A Decade of Feminist Influence on Psychotherapy

Annette M. Brodsky
The University of Alabama

The last decade has seen some major impacts of feminism on the
institution of psychotherapy regarding theories, treatment techniques, and
assessment instruments. The changes in attitudes toward women as
therapists and as clients have reflected the general advances of the women's
movement in that women clients are more likely to seek women therapists
and to receive treatments specifically developed for crises affecting women
such as rape, pregnancy and domestic violence. The difficulties in designing
empirical studies to demonstrate bias in psychotherapy have resulted in a
confusing state of the art because only the higher-order interactions have
consistently been significant. Attempts of some women to resist changes
brought about by the women's movement and the apathy and levity of
others have also presented problems in the path of progress. However,
movement toward the long-range goal i s encouraging when one compares
the writing on women and psychotherapy in recent professional journals with
examples from the 1960s.

I n 1963, as the first female clinical psychology intern i n the U.S.

Army, I was assigned a 40-year-old woman client who refused to
accept m e as her therapist because I was younger than she, and a
woman. She was convinced that she was assigned to the lowly female
intern because her husband was only a sergeant. Her parting words as
w e aborted our tenuous relationship were something like, "I'm a
difficult case, honey. It's not your fault. I hope someday you'll be
another Joyce Brothers."
O n the other hand, recently a woman client peeked into m y
office after leaving our initial session and commented, "You know,

Presidential Address, Division 35 of the American Psychological Association, Toronto,

September, 1978.

Psychology of Women Quarterly, Vol. 4C3) Spring I980 331

0361-684318011300-0331$00.95 @ 1980 Human Sciences Press
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PSYCHOLOGY OF WOMEN QUARTERLY

I’m glad you’re a woman. I don’t think I could be as honest with a

man. I would be worrying too much about whether or not he ap-
proved of me.”
These two comments reflect more than differences in personal-
ity, age, marital status, or some unknown variable. They reflect al-
most two decades of change in attitudes toward women in positions
of authority. They also reflect a change in knowledge of women’s
roles in society. Individual women may not have made the personal
changes that the women’s movement has fostered, but they are aware
of the potential for such changes and have a sense of where they fit in.
Instead of seeing themselves as ”difficult cases” that only a strong
man can handle, they are more receptive to being independent of
men and working with other women.

WOMEN AND PSYCHOTHERAPY

There has probably been more said and written about the subject
of women and psychotherapy in the last decade than in the 50 pre-
ceding years. During this period, the women’s movement has had a
strong influence on many areas of our lives, including new life styles,
work situations, and relationships between the sexes. We have been
examining and reexamining our stereotypes and their scientific or
lack of scientific bases.
Observers of psychotherapy have made very little progress to-
ward a better understanding of what is helpful in insuring that clients
achieve mental health and self-actualization. Critics of the institution
of psychotherapy, especially women (Fields, 1975; Tennov, 1979,
have been vocal about this. The field of psychotherapy appears to
have developed laterally more than it has linearly. There are now
hundreds of systems of psychotherapy, each with its own vocabulary,
process, and specific goals. Little common ground exists among the
psychotherapies other than the assumption that the client, who is
experiencing some sort of distress, enters into a verbal relationship
with an expert, who through use of specified techniques based on a
particular theory of personality, facilitates growth toward remediation
and well-being.
What we do know from empirical research about the ingredients
of good therapy i s limited and often elusive. We know that, in gen-
eral, clients report they feel better after therapy than they did before,
no matter what type of therapy they have received (Aronoff & Lesse,
1976). Women report more satisfaction with therapy than men (Or-
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ANNETTE M. BRODSKY

