Not only do women have to contend with overt forms of violence and control at the hands of men, they also have to contend with gender microaggressions on a daily basis - such as sexual objectification, assumptions of inferiority, assumptions of traditional gender roles, use of sexist language, denial of individual sexism, invisibility, denial of the reality of sexism, and environmental gender microaggressions (McSorley, 2020).
Women in general - and racialized women in particular - experience more social disadvantage than men, which is a mental health risk factor and which also impacts access to care (Straiton et al., 2016). Trans women may likely have experienced quotidian microaggressions and possibly violent discrimination as a result, both linked to depression, anxiety, and suicidality (Hughto et al., 2017; McSorley, 2020), while any female-coded client’s sexual orientation, and the world’s response to it, may play a big part in their well-being; 2LGBTQ+ people face heterosexism, violence, and discrimination again associated with mental and physical health problems (American Psychological Association, 2012) - lesbians and bisexual women face this in relation to both sexuality and gender, while the cumulative effects of heterosexism, sexism, and racism puts racialized 2LGTBTQ+ people at unique risk (American Psychological Association, 2012).
The literature suggests that all of these experiences have a profoundly negative impact on mental health outcomes, with women being 60% more likely to have anxiety and 80% more likely to have major depressive disorder as compared to men (McSorley, 2020), while the lifetime prevalence rate of Social Anxiety Disorder has been found to be 5.7% in women compared to 4.2% in men (Straiton et al., 2016; Graham-LoPresti et al., 2017). And yet, despite this, therapy itself continues to be contextualized within the dominant patriarchal culture that upholds narratives situating cis men as superior to cis women (McSorley, 2020). As a male practitioner, the absolute minimum I require of myself in order to be culturally competent while working with this demographic is to divest from such conceptualizations.
A list of gender microaggressions that women might experience during therapy includes: objectification, stereotypes about their psychological distress, assumptions about diagnoses, insensitive treatment suggestions, and neglect of gender issues (McSorley, 2020). Furthermore, interventions in which the practitioner uses manipulation, persuasion, and assimilation into the male-dominant society also shows a lack of knowledge of a female-coded client’s worldview and are thus flawed (Henderson-Daniel et al., 2004).
Holding all of this in mind is critical in my attempts to embody