re interested in working with

HISTORICAL CONTEXT 335

in part by his friendship and marriage to feminist Second Wave Feminism
Harriett Taylor, wrote essays decrying the oppres- Second wave feminism describes the feminist
sion of women, pointing out great costs to society movement during the mid-1900s (Collins, 2009).
that resulted from this oppression. Historically, This wave is characterized by the Women’s Liber-
women’s rights and freedoms have ebbed and flowed ation movement, the formation of NOW (National
in a manner suggesting that only great leaps in global Organization of Women), and shifting toward a
social and gender consciousness could solidify cur- focus on women’s political and personal experi-
rent gains and make future progress possible. ences. During this time, feminists worked toward
changes in their relationships, health care, and
To understand how feminism applies to modern career opportunities. Many people think of second
counseling and psychotherapy, it’s useful to have an wave activists when they hear the word, ‘‘feminism,’’
awareness of feminist history in the United States. as this was when feminist activists were highlighted
This is a topic worth volumes; we hope this limited (and often demonized) in the media (Collins, 2009).
synopsis will help you understand how feminism This movement significantly addressed policy and
evolved over time and glimpse how it has influenced attitudes about women and gender in political, rela-
counseling and psychotherapy today. tional, and professional realms. This wave also ini-
tiated feminist explorations of masculinity and the
Recent feminist history is typically organized into oppression of men under patriarchy.
three movements. These movements are referred to
as different ‘‘waves’’ of feminism, a descriptor that Although minority women’s voices are included
highlights the influence each time period had on in some historical references to second wave fem-
the next, and the continuous nature of feminism’s inism, and many women of color contributed
evolution. significantly, the movement is retrospectively
seen as predominantly white. For example, when
First Wave Feminism ‘‘Women’s Lib’’ advocated for a woman’s right to
First wave feminism refers to the feminist and work, the fact that many poor women and women of
liberation-oriented activities occurring around and color had no choice and had to work low-wage jobs
before the women’s suffrage movement. Some of was largely ignored. At that time the women who
the roots extended into the anti-slavery movement, were fighting for the right to work were generally
before the focus shifted to equal rights for women. wealthy enough to have the option of working or
During this time, feminists lobbied for all women’s not working (although it was difficult for women to
rights to vote, own property, and be acknowledged work in positions of power equal to men). Second
as citizens. Sometimes students ask us about the wave feminism was also associated with a ‘‘women
relevance and contribution of feminism in their versus men’’ mentality. In retrospect, this mental-
lives. Usually we respond with something like, ‘‘If ity is viewed as part of a developmental process of
you’re female and you can vote and own property differentiation and self-definition.
or you’re a male who thinks females should be able
to vote and own property, then you owe at least a Third Wave Feminism
small debt to feminism.’’ Contemporary or third wave feminism is an explic-
itly more expansive and inclusive feminism (Espı´n,
Contemporary feminists honor the first wave 1993). In contrast to second wave feminism, con-
feminism period and its leaders, while also acknowl- temporary feminism has expanded further into areas
edging its inherent limits. For instance, stories of beyond women’s issues. There’s a broad focus on
racial minorities who were also working hard for how sexism and patriarchy impact all members of
change are rarely acknowledged when discussing the society (Barrett et al., 2005; Espı´n, 1997; Kawa-
suffrage movement. As feminist consciousness con- hara & Espı´n, 2007; Yakushko & Espı´n, 2010).
tinues to expand, efforts are being made to develop The concept of women versus men—the battle of
more inclusive historical representations of early
feminism (Collins, 2009).

336 CHAPTER 10 FEMINIST THEORY AND THERAPY

the sexes—popular back in the 1970s and early Feminism Continues to Evolve
1980s is viewed as too simplistic. Third wave fem- As with all social justice movements and cultural rev-
inism brings women and men together to work olutions, feminism has gained ground, lost ground,
against social injustice. Contemporary analyses of and regained it. Whether considered first, second,
power and gender look well beyond sex-defined third, or even fourth wave, at the core feminism
boundaries. Third wave feminism challenges under- is about liberation. bell hooks (2000) articulates
lying systems of oppression—the fight is against this in the following statement:
all systems that oppress and limit societal mem-
bers regardless of where they fall along the gender All of us, female and male, have been socialized
continuum (Enns, 2004). from birth on to accept sexist thought and action.
As a consequence, females can be just as sexist as
Although second and third wave feminists ad- men. And while that does not excuse or justify
dress many of the same issues, there are a number of male domination, it does mean that it would be
contrasts in terms of how these issues are addressed. na¨ıve and wrongminded for feminist thinkers to
For example, second wave feminism challenged see the movement as simplistically being for
the meaning of and limits associated with being women against men. To end patriarchy (another
a woman (Collins, 2009). Women were encouraged way of naming the institutionalized sexism), we
to move beyond their traditional employment need to be clear that we are all participants in
options and into traditionally male dominated perpetuating sexism until we change our minds
vocations (e.g., firefighting, police work, medicine, and hearts, until we let go of sexist thought and
welding). This chapter’s opening story of the action and replace it with feminist thought and
woman airplane pilot is a good example of second action. (pp. viii–xi)
wave feminism.
Key Figures and Factors in the History of
Similar to the second wave, third wave feminism Feminist Theory and Therapy
has an agenda that honors all occupations and roles
as legitimate and valuable, and takes these concepts Despite many obstacles women faced in the early
further. The mothers’ movement is one of many 1900s, there were many original feminist thinkers
examples of this shift (Bridson, 2010). Another within psychotherapy and counseling. Two of the
distinction is that in the past, great emphasis was most prominent were Raissa Epstein Adler (see
placed on minimizing differences between men Chapter 3) and Karen Horney (see Chapter 2).
and women (Collins, 2009). This was ostensibly
because all qualities associated with being female Raissa Epstein Adler was a radical socialist
were devalued and subject to discrimination. Now, and intellectual from a wealthy Jewish family in
feminism focuses on respecting and celebrating Russia. She moved from Russia to study zoology,
potential differences between men and women, biology, and microscopy in Zurich because, at the
while at the same time highlighting the fluidity time, women weren’t allowed to attend Russian
of gender and the individual experiences of each universities. While in Vienna she met and married
person’s gender definition. In this respect, wearing Alfred Adler in 1987. Although she was primarily
make-up or spike heels are considered women’s involved in raising the couple’s four children (two of
(and men’s) choices—as long as those choices are whom, Alexandra and Kurt, became psychiatrists),
accompanied by awareness and empowerment of Raissa was also deeply involved in the development
alternative choices. The film Erin Brockovich as a of Alfred Adler’s theory of Individual Psychology.
third wave manifesto, demonstrated how ‘‘showing Raissa took minutes at meetings of the Society
cleavage’’ could be symbolized not only as a for Free Psychoanalytic Research and undoubtedly
women’s right, but also as a means of employing influenced Alfred’s views on women (R. Adler,
female attributes, including sexual attributes, as a 1982). Alfred Adler’s public comments on sexual
source of power. equality remain radical today.

HISTORICAL CONTEXT 337

As we’ve seen from pre- Phyllis Chesler was a psychological researcher
turned critic of the patriarchic mental health system.
vious chapters, Karen Following the 1969 meeting of the American
Psychological Association where she was exposed
Horney was a power- to a feminist protest, she decided to use her skills to
support the movement (Chesler, 1995). Her work
fully influential woman articulated the following points:

within psychology and • Psychotherapy for women replicated conditions
associated with a society that was sexist and
psychoanalysis. She an- oppressive toward women.

alyzed at least two • Women were labeled as disturbed simply because
they did not want to engage in full-time parenting
Karen Horney very influential histori- or wanted to venture into the working world.
cal figures within psy-
• Many women were sexually violated during
chotherapy (i.e., Fritz Perls, Chapter 6 and Albert psychotherapy.

Ellis, Chapter 8). Her work on tyranny of the According to Brown (2010), Women and Madness:
Exposing Patriarchy in the Consulting Room (Chesler,
shoulds is often viewed as an intellectual predecessor 1972) remains relevant today.

of REBT and cognitive therapy. She was persistent Naomi Weisstein was studying comparative and
physiological psychology at Harvard University in
and sometimes provocative. She provided a strong the 1960s. As a woman, she had substantial obsta-
cles; she wasn’t allowed access to laboratory facilities
‘‘push back’’ to traditional Freudian psychoanalytic or the library. In 1968, Weisstein published a highly
controversial article, Kinder, Kuche, Kirche as Sci-
theory. Her views on womb envy and other feminist entific Law: Misogyny in the Science of Psychology.
The article was subsequently included in a fem-
psychological phenomena are featured in Chapter 2. inist anthology, Sisterhood Is Powerful (Morgan,
1970). Weisstein’s article was especially provoca-
From the early twentieth century forward, in tive and indicting because she used the German
words Kinder (children), Kuche (kitchen), and
psychiatry, as in many fields, women slowly, against Kirche (church), which harkened to the role of
women as originally articulated by Kaiser Wilhelm
great odds, began joining the ranks of educated male II and later endorsed by the Nazi Third Reich.
In her article, Weisstein described ways in which
professionals. The inclusion of women in doctoral broad generalizations about women were articu-
lated by experimental psychologists—even when
programs was initially and vehemently resisted. One women were rarely included in the research studies.
Brown’s (2010) description of Weisstein’s argument
can imagine that the ‘‘Old Boys in Academia Club’’ (and reflection back to Karen Horney) illustrates
this point:
might have choked a bit when reading Horney’s
Weisstein—perhaps echoing Karen Horney’s
1922 paper addressing the genesis of the castration (1967) earlier observation that the concept of penis
envy might simply reflect the egocentric musings
complex in women. She wrote:

In this formulation we have assumed as an
axiomatic fact that females feel at a disadvantage
because of their genital organs, without this being
regarded as constituting a problem in
itself—possibly because to masculine narcissism
this has seemed too self-evident to need
explanation. Nevertheless, the conclusion so far
drawn from the investigations—amounting as it
does to an assertion that one half of the human
race is discontented with the sex assigned to it and
can overcome this discontent only in favorable
circumstance—is decidedly unsatisfying, not only
to feminine narcissism but also to biological
science. (Horney, 1967, p. 38)

Three Groundbreaking Feminist Publications
Many different publications contributed to dynamic
feminist changes within psychology and counsel-
ing beginning in the 1970s. In this section we
describe three particularly groundbreaking publi-
cations identified by Brown (2010).

338 CHAPTER 10 FEMINIST THEORY AND THERAPY

of a now-grown male child who was himself so scientists; they were objective. Well, as it turned out,
attached to his penis that he could not imagine they were scientists—but they weren’t objective.
how those not possessing one would not envy And to steal (and paraphrase) a line from the film
him—critiqued then-pervasive psychoanalytic Network (1976), the women of psychology were mad
formulations of women as being less morally as Hell and weren’t going to take it anymore.
capable, more dependent, and less fully adult than
men. She pointed out the complete absence of Consciousness-Raising Groups and
empirical, research-based support for these Recent Developments
assertions upon which most of psychotherapy with Women and madness (1972), Kinder Kuche,
women was founded. While today such assertions Kirche as scientific law (1968), and sex-role
about women might seem outrageous, rereading stereotypes and clinical judgment of mental health
Weisstein reminds us that in 1968 and for many professionals (1970) came from and contributed to
years afterward, they were the conventional a bubbling grassroots feminist phenomenon in the
wisdom about women ascribed to by almost all United States in the late 1960s and early 1970s.
practicing psychotherapists. (pp. 15–16) The phenomenon was labeled as the feminist
consciousness-raising groups. These were loose-
This quotation deserves a brief commentary: ly structured and non-hierarchical meetings sweep-
When she refers to ‘‘almost all practicing psy- ing through the United States and catalyzing the
chotherapists’’ Brown isn’t referring to Carl Rogers women’s movement within and outside psychology.
whose approach to psychotherapy focused on valu- Worell and Remer (2003) described how these
ing all persons (yes, even women). Also, although groups promoted psychological awareness:
‘‘such assertions about women’’ might be seen as
‘‘outrageous’’ today, anyone capable of conducting In response to their growing awareness of personal
a brief Internet search can uncover many examples dissatisfaction and unexplained malaise, groups
of individuals and groups that continue to not only of women began to congregate to discuss their
denigrate women, but to strongly express their view life situations. In sharing experiences of restricted
of women as clearly inferior to men. and stereotyped expectations for how they should
conduct their lives, they discovered that their
A third groundbreaking publication hit the problems were voiced and mirrored by others. (p. 6)
presses in 1970. Broverman, Clarkson, Rosencrantz,
and Vogel (1970) published results from a study These feminist consciousness-raising groups
focusing on professional psychologists judgments of illustrated a two-sided principle associated with
healthy males, females, and adults. Not surprisingly, positive psychological development in general and
it turned out that healthy males and healthy adults women’s positive psychological development in
were essentially identical. What stood out was the particular.
finding that:
• Isolating women enables oppression, but . . .
The mentally healthy adult woman was not, in
fact, an adult; in the eyes of the typical • Connecting women with each other facilitates
psychotherapist of the time, she was a lesser being awareness, motivation, and change.
whose attributes were less socially desirable.
(Brown, 2010, p. 17) More recent contributors to feminist thinking
have pursued this and other core principles. For
In many ways the psychotherapists of the example, Jean Baker Miller (1976), Judith Jordan
time were simply reflecting the social climate (1997, 2010), and other therapists/scholars were
(Collins, 2009). Women were devalued. Women instrumental in developing relational-cultural
were considered inferior—even childlike in their therapy (RCT). RCT is a contemporary feminist-
ability to reason. But the psychotherapists should informed therapy approach currently gaining in
have known better, because after all, they were

HISTORICAL CONTEXT 339

popularity. Jordan (2010) described the distinctly and patriarchy. Funderburk and Fukuyama (2001)
feminist conceptual principles of RCT: define feminism as:

The practice of RCT is based on a new model of The belief that human beings are of equal worth
human development that places connection at the and that the pervading patriarchal social structures
center of growth. The fundamental principles of which perpetuate a hierarchy of dominance, based
RCT, as it emerged over the years, posit that we upon gender, must be resisted and transformed
grow in relationship throughout our lives. RCT toward a more equitable system. (p. 4)
sees the ideal of psychological separation as
illusory and defeating because the human Of course, feminism has never been easy to
condition is one of inevitable interdependence define. We should consider the famous quote by
throughout the lifespan. (p. 3) Rebecca West who lived from 1892 to 1983.