linsky & Howard, 1976), but we do not know if their reports of

satisfaction correlate with behavioral criteria of improvement. We
know that therapy cannot be completely value free, and we suppose
that clients are often seen as improved because they become more
like their therapists (Welkowitz, Cohen, & Ortmeyer, 1967). We have
evidence that it is the therapist more than the therapeutic technique
that may make the difference in whether or not a client improves
(Dent, 1978), and we know, therefore, that the therapist’s personal
traits, values, attitudes, and impressions of the client have a major
impact on the client and the course of therapy (Abramowitz &
Dokecki, 1977).
The influence of therapist variables has only recently been rec-
ognized. The empirical basis for evaluating the benefits of psycho-
therapy remains shaky, even though researchers have for many years
been painstakingly trying to isolate the components that make for
good psychotherapy outcome. The variables involved in therapy are
enormously complex, and researchers have examined effects of
therapist, process, and client dimensions, alone and in combination
with one another (Strupp & Luborsky, 1962). However, the ethics of
dealing with human beings in need, controlling pertinent variables,
isolating therapy segments from their total context, and so forth have
understandably restricted the extent of knowledge that empirical re-
search has been able to provide (Bergin & Strupp, 1972).

SEX BIAS IN PSYCHOTHERAPY

From this limited research base, feminists have attempted to ex-

amine sex bias in psychotherapy. As a variable superimposed on
those applicable to psychotherapy in general, sex bias presents al-
most formidable problems to the researcher. After all, bias, by defini-
tion, implies a lack of awareness of one’s actual behavior. Deception
therefore becomes necessary in most experimental research designs
to avoid any artificial sensitization of subjects to sex role bias that
does not reflect the typical behavior of therapists in the field.
In spite of these difficulties, a need arose to validate empirically
the gut feelings of feminists that biases were rampant in therapy. The
clinical experiences of feminist therapists and clients convinced them
that sex bias and sex role stereotyping were very real and not at all rare
(APA, 1975). Thus, an era emerged of investigation of therapist, client,
and process variables related to sex roles. We started the decade by
examining relevant demographic statistics. Several researchers
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PSYCHOLOGY OF WOMEN QUARTERLY

(Cheder, 1971; Gove & Tudor, 1973) alerted us to the fact that
therapists are mostly male, whereas their clients are mostly female,
and that the longest treatment relationships are most likely to be
between attractive young male therapists and attractive young female
clients. Next w e learned that diagnostic labels vary by sex; women
are deemed depressed, hysterical, anxiety neurotics, and phobic,
whereas men are deemed alcoholic, organic, and antisocial (Gove &
Tudor, 1973; Howard & Howard, 1974).
Reeling with this information, we invaded the mechanics of the
therapist-patient relationship. Very few main effects indicative of bias
were found, however. Sex of the therapist, for example, has not pro-
ven to be an important variable in the majority of published studies
that investigated sex role bias toward clients. The impact of the most
often cited study that did find a sex of therapist effect (Haan & Livson,
1973) was softened when Werner and Block (1 975) reanalyzed the
data using a more appropriate error term and found no differences.
However, the original Haan and Livson study is still being cited to-
day, perhaps because the need to validate personal experience that
sex bias i n psychotherapy exists is so strong that researchers feel
almost compelled to demonstrate it empirically. Even feminist re-
searchers, however, fail to find the effect they seek (Billingsley, 1977;
Gomes & Abramowitz, 1976; Kaschak, 1978). The inability to vali-
date one’s personal experiences is frustrating.
In an article in the American Psychologisr, Stricker (1 977) sharp-
ly criticized the research on sex bias on a number of methodological
grounds. Although he insists that empirical studies be the final deter-
minant of whether bias occurs, his own need to proceed without such
empirical evidence surfaces later when he chastizes the Task Force
on Sex Bias and Sex Role Stereotyping (APA, 1975) for bothering to
survey the obvious by asking women psychologists for examples of
sexist practices. W e certainly would prefer not to have to research
what we consider obvious, but many of our colleagues will not be-
lieve our experiences unless w e are able to present data to validate
them. All research is colored by the biases of the investigator and as
long as a certain segment of the profession believes that sex bias does
not exist, w e will have to demonstrate what we, with feminist biased
eyes and ears, know to be true. I am not particularly worried about a
Rosenthal (1966) effect in feminist research, as I am fully confident
that our detractors are actively counterbalancing it with their o w n
equal and opposite experimenter biases. Feminist research originally
emerged to challenge a male bias that has existed for many years.
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ANNETTE M. BRODSKY

To return to our failure to find sex of therapist as a significant

variable, however, our insights, clinical experiences, and surveys of
women therapists (APA, 1975; Sherman, Koufacos, & Kenworthy,
1978) are being supported empirically, not through main effects, but
through higher-order interactions. We are where the more generic
psychotherapy research was about 20 years ago. We are finding that
only by taking into account the interaction of many relevant variables
affecting psychotherapy will we find the effects of sex bias. Thus, for
example, Orlinsky and Howard (1976) found the relationship of
therapist sex to the therapy experiences of women depended on
factors such as age, marital status, and independence of the woman
client. Although the dependent variable in this study was not a be-
havioral indicator from a therapy session but a report by the client
after termination, this finding nevertheless is representative of where
we are in answering such questions as “should women clients see
male therapists?”
At the beginning of the decade, Phyllis Chesler (1 972) concluded
that the answer to this question was no. Today, if we believe clients’
retrospective reports, there are more likely to be two answers: (a)
“no” for young single women uncertain as to their direction in life, or
in their relationships with men, or both; and (b) “yes“ if the client is
older, or married. We do not, however, know what other factors, yet
to be studied, may also have a bearing on the answer.
In general, we do not have enough empirical support from
well-designed and executed studies to state relationships between
psychotherapy and sex bias or sex role stereotyping with confidence.
Because our methodology is restricted, we may never be able to
“prove” that, certain attributes relevant to sex bias are prominent
among therapists. We can point to such attributes in individual cases,
however, and we can prepare clinicians for their vulnerability to
sexist behavior. Sherman, Koufacos, and Kenworthy (1 978) point out
from their survey regarding the practices and knowledge about
women clients of Wisconsin therapists that there may be less bias
than misinformation about women’s problems.
There i s a bright side to the status of our knowledge about
women in therapy, however. For while some feminists have invested
their energies in demonstrating empirically that women have suf-
fered, others have approached the issues from more applied perspec-
tives. There is much that we can use now as a result of the theoretical
and applied efforts of feminist practitioners in psychotherapy during
the last decade.
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PSYCHOLOGY OF WOMEN QUARTERLY

FEMINIST INFLUENCES IN ASSESSMENTS

With the rise of the new feminist movement, some women re-
jected the psychological professions entirely and took advantage of
consciousness-raisinggroups, finding that they could help each other
where traditional psychological sources of help had failed. This was
in the context of the development of other self-help techniques that
enabled women to learn about their bodies, pregnancy, and
childbirth. Women also shared their expertise and compassion with
each other in crisis situations, such as rape or abortion counseling.
Rape centers were established by radical feminists who were not
professionals. Feminists in the helping professions were often in-
volved, and it was in this atmosphere of working with women who
rejected professional health care that women in psychology and
psychiatry began to look at how their own professions were contribut-
ing to this widespread dissatisfaction.
With the birth of the Association for Women in Psychology in
1968, presentations on the psychology of women began to surface at
APA conventions and in the feminist literature. Naomi Weisstein
(1 970) attacked the misguided wisdom on which clinical stereotypes
were based, and Phyllis Cheder's Women and Madness (1972) be-
came an impetus for clinical researchers to examine assessment and
treatment issues. Julia Sherman (1 971) and others reviewed studies
that refuted psychoanalytic concepts used to reify penis envy, moral
inferiority of women, and "inner space."
In the area of sexual functioning, Masters and Johnson (1966)
reported that women had mutiple orgasms. The physiological re-
sponse to sexual arousal was comparable between men and women,
with the clitoris being the major if not the sole source of orgasmis in
women. These discoveries led to a tremendous amount of debate and
discussion of the nature of female sexuality. The psychoanalytic insis-
tence that orgasms experienced during sexual intercourse were
superior to those felt through clitoral stimulation was simply
physiologically incorrect. Thus the analogous insistence that passivity
i s a biologically determined trait for sexually mature women was
likewise refuted.
Meanwhile, other feminists were challenging the assessment
measures used to equate nonconformity with pathology in the
female. Thus counseling psychologists became concerned that the
Strong Vocational Inventory, with its pink and blue forms for female
and male, was prejudiced by having three times as many scorable
occupations for males as for females. It was noted that many coun-
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ANNETTE M. BRODSKY