Interestingly, as observations of women’s con- I myself have never been able to find out precisely
sciousness-raising groups illustrated years earlier, what feminism is: I only know that people call me
RCT contends that psychological connection for a feminist whenever I express sentiments that
women (and men) has developmentally stimulating differentiate me from a doormat.
and growth producing effects (Gilligan, 2003; Jor-
dan, 2010). Additionally, the migration in thinking Subversive
from second wave to third wave feminism is visible. In Subversive Dialogues (1994), Brown framed fem-
No longer are women required to compete with inist therapy as a subversive partnership. She suc-
men to fit men’s theories of healthy development. cinctly describes and defines subversion in her most
Instead, women’s ways of being are valued in their recent book:
own right and used to describe human health and
well-being. Subversion is a concept that broadly represents
the psychotherapeutic strategies by which
We should also note that Laura S. Brown therapist and client, working together
is another historical and contemporary leader collaboratively, use the tools of psychotherapy to
within the feminist therapy literature. We’ve used undermine the internalized and external
several of Brown’s popular feminist works as a patriarchal realities that serve as a source of
guide in writing this chapter. Some of her books distress and as a brake on growth and personal
include Diversity and Complexity in Feminist Therapy power for all humans. (Brown, 2010, p. 4)
(Brown & Ballou, 1990), Subversive Dialogues (1994),
Rethinking Mental Health and Disorder (Ballou & It’s important to note that Brown isn’t really
Brown, 2002), and Feminist Therapy (Brown, 2010). suggesting that psychotherapy could be subversive,
she’s contending that it should be subversive. If you
Working Definitions think about it, subversive feminist psychotherapy
constitutes a significantly transformative leap from
For the purposes of clarification, we offer several oppressive psychotherapy as written about by
working definitions of concepts central to feminist Chesler in 1972.
theory. These definitions are evolving, even as
feminism is evolving. Patriarchy
In the preceding (and following) pages we fre-
Feminism quently use the word patriarchy. It can be easy to
The essence of feminist theory involves a belief look at that word and assume it represents anger
in human equality and an understanding that an towards men or specific criticism of men’s leader-
essential step in creating this equality is to shift ship styles. To clarify, criticizing patriarchy isn’t
existing paradigms about gender, sexuality, power, necessarily male-focused. Many women participate

340 CHAPTER 10 FEMINIST THEORY AND THERAPY

heartily in the dominant hierarchical patriarchy, and Feminist theories in general and feminist theories of
have the ability (and sometimes desire) to oppress, mental health in particular have sought to identify
discriminate, and hold others back. Third wave fem- and address cultural forces and practices that are
inism emphasizes that this isn’t about blaming men. sexist and psychologically damaging.
Instead, it’s about working through gender, racial,
cultural, spiritual, and other partnerships to develop THEORETICAL PRINCIPLES
awareness and solutions.
Feminist theory is at once complex and simple,
With that in mind, here’s Brown’s (2010) def- innocent and insidious, common sense and deeply
inition of patriarchy: profound. What can be more obvious (at least to
the Western European mind) than the notion that
Patriarchies are the near-universal hierarchical every baby born deserves to pursue her or his calling
social systems in which attributes associated with to the fullest, with no obstacles arbitrarily put in
maleness are privileged and those attributed to place due to sex, race, or culture? Who disagrees
women are denigrated . . . no matter the sex of the with this ideal of universal fairness and equal
individual in whom these qualities are found. opportunity?
Patriarchical systems are identified by feminist
therapy and theory as the primary sources of On the other hand, fairness and equal opportu-
human distress, including those kinds of distress nity is deeply disturbing to some individuals and
that are organized into diagnostic categories and groups. The problem is apparent on many levels.
labeled psychopathology by the mental health Universal fairness and equal opportunity immedi-
disciplines. The actual distress or dysfunction ately call into question the status quo. It disrupts the
about which an individual initiates therapy is thus natural (or unnatural) order of things. If your sex
seen not as pathological per se, no matter how should not in any way determine your role in cul-
much it impairs a person’s functioning, but most ture or excuse you from culturally identified adult
likely a response to being immersed in toxic obligations, what are the implications?
patriarchal realities. Such toxic social hierarchies
of value are construed inherently inimical to • Equal responsibility for serving in the military.
personal power and healthy function for all
people, even those apparently privileged by • Equal responsibility for providing income to your
patriarchal norms of dominance and hierarchy. family.
(Brown, 2010, p. 5)
• Equal responsibility for nurturing your children.
QUESTIONS FOR Feminist theory
REFLECTION and therapy inher- • Equal opportunity for all employment options.
ently critique the
What cultural forces damaging dominant • Equal opportunity to attend the college of your
and practices do you patriarchy and the choice.
think are psychological- pathological use of
ly damaging to women? power over others. • No more enhanced opportunities or limits based
In contrast, what cul- Since the 1960s, on skin color, shape of your body, native language,
tural forces and prac- feminist mental or ethnic origin.
tices do you think are health theorists, re-
psychologically damag- searchers, and ther- About 20 years ago, in a psychology of women
ing to men? Is it fair to apists have exercised class at a small, private university, Rita asked the 14
suggest that patriarchal increasing influ- female students, ‘‘Do you believe you should have
systems are to blame for ence in counsel- the options of either being a stay-at-home mom
this damage to women ing and psychother- with your children or joining the workforce and
and men? apy (Enns, 2004).

THEORETICAL PRINCIPLES 341

hiring nannies or using a day care to take care of Put another way, female and male refer to sex
your children?’’ differences and feminine and masculine refer to
gender differences (see Putting it in Practice 10.1 for
The response was unanimous. These young an activity focusing on sex and gender distinctions).
women were adamant: Yes! The choice to either Maleness and femaleness doesn’t vary a great deal
stay home or enter the workplace should be theirs. across cultures, but what is considered feminine or
Rita then posed a second question: ‘‘If you’re in a masculine can vary drastically.
heterosexual partnership or marriage, should your
children’s father have the same option? Is it totally Biological Sex
okay for him to choose to be a stay-at-home dad?’’ There are a few biological distinctions that classify
humans as male or female. These include the sex
This time the response was muted and mixed. chromosomes and sex-determining genes, the H-
A few women dared to share that they wouldn’t Y antigen, gonads, certain hormones, and internal
want to marry someone who chose to stay at home reproductive organs (Zucker, 2001). The majority
with the children and expected her to work. An of those classified as female are born with clitorises,
excellent discussion followed. When we ask this labia, vaginas, and uteruses and at puberty will
question now, depending on the group, the age of develop breasts capable of milk production and
the respondents, etc., the responses are different, but begin a menstrual cycle that will last until midlife.
what’s clear is that men’s and women’s rights and The majority of those classified as male will have
choices are inextricably bound together. Allowing testicles and penises and at puberty will experience
men equal freedom to choose to stay home and take a hormonally driven change in their vocal cords that
care of a baby affects his partner. One respondent lowers their voices.
recently pointed out, ‘‘The bottom line is this:
We’re in this together and so we’d better start Although well over 90% of human biology is
talking and negotiating to develop more functional, identical for both sexes, there are important phys-
mutual, and fair partnerships.’’ ical and hormonal differences. These physical and
hormonal differences vary greatly within any group
Sex and Gender Powerfully Affect Identity of males or females and a significant number of
babies (about 1.0% to 1.5%) are born with less
The first principle of feminist psychological theory pronounced physical sexual characteristics (Reis,
is that both biologically determined sexual charac- 2009). Given culture’s insistence on male and female
teristics and socially constructed gender-role expec- as dichotomous categories, these individuals often
tations play a central role in understanding client struggle to find their sense of identity—or there is
experiences. As we explore this principle, keep in immediate surgery to modify the condition (Cull,
mind distinctions between the scientific meaning of 2002; Reis, 2007). Although intersex conditions
the words sex and gender. were recently labeled as disorders of sexual devel-
opment (DSD), some authors are advocating for
• Sex refers specifically and exclusively to the a less pathologizing label, recommending instead
biological, physiological, and anatomical char- that these conditions be referred to as devel-
acteristics associated with being female or male. opmental sex divergences (Reis, 2007). This
(Keeping in mind that intersex conditions or the language reduces stigma and endorses reality, espe-
presence of hermaphrodites within the general cially when surgical intervention is inappropriate or
populations require that we realize there are more unnecessary.
than two dichotomous ‘‘sexes.’’)
There’s also a significant population of people
• Gender refers to the socialized or socially con- who feel they were born into the wrong body in term
structed roles, behaviors, activities, and attributes of sexual designation. Transgendered populations
associated with identifying as female or male. continue to lack equal rights and acknowledgment
in our society, and a large part of their struggle

342 CHAPTER 10 FEMINIST THEORY AND THERAPY

PUTTING IT IN PRACTICE 10.1

Distinguishing Between Sex and Gender

To help make sex and gender distinctions even clearer try out the following activity.
After reviewing our examples, make a list of different sexual characteristics associated

with females and males:

• Women have uteruses and vaginas—men do not.
• Men have penises and testicles—women do not.

Now try generating some sex differences on your own:

• Women —men do not.
• Men —women do not.

In terms of gender, there are no hard and fast rules and so caveats are included to
note the differences are not universal:

• In the United States, women wear skirts and dresses—men do not.
• In the United States, men can go topless in public—women do not.
• In the United States, men play American football—women do not.
• In some Arabic countries, men drive cars—women do not.
• In some African countries, women tend gardens—men do not.

As you read through the preceding list, you may have noticed yourself disagreeing
with some of the statements. There are always exceptions, and gendered behaviors are
always evolving. Try your hand at generating your own gender differences list:

• In , men —women do not.
• In , women —men do not.

Did you notice yourself focusing on any particular cultures or countries as you made
your distinctions? What insights did you have about your own male/female biases . . . or
perhaps you have no biases?

THEORETICAL PRINCIPLES 343

stems from two factors: (1) their presence in the notion that biology is destiny and holds suspect most
population disturbs the neat and tidy normative sex- claims of innate male-female behavioral differences,
ual divisions between male and female and (2) they noting that such differences are often used to
are pathologized by psychiatry, mental health, and exclude, exploit, or devalue individuals on the basis
the general public. Although homosexuality was of sex or gender.
removed from the Diagnostic and Statistical Manual
(DSM, 2000), gender identity disorder continues as Human Development
a psychiatric diagnosis. Feminists consider pressure Human development theorists believe our first
to conform to a dichotomous sexual classifica- self-defining insight is the realization, occurring
tion system as the primary causal factor in gender during infancy, that mommy (or daddy or pri-
identity disorder. In other words, if the culture mary caregiver) is distinct from the self (Mahler,
accepted this condition as a normal human varia- Pine, & Bergman, 1975). The second, identity-
tion, the pathology assigned to the condition would delineating insight is an awareness of our biological
disappear. sex. Researchers believe that by as early as 18
months, many toddlers know their sexual identity
Gender and have begun selectively processing information
Beyond the few biological differences that theorists accordingly. This is highly significant in the world
identify as sexual differences, humans add many of identity formation. Think about it. The first two
layers to maleness and femaleness. Much of the human developmental insights are:
behavior we classify as male or female is culturally
constructed, not biologically determined. As it turns 1. I am.
out, at least based on science, women are not from
Venus and men are not from Mars—we reside 2. I am a girl (or boy).
together on planet Earth in a complex set of
culturally and biologically diverse bodies, working This awareness—and associated drive to fit with
things out as best we can. And we may not be one’s sexually identified group—opens the door for
as different as we think. In a review of 46 meta- culture to step in and offer developing boys and girls
analyses, Hyde (2005) reported that females and (and those with developmental sexual divergences)
males are strikingly similar across a wide range of all sorts of potentially useful and harmful guidance.
psychological variables. From religious instruction to Saturday morning
cartoons, from the lyrics of popular music to
Gender is a social construction. As such, it’s parental role modeling, young people generally
characterized by surprising fluidity and rigidity. In follow cultural rules for expressing their gender
some cultures, it’s feminine to be emotionally needy identity (Powlishta, Sen, Serbin, Poulin-Dubois, &
and unstable. In others, it’s considered feminine to Eichstedt, 2001).
be stoic, centered, and a source of family stability.
Some cultures prefer physically aggressive males. No matter what you believe about the relative
Others value intellectual skills as indicators of contributions of biology and environment on
maleness. Sometimes gender-related behaviors will human behavior, sexual identity is a defining feature
shift in a matter of minutes as when an executive of human identity. Think about how often male
transitions from the office, to the car, and to and female differences get magnified and broadcast
the nightclub. Determining just what’s biological into your homes on television or through the
and what’s socially constructed has been the goal Internet. For the most part, social forces in the
of many research projects, the source of much United States seem to want the differences between
controversy, and fuel for heated arguments at the females and males to be large and unequivocal . . .
dinner table (Unger, 2001). Regardless of exactly and sometimes, when comparing individuals to
where divisions lie, feminist theory rejects the individuals, the differences seem substantial and
obvious. However, there are many exceptions to

344 CHAPTER 10 FEMINIST THEORY AND THERAPY

these marked differences between the dichotomous then you will likely also regularly experience dis-
sexes. This is in keeping with what Gilbert and tress. This distress may or may not be completely
Scher (1999) dubbed the iron rule, which states that conscious . . . just as distress of undervalued minority
‘‘for any psychological or cognitive variable studied populations may not always be consciously acces-
by psychologists, the differences within each sex are sible. If you’re male, take a moment to pretend
always greater than the differences between the two you live in a world that devalues your existence
sexes’’ (p. 37). Hyde’s (2005) meta-analytic review and considers you as less than, as not completely
supports the iron rule. normal, and as not inherently valued. Then, wish
yourself a warm welcome to the world of women
QUESTIONS FOR REFLECTION and minorities—where you can be labeled abnormal
or inferior simply because of what you’re not.
The iron rule means that the average differences
between males and females on all cognitive measures, New Research: Similarities and Differences
including the SAT, ACT, and GRE, are smaller than Remnants (and more) remain of male as normative
the average differences within groups of males and in psychology, although significant progress is
within groups of females. Why do you think some being made. For example, while working with the
people still insist on emphasizing differences despite renowned moral development theorist, Lawrence
this scientific fact? Kohlberg, Carol Gilligan began wondering if
Kohlberg’s stages of moral development were
Deviance Comes From complete, since he had done most of his research
Dysfunctional Culture using male subjects. Gilligan’s (1982; Gilligan &
Attanucci, 1988) research led her to hypothesize
Much of human suffering and distress comes from that an ethic of caring for others might constitute
inequities suffered by women and others who were a different type of moral reasoning, one more readily
not born into the white, male, privileged class displayed by females in our particular culture. For
in North America and Western Europe. In the example, someone who makes a moral decision
dominant cultural setting, patriarchy reigns and based on relieving someone else’s emotional pain
male is normative. might constitute a higher moral reasoning (or at
least as high) as people who base their decision on a
Male as Normative rational analysis of fairness.
Although male and female babies are born at
roughly the same rate throughout the world, most Gilligan’s revised perspective on moral develop-
cultures place greater value on male babies and ment has generated controversy for moral philoso-
regard maleness as normative (Enns, 2004; Nutt, phers and feminists alike. What’s important about
2005). But what does ‘‘male as normative’’ mean? Gilligan’s contributions is that she provided an
example of what’s left out when we don’t include
Male as normative means that maleness sets the multiple perspectives. Having a divergent moral
standard for whatever is considered normal, average, model that includes women’s voices creates a more
or representative (Kaschak, 1992). Conversely, it complete model.
means that anything deviating from male can be
considered abnormal and inferior (Beauvoir, 1952). Stress researcher and social psychologist Shelly
Taylor made a similar contribution when research-
Male as normative also includes an inherent ing the well-known fight or flight phenomenon (Taylor
assumption of male is valuable. If you’re not male et al., 2000). She and her colleagues wrote:
and you regularly experience maleness as more
normal and more valuable than your femaleness A little-known fact about the fight-or-flight
response is that the preponderance of research
exploring its parameters has been conducted on
males, especially on male rats. Until recently, the

THEORETICAL PRINCIPLES 345

gender distribution in the human literature was Despite new research and theoretical modifica-
inequitable as well. Prior to 1995, women tions linked to work of individuals like Gilligan and
constituted about 17% of participants in Taylor, behavior and beliefs outside the psycho-
laboratory studies of physiological and logical laboratory remain strongly oriented toward
neuroendocrine responses to stress. (2000, p. 412) male as normative. Old ways of thinking are hard to
change.
Reanalysis of existing data and new research
revealed significant differences in the ways in which Old Patterns: Can Men Understand Women?
females and males respond to stressful situations. Men sometimes playfully perpetuate male as norma-
Taylor and colleagues (2000) concluded: tive and female as deviant. At a recent public lecture
John was presenting with a panel on the ‘‘Amazing
We propose a theory of female responses to stress Brain.’’ Off and on during the panel discussion there
characterized by a pattern termed ‘‘tend-and- were observations and comments about differences
befriend.’’ Specifically, we propose that women’s between male and female brains. Toward the end
responses to stress are characterized by patterns of the evening, a man in the back raised his hand
that involve caring for offspring under stressful and asked: ‘‘I don’t suppose anyone can ever really
circumstances, joining social groups to reduce answer this, uh, this age-old question, but how can
vulnerability, and contributing to the development you understand women?’’ His question was care-
of social groupings, especially those involving fully intoned and worded in such a way that it
female networks, for the exchange of resources and was clear that he wasn’t (a) complimenting women
responsibilities. We maintain that aspects of these because of their sophisticated complexity or (b)
responses, both maternal and affiliative, may have speaking about his own shortcomings or inabilities
built on the biobehavioral attachment caregiving to comprehend women. This comment was an artic-
system that depends, in part, on oxytocin, estro- ulation of the age-old belief—perpetuated primarily
gen, and endogenous opioid mechanisms, among by men—that women are irrational and therefore
other neuroendocrine underpinnings. (p. 422) are impossible for rational-logical-superior men to
understand.
The preponderance of the research suggests that
in fact, that male ways of being aren’t always John responded to this man’s question by stating:
normative for females, or even for all males. There
are physical and psychological similarities between I’m not really going there, but I guess I’d say that
females and males, but there are also differences. to understand women you’d actually have to spend
In this case, it would be inappropriate to make time with them, listen to them, and be interested
the case that a typical male fight-or-flight response in what they have to say.
is superior to a typical female tend-and-befriend
response. There is likely an evolutionary benefit to We encourage you to watch and listen for
both stress-related behavior patterns (Master et al., additional subtle or direct examples of male as
2009; Taylor & Gonzaga, 2007; Taylor & Master, normative in your everyday experiences. Additional
2011). Sometimes differences are just differences examples we’ve seen or that we’ve read about in the
and there’s no need to advocate for one sex-related literature include:
pattern as superior over another (although if they
feel threatened by this information, white male rats • Males are overrepresented in politics, entertain-
are highly likely to fight for their position . . . or run ment, and literature: Spend an evening counting
and hide in little holes in our cupboards). In this case the number of male versus female characters on
it seems clear: Neither behavior pattern represents television shows or in movies. The Sesame Street
psychopathology . . . and neither will always be the puppets provide a prime example.
superior response to threat.
• When specific vocations are all or mostly
male, the average salary is higher. Welders and

346 CHAPTER 10 FEMINIST THEORY AND THERAPY

custodians are generally paid more than teachers. Cumulatively these examples illustrate the point
Go figure. Garbage collectors make more than that maleness has been and still is the primary
child-care workers. normative definition of being human. This leads
to a core tenet of feminist (and multicultural)
• When males have problems, efforts will be made therapy: When a culture treats certain members
to deny those problems, explain them as failures of as exemplary, or normal, and other members as
the system, or reframe them as hidden strengths. different from normal and therefore inferior, it
We once had a man at a workshop explain that takes a psychological toll (Sparks & Park, 2002).
male suicide rates were 3 to 4 times higher than The blame for the problems this toll creates rests
female suicide rates because ‘‘men know how to with the culture, not in the individual.
get the job done.’’
Consciousness-Raising Is Part of
• When women or minorities have problems it will Healing and Change
be interpreted as due to their inherent weakness
or defectiveness. High rates of depression and Another key feminist principle is that con-
anxiety in women are sometimes explained by sciousness-raising facilitates healing and growth.
their fragile constitution. To change, clients must recognize the culturally
inflicted damage they carry. They must stop blam-
• When a women or person from a minority group ing themselves for not being heterosexual, white,
gains power or recognition, groups of primarily male, or for being the wrong kind of male, and begin
white males will make extreme, inaccurate, and seeing that the primary source of their problems is
inflammatory statements about that individual’s a patriarchal, and male-dominated culture.
character, mental health, or legitimacy. During
early parts of Barack Obama’s presidency, he was Without consciousness-raising, women and men
compared to Hitler and accused of not being an might continually try to change themselves to sur-
U.S. citizen. vive in patriarchal, sexist environments. Empirical
research supports that this ‘‘taking of responsibil-
• If an entity has no stereotypically male or female ity’’ will add stress and distress. Denial of sexism in
features, it will be referred to as male until proven an environment is linked to higher distress (Moradi
otherwise. How could Big Bird or Bugs Bunny & DeBlaere, 2010; Moradi & Funderburk, 2006;
have been construed as male? Rederstorff, 2010).