selors were giving the male forms to females when they expressed an
interest in a more "masculine" occupation. The Campbell-Strong
Revision (Campbell, 1974) eliminated the male-female dichotomy
and provided norms that included women. Intelligence tests also
were scrutinized for items slanted toward males. The new revision of
the WlSC (Wechsler, 1974) includes an arithmetic problem involving
the counting of hair ribbons.
The Dictionary of Occupational Titles became suspect when
feminist researchers discovered that occupations were rated with
higher status if they were traditionally male rather than traditionally
female. Thus a dog trainer was considered to have more skill dealing
with persons, data, and concepts than was a kindergarten teacher
(Briggs, 1971). In the new revision, titles of occupations have become
nonsexist. Thus the former mailman is now a postal worker, and the
stewardess is a flight attendant, but the ratings have not yet been
changed to reflect more accurately the status of the skills involved
(Witt & Nahenny, 1975).
When we move into the area of projective testing and eval'uation
of personality, we approach even more sensitive issues. A study that
reanalyzed hundreds of assessment reports of adolescents discovered
that descriptors of female clients did not differentiate women from
each other, but merely served to stereotype women as a class regard-
less of their personality characteristics. Thus when a report described
a woman as emotional, it did nothing to aid in evaluation other than
to indicate that the person described was probably female (Haller,
1975). Some Rorschach interpreters were distressed when it was dis-
covered in the early seventies that the symmetrical figures on Card Ill
were producing new norms. Clients were increasingly reporting one
figure as female and the other as male. One male psychiatrist even
suggested that this reflected sexual identity confusion caused by uni-
sex dressing in our culture. Regardless of the interpretation given,
however, there was at least the demonstration that perceptions of
women were indeed changing.

FEMINIST TREATMENT ALTERNATIVES

It i s in the area of providing direct psychotherapeutic services

that the most dramatic progress has occurred. In the area of rape, for
example, the last several years have seen the protest against the iden-
tification of rape victims as seducers and the recognition of the rape
trauma syndrome to understand the dynamics of the victim and to
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PSYCHOLOGY OF WOMEN QUARTERLY

work with her on reintegrating her life after the assault. Burgess and
Holstrum (1 973) reported on the sequence of shock, disorganization
of everyday life, and eventual reintegration of the rape victim. The
shock is less that of being sexually violated than the threat of death or
the experience of loss of control over one’s body. Since then, we have
seen the development of support systems, family counseling, and
follow-up services for rape victims, as well as direct emergency aid
for the victims. The updating of archaic corroboration rules of evi-
dence, and the differentiation of degrees of rape (so that victims and
juries do not feel that a conviction means the death sentence in all
cases) were partly a response to the rape crisis center movement.
Another spin-off was concern about family violence, where
feminist psychologists had much input on theoretical and practical
application. Factors such as poverty, low self-esteem, stigma, and so
forth, countered the victim-precipitation explanation for the low inci-
dence of reporting. Victims had little free choice to leave their situa-
tions due to economic and psychological bondage to their assailants.
Needs of battered wives thus emerged as an area of psychological
attention, and we are seeing some feminist analyses of the situation
that do not blame the victim (Walker, 1978).
With regard to abortion, the last decade has seen the legalization
of the procedure, changing the counseling process into a more per-
sonal decision rather than one based on ability to find and risk the
dangers involved. This topic is still fraught with great emotion and
controversy on moral grounds. Now, however, at least there is access
to a variety of alternatives for the women who have the economic
means and good fortune to live in a community that does not try to
circumvent the law by enacting local statutes requiring the reading of
propaganda including pictures of aborted fetuses.
We are also seeing some changes in the concepts of disorders
that are frequently diagnosed for females. For example, many women
were laughingly passed off as hysterical personalities because they
were flamboyant in dress and manner, constantly demanding atten-
tion, seductively and often desperately seeking approval of men, and
demeaning of other women. Such a woman was usually termed man-
ipulative and considered to have a style of life that was difficult to
change in therapy, because her manipulations usually included her
male therapist. Now hysterical personality disorders are being under-
stood as exaggerations of the traditional feminine sex role, an over-
conditioned reaction in vulnerable women to their dependency on
males for their self-esteem. This “disorder” turns out to be something
they acquired in the normal process of being rewarded for cute dres-
 3 39

ANNETTE M. BRODSKY

sing and acting coyly toward their fathers and of being fawned on by
adults for performing and catering to their superficial needs
(Wolowitz, 1972). As adults, these women have continued to man-
ifest these traits past their usefulness and have leaned on approval of
others, particularly males, as their sole source of self-esteem. Tra-
ditional therapies deal with insight into the inability of the manipula-
tions to work and the substituting of less dramatic means to gain
approval. The feminist perspective emphasizes the development of
an independent self-identity and self-determination, so that the need
for approval diminishes.
The area of depression in women has also seen strong feminist
influence as a result of Pauline Bart’s (1972) work on “the empty nest
syndrome.” Women had been socialized to become “supermoms”
who depended entirely on this role for a sense of usefulness. Pre-
viously we had notpaid much attention to the meaninglessness of the
role of women who completed their childrearing tasks by the age of
40 and who were not prepared for any other role to occupy their next
40 years. Depression has also been associated with a mourning for
the lives women have not permitted themselves to pursue and their
sense of helplessness in determining the course of their current lives
(Beck & Greenberg, 1974). The contribution of role conflicts to post-
partum and involutional depressions has also been examined (Melges,
1972).
Feminists have become involved in a closer look at phobias in
women. We are just beginning to discover the extent of inhibiting
fears that keep women housebound and dependent. Most agora-
phobics are women, and the great majority are married (Fodor,
1974). Socialization of dependence in women fosters development of
phobic reactions. In fact, assertive training has surfaced as a tech-
nique applied so predominantly to women that books and workshops
on assertive training for women are requested by men.

BACKLASH, REGRESSION, A N D APATHY

Not all women, however, are reaping the benefits of the proce-
dures that can help them to counteract the years of socialization that
convinced them they had no right to put their own needs on a level
with that of the rest of the family. Many women do not yet believe
they should have this right. In a letter to the editor of the Tuscaloosa
News, a woman wrote explaining her objection to the ERA and ended
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PSYCHOLOGY OF WOMEN QUAKTERLY

with the statement, “I have no desire to be equal to anyone, espe-

cially a man.”
For all the progress that has been made in working with women
in therapy in the last decade, there are also discouraging aspects to
the story. Rapid advances always leave some casualties behind. As
Bardwick and Douvan (1 972) noted, one way to deal with an ex-
pected change with which you are not yet ready to cope is to deny
the need for adoption of new behaviors by a reactionary exaggeration
of the necessity and desirability of the outmoded roles. Thus in the
seventies we have not only contended with the exciting new pos-
sibilities and options for women, but we must also deal with a flight to
exaggerated, stereotyped feminine roles as prescribed by Marabel
Morgan’s The Total Woman (1975) or Andelin’s Fascinating
Womanhood (1974).
These superfeminine women sincerely believe that the new roles
are destructive for them and others, and they hear the women’s
movement telling them that they have wasted their lives. A therapist
cannot tell a 50-year-old housewife that she has lived her life in vain,
that it was not necessary to make all those sacrifices, or that her
children should not be expected to repay her for them. Her self-
esteem is at stake. Holding on to the last glorious remnants of the past
era i s one way to survive a confusing transition period. In her Playboy
(Kelly, 1978) interview, Anita Bryant, a friend of Marabel Morgan,
told how frightened she was when she realized that she was under
great stress and needed psychological help. She finally went to a
religious retreat after having rejected the possibility of being helped
by a traditional psychiatrist.
So fear of the power and influence of the therapist over the client
i s not restricted to feminists wanting to be free of stereotypes, but
extends also to antifeminists who fear the prospect of change and its
responsibilities. In fact, keeping therapists objective and ethical has
been a prime goal of feminists in the psychotherapeutic professiorls.
The Task Force on Sex Bias commissioned by the American
Psychological Association (APA, 1975) collected data from women
psychologists in 1974 and derived a set of guidelines for therapy with
women (APA, 1978). Division 17 of the APA (1978) has just en-
dorsed a set of principles for counseling women. So identification of
the problem areas has been accomplished; but getting therapists to
abide by these guidelines will be an enormous task. No one identifies
him or herself as sexist. It is very difficult to examine one’s own
prejudices. It takes openness, sensitvity, and dedication to recognize
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ANNETTE M. BRODSKY