• Traditional masculine adjectives can be used as The Personal Is Political
compliments for males and females (i.e., she or Fundamental to feminist therapy is the familiar
he is so active, dominant, strong!); in contrast, feminist claim that the personal is political. This
traditional feminine adjectives can’t be effectively statement underlines how personal problems are
used for complimenting both sexes and even intertwined with an individual’s social-political cul-
have less positive valence for females. Try this tural setting (Enns, 2004). In other words, personal
one out by calling one of your guy friends soft, transformation facilitates social transformation and
sensitive, or demure. Also, using these same terms vice-versa (Funkerburk & Fukuyama, 2001). One
on women isn’t necessarily complimentary. As measure of success in feminist therapy might
Kaschak (1992) noted, ‘‘Women are subject to be increased social interest and awareness—an
censure not only for behaving too much like men, optimistic desire to change the world for the
but for behaving too much like women’’ (p. 40). better—an outcome with which Adlerians would
certainly agree. As stated by Worell and Remer
• Women’s activities are referred to as women’s (2003):
activities. Male activities are simply activities.
Women’s work, versus work. Women’s ways of
knowing, versus ways of knowing.

THE PRACTICE OF FEMINIST THERAPY 347

Overall, our feminist psychological practice • Allowing clients to experience this shared power
approach seeks a dual outcome: assisting women in the therapy relationship.
toward empowerment in their own lives and
seeking change in whatever social power structures • Honoring and facilitating female ways of being or
form the basis of many of their problems. (p. 18) feminist consciousness, including growth stem-
ming from deep, intimate relationships.
The personal is political is a concept that
relies on consciousness-raising, on recognizing Worell and colleagues (Worell & Chandler,
the connection between one’s personal misery 1996; Worell, Chandler, & Robinson, 1996; Worell
and the related political practices. This is why & Johnson, 2003) articulated a systematically fem-
consciousness-raising groups discussed previously inist approach to counseling and psychotherapy.
were so powerful. As women met together and spoke Essential ingredients of their approach include:
of their experiences and feelings, they began to (a) empowerment; (b) an analysis of power; and
recognize the political significance of their personal (c) evocation of feminist consciousness. We weave
situations. From the personal is political perspective, Worell’s essential feminist therapy ingredients into
the goal is change—change in the women, but more the following sections.
importantly, change in the structure and function
of the politics (or power arrangements) within their Informed Consent
environments.
Informed consent is more than a written document
THE PRACTICE OF FEMINIST (see Putting it in Practice 10.2). It’s an important
THERAPY part of your interactions with clients. Because they
believe the therapy relationship is a partnership,
Feminist therapy is primarily theory-driven and not feminist therapists engage in ongoing informed
necessarily linked to specific techniques or proce- consent. They let clients know why they suggest
dures. This is unusual in the current psychotherapy- certain activities, homework, or topic areas. They
as-procedure political environment. Although fem- check in on the therapy relationship frequently to
inist therapists are comfortable using techniques ensure that they respect client questions and wishes.
from a broad range of therapy orientations (e.g., Consider the following exchange:
Adlerian, person-centered, existential, cognitive-
behavioral), the work they do must flow from C: It says in your paperwork that you’re a feminist. I
and be compatible with their underlying feminist didn’t know that when I made the appointment.
philosophy; Enns (2004) described feminism as an
‘‘umbrella framework’’ for psychotherapy practice T: Yes, it’s important for us to consider that part
(p. 8). of my professional identity. Probably some other
parts, too.
Feminist therapy is technically eclectic; feminist
therapists use strategies and techniques originating C: Well, I don’t know if I would have come in if I’d
from other theoretical perspectives. However, the known this.
underlying goals of feminist therapy are not eclectic.
They include: T: Sounds like you’re unsure about working with
someone like me who says she’s a feminist.
• Helping clients see the patterns and social forces
that have diminished their sense of power and C: Yes, I am. And I only have six visits total with my
control. managed care.

• Encouraging clients to reclaim power, authority, T: Yeah, I can see why this would feel bad. How
and direction in their lives. about this? Let’s explore what I mean in my
paperwork, and let’s explore what brought you
in, and if you feel it would be better to work with

348 CHAPTER 10 FEMINIST THEORY AND THERAPY

someone else, I won’t turn this session in to your get on with talking about it. It’s okay what you
company. believe as long as you’re not going to push it or
judge me. I’ve got to talk about it, or I’m going
C: Wow, really? I mean, yes. I guess that would be to just up and leave him.
okay. Thanks.
T: Okay. Seems really important to let you get
T: What happened inside you when you read that some things talked through today. But anytime
informed consent? you feel worried about what I’m thinking, or if
you feel like I’m pushing an agenda, will you tell
C: Well, I’m not comfortable with gays and I think me?
women need to raise their children at home, and
I know it isn’t good for animal testing and all, C: Yeah. I think so.
but I like wearing make-up and I respect my
husband, at least when he’s sober. [Client gets a From this interaction, it’s possible to see how
little emotional.] a feminist therapist might work effectively with
clients who may not envision becoming feminists
T: You know, I can tell you’ve got a lot on your themselves. For most people, feeling empowered
mind, both from what you filled out and the way and respected is a welcome experience. However,
you just said that. I want to assure you about a an honest, careful exchange is both necessary and in
couple things and then hear more about what’s keeping with ethical practice.
troubling you. Would that be okay?
Assessment Issues and Procedures
C: Yeah. Sorry. I’m pretty strung out.
This section on feminist therapy assessment is
T: That’s okay. You’ve made a good choice to get longer and more detailed than assessment sections
help. I just want you to know that my counseling in other chapters. There’s irony about this because
work is all about you, not all about me. I don’t feminists generally avoid traditional standardized
need to change you at all. I just want to help you assessment. However, consistent with feminist the-
change in the ways you think are best for you. ory, feminists approach assessment in a therapeutic
We don’t need to talk about gays. I don’t have and constructive manner. In other words, assess-
any hard and fast rules about the ways women ment doesn’t involve one person judging another
should dress or raise kids or anything. I just person’s well-being. Instead, assessment is a mutual
believe women deserve a fair shake, on their own exploration of what’s happening in the client’s
terms. But I don’t push it. I mostly listen and intrapsychic world within a cultural context. As
reflect things back to you. a consequence, because mutual assessment and
exploration of both the client and the world she
C: But I like men, and I think they deserve our lives in is inherently therapeutic, feminist therapists
support, working and all. My dad worked himself employ fewer specific techniques. Client symptoms
to death, basically. [Client gets teary again.] are viewed as communications about what’s wrong
in the client’s world and when treated as such and
T: So far, I don’t think we really disagree in ways explored in a safe environment, they tend to shrink
that will matter in our work together, but I’m (Enns, 2004).
sure open to talking about it some more. And
I can see that your dad meant a lot to you. Standardized Assessment
[Therapist makes two statements, giving her Feminist therapists are familiar with standard assess-
client the choice to respond to further concerns ment procedures, but generally avoid using them.
about the feminist orientation or to move into This is because assessment and diagnosis place
some of what is troubling her.] problems within the psyche of individuals—even

C: He was my savior. That’s why I got together
with my husband. They seemed so much alike.
Boy, was I wrong. That’s why I need help. I need
perspective or something. I guess I want to just

THE PRACTICE OF FEMINIST THERAPY 349

PUTTING IT IN PRACTICE 10.2

Aspects of a Feminist Informed Consent

Mental health professionals work from different theoretical perspectives. They have
different beliefs about what hurts, limits, or damages people and what it takes to heal or
change. My own perspectives will influence the ways I will work with you.

As a feminist, I believe both women and men deserve equal chances for jobs, recreation,
and other things that make life meaningful. I believe that gender matters a great deal
and can sometimes get in the way of our development. I also believe our culture can
make things tough on men or women because of how narrowly we’ve defined these terms.
Often, people find that exploring gender issues makes a big difference in the ways they
feel about themselves.

What does this mean in my work with you?
First, it’s important for you to know I won’t try to change your beliefs. I will respect
our differences.
Second, we’ll be partners in our work together. You’re the expert on you, and I hope
I can offer my education and experiences as you work on the issues bringing you to
counseling.
Third, as we explore the distress you’re feeling in your life, we may talk about social
and cultural forces outside of yourself that are increasing your distress. We may also talk
about how you’ve come to believe unhelpful messages given to you by our culture.
Fourth, because therapy is about you and your life, we’ll focus on what you can do,
what you can think or believe, and how you can act to help you feel better about yourself
and your life situation. Sometimes this will involve changing the way you think or other
things inside yourself. Other times it will involve changing your life situation or learning
to deal with your life situation more assertively.
Fifth, the overarching goal of therapy is to empower you as a person.

when there is ample evidence to suggest the pro- described as such. Second, it blocks our ability to
blem is initiated and maintained by deviant social, look outside the individual to see forces, dynamics,
political, and patriarchal forces. and structure that influence the development of
such thinking, values and actions. (p. xviii)
Feminists avoid labeling nonconforming
thoughts and behaviors as deviant. Brown and The goals of feminist therapy include not dis-
Ballou (2002) describe the rationale for this: counting clients and not being seduced into thinking
that the whole of the problem resides within the
The decision to call nonconforming thoughts, entity that entered the office. However, that said,
values, and actions psychopathology does two if standardized assessments are used, they’re done
things. First, it discounts she or he who is

350 CHAPTER 10 FEMINIST THEORY AND THERAPY

so collaboratively, sensitively, and the results are are disempowered, it’s often manifest through
interpreted carefully and within the crucible of con- negative body image or feeling dissociated from
text; women and persons from other cultures are their bodies. Healthy personal power with regard
all too familiar with assessment processes than can to the body involves feelings safety and security
marginalize them and inappropriately label them as and acceptance of one’s body as it is, rather
deviant. than preoccupation with unattainable media-
based body ideals.
Feminist assessment focuses on individual client
distress. Exploring this distress with an eye to the 2. Intrapersonal/intrapsychic power. When
toxic interpersonal, emotional, and spiritual triggers there are power shortages in this dimension, indi-
captures an essential element of feminist assessment. viduals frequently oriented toward other people’s
thoughts and feelings or are consumed with a
Diagnosis focus on past events that cannot change. Many
The Diagnostic and Statistical Manual of Mental Dis- oppressed individuals are so focused on taking
orders (DSM) has a checkered history when it comes care of others that they’re out of touch with
to sex, gender, and racial sensitivity (Caplan, 1995; what they feel and what they want. Healthy
Caplan & Cosgrove, 2004). This is one among intrapersonal/intrapsychic power is linked to
many reasons feminists eschew the DSM. Soon to self-awareness, clarity of purpose, and attune-
be in its fifth edition, over the years the DSM has ment with one’s emotions.
included and does include many controversial and
gender biased disorders (Ali, Caplan, & Fagnant, 3. Interpersonal/social-contextual power. A
2010; Cosgrove & Riddle, 2004; Kupers, Ross, power shortage in the interpersonal domain is
Frances, & Widiger, 2005). As this textbook was common among oppressed peoples. Often this
being written, the Association for Women in Psy- situation is associated with feelings of help-
chology posted concerns about DSM-5 (see AWP: lessness, hopelessness, or isolation. Individuals
http: / / www. psychologytoday. com/ blog / science- might feel invisible or irrelevant. Healthy inter-
isnt-golden/201107/association-women-in-psycho personal power is characterized by the ability to
logy-addresses-dsm-5-concerns). Although femi- be assertive. In terms of Bandura’s self-efficacy
nist therapists don’t refuse to diagnose clients, they concept, healthy interpersonal power involves
do so in an educational and collaborative manner confidence in one’s ability to help oneself and to
that involves the client directly and interactively. make a difference in the world.

Power Analysis and Empowerment 4. Spiritual/existential power. Power shortages
The purpose of power analysis is to help clients in this domain involve feeling meaninglessness
assert or acquire power. As women acquire power, and disconnection. In contrast, healthy spiri-
feminist therapists work with them to feel a sense of tual/existential power involves feeling free to
empowerment—as equals in interpersonal, work, embrace culturally preferred spiritual or reli-
and intimate relationships who can speak up for gious rituals and practices.
their rights (Worell & Remer, 2003). Brown (2010)
describes four power types that can be analyzed and Bases of Self-Esteem and Self-Efficacy
understood within feminist therapy. Subsequently, Many women continue to evaluate themselves based
these areas become targets for feminist therapy on the success of their mating and nurturing
interventions. accomplishments. Although these are important life
dimensions, completely basing one’s self-esteem on
1. Somatic power. Somatic power is related to mating and nurturing distracts from the opportunity
body image and comfort. When individuals to focus on one’s own individual needs and
development. To check for imbalance in these

THE PRACTICE OF FEMINIST THERAPY 351

areas consider the impact of answering following and ambitions. An offensive old Groucho Marx joke
questions: captures the status of a traditional wife:

• How desirable or attractive am I to potential Behind every successful man is a woman, behind
sexual partners? her is his wife.