one’s flaws, to learn from them, and thus to modify one’s behavior. In a
survey Jean Holroyd and I conducted on erotic practices of licensed
psychologists (Holroyd & Brodsky, 1977), 5.6% (1 in 20) of the males
and .6% (1 in 200) of the females admitted to having sexual inter-
course with their opposite-sex clients. The general consensus of those
who engaged in such practices was that the incident was destructive
to either client, therapist, or both, but most of those who engaged in
the activity were repeaters.
This study at least provided some data on the prevalence of a
blatantly unethical act after a decade of feminist concern and atten-
tion to the practice. The victory, however, was only one battle in the
war. The reactions to the study included, “Oh, is that all, I thought the
rate would be much higher.” Playboy magazine treated it with a
comment under Sex News (1978) in a piece entitled ”Kiss my
Couch.” They noted that, ”It is as hard to find a good therapist these
days as it is to find a good masseuse.”
Like violence on TV, there is the danger that the public and
profession will become immune to the reports of sex in the therapy
hour. When the news no longer i s hot, who will continue to monitor
the behavior? Interest in rape victims has already passed its prime.
Rape centers are struggling for financial support which is now being
diverted to newly exposed abuses of children and battered wives and,
most recently, the elderly. We will need steady monitoring to assure
reasonable long-term attention to issues that present mental health
delivery problems past their hour in the spotlight.

A N ENCOURAGING WORD

In concluding, I think we can feel encouraged by the distance we

have traveled in the last decade. Certainly there are still incidents of
gross sexism and ignorance of women’s unique problems, and large
segments of the therapist population are unwilling to admit they may
have any biases, much less be educated on how to remediate them. It
only seems that we are losing ground every time we see a throwback
to the rampant sexism of the fifties and sixties. To appreciate our
progress one has to revisit some old issues of our psychotherapy
journals. In a 1967 issue on the sexual revolution (Voices, 1967),
under the title of “Women and Other Revolutionaries’’ (O’Donovan,
1967)’ an author shares with the reader his insights about the wom-
en’s movement.
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PSYCHOLOGY OF WOMEN QUARTERLY

Having obtained many rights, they are dissatisfied with not

having more.. . . Indeed there are definite advantages to their
present status. There is also some biological evidence supporting
their present status. They have not been trained for equal status
and responsibility. They seem naturally adapted to their less free,
less responsible, more serving role. They are in danger of losing
what makes them unique and lovable if they gain equal status.

On the preceding page of this issue is a cartoon of a female client

lying nude on the office couch, while the therapist at the open door
says to a colleague, “I tell you Fred, it’s a shame to cure her.” I think
our professional journals have improved, even though we may !;till
find much covert sexism. I do not have the fantasy that sexism can be
eliminated entirely, but I do feel that by the next decade today’s
seemingly more subtle sexist publications and offhand comments will
seem just as blatant to everyone as the 1967 issue of Voices seems
today.

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