• How much status does my current romantic Examining how clients’ feel about their gender
partner have? role is an important part of feminist assessment.
Many women and men seek counseling when their
• What do others think of how I look? storybook marriage or partnership takes a bad
turn and it’s clear that ‘‘happily ever after’’ isn’t
• Is my house clean enough? happening. The focus on gender-role satisfaction
central to feminist-informed therapy can be helpful
• Are my offspring getting all the opportunities before, during, or after relationship break-ups.
they expect? This is true for heterosexual and gay or lesbian
relationships. Although the dynamics are unique
• How many people am I able to nurture or take to different relationship configurations, explicitly
care of? negotiating couple and family gender-related roles
and expectations is critical.
The feminist therapy perspective considers it
healthy for females and others to balance mating and Within heterosexual relationships women con-
nurturing activities with activities outside the family. tinue to bear a disproportionate burden of house-
Success outside of family can increase self-esteem, hold and parenting responsibilities (Askari, Liss,
but there may be costs associated with venturing out Erchull, Staebell, & Axelson, 2010; Fisher, 2009).
of stereotypical female behaviors. Jean Baker Miller This may be a conscious and intentional choice for
(1986) wrote, some couples, but a feminist assessment of gender
role comfort is helpful for examining the intention-
Some women have managed to create other roles ality of gender roles within romantic relationships.
for themselves to contribute to their self-esteem.
But a woman who has done so has violated a Important questions within this domain include:
dominant system of values that says she is not
worthy: indeed, it implies there must be • How do you feel about the sharing of household
something wrong with her for even wanting workloads within your relationship?
alternatives. (p. 45)
• If you have children, are you satisfied with your
It would be nice to believe that things are signifi- role in parenting?
cantly different since Miller wrote those words, but
the clinical experience of many feminist therapists • Have you and your partner talked specifically
suggests otherwise (Brown, 2010; Wright, 2002). about who makes more money and how you feel
about your relative incomes?
Gender-Role Comfort, Development,
and Satisfaction • How do you and your partner decide the relative
Women and men often limited their personal de- worth or value of what each of you contributes to
velopment to conform to traditional definitions of your relationship and to your household?
what it means to be male or female. Females have
traditionally been encouraged to seek a male and In recent years several writers have addressed
that male is supposed to provide income, identity, what has been termed a male crisis within the
and be a stabilizing force for the family. In the popular media (Hymowitz, 2011; Kimmel, 2010).
traditional scenario, females are cast as helpmates This crisis is related to an apparent lack of career
(wives) who support their husband’s needs, career, ambition in young men, partially measured by a

352 CHAPTER 10 FEMINIST THEORY AND THERAPY

significant drop of male enrollments in college. Feminist therapists are concerned with the
Most recently it’s estimated that about 55% to 60% physical experiences of all clients and have been
of enrolled college/university students are female. centrally involved in the shift in psychology toward
Although males have traditionally been socialized to acknowledging the negative effects of psychological
assume a provider role in relationships and families, and physical trauma. About 20 years ago, influential
fewer men are taking on that role. Based on our own psychiatrist Judith Herman (1992) highlighted the
observations of university students seen in a campus- resistance of mainstream society to grapple with
based career counseling clinic, a significant number these negative outcomes:
of distressed females are balancing employment,
school, and romantic relationships. These young The study of psychological trauma must
women are doing the lion’s share of household work, constantly contend with this tendency to discredit
attending college, and bringing substantially more the victim or to render her invisible. Throughout
income into the relationship. In contrast, at least the history of the field, dispute has raged over
some of the males seem more interested in getting whether patients with posttraumatic conditions
stoned and playing video games than they are in are entitled to care and respect or deserving of
pursuing academic or vocational goals. Of course, contempt, whether they are genuinely suffering or
these are trends and there are many exceptions to malingering, whether their histories are true or
these general observations. false, and, if false, whether imagined or
maliciously fabricated. In spite of a vast literature
Females, Males, and Bodies documenting the phenomena of psychological
We considered titling this section ‘‘Women and trauma, debate still centers on the basic question
Their Bodies’’ but a negative body image epidemic of whether these phenomena are credible and
has hit young girls so hard that it would be blatantly real. (p. 8)
neglectful to only focus on adult females. Further-
more, boys and men are experiencing greater body Herman’s comments illustrate how important
dissatisfaction than ever before (Blashill, 2010; Jona- it is for feminist therapists to be alert to victim
son, Krcmar, & Sohn, 2009). Clearly, the U.S. guilt among traumatized clients. It also notes the
marketing media has pushed images of unattain- therapist’s central role in validating clients’ trauma
able bodies onto the general public with such experiences. Exploring trauma with clients is always
force that there have been dramatically negative simultaneously an assessment and therapy process.
consequences.
By focusing on the reality of their clients’ physical
Honoring the body is an important element of experiences, feminist therapists have paved the way
feminist therapy and clients’ attitudes toward their for mind-body integration approaches to psycho-
bodies is a core assessment domain. Eating disor- logical trauma. In addition, some feminist therapists
ders, obesity, sexual dysfunctions, self-mutilation, contend that physical and psychological trauma
psychosomatic disorders, and other body-related (aka: posttraumatic stress disorder) constitutes one
distresses are more common among females than of the most significant and important psychiatric
males (Preti et al., 2009; Touchette et al., 2011). diagnoses for females. There’s no question that
Noncombat posttraumatic stress disorder is also trauma inflicted on human beings by other human
more common in females; this disorder has impor- beings takes an enormous toll on individuals and on
tant physical/somatic dimensions. Many females society. This is an example of why the personal is
who come to counseling have a history of phys- political, and why positive therapy outcomes include
ical or sexual abuse or rape. They may or may social, political, and legal reform.
not focus on this trauma, but such experiences are
likely to affect their relationship with their bodies. Therapy Relationships
Feminist therapists will often inquire about how
clients feel about their bodies. A genuine feminist politics always brings us from
bondage to freedom, from lovelessness to loving.

THE PRACTICE OF FEMINIST THERAPY 353

Mutual partnership is the foundation of love. A consciousness. Feminist consciousness involves
feminist practice is the only movement for social becoming aware of balance and equality in roles
justice in our society which creates the conditions and relationships.
where mutuality can be nurtured. (hooks, 2000,
p. 104) The feminist therapy relationship is similar to
the person-centered therapy (PCT) relationship.
Feminists place great emphasis on therapy There is congruence, unconditional positive regard,
relationships as a primary therapeutic factor. This and empathy. Although these factors are impor-
relationship should be mutually empathic and tant, feminist therapy is even more relationship-
egalitarian. Rader and Gilbert (2005) describe based than PCT. Jordan (2010), speaking about
the components of an egalitarian feminist therapy the feminist-oriented relational-cultural therapy
relationship: (RCT), contrasts PCT and RCT:

According to Gilbert (1980), an egalitarian In his later years, Rogers noted that he felt his very
relationship was achieved when the therapist: being, his presence, was of great importance in the
(a) viewed the client as his/her own expert, healing process. But even then Rogers did not take
(b) informed the client of the therapy process and the next step RCT takes, which is to locate the
his/her role and rights in that process (e.g., a healing in the therapeutic relationship itself. RCT
client’s right to ‘‘shop around’’ for a therapist or to might be characterized as ‘‘relationship-centered
understand the potential risks of therapy), (c) used therapy’’ in contrast with Rogers’s client–centered
strategies that promoted the client’s autonomy therapy. ( Jordan, 2010, p. 16)
and power, (d) encouraged the expression of
anger, and (e) modeled appropriate behaviors for Reflecting this relationship focus, feminist ther-
the client. (Rader & Gilbert, 2005, p. 427) apy tends to be a more explicitly focused on rela-
tionship connection and mutuality than any other
Gilbert’s (1980) fourth item, ‘‘encouraging therapy approach, including person-centered ther-
expression of anger,’’ is worth further examina- apy. Further, feminist therapists are more likely
tion. Feminist therapy encourages anger expression to employ self-disclosure as a therapeutic change
for at least four reasons: strategy.

1. Direct expression of anger has been traditionally Self-Disclosure
discouraged for females in many cultures.
Self-disclosure is used to facilitate therapy in sev-
2. Anger is a vehicle for insight or consciousness- eral ways ( Jordan, 2010; R. Sommers-Flanagan,
raising. Anger helps clients clarify their sense 2012). First, therapists self-disclose to model open-
of mistreatment. It also helps them identify ness and transparency. Second, self-disclosure is
counseling goals. used to enhance relationship connection. As ther-
apists and clients come to know one another, trust
3. Anger may occur within counseling and toward builds. Third, self-disclosure is used to share expe-
the counselor; feminist counselors welcome this riences and wisdom in a non-hierarchical manner.
anger and are prepared to explore its potential It’s not that the therapist is the only one who has
underlying insights. knowledge and life experiences, it’s just that to
hold back helpful knowledge and experience is anti-
4. Anger is an appropriate emotional response to therapeutic. The client’s knowledge and experience
oppression and abuse. To suppress this response is equally valued. Fourth, self-disclosure can facili-
is to inhibit clients from experiencing their full tate an egalitarian relationship. Again, the more this
range of humanity. type of relationship is established, the more trust
develops, and the more open clients can be about
For all these reasons and more, the anger ex-
pression is encouraged in the feminist therapist’s
office. Nurturing anger can facilitate feminist

354 CHAPTER 10 FEMINIST THEORY AND THERAPY

their challenging situations and traumatic experi- pace, offering information and education without
ences. Examples of self-disclosure are included in an agenda or rigid idea of what’s normal or accept-
the case vignettes and case analysis. able, but rather helping clients to determine these
boundaries for themselves.
There are limits on self-disclosure. The therapy
office shouldn’t become a place where therapists What About Men?
focus too much on their own pain. If you’re
interested in doing feminist therapy, supervision Feminist theory and science directly examines
is a good place for you to learn how to balance your how society damages individuals who don’t fit
self-disclosure in ways that maximize its usefulness into gender stereotypes (e.g., from sissies and
for clients. tomboys to transgendered people) but that’s not
all. Contemporary feminism also focuses on the
Focusing on Sex and Sexuality price individuals pay when they fit too well! Many
problems faced by men, such as homophobia,
Sexuality is a topic where many men and women feel aggression, workaholism, and the inability to relate
rigid about gender roles and ashamed or confused to women, children, or even their own emotions,
if they don’t fit into the male-female cultural are by-products of male socialization (Levant &
norms. Female sexuality is still less well-understood Pollack, 1995). The painful costs of devaluing all
than male sexuality. In an article titled ‘‘Female things feminine and strict rules for being male are
Sexual Disorders: Psychiatric Aspects,’’ the author evidenced in William Pollack’s (2000) book, Real
stated directly, ‘‘Knowledge of female sexuality has Boys’ Voices. Scotty, a 13-year-old boy from a small
consistently lagged behind our knowledge of male town in the Northeast, said,
sexuality’’ (Segraves, 2002, p. 420).
Boys are supposed to shut up and take it, to keep it
Many people don’t understand their own bodies all in. It’s harder for them to release or vent
well and might be unable to express their sexual without feeling girly. And that can drive them to
needs in their intimate relationships or might shoot themselves. (p. ix)
fear their needs are abnormal or shameful. The
female orgasm has been the subject of many books As feminists began exposing gender role falla-
and much lively debate, from at least Sigmund cies during the 1960s and 1970s, they also began
Freud forward. Part of the women’s movement revealing the damage to men by the narrow defi-
in the 1960s focused on women’s reclaiming nitions of masculinity enforced in our culture. The
their bodies, and this continues to be a focus men’s movement grew from these efforts. A lim-
in feminism today, as is analyzing the rigidity of ited list of influential and enlightening men’s move-
attitudes about sexual orientation and the effect of ment books includes:
homophobic attitudes on all people. Celia Kitzinger
(2001) writes: • The Myth of Male Power by Warren Farrell (1993)

The classic models of lifespan development, • I Don’t Want To Talk About It: Overcoming the
interpersonal attraction, relationship formation Secret Legacy of Male Depression by Terrence Real
and dissolution, parenting, personality, stress and (1998)
coping, and so on are based on an unacknowledged
assumption of heterosexuality just as surely as they • The Macho Paradox: Why Some Men Hurt Women
are based on sexist assumptions of masculinity and and How All Men Can Help by Jackson Katz
femininity. (p. 275) (2006) [Katz is also creator of the movie Tough
Guise: Violence, Media and the Crisis in Masculinity
In discussing relationships, sexuality, and inti- (1999).]
macy, a feminist therapist provides an open and safe
space for these topics to be explored at the client’s • Guyland by Michael Kimmell (2010)

THE PRACTICE OF FEMINIST THERAPY 355

The challenge for feminists and men’s movement Ellen talks about her drug use and her feelings that
advocates is to engage males who are trapped tightly this is her own business, not something people need
in male stereotypes that give them privilege, but to know about or judge her on. She makes the
limit their full development. Pollack’s boy code claim that it really hasn’t interfered with her life,
is one way in which an effort has been made to but catches herself, just as Dr. Brown says, with
increase awareness of the ways that contemporary warmth, ‘‘Wait a minute. What’s wrong with this
gender-based stereotypes adversely affect males (see picture?’’
Putting it in Practice 10.3).
Ellen admits that her drug use did cause a slight
Feminist Therapy in Action: problem, in that she lost her job and has to go to
Brief Vignettes counseling, but she denies most of the problem.
Rather than going after the denial, Dr. Brown
As you read the following vignettes look for comments gently:
therapy interactions that you believe are distinctly
feminist. In particular, watch for mutuality, self- Dr. Brown: How things look is very important to
disclosure, empowerment, and valuing of feminine you, and it is very hard for you to keep it up. It’s
consciousness. very tiring.

Vignette I: Laura Brown Ellen: Yes, I work hard at how I look. And I’m not
saying it isn’t tiring.
In this vignette we
Dr. Brown: Let yourself notice the tiredness. Don’t
review highlights of an talk about it. Just notice your body and how tired
it is in there. Feel how hard it is to keep that
unscripted demonstra- pretty picture in place.

tion videotape featuring Ellen complies, with Dr. Brown’s guiding
encouragement. She relaxes her body and is quiet,
Laura S. Brown, PhD, while Dr. Brown encourages her to keep relax-
ing. Ellen actually lets herself tear up a little bit.
working in her third She’s able to talk about how hard she tries and
how much she wishes her father would be proud of
session with a client her. She spontaneously explores her father’s gender
messages—either be a lawyer like him or a wife and
Laura Brown named Ellen (L. Brown, mother. Ellen explains that she can’t do either. She
1994). The client-ther- faces how alone that makes her feel. Dr. Brown
asks a strategic question: ‘‘Ellen, when did you get
apist interactions below are paraphrased rather yourself to be at peace that you’re father will never,
ever say he’s proud of you, no matter what you
than verbatim. Ellen is a 34-year-old client man- do?’’ Ellen admits that though her father will never
say that, she isn’t at peace about it and at 34 is
dated to engage in counseling because of a drug still letting that wish drive her life. Together, for a
short time, Dr. Brown and Ellen explore how alone
problem. she is and how no one has ever really taken care
of her much. At this point, Dr. Brown tells Ellen
Early in the session, Ellen explains that she she would like to revisit something Ellen mentioned
last session—the fact that when Ellen was in college,
went to a Narcotics Anonymous (NA) meeting someone she knew broke into her apartment and
raped her.
in Baltimore, and Dr. Brown lifts her eyebrows,

saying ‘‘Baltimore?’’ in a surprised tone. Ellen

acknowledges that it is quite a distance from her

home, but she doesn’t want to be seen by anyone

who might know her locally. This leads to a gentle

inquiry: ‘‘Ellen, what will people see if they see the

real Ellen?’’

Ellen defends herself against this question,

talking for a while about clothes, jewelry, and the

desire she believes everyone shares to stay hidden.

Dr. Brown stays on the theme, asking about what

dark secrets Ellen fears that people might see, and

356 CHAPTER 10 FEMINIST THEORY AND THERAPY

PUTTING IT IN PRACTICE 10.3

The Boy Code

In the 1990s, Harvard professor William Pollack conducted a series of qualitative interviews
with boys to determine what they viewed as the rules by which boys are required to live.
He summarized their responses as the boy code. The boy code includes the following
rules:

• Stand on your own two feet.
• Separate from your mother and all things female ASAP.
• Never show any feelings—except anger.
• Stay on top, in control, and in the limelight.
• Remember, sex is a conquest.
• Bullying and teasing is normal boy behavior.
• Never give in, never apologize, and never really listen to anyone else (these are signs

of weakness).
• Don’t show any fear of violence.
• Never ‘‘rat’’ or ‘‘nark’’ on another boy. (Pollack, 2000)

Pollack’s boy code is often viewed as an unhealthy contributor to violence and distress
in young males. In an effort to achieve gender balance, we searched for an existing girl
code, but found none. Consequently, we conducted an informal survey with our students
and obtained the following gender-based rules for girls. After checking them out, think
about whether you’ve got something new to add to either list.

• Always look pretty.
• Always be clean and smell good.
• Be as thin as you can be.
• Want to be a mother.
• Want to take care of other people and the family home.
• Be more interested in the needs of others than your own.
• Be sexy, but not too sexy.
• Defer to your man—especially in public.
• Always be nice and polite—if not, you’ll be a bitch.
• You need a man to be complete.
• Don’t compete with men or boys.

THE PRACTICE OF FEMINIST THERAPY 357

Ellen: Yeah, I don’t think there’s that much to talk At the conclusion of the recording, Dr. Brown
about. It was college. I was trying things out, you reflects on the session. Her goals for Ellen were to
know. Freedom. Being an adult. Lots of sex and help the relationship develop and encourage Ellen
stuff. I was giving it away for free anyway, so to listen to her emotional self, which Dr. Brown
I didn’t think there was much to do. I told my explains to be especially important with women
brother later. He said I should tell the police and who have used substances to numb emotions after
see a psychologist, but I didn’t. I mean I sort of traumatic experiences. She also notes her intention
chose that life. I thought, hey, if guys can sow to gently begin exploring gender issues and how
their wild oats, so can I. So I was pretty out there. Ellen constructs herself as an adult woman. In
I tried it all. No inhibitions. I guess the drugs Ellen’s case, as in many, it’s important for the client
aided that. I can say that back then, I really was a to know that she will not be abandoned, judged, or
drug addict. overpowered as she begins to explore her pain and
seek ways to make changes (adapted from Brown,
Dr. Brown: So, you felt like, I can do this. It’s my 1994).
choice, and if it hurts or feels bad, it’s my own
fault? Vignette II: Relational-Cultural Therapy
Relational-cultural therapy (RCT) is a feminist-
Ellen: Yeah, I chose it. That’s how I feel about the oriented therapy developed by Jean Baker Miller,
rape, I guess. I don’t know. Judith Jordan, and other collaborators at the
Stone Center ( Jordan, 2010). RCT founders were
Dr. Brown: Ellen, what’s your body saying as you trained in psychoanalysis and so the orientation is
say, ‘‘I don’t know’’? toward depth psychotherapy that closely examines
relationship connections, disruptions, and growth
Ellen: It’s tired . . . I didn’t stand up for my own potential from mutually empathic intimate rela-
body. It’s a little sad. But I can’t go back now and tionships. Core concepts of RCT include (from
change it. Jordan, 2010):

Dr. Brown: No, but we can explore how that 1. People grow through and toward relationship
experience might be affecting things now—how throughout the life span.
being an adult, sexual woman is for you now.
What do you wish would have happened? 2. Movement toward mutuality rather than separa-
tion characterizes mature functioning.
Ellen tearfully admits her wish that someone
might have helped her, been there for her. She 3. Relationship differentiation and elaboration
condemns herself as well, claiming that she should characterize growth.
have handled it, wishing she had fought her assailant
but noting that her drug-induced state made that 4. Mutual empathy and mutual empowerment are
unlikely. She ends with a sort of wistful statement: at the core of growth-fostering relationships.
‘‘I wish someone would have been there, but there
wasn’t anyone. So I dealt with it.’’ 5. Authenticity is necessary for real engage-
ment and full participation in growth-fostering
As the session ends, Dr. Brown asks Ellen to relationship.
consider doing two things during the week: going
to one more NA meeting and using her art, either 6. In growth-fostering relationships, all people
in writing or painting, to explore the question: contribute and grow or benefit. Development
What does Ellen want? Ellen agrees, saying that she is not a one-way street.
has neglected her painting. Smiling, Ellen also says
that the painting will have to be a Monet, because 7. One of the goals of development from a relational
she only has impressions, but no clarity. Dr. Brown perspective is the development of increased
counters with support and the observation that even relational competence and capacities over the
a Monet, from the right position, is clear. Ellen acts life span. (p. 24)
surprised and pleased.

358 CHAPTER 10 FEMINIST THEORY AND THERAPY

Mutual empathy is a central tool in RCT work. I hesitated and agreed that the thought had
Using modern brain research as a foundation, crossed my mind (what her colleagues might
Jordan describes how empathic relationships can think), but that I also could see she was in real pain
change clients: and needed to be able to communicate that to me.
She looked at first triumphant (at my admission of
Empathy is not just a means to better understand personal concern about my ‘‘reputation’’) but then
the client; in mutually empathic exchanges, the genuinely relieved (perhaps that I had spoken a
isolation of the client is altered. The client feels piece of truth about myself that she knew anyway).
less alone, more joined with the therapist. It is We then had a truly collaborative conversation
likely that in these moments of empathy and about how she might be able to really let me know
resonance, there is active brain resonance between her conversation about her pain and whether she
therapist and client (Schore, 1994), which can alter could trust my response. (p. 54)
the landscape and functioning of the brain. Thus,
those areas of the brain that register isolation and You can see from these descriptions that RCT
exclusion fire less and those areas that indicate is an approach that involves deep and authentic
empathic responsiveness begin to activate. interpersonal exchanges. There are rough patches
(challenges and disconnections), but as therapists
Jordan (2010) describes a case in which she stay with empathy, honest self-disclosure, and focus
worked with a woman named Barbara, a ‘‘well- on therapy process, positive changes can happen.
educated white woman who had seen six therapists
before she began treatment with’’ Jordan (p. 53). Jordan reported that after over 2 years of
Barbara’s previous therapy experiences had been challenging therapy, the process settled down. In the
negative. She had been labeled with various psychi- end, Barbara made remarkable process (immensely
atric diagnoses was in the hospital due to a suicide improving her job status, beginning to date a gentle
attempt when Jordan began RCT with her. and kind woman, and moving beyond her self-
destructive behaviors). In ending, Jordan quotes
The therapy was characterized by open Barbara:
exchanges in both directions. Barbara made her
evaluation of Jordan clear: ‘‘She [Jordan] was not Isn’t it ironic that when you showed yourself as
much better than the other clinicians she had seen’’ most fallible and vulnerable, I had the most trust
(p. 53). Jordan worked intermittently through long in you? You didn’t always get it right . . . and often
silences to both resonate with Barbara’s fears and it took awhile for you to get it at all, but you
express what she could provide: almost always came back, trying and clearly
imperfect. That made you feel safe to me. (p. 55)
I did not press her to give up her fears,
acknowledged it had been a hard road, and told RCT is about authenticity. Be sure to compare
her that while I could not guarantee that I would this style with the more professional and clinical
understand her any better than the others, I was approaches discussed elsewhere in this text. Which
committed to trying. But I also suggested she had style would you prefer?
no real reason to trust me.
CASE ANALYSIS AND
A turning point in therapy appeared to occur TREATMENT PLANNING
when Barbara came to a session following a fresh
self-mutilation incident (she had scratched her arm In an interesting twist we’re featuring a case
until it bled). Barbara became provocative. She with a male therapist and male client in the
asked if she might be ‘‘fired’’ as a client. She asked feminist chapter. This is intentional and designed
if perhaps Jordan would be embarrassed or worried to illustrate how working within a feminist model
that she was seeing a client who had blood dripping can work for boys and men. In particular, this
from her arm. Jordan (2010) describes her response:

CASE ANALYSIS AND TREATMENT PLANNING 359

case focuses on a 16-year-old male’s struggle with by Pollack’s boy code (2000) and unable or unwill-
emotional expression. John SF is the therapist and ing to risk feeling anything other than anger and
the case is told in a storytelling format. irritation. From the feminist worldview, this wasn’t
Josh’s problem; it was a problem that his culture
Josh was a white, 16-year-old sophomore in high insisted on keeping him in an emotional straitjacket.
school. He had never met his biological father
and lived in a middle-class neighborhood with his Josh’s problem and problem formulation list
mother and three younger sisters. His mother was looked something like the following:
suffering from bipolar disorder. Josh’s main loves
were consistent with his gender identity. They 1. Learning to deal more effectively with sadness,
included basketball, cars, girls, and sarcasm. He grief, and anger within the context of a repressive
very much disliked school. emotional environment.

Josh and I had been meeting for therapy for 2. Coming to an understanding that his beliefs and
years. At the beginning of one of our sessions Josh views of emotional expression were not in his
handed me a packet of photos. best interest, but instead, foisted upon him by
toxic cultural attitudes about how boys and men
‘‘Hey, what’s this about?’’ I asked. should experience and express emotion.
He responded with a half-mumble about some
recent awards ceremony. I thought I discerned a 3. Developing trust and confidence in himself—
little pride in that mumble. I looked through the despite not having a father figure or a mother
pictures while he told me about each one. There who could provide him and his sisters with a safe
was one in particular that he gently lifted from my and stable home environment.
hands. It was a picture of him in a line-up with
five other people. He carefully pointed out that he 4. Learning to talk about what he really feels
was standing next to the Lieutenant Governor of inside and pursue his life passions whatever
Oregon. I teased him because there were no pictures they might be instead of reflexively pursuing
of him and the actual governor. culturally ‘‘manly’’ activities.
‘‘What’s the deal?’’ I asked. ‘‘Wouldn’t the Guv
pose with you?’’ Josh rolled his eyes and signaled 5. Expanding Josh’s limited emotional vocabulary
for me to move on to the next photo. through facilitating his feminist consciousness.

The Problem List and Problem Formulation Interventions

Unlike CBT, feminist therapy doesn’t involve col- Feminist therapists are technically eclectic and use
laboratively generating a concrete problem list and a wide range of interventions imbedded in an
then proceeding to develop problem formulations— egalitarian relationship characterized by mutuality.
as if these problems resided in the client. Instead, In Josh’s case, the interventions included:
because problems and problem-formulation are
inseparable, we can’t talk about the problems with- 1. Encouraging Josh to speak freely and openly
out also talking about cultural factors creating and about his life experiences.
contributing to the problems.
2. Empathic listening with intermittent focusing on
If problems are listed and discussed as problems, more tender emotions, depending on how much
they’re likely discussed as situational challenges. In of this Josh was willing or able to tolerate.
Josh’s case, his mother had brought him to therapy
due to anger problems. Anger continued to be a reg- 3. Therapist self-disclosure and modeling.
ular focus in Josh’s therapy. Like many 16-year-old
boys immersed in the dominant U.S. culture, Josh’s As Josh and I continued to look at photos
emotional life was highly constricted. He was living together, I responded with interest and enthusiasm.
Because connection is a meaningful part of therapy,
I didn’t rush him to move on to our therapy

360 CHAPTER 10 FEMINIST THEORY AND THERAPY

agenda. I shifted back and forth between saying, I was not there, that I was not a witness, that he
‘‘Cool’’ or ‘‘What’s going on there?’’ to making knows all about it . . . and I don’t. Silence follows.
sarcastic wisecracks like ‘‘Now why exactly did I cautiously probed a bit more by sharing more of
the government actually let you into the capital what I knew.
building?’’ This adolescent sarcasm was a way of
using his communication style to express interest ‘‘When I talked with your mom yesterday, she
and affection indirectly, mirroring his humor and told me that she got pretty caught up in some
style. After seeing most of the photos I asked, housing project.’’ This statement lit a fire in Josh
‘‘Who’s the young woman standing in the line next and he plunged into the story.
to you?’’ I could tell from his response that I had
asked a good question. ‘‘You won’t believe what she did. It was so f *ing
stupid. Some punk developer is gonna build three
‘‘Oh, yeah, her. Her name is Sharice; her mentor houses. Three houses at the end of our street. This
was getting the same award as my mentor. I danced is no big deal. She just f *ing freaked out. She chained
with her. She’s a good dancer.’’ herself up to a tractor to stop them from building
a house. Then she called the f *ing senator and
And so we talked for a while about dancing and road department and I don’t know who in hell
what it was like for him to feel attracted to her. We else she called and she was totally nuts. So I told
were ten minutes into therapy and both of us had her she had a choice. I told her that she could
completely ignored the fact that we hadn’t been able go back home or I’d call the police and have her
to see each other for five weeks. Finally, I decided committed. She wasn’t taking care of my sisters.
to break the avoidance pattern. I asked ‘‘So . . . how She was being a s *** for a mom. So I just gave her
are you doing with all that’s been going on?’’ a choice.’’

He looked toward me, glancing downward. I nodded and said, ‘‘What a great idea you had.
‘‘I’m doing okay, I guess.’’ You must be practicing to be a parent. That’s the
Because this was a young man who had been kind of choice parents give their kids.’’
socialized to keep his emotions tightly wrapped, I
gently probed a little more. His voice grew louder as he continued: ‘‘I gave
‘‘I understand it’s been pretty wild times?’’ her the choice five times. Five f *ing times! She
He looked up, eyes fixed on some invisible spot bought a Mercedes and a Volvo over the phone.
on the ceiling. I recognized this strategy. It’s an She’s gonna s*** bricks when she gets the bills. So
old trick that I learned from a previous client. She I called the cops. And the woman asked me what
had bragged about learning it from her father. She to do. I’m f ***ing 16 years old and they f *ing ask
said one sure-fire way to avoid crying in public is me what to do. I didn’t know what to say. We were
to look up at the ceiling. Apparently the upward on the phone forever. I told ‘em to come get her.
gaze constricts the tear ducts and so tears simply They finally sent some really big cops over to take
cannot flow. her away.’’
He looked back down and said, ‘‘I’ve been pretty
busy. My mom’s been in the hospital for about a ‘‘Then what happened?’’
month now.’’ ‘‘My mom was still acting nuts and my sisters
‘‘I heard she had a pretty hard time.’’ were crying. So I just picked them up and held them
He grunted and then, slowly, in a quiet and they took her away. We sat and they cried and
growly voice, the words, ‘‘Let-me-tell-you-about- we snuggled for a while. And then I drove us home.
it’’ seeped out from behind his teeth. I recognized I don’t have my license, but I can drive. My mom is
that this is not a statement indicating he wants to tell still pissed at me about that, but I don’t give a s ***!’’
me about what happened. Instead, it’s an expression Now, I have an image of Josh in my mind. I
about him witnessing a powerful event. And it’s an see an awkward and 16-year-old boy ‘‘snuggling’’
expression that tells me, in no uncertain terms, that his sobbing sisters while the cops take their raging
mother away. The girls were 9 and 6 and 4 years old.
In my mental version of this scene, they’re taking up

CASE ANALYSIS AND TREATMENT PLANNING 361

his considerable lap. These are the same sisters he recall, but we both know that several years ago he
complained about and harassed on a regular basis. had sat on my couch and sobbed himself to sleep.
Instead of going back there, I asked him what might
Talking with teenage boys about emotional issues make him cry now. Would he cry if his girlfriend
is tricky business. Too much empathy and they broke up with him . . . if he lost his favorite CD . . .
retreat. No empathy and you’re teaching the wrong if one of his sisters got cancer . . . if he didn’t get a
lesson. Throughout Josh’s storytelling, I used gentle chance to graduate from high school? Josh fended
sarcasm, empathy, and sometimes careful emotional off my questions about tears by repeating his resolve
exploration, like, ‘‘What was that like for you to to get ‘‘pissed’’ about everything that might make
really be there for your sisters?’’ But I knew if I him feel sad. But the question about one of his
asked too much about feelings or forced him to go sister’s getting cancer stumped him. He admitted,
too deep too fast, I would no longer be cool and our ‘‘Yeah, I might cry about that . . . ’’ while quickly
relationship would be harmed or over. adding, ‘‘ . . . but I’d do it alone!’’

I knew that Josh needed to know that it’s okay, I responded, ‘‘Right. Absolutely. I’d never expect
even a positive thing, for boys and men to feel and you to cry in front of somebody. There might be
express their more tender feelings. some things worth crying about . . . even though it
wouldn’t change things . . . but you’d want to do the
Much of the session focused on empathy for crying alone.’’
Josh’s anger. Josh ranted and I listened. He was
immensely angry and disappointed and hurt about We talked a bit indirectly and intellectually about
his mother’s behavior. sadness and tears, trying to model that we can talk
about it—once removed—and if he cried someday,
About halfway through our session, I asked Josh it would be perfectly okay, there would be no need
a question that I use with boys; it’s a question to feel ashamed.
designed to let us talk about feelings and sadness in
a way that’s more safe and distant. Toward the end of the session, I decided to
lighten things up by teasing Josh about his social
‘‘So Josh,’’ I said, ‘‘When was the last time you insensitivity. I said, ‘‘I can’t believe that we’ve talked
cried?’’ this whole hour and you never asked me a single
thing about myself.’’
The question caught him by surprise. After a
short pause he spoke with extreme deliberation, Josh grinned. He knew therapy was all about him
‘‘I . . . don’t . . . cry . . . I . . . just . . . get . . . pissed.’’ and not about me. He probably knew I was playing
some sort of therapy game with him. He was a good
There’s something very efficient about the way sport and played along.
Josh expressed this masculine emotional principle. I
was reminded of a phrase I memorized after years of ‘‘Okay. So what am I supposed to ask?’’
playing Monopoly. The phrase is printed on a small I acted chagrinned, saying, ‘‘After all those
card that says, ‘‘Go to jail. Go directly to jail. Do questions I asked you, at least you should ask me
not pass Go. Do not collect $200.’’ While sitting when I last cried.’’
with Josh, I offered a new version of this phrase, ‘‘Okay. God you don’t know when to drop things.
‘‘Go directly to anger. Do not experience sadness. Okay. So when did you cry?’’
Do not let yourself cry.’’ Josh responded by offering I leaned forward and said, ‘‘I think it was
me further education about emotions. yesterday.’’
And then I looked into his wide-open eyes and
‘‘Crying doesn’t do any good. It doesn’t change said, ‘‘Yeah. As a therapist, I hear some really hard
anything. It’s just stupid.’’ stories and even though it doesn’t change anything,
sometimes it feels better to let my sadness out.’’
‘‘I know, I know’’ I said. ‘‘The whole idea of It was time for the session to end. We both stood
crying sounds pretty stupid to you. It’s not like and I said, ‘‘I know we have to stop talking for
crying will change your mom and make her better.’’

‘‘Nothing will ever change her.’’
I renewed my pursuit of when he last cried. He
insisted that was so long ago that he can’t really

362 CHAPTER 10 FEMINIST THEORY AND THERAPY

today, but of course we can talk more about this or was done so in a manner that empowered him,
anything else when we meet next time.’’ rather than causing him to feel put upon for having
to engage in assessment tasks. A more traditional
Outcomes Measurement assessment might include the Youth Outcomes
Questionnaire-Self-Report (Y-OQ-SR; Ridge,
Feminists generally don’t use outcomes assessments Warren, Burlingame, Wells, & Tumblin, 2009;
(Santos de Barona & Dutton, 1997). As discussed Wells, Burlingame, Lambert, Hoag, & Hope,
earlier, assessment potentially labels clients and adds 1996). Additionally, although it would take time to
to pressure and expectations to behave in particular help him come to the point of seeing it as useful,
ways. In Josh’s story, his progress was mainly Josh might benefit from regularly completing
monitored through verbal and narrative updates. questionnaires focusing on emotional awareness
However, it might have been reasonable to have and expression.
him respond to a few measures of feminist therapy
process and outcome. These measures focus on the CULTURAL AND GENDER
degree to which the therapist is collaborative and CONSIDERATIONS
shares power.
Professional cynics might argue that feminist ther-
• The Working Alliance Inventory (Horvath & apy has been limited to special populations or to just
Greenberg, 1986; Horvath & Greenberg, 1989) one special population—discontented white women
with feminist leanings. Historically, there was some
• Client Therapy With Women Scale (Worell amount of truth to this complaint. In 1992 Brown
et al., 1996) and Brodsky published an article titled The Future
of Feminist Therapy (1992). They stated,
Additionally, RCT researchers have developed
a measure called the Relational Health Indices Currently, feminist therapy theory is neither
(Liang et al., 2002; Liang, Tracy, Kenny, Bro- diverse nor complex in the reality it reflects. It has
gan, & Gatha, 2010). This is a 37-item question- been deficient from the start in its inclusiveness of
naire that has been used with men. It measures the lives and realities of women of color, poor or
three dimensions of growth-fostering relationships: working class women, non–North American
engagement, authenticity, and empowerment/zest. women, women over sixty-five, or women with
It might be useful to have Josh complete this ques- disabilities. (p. 52)
tionnaire regularly to both as a means of evaluating
his relationships and as a structured way to help him However, as discussed throughout this chapter,
talk about relationship issues. feminism has transformed itself and is now sensitive
to oppression as experienced by all marginalized and
Feminist therapies sometimes have therapists minority populations. Acknowledging historical
complete questionnaires about their behaviors dur- shortcomings, feminist therapists and writers have
ing therapy. This can be useful in determining worked and are working to continually expand their
how closely therapists are following a feminist ther- awareness and educate future generations about the
apy model. For example, as I worked with Josh I relevance of feminism to their lives by challenging
could have repeatedly completed the Feminist Self- the idea that feminism only applies to discontented
Disclosure Inventory (Simi & Mahalik, 1997) to middle-class white women. Feminists have been
monitor whether and how I was using self-disclosure among the first and most vocal of those advocating
as a therapy technique. for diverse and multicultural perspectives in the
practice of counseling and psychotherapy. For
Finally, more traditional assessments could be
used to monitor progress with Josh as long as this

CONCLUDING COMMENTS 363

example, years before other professional confer- therapy goals, accomplishment, and effectiveness.
ences had signers for the deaf, feminist conferences Several examples are summarized:
made a point of having signers and of meeting
only in fully accessible conference centers. Simi and Mahalik (1997) found evidence that
feminist therapists tend to behave differently than
At the core of feminist thinking is the notion other therapists in several ways. In their study
that subjugation of any segment of the human of 143 female therapists, feminist therapists were
species based on race, ethnicity, religious beliefs, more likely to: (a) create an egalitarian relationship
sex, disability, or sexual orientation is wrong (Barrett in therapy; (b) encourage their clients to select a
et al., 2005; Espı´n, 1997; Gilligan, 2003). Therefore, positive role model during therapy; and (c) inform
feminist theory is applicable to other populations clients of their sexual orientation.
suffering from externally imposed limits, stereo-
types, abuse, and exploitation. Several other studies using a variety of measures
support Simi and Mahalik’s (1997) findings that
Despite feminist therapy’s laudable stance feminist therapists offer a distinct therapy consis-
toward all oppressed populations, the naturally tent with feminist theoretical principles (Chandler,
activist orientation of feminist therapists can pro- Worell, Johnson, Blount, & Lusk, 1999; Worell
duce tension between feminists and diverse groups. & Chandler, 1996; Worell et al., 1996; Worell
For example, within different spiritual or religious & Remer, 2003). Overall, it appears that feminist
traditions women’s roles are frequently narrow therapists provide a distinctive product character-
and punishments to women stepping outside their ized by power sharing, an egalitarian relationship,
roles can be severe. Although feminist therapists self-disclosure, client empowerment, and support
will advocate and work toward consciousness and for feminist goals.
change in these situations, adherents to particular
religious or cultural norms are unlikely to welcome Worell and Johnson (2003) summarized the
feminist critique on their values. This is where the existing feminist therapy research and provided this
potential for conflict is highest and where feminists optimistic conclusion:
might be viewed as imposing their values on other
cultural groups, rather than accepting the cultural These preliminary studies on measuring process
group’s values. and outcomes in feminist therapy are suggestive
and encouraging. They suggest that feminist
EVIDENCE-BASED STATUS therapy, when articulated in a structured and
clearly defined model, is a unique and measurable
Whether feminist therapy measures up to the form of intervention that provides positive
treatment outcomes standards of modernist empir- outcomes for women in personal distress. (p. 327)
ical science is easily answered. Feminist therapy
does not measure up. However, similar to person- Overall, as with other less symptom-oriented ther-
centered and existential perspectives, feminist ther- apies, it’s difficult to compare feminist treatment
apists aren’t interested in measuring up to this outcomes with contemporary cognitive and behav-
standard. Why would they want to measure up ioral therapies.
to a standard they view as a narrow-minded means
through which individuals seeking feminist therapy CONCLUDING COMMENTS
can be further controlled and marginalized?
Perhaps more than any other chapter in this text,
Despite this general negative attitude towards feminist theory and therapy tends to get students
rigid approaches to therapy outcomes research, and readers a bit riled up. Sometimes there’s strong
there is empirical research attesting to feminist opposition to these ideas and other times stu-
dents decide they want to begin self-identifying

364 CHAPTER 10 FEMINIST THEORY AND THERAPY

as feminists. Either of these responses is fine. More professional activities in which we engage: theory
importantly than a sense of agreement or disagree- building, prevention, counseling and therapy,
ment, we hope you can consider the question: assessment, pedagogy, curriculum development,
Could you become a feminist therapist? In one last research, supervision, leadership, and profes-
overview, Worell and Remer (2003) provide eight sional training (p. 18).
tenets of feminist psychology. Consider whether
these statements fit for you: QUESTIONS FOR REFLECTION

1. We advocate inclusiveness. We acknowledge Now that you’ve made it through this chapter, try
that the social impact of gender is experienced on the feminist label again. What’s it like to say,
unequally and unfairly for women with diverse ‘‘I’m a feminist therapist’’ this time? What are your
personal and social identities, including ethnic- gut reactions now? What goes through your mind?
ity and culture, sexual and affectional orientation, Are you closer or further from embracing a feminist
socioeconomic status, nationality, age, and phys- therapist label?
ical characteristics.
CHAPTER SUMMARY
2. We advocate equality. We recognize that the
politics of gender are reflected in lower social Feminist theory and therapy is part of a grassroots
status and unequal access to valued resources for historical effort to bring sexual inequities into
a majority of women in most societies. awareness and resolve them through egalitarian and
nonhierarchical solutions. The feminist movement
3. We seek new knowledge. We value and advocate in the United States is generally divided into three
increased understanding about the diversity of stages: (1) First wave feminism—characterized by
women’s experience as it is framed by multiple striving for universal suffrage and property rights;
personal and social identities. (2) second wave feminism—characterized by an
effort to obtain equal rights for women; and (3) third
4. We attend to context. Women’s lives are wave feminism—characterized by worldwide and
embedded in the social, economic, and political multicultural efforts to dismantle oppressive and
contexts of their lives and should not be studied damaging patriarchic systems.
in isolation.
Many factors contributed to the develop-
5. We acknowledge values. Personal and social val- ment and implementation of feminist therapy.
ues enter into all human enterprises; education, As women became more established within aca-
science, practice, and social advocacy are never demic and scientific communities they produced
value-free. numerous groundbreaking publications. Addition-
ally, women’s consciousness-raising groups helped
6. We advocate change. We are committed to move women to take action together to improve
action to accomplish social, economic, and their situations.
political change toward establishing equal justice
for all persons. Three primary feminist theoretical principles
were defined and discussed. These included:
7. We attend to process. Decision-making pro- (1) sex and gender powerfully affect identity;
cesses that affect personal and group outcomes (2) deviance comes from dysfunctional culture; and
should be consensual and consistent with fem-
inist principles of mutual respect and honoring
all voices.

8. We expand psychological practice. We recog-
nize that feminist principles can be applied to all

CHAPTER SUMMARY 365

(3) consciousness-raising is a part of healing and image issues, self-esteem, gender role comfort, and
change. men’s issues.

The practice of feminist therapy is not associated Feminist therapy is very sensitive to women’s
with a particular set of techniques or procedures. issues and has become progressively more ori-
Instead, feminist therapists seek to integrate fem- ented toward addressing multicultural issues and
inist philosophical principles into counseling and GLBT issues. The evidence base for feminist ther-
psychotherapy. This process involves informed con- apy is very limited. There is some evidence that
sent, nonstandardized assessment of a variety of feminist therapists are more focused on therapy
feminist-related issues, development of a therapeu- process, relationship development, self-disclosure,
tic relationship, self-disclosure, empowerment, and and empowerment than other therapies. Addition-
development of feminist consciousness. Addition- ally, a few research studies suggest there are positive
ally, feminist therapists focus on sex, sexuality, body outcomes.

FEMINIST KEY TERMS Iron rule
Kinder, Kuche, Kirche as Scientific Law
Boy code Male as normative
Consciousness-raising groups Male crisis
Developmental sex divergences Mutually empathic
Disorders of sexual development Patriarchy
Egalitarian Power analysis
Empowerment Relational-cultural therapy
Ethic of caring Second wave feminism
Feminist consciousness Self-disclosure
Feminism Sex
Fight or flight phenomenon Somatic power
First wave feminism Spiritual/existential power
Gender Subversive
Gender role Tend and befriend response
Girl code The personal is political
Informed consent Third wave feminism
Interpersonal/social-contextual power Women and madness
Intersex conditions
Intrapersonal/intrapsychic power

366 CHAPTER 10 FEMINIST THEORY AND THERAPY

RECOMMENDED READINGS AND RESOURCES

The following resources may help you deepen your understanding of feminist theory and therapy.

FEMINIST-RELATED THERAPY JOURNALS

Gender and Psychoanalysis Psychology Women Quarterly
Men and Masculinities Sex Roles
Psychology of Men and Masculinity Women and Therapy

READINGS ON FEMINIST THEORY AND THERAPY

Brown, L. S. (2010). Feminist therapy. Washington, DC: Hrdy, S. B. (1999). Mother nature. New York, NY:
American Psychological Association. Pantheon Books.

Chesler, P. (1972). Women and madness. New York, NY: Katz, J. (2006). The macho paradox: Why some men hurt
Doubleday. women and how all men can help. Naperville, IL:
Sourcebooks.
Collins, P. H. (2009). Black feminist thought. New York,
NY: Routledge. Miller, J. B. (Ed.). (1973). Psychoanalysis and women. New
York, NY: Brunner/Mazel.
Enns, C. Z. (2004). Feminist theories and feminist psychother-
apies: Origins, themes, and diversity (2nd ed.). New York, Mitchell, J. (1976). Psychoanalysis and feminism: Freud,
NY: Haworth Press. Reich, Laing, and women. New York, NY: Random
House.
Freidan, B. (1963). The feminine mystique. New York, NY:
Norton. Tavris, C. (1998). The mismeasure of woman. New York,
NY: Smith, Peter.
Gilligan, C. (1982). In a different voice. Cambridge, MA:
Harvard University Press. Thompson, C. (1971). On women. New York, NY: New
American Library.
Herman, J. (1997). Trauma and recovery. New York, NY:
Perseus Books. Worell, J. R., & Remer, P. (2003). Feminist perspectives
in therapy: Empowering diverse women (2nd ed.). New
hooks, b. (2000). Feminism is for everybody: Passionate York, NY: John Wiley & Sons.
politics. Cambridge, MA: South End Press.

Horney, K. (1967). Feminine psychology. New York, NY:
Norton.

TRAINING ORGANIZATIONS AND WEBSITES

Association for Women in Psychology (AWP; www National Organization for Men Against Sexism
.theworks.baka.com/awp) (NOMAS; www.nomas.org)

Jean Baker Miller Training Institute (www.jbmti.org) National Organization for Women (NOW; www
.now.org)

VIDEOS/DVDS Brown, L. (2007). Feminist therapy [DVD]. Washington,
DC: American Psychological Association.
Ballou, M., & LaRoche, M. (2009). Feminist counseling and
cultural therapy. North Amherst, MA: Microtraining
Associates.

CHAPTER SUMMARY 367

Brown, L. (2009). Feminist therapy over time [DVD]. Katz, J. (1999). Tough guise. [Videotape]. Northampton,
Washington, DC: American Psychological Associa- MA: Media Education Foundation.
tion.
Kilbourne, J. (2000). Killing us softly III [Videotape].
Jhally, S. (2007). Dreamworlds 3 [Videotape]. Northamp- Northampton, MA: Media Education Foundation.
ton, MA: Media Education Foundation.

GOING FARTHER AND DEEPER

Additional feminist counseling and psychotherapy resources are available at johnsommersflanagan.com.



11CHAPTER

Constructive Theory and Therapy

We are what we think. All that we are arises with our thoughts. With our thoughts, we make the world.
—Buddha (quoted in Boldt, 1999, p. 91)

THIS CHAPTER

Reviews key figures, historical, and philosophical factors contributing to the development and
evolution of constructive psychotherapies
Outlines and describes constructive theories of counseling and psychotherapy
Describes and discusses principles and strategies associated with narrative and solution-focused
practice, including

Assessment issues and procedures
Specific therapy techniques
Provides short vignettes to demonstrate constructive approaches in action
Illustrates how treatment planning, outcomes assessment, and gender and cultural issues can be
integrated into a constructive therapy approach
Reviews the empirical status of various narrative, solution-focused, and other constructive therapies
Offers resources for further study

Without question, the best way to begin a chapter Silence followed.
on constructive theory and therapy is with a story. Then, the man spoke again,
‘‘Can you hear me?’’ he asked.
Once upon a time a man and a woman met in the This time the woman responded immediately.
forest. Both being academic philosophers ‘‘I’m not completely certain about the nature of
well-steeped in epistemology, they approached hearing and the auditory process, but I can say that
each another warily. The woman spoke first, in this lived moment of my experience I’m in a
asking, ‘‘Can you see me?’’ conversation with you and because my knowledge
and my reality is based on interactive discourse,
The man responded quickly: ‘‘I don’t know,’’ whether you really exist or not is less important
he said. ‘‘I have a plethora of neurons firing in my than the fact that I find myself, in this moment,
occipital lobe and, yes, I perceive an image of a discovering more about myself, the nature of the
woman and I can see your mouth was moving world, and my knowledge of all things.’’
precisely as I was experiencing auditory input.
Therefore, although I’m not completely certain There are two main branches of constructive the-
you exist out there in reality—and I’m not ory. These branches are similar in that both perspec-
completely certain there even is a reality—I can tives hold firmly to the postmodern idea that knowl-
say without a doubt that you exist . . . at least edge and reality is subjective. Constructivists,
within the physiology of my mind.’’

370 CHAPTER 11 CONSTRUCTIVE THEORY AND THERAPY

as represented by the man in the forest, believe Postmodern Philosophy
knowledge and reality are constructed within indi-
viduals. In contrast, social constructionists, as Postmodern philosophy emphasizes that objec-
represented by the woman in the forest, believe tivity and reality are individually or socially con-
knowledge and reality are constructed through dis- structed. These constructive ideas are philosoph-
course or conversation. Constructivists focus on ically and psychologically compelling, especially
what’s happening within the minds or brains of within our contemporary multivariate, multidimen-
individuals; social constructionists focus on what’s sional, and multicultural society. As a consequence
happening between people as they join together to of this philosophical position, we humans can no
create realities. Guterman (2006) described these longer stake any claim to objectivity. Everything is
two perspectives: perspective, and perspective is everything. Hier-
archical structures of expert and nonexpert are
Although both constructivism and social challenged. Each of us views reality through our
constructionism endorse a subjectivist view of own particular lenses or created social discourse.
knowledge, the former emphasizes individuals’ The prominent social psychologist and social con-
biological and cognitive processes, whereas the structionist Kenneth Gergen (2009) explains:
latter places knowledge in the domain of social
interchange. (p. 13) At the outset, constructionist ideas alert us to the
absence of foundations (rational, empirical,
In this chapter, we de-emphasize distinctions ethical, or otherwise) for any position that one
between constructivist and social constructionist advocates. All articulated positions emerge from
perspectives. Mostly, we lump them together as social process, and even the attempt to elaborate
constructive theories and therapies and emphasize foundations must ultimately beg the question of
the fascinating intervention strategies developed how its elaborations are to be warranted. This
within these paradigms. This might be upset- scarcely suggests that we should abandon the
ting to staunch constructivists or radical social positions we occupy. Rather, it is to become aware
constructionists, but we take this risk with full that we live within traditions that may or may not
confidence in our personal safety. That’s because be adequate to the contingencies of today.
most constructive types are nonviolent thinkers who Reflection, curiosity, and doubt must all be
very much like talking and writing. Consequently, encouraged. (p. 99)
within our socially or individually constructed real-
ities we’ve concluded that we’re in no danger of With reflection, curiosity, and doubt as our
harm from disgruntled constructive theorists or guides, we now turn to a look at the roots of con-
therapists. structive psychotherapy.

KEY FIGURES AND The Roots of Constructive Psychotherapy
HISTORICAL CONTEXT
Constructive approaches to counseling and psy-
Constructive theories and therapies help clients chotherapy also have roots in traditional talk
reconstruct or restory their lives in more adaptive therapy. As an example, Steven de Shazer, a
and satisfying ways. This emphasis requires that co-originator of solution-focused therapy, used a
therapy interactions focus primarily on the present phrase from Sigmund Freud (Words were originally
and future. To explore constructive theories is to magic) as a title for one of his solution-focused books
dive more deeply into the abyss of ‘‘as if’’ as intro- (de Shazer, 1994). In the 1915 writings from which
duced to philosophers (and Alfred Adler) in the de Shazer was quoting, Freud wrote,
early twentieth century by Hans Vaihinger (1911).
Nothing takes place in a psycho-analytic
treatment but an exchange of words. . . .

KEY FIGURES AND HISTORICAL CONTEXT 371

The patient talks. . . . The doctor listens. . . . misanthropic caricatures of the only person he
Words were originally magic and to this day knows—himself. (Kelly, 1969, p. 24)
words have retained much of their ancient magical
power. By words one person can make another Kelly described many foundational constructive
blissfully happy or drive him to despair. . . . Words psychological concepts. Although Vaihinger and
provoke affects and are in general the means of other philosophers influenced him, his theoretical
mutual influence among men. (Freud, 1961, p. 17) work is based primarily on clinical observation.
For example, early in his transformation from
As Freud notes, the magical power of words Freudian analysis to personal constructs, Kelly
began long before psychoanalysis. Ancient healers, began ‘‘deliberately’’ offering clients preposterous
storytellers, and religious evangelists knew the interpretations. His only criteria were that the
power of words. Regardless of your particular interpretative statements (a) integrate his clients’
religious or spiritual beliefs, it’s difficult to argue current perspective and (b) have ramifications ‘‘for
over the word and story power included in the approaching the future in a different way’’ (Kelly,
I Ching, the Bible, the Koran, the Talmud, the 1969, p. 52). Somewhat to his surprise, Kelly
sayings of Confucius, the Book of Mormon, and discovered that his preposterous interpretations
other religious documents. often worked very well in moving clients toward
more positive future behavior and emotions.
Early philosophers who contributed to construc-
tive theory and therapy include Immanuel Kant Milton Erickson, Strategic Hypnotherapy,
and Hans Vaihinger. Kant’s view that knowledge and Solution-Based Approaches
of reality can only be approximated and Vaihinger’s
conception of many individual fictional realities Stephen de Shazer and
both are at the root of contemporary constructive
theory. Constructive thought is in opposition to others trace the mod-
modernism or objectivism. Both constructivism and
social constructionism hold that individuals actively ern origin of solution-
construct reality based on either their own percep-
tual experiences or jointly held social agreements. focused constructive
Both these perspectives make reality quite flexible.
In contrast, objectivism holds that individuals know thinking to the late,
reality by passively receiving sensory information
directly from the environment (aka: the real world). great hypnotherapist

George Kelly, Personal Construct Theory, Milton Erickson (de
and Preposterous Interpretations
Shazer, 1985; Haley,
With the publication of The Psychology of Personal
Constructs, George Kelly (1955) developed the first 1973; O’Hanlon, 1988;
unarguably constructive approach to psychother-
apy. He wrote, O’Hanlon & Bertolino,

Life provides man with no scientific footholds on 1998). Erickson is also
reality, suggests to him no narrative plots, offers
no rhythmic metaphor to confirm the moving Milton Erickson considered the innova-
resonance of a human theme. If he chooses to tive inspiration for the
write tragedy, then tragedy it will be; if comedy,
then that is what will come of it; and if burlesque, strategic therapy approach with individuals and
he, the sole reader, must learn to laugh at his
families (I. Goldenberg & H. Goldenberg, 2008).

In his therapeutic work, Erickson made no effort

to correct ‘‘causative underlying maladjustments’’

lurking in his clients’ unconscious, self, past, or

environment (Haley, 1967, p. 393). Instead, his

focus was on how to deconstruct and reconstruct

the skills and strengths his clients brought with

them to therapy. The following case, adapted from

Rossi (1980) and later summarized in O’Hanlon and

Bertolino (1999), illustrates Erickson’s strength-

based approach.

372 CHAPTER 11 CONSTRUCTIVE THEORY AND THERAPY

A 70-year-old woman named Ma met with Lankton & Frischholz, 2009; Patterson, 2010;
Erickson. She was unable to read despite many Zeig, 2010). He made many contributions to what
years of sincere effort. She had resolved to learn we know about psychotherapy today. He is best
how to read at age 16 but had subsequently known for brief hypnotherapeutic techniques and
become frightened and blanked out whenever innovative approaches to working with individual
someone tried to teach her. Erickson promised cases. One of his most significant contributions to
her that she would be reading and writing within therapy is the intervention referred to as utilization
three weeks. (Erickson, 1954).

Erickson’s approach to teaching Ma to read Utilization is both an intervention and a theo-
was innovative. He told her that she wouldn’t have retical concept. Erickson believed it was crucial for
to learn anything that she didn’t already know. clients to utilize whatever strengths they brought
The core of his message was that she already had with them to therapy. These strengths included
within her all of the skills and strengths needed to their humor, work experiences, language style, per-
learn to read and write. sonal resources, and nonverbal behaviors. As with
Ma, Erickson incorporated or utilized the personal
He asked her to pick up a pencil in any old way qualities his clients possessed into their therapeu-
she wanted. Then, he had her make some marks tic work.
with the pencil on paper, just scribbling, like any
baby might do. Progressively, he had her make Erickson’s legacy is characterized by three of his
straight lines at various angles, donut holes, donut personal attributes. We believe these qualities con-
halves, and two sides of a gabled roof. As a way to tinue to shine through and shape the contemporary
decrease her anxiety about writing, Erickson did practice of many constructive therapies and thera-
not have the woman learn to copy letters but pists. Erickson was many things, but in particular
instead had her draw objects that she had been he was:
familiar with during her lifetime. He had her
practice making these familiar marks on paper • Optimistic (and confident)
between sessions.
• Clever (and intelligent)
During their next meeting, Erickson explained
to Ma that the only difference between a pile of • Indirect (and collaborative)
lumber and a house was that the house was put
together in a particular way. Ma agreed but didn’t Erickson was so positive and creative with clients
see the relevance between building a house from that, before long, often without even realizing
lumber and turning pencil marks on a page into what had happened, clients would experience a
letters. Then, Erickson helped Ma make a series of doubling or trebling of their previously unnoticed
26 new marks, based on the marks she had and underutilized personal strengths and resources.
previously produced. Of course, these marks were As we see later, he was a masterful listener and had
the 26 letters of the English alphabet. a knack for framing or constructing solutions that
his clients could instantly ‘‘get.’’
Erickson’s work with Ma continued along the
same lines. He coaxed her into naming the QUESTIONS FOR REFLECTION
different letters and words she produced. After all,
just as farm animals needed names, so did the Consider the following questions: How much of
marks she produced on a piece of paper. Erickson’s personality is reflected in the development
Eventually, he had her write a sentence: ‘‘Get and evolving nature of constructive theory and
going Ma and put some grub on the table.’’ This therapy? Have you noticed how the personalities
was a statement she had frequently heard from her of other major theorists (e.g., Freud, Adler, Rogers,
late husband, which helped Ma realize that reading Beck) shaped how their therapies are practiced?
was just like talking. In the end, without causing How might feminist and multicultural life experiences
Ma any anxiety whatsoever, Erickson taught her to shape theory?
read and write in less than three weeks.

Erickson was a powerful and creative individual
whose work is still highly regarded (Cade, 2009;

KEY FIGURES AND HISTORICAL CONTEXT 373

The Palo Alto Projects and Brief Therapy strategic therapy techniques, but the most relevant
to our discussion is positive relabeling or reframing.
in Italy
In one famous case, Haley informed a woman
In 1952 Gregory Bateson began the Double-Bind whose husband had recently chased her around the
Communications Project (DBCP) with Jay Haley, house with an ax that her husband ‘‘was simply
John Weakland, and Donald Jackson (as consul- trying to get close to her’’ (I. Goldenberg &
tant) in Palo Alto, California. This project focused H. Goldenberg, 2008, p. 280). Obviously Haley’s
on communication patterns in schizophrenic fam- positive relabeling in that case was a bit over the
ilies. Shortly after this project started, Haley and top, but strategic therapy approaches were boldly
Weakland became interested in communication positive. Similarly, in her work at the Milan Center,
patterns that occur between hypnotherapist and Selvini-Palazzoli and her group (Selvini-Palazzoli,
client. With Bateson’s encouragement, Haley and Boscolo, Cecchin, & Prata, 1974) developed an
Weakland began attending some of Milton Erick- active-directive family therapy technique called
son’s hypnosis workshops and visited him regularly positive connotation, in which negative symptoms
in Phoenix. or behaviors are recast in a positive light (e.g., ‘‘Your
child is setting fires in order to get your attention
In 1958 Jackson established the Mental Research and some emotional warmth in his life’’).
Institute (MRI) along with Virginia Satir and Paul
Watzlawick, also in Palo Alto. This project and the QUESTIONS FOR REFLECTION
DBCP both focused on the power of verbal and
nonverbal communication in influencing human Some writers have strongly criticized the extremely
behavior. The project boundaries were somewhat positive reframing approaches that Haley and Selvini-
blurred because Jackson was heavily involved in Palazzoli popularized. What are your thoughts on
both. Together, the projects resulted in more than this issue? How do you think provocatively positive
200 professional publications, including numerous reframes might affect clients?
books (Bateson, Jackson, Haley, & Weakland,
1963; Watzlawick, Beavin, & Jackson, 1967; Efran and Fauber (1995) offer the following
J. Weakland, 1962). criticism of overly positive therapy interventions
based on ‘‘verbal magic’’:
In 1968 the Brief Therapy Center was established
at MRI. By then the DBCP had ended and Haley In our view, some workers have stretched the
and Weakland had joined MRI. Around the same meaning of such terms as reframing and positive
time, four Italian psychiatrists led by Mara Selvini- connotation . . . to the breaking point. They
Palazzoli broke away from their psychoanalytically underestimate the solidity of a constructed reality
trained colleagues and formed the Milan Center and assume that because something is language
for the Study of the Family. Their goal was dependent, it is insubstantial and can be easily
to work more specifically with family systems modified by relabeling problems willy-nilly. They
using briefer therapy models. The Milan group feel free to portray faults as virtues, failures as
was strongly influenced by the Palo Alto group successes, and selfishness as altruism. Some
and, in particular, by the publication Pragmatics of therapists will say almost anything for strategic
Human Communication (Watzlawick et al., 1967). effect. Critics have attacked such ad hoc
Watzlawick became the main consultant for the conceptualizations as superficial and
Milan group. manipulative—an uncomfortable melding of the
roles of therapist and con artist. . . . We tend to
Haley and Cloe Madanes (who was trained agree. (p. 291)
at MRI) later married and developed the strate-
gic approach to family and individual therapy Clearly, a significant danger associated with
(Madanes & Haley, 1977). The essence of strategic constructive approaches is the minimization or
therapy is to devise a unique strategy for each partic-
ular client or family problem. There are numerous

374 CHAPTER 11 CONSTRUCTIVE THEORY AND THERAPY

denial of what Efran & Fauber (1995) refer to reality of what they are talking about. This is the
as the solidity of constructed reality. way language works, naturally. (p. 6)

Discovering Solutions and Narratives Not long after solution-focused brief therapy
began growing in popularity, William O’Hanlon
The work of Kelly, Erickson, Bateson, MRI, the and Michele Weiner-Davis developed solution-
Milan Group, and Haley and Madanes are directly oriented therapy (O’Hanlon, 1988). The solution-
related to contemporary constructive theory and oriented approach is derived from three main
therapy. Within the constructive paradigm, this theoretical-practical precursors: (1) Milton Erick-
chapter focuses primarily on two distinct therapeu- son’s work; (2) strategic intervention and problem-
tic movements and approaches: solution-focused solving techniques developed at MRI; and (3) de
and narrative therapies. Shazer and Berg’s solution-focused brief therapy.
O’Hanlon (1998) describes the evolution of his
Solution-Focused Brief Therapy approach:
Steve de Shazer and Insoo Kim Berg cofounded the
Brief Family Therapy Center (BFTC) in Milwaukee In the early 1980’s I began a correspondence with
in 1978 and developed solution-focused brief Steve de Shazer. . . . [H]e and some colleagues had
therapy (SFBT). Their approach emphasized that begun what came to be called the Brief Family
clients don’t need to know anything about why Therapy Center. . . . De Shazer and I shared a
or how their problem originated. Even further, common view that mainstream therapies that saw
therapists also don’t need to know anything about clients as pathological and resistant were all
how clients’ problems developed—and they need to wrong. People were naturally cooperative if
know very little about the problem itself. Instead, approached in the right way and treated as
solution-focused brief therapy primarily (and often resourceful and competent. De Shazer’s work
exclusively) focuses on helping clients generate began to take shape and has turned into
solutions (de Shazer et al., 2007). de Shazer refers to ‘‘solution-focused therapy.’’ . . . My work took
standard therapy interventions as ‘‘formula tasks’’ shape and I began to call it ‘‘solution-oriented
and ‘‘skeleton keys’’ (de Shazer, 1985, p. 119). therapy.’’ . . . Because the two were often
In the following, he describes the similarity of his confused and I have some major differences with
approach to that of the Milan group: the Milwaukee approach, I began to speak of my
approach as ‘‘possibility therapy.’’ (p. 139)
[The Milan group’s] prescription (which follows a
formula) and our ‘‘formula tasks’’ (each of which The differences between SFBT and possibility
are standardized) suggest something about the therapy are small but important. As compared to
nature of therapeutic intervention and change SFBT, O’Hanlon’s approach is described as,
which has not been clearly described before:
Interventions can initiate change without the • Having more focus on acknowledging and vali-
therapist’s first understanding, in any detail, what dating clients’ emotions and experience.
has been going on. (de Shazer, 1985, p. 119)
• Somewhat less directive and less formulaic.
Also, de Shazer was inspired by Ludwig Wittgen-
stein’s (1968) concepts of language games as inter- • More collaborative.
personal determinants of reality. Berg and de Shazer
(1993) articulate this linguistic development: • More open to considering political, gender,
and historical factors as important in problem
As the client and therapist talk more and more development.
about the solution they want to construct
together, they come to believe in the truth or O’Hanlon also believes that therapists must take
responsibility for pursuing issues that clients don’t
bring up—especially if the issues lead to violent,

THEORETICAL PRINCIPLES 375

dangerous, or painful life outcomes. In contrast, letters to clients as an extension of therapy (Epston,
de Shazer (Hoyt, 1994) has gone on record to say 1994). In collaboration with Stephan Madigan of
that therapists should avoid reading ‘‘between the Canada, Epston cofounded the Anti-anorexia/
lines’’ and instead simply stick with what the client Anti-bulimia League, an organization that turns
is saying is the problem and whatever is working so-called eating disordered patients into empow-
(e.g., ‘‘[if] he says he doesn’t drink too much and it’s ered community and political activists. Accord-
not a problem. Leave it alone. Take it seriously’’; ing to Madigan, narrative approaches spring from
pp. 29–30). diverse sources, including Foucault, Bateson, fem-
inism, anthropology, geography, and postmod-
Narrative Therapy ernism (Carlson & Kjos, 2000; Madigan, 2011).
Michael White of Australia and David Epston of These approaches also carry the distinct flavor
New Zealand met in 1981 at an Australian–New of George Kelly’s (1955) psychology of personal
Zealander family therapy conference and subse- constructs.
quently developed a therapeutic approach based on
narrative metaphor (I. Goldenberg & H. Golden- THEORETICAL PRINCIPLES
berg, 2008). The personal narrative metaphor is
the story that defines and organizes each individ- Constructive therapies are approaches that begin with
ual’s life and relationship with the world. As we the recognition that humans are meaning makers who
live and accumulate experiences, we each develop construct, not simply uncover, their psychological realities.
a personal story or narrative that gives our lives They are based on ‘‘the construction that we are
meaning and continuity. Much like a well-written constructive.’’
story, our personal narrative includes an organized
plot, characters, points of tension and climax, and a —Michael F. Hoyt, The Handbook of Constructive Therapies
beginning, middle, and end. (1998, p. 3)

White was strongly influenced by Michel Fou- A powerful conceptualization of constructive
cault (1965), a French intellectual and social critic. therapy comes from Michael White (1993), who
Foucault accused dominant culture of oppres- described therapists as not just ‘‘taking history,’’
sively maintaining power and control over minority but ‘‘making history.’’ Certainly, in their own
groups by eliminating alternative historical per- particular and sometimes peculiar way, constructive
spectives. Eventually, the dominant culture turns its theorists and therapists are currently making history
historical stories into objective truth, and alter- in counseling and psychotherapy.
native ways of being are pathologized. White’s
application of Foucault’s thinking to the ther- Postmodernism
apy process allows individuals who have oppressed
themselves through personal narratives to decon- The most basic position that postmodernists hold
struct and reconstruct their life stories into more is antirealism (aka: subjectivism). Postmodernists
complete, more adaptive, and personally meaningful firmly believe there is no such thing as objective
storylines (M. White & Epston, 1990). Narra- fact. This position is, of course, at once illogical,
tive therapy as formulated by White and Epston subjective, nonlinear, and essentially unprovable,
also helps individuals break free from internalized but from the postmodernist’s perspective, such
social, cultural, and political oppression and rewrite is the inherent nature of all things. de Shazer
their life stories from a perspective of personal articulates the subjective or antirealist nature of
freedom. client symptoms when he writes, ‘‘There are no
wet beds, no voices without people, no depressions.
David Epston introduced narrative metaphor There is only talk about wet beds, talk about voices
concepts to White (I. Goldenberg & H. Gold-
enberg, 2007). He also has pioneered the use of

376 CHAPTER 11 CONSTRUCTIVE THEORY AND THERAPY

without people, and talk about depression’’ (de QUESTIONS FOR REFLECTION
Shazer, 1993, p. 93).
Think about what it’s like to experience confusion.
Let’s take a moment to deconstruct postmod- What might be the purpose of Erickson’s confusion
ernism. As a term, postmodernism derives from art tactics? When you’re confused about something do
and literature. It originally referred to a movement you reach out and grab onto the first thing that
or perspective that was in opposition to or in reac- makes sense? Could that work as a therapy strategy?
tion against modern art or literature. Of course, this
means that to define postmodernism adequately, Language and Languaging
we must first define modernism. Technically, mod-
ernism is associated with the scientific, objective, Constructive therapists focus on how language
and deterministic paradigm of an external reality. builds, maintains, and changes each individual’s
In some ways, however, defining modernism is like worldview (H. Anderson, 2007; H. Anderson &
trying to catch a snowflake because all things mod- Burney, 2004; Lipchik, 2002). As Hoyt (1998,
ern melt away very quickly with the passage of time. p. 4) stated, ‘‘Language and languaging are the
It’s possible to define the modern art and modern ways we make meaning and exchange information.’’
science period and style, but when doing so, we’re Language determines reality. Efran and Fauber
struck that using the word modern in that context (1995) described,
is a misnomer. Modern art is no longer ‘‘modern’’
art in the sense that it is no longer contempo- Language is where people live. . . . It allows people
rary but instead representative of a static period to have names, to ‘‘know’’ who they are, and to
in time. And most likely, postmodernism, too will carve separable things out of the interconnected
come to represent a period of time and a way of flux that they take to be the universe. One can
thinking that emphasizes the profound subjectivity manage to play baseball without a shortstop, but
of reality. not without the words and symbols that
differentiate first base from home plate. Without
If you’re feeling confused, that’s exactly the point. language, it would not be possible for a person to
Milton Erickson sometimes based his therapeutic engage in self-conscious thought, to keep an
interventions on what he referred to as the con- appointment book, or to have problems. (p. 279)
fusion technique (M. H. Erickson, 1964). In an
effort to produce positive change, he would speak Given their focus on language, constructive
to clients in ways that were circular, nonlinear, and therapists are open to an entire domain of ther-
confusing. apy interventions including relabeling, reframing,
solution-focused questioning, restorying, and prob-
Once confusion set in, client responsiveness lem externalization (Guterman, 2006; Murphy,
to hearing and accepting alternative ways of 2008). We review these approaches in the Practice
thinking were increased. As discussed in Chapter 8, of Constructive Psychotherapies section.
Albert Ellis helped clients deconstruct irrational
beliefs through vigorous disputation—a forceful Change Is Constant and Inevitable
approach, based on modernist, rational thinking.
In contrast, like Erickson, constructive therapists Solution-focused and narrative therapists believe
help clients deconstruct and reconstruct specific change is constant and therefore change is
beliefs as well as personal narratives through a inevitable. Change happens every day, both in the
careful and subtle use of words and language. domain of internal human perception (what you
This theoretical perspective encourages cognitive see, hear, etc.) and the domain of social discourse.
activity that involves what Gergen (2009a; 2009b;
2011) described earlier—reflection, curiosity,
and doubt.

THEORETICAL PRINCIPLES 377

From the constructive perspective, because change Therapy Is a Collaborative, Cooperative,
is inevitable, therapists can help guide the change Co-Constructive Conversation
in positive directions. Perhaps even more impor-
tantly, constructive theorists believe that only a Constructive therapists seek to establish a collab-
small change is required to change so-called big orative relationship with clients. Guterman (2006)
problems (de Shazer et al., 2007). noted: ‘‘Borrowing from the field of anthropol-
ogy, some social constructionists have described
Problems Are Co-Created their role as a participant-observer’’ (p. 15). This
idea implies an interconnection between client and
Constructive theory holds that you can change the therapist and leads to a process wherein therapists
past from the present. This is because problems ‘‘act with’’ their clients collaboratively rather than
are either creations (constructivist) or co-creations ‘‘acting on’’ their clients as an outside modernist
(social constructionist). The client—as creator/ influencer.
author/architect—can take apart the problem
(deconstruct it) and then reassemble it differently. This collaborative formulation of therapist-client
relationships has led to constructive therapists
As described in more detail later, therapy denouncing the concept of resistance. If you recall,
conversations are opportunities to reconstruct, much of the old modernist psychoanalytic model
restory, or accommodate experiences from the was based on the therapist as an authority who
past. You may recall the concept of introjection interpreted reality to clients and then helped clients
or ‘‘swallowing whole’’ from Chapter 6 (Gestalt work through their resistance to the psychoanalytic
therapy). In constructive therapy, particularly its reality. In contrast, constructive therapists view
narrative therapy format, the therapist helps clients resistance as natural and as the responsibility of
cough up their old life stories and chew them up the therapist—and not the fault of the client.
in a new and different way before trying to swallow For example, O’Hanlon and Weiner-Davis (1989)
and digest them again. wrote:

This process is supported by recent brain [C]lients do not always follow therapists’
research. Memories are electro-chemically stored suggestions . . . this is not viewed as resistance.
in the brain, typically in the hippocampal region. When this happens, clients are simply educating
When memories are accessed, they’re pulled out therapists as to the most productive and fitting
of storage and into active memory; they may even method of helping them change. (pp. 21–22)
be re-experienced in some ways. Then, when the
memories are placed back in long-term storage, Moving responsibility for cooperation and resis-
they’re reconsolidated. Neuroscientists claim this tance from clients to therapists is a major contri-
reconsolidation process is open and involves re- bution of constructive theory. It’s not surprising
remembering (Quirk & Mueller, 2008; Ru¨ egg, that many involuntary clients are relieved when
2009). As a consequence, every remembering is an an appointed therapist focuses on strengths and
opportunity to re-remember things differently. Of possibilities, rather than trying to break down
course, as humans we often re-remember things denial and get them to admit to owning the
differently (depending on mood, who we’re with, problem. The gentle, collaborative, and positive
time of day, etc.), which fits with the idea of approach that constructive therapists advocate may
change being constant. In the case of trauma, be why many therapists and agencies that work with
when memories are very troublesome, constructive involuntary or mandated clients find constructive
therapies take advantage of this re-remembering approaches so useful (Rosenberg, 2000; Tohn &
process to shift the storyline toward more positive Oshlag, 1996).
and controllable outcomes.

378 CHAPTER 11 CONSTRUCTIVE THEORY AND THERAPY

Therapy Focuses on Strengths personal life narrative. Instead of using diagnos-
tic categories, constructive therapists meet clients
and Solutions where they are, emphasizing unique strengths that
each client brings to therapy.
With the preceding emphasis on collaboration and
cooperation and co-construction of new stories, On the other hand, constructive therapists are
you might think constructive therapists strive for an practical and in touch with contemporary needs for
absolutely equal sharing of power in their relation- diagnostic assessment and categorization (Guter-
ship with clients. After all, egalitarianism is a basic man, 2006). As most of us recognize, diagnosis
constructive theoretical position. Even further, the and labeling constitute a means of professional
client is respected and viewed as her own best expert. communication, and this form of communication
Not long ago, a student in one of our theories is used—while simultaneously being questioned.
classes queried us about this egalitarian theoretical Consequently, solution-focused, possibility, and
position. As we lectured on solution-focused narrative approaches are routinely applied to the
methods for leading clients toward solutions, she treatment of many different traditional problems.
exclaimed, ‘‘But just a few minutes ago you said These applications include alcoholic narratives,
constructive theory embraces equality between grief therapy, eating disorders, domestic violence,
therapist and client and views the client as the best dissociative disorders, and more (Connie & Metcalf,
expert on her own reality. I thought that meant 2009; Hoyt, 1998; Metcalf, 2008; Monk, Winslade,
constructive therapists don’t lead their clients?’’ Crocket, & Epston, 1997).

Well, the truth is that although constructive Broadly speaking, there are two main determi-
therapists respect and accept their client’s per- nants of client problems, regardless of whether the
spectives, they also direct and lead clients in a client is an individual, couple, or family:
preplanned direction—toward personal strengths
and positive problem-solving abilities. As Weakland The client has gotten stuck using ineffective solu-
(1993) stated, ‘‘Just as one cannot not communicate, tions. This view, derived from Erickson’s work and
one cannot not influence’’ (p. 143). Weiner-Davis the Mental Research Institute approach, emphasizes
(1993) asked, ‘‘Since we cannot avoid leading, that individuals become stuck repeating maladap-
the question becomes, ‘Where shall we lead our tive behavior patterns even though they possess
clients?’’’ (p. 156). many personal strengths and resources. For the
most part, clients become stuck because they con-
The answer to this question is simple: Construc- struct their experiences, using language and other
tive therapists direct clients toward (a) solutions, meaning-making procedures, in a manner leading
(b) exceptions to their problem-centered viewpoint, to stuckness. Constructive therapists examine client
(c) optimism and self-efficacy, and (d) new versions symptoms, problems, and psychopathology for the
of personal stories that promote greater psycho- sole purpose of deconstruction. As noted previously,
logical health (Monk, 1997; Winslade & Monk, many solution-focused therapists almost completely
2007). In this way, constructive theory and ther- ignore client statements about problems and reori-
apy are clearly laden with the values of Erickson’s ent therapy conversations toward solutions.
utilization concept.
The client believes in an unhealthy, pathology-based
Theory of Psychopathology self-, couple, or family narrative. Narrative thera-
pists believe that human problems develop when
Constructive theory doesn’t support or use tradi- clients write themselves into their self-narratives as
tional psychopathology models. Diagnosing clients inadequate, problem-plagued losers. Clients often
is viewed as an unhelpful procedure. Client show up in therapy because they have constructed
symptoms such as anxiety and depression are not a narrative in which the dominant theme of
objective entities but part of an individual’s per- ‘‘personal problem’’ is obscuring a nondominant
sonal emotional experience cast within an overall theme of ‘‘personal strength and resourcefulness.’’

THE PRACTICE OF CONSTRUCTIVE PSYCHOTHERAPIES 379

Deconstructing and reconstructing of the client’s procedures. Instead of formally introducing clients
personal narrative is the road to improvement. to the therapy process, the constructive therapist
continuously collaborates with clients to identify
THE PRACTICE OF goals, strategies, and the overall therapy direction.
CONSTRUCTIVE (See Putting it in Practice 11.1: Informed Consent
PSYCHOTHERAPIES From the Constructive Perspective)

Constructive therapy is collaborative. This may Assessment Issues and Procedures
be the biggest reason why constructive therapists
don’t emphasize psychoeducation or role induction Constructive therapy approaches use minimal
formal assessment procedures. In keeping with

PUTTING IT IN PRACTICE 11.1

Informed Consent From the Constructive Perspective

I’m looking forward to working with you in counseling. This next section describes a little
bit about my theoretical orientation and my ways of working with people. Questions are
always welcome!

There are many words used to describe the kind of work I do, but some people call
it constructivist. This means that I believe people construct many aspects of their lives,
and when things aren’t going well, it’s possible to change the way things are constructed.
Each of us has our own reality, and our own beliefs about things. Sometimes, problems
can be changed or pushed back by working on the way we see things and experience
them.

As we work together, I will be excited to hear your life story and help you notice the
way you tell your story. I will help you turn your attention to your successes and your
strengths. We will explore how to build on these successes and strengths. We will also
work to get a grip on those pesky problems that creep into our lives, and experiment with
ways to see them differently.

I believe words can be magic. Just talking together, paying attention to the words
we use, can bring about change. We don’t need to go over every detail of your past, and
we won’t necessarily need to meet for very long. Sometimes my clients only need a few
sessions to make the changes they want to make.

In my work with people who are fighting back problems in their lives, I am curious and
optimistic. Each individual has a unique reality that I am always excited to learn about.
Believe it or not, we can tinker with your reality in ways that can make your life seem
new, better, and more in your own control. . . .

380 CHAPTER 11 CONSTRUCTIVE THEORY AND THERAPY

de Shazer’s (1985) emphasis on keys to solution As we explore constructive assessment strategies,
and White and Epston’s (1990) emphasis on client keep in mind the possibility that clients could get
narratives, the primary therapy focus is either questioned out.
on identifying and implementing solutions or on
deconstructing problem narratives and constructing Opening the Session
more satisfying narratives (White, 2007; White & Discovering the client’s problem view is the pri-
Denborough, 2011). Narrative therapists spend mary initial focus for constructive therapists. The
a bit more time assessing and exploring client solution-focused brief therapist usually begins ther-
problems than solution-focused brief therapists, apy with a query like, ‘‘What brings you here?’’ This
but, overall, too much time spent discussing standard opening allows clients to discuss their con-
problems might only strengthen, build, and further ceptualization of the problem and take the lead in
deepen the client’s problem-focused worldview. the ensuing therapeutic conversation.
The main therapy goal is to help clients move
past their problem focus and develop solution- and In keeping with their optimistic orientation,
strength-focused worldviews and adaptive personal solution-based therapists ask questions that stim-
narratives. ulate clients to begin moving up a positive path.
The following opening questions fit with a solution-
Even though solution-focused brief therapists focused/narrative model:
want clients to shift from problem talk to solution
talk, it’s still important to begin therapy by allowing • What could happen during our time today that
clients to tell their stories. If therapists ignore the will make your visit with me worthwhile?
client’s problem, rapport can be damaged. The
general rule for solution-focused brief therapists at • If this session goes very well, what will we
the beginning of therapy is to follow the client’s lead. accomplish together?
This rule flows from Erickson’s indirect hypnotic
approach with clients, in which therapists begin • How did you decide to come to counseling?
by pacing the client and later take the lead and
make indirect and direct suggestions (Haley, 1967). Usually, these questions prompt clients to iden-
Insoo Kim Berg also articulated this philosophy tify specific goals they want from treatment. Iden-
when she wrote about leading from behind (Berg & tifying or constructing reasonable goals is an
Miller, 1992). important assessment component of solution-based
therapies.
The primary therapist tool in solution-focused
and narrative therapy is questioning. However, Narrative therapists generally want to know more
excessive questioning can be problematic. To help about the original construction of the problem;
address potential negative outcomes associated with this involves gathering information about how the
using too many questions, Monk (1997) describes a problem first started and how it initially affected
role induction statement in narrative therapy with a the client’s view of herself (Monk, 1997). Early
young client: narrative-based assessment questions include:

A therapy of questions can easily make the client • How will your life go forward if [the problem]
feel like the subject of an interrogation. To avoid continues into the future?
the power imbalance that might follow from this
kind of conversation, I sought permission from • How will your life go forward if [the problem]
Peter to ask him some more questions, saying that gets smaller or goes away completely?
if I asked too many questions, he could either not
answer them or tell me he was ‘‘questioned A key concept to keep in mind when constructing
out.’’ (p. 9) assessment questions from the narrative perspective
is to work on externalizing the problem from the
person or the family. This is accomplished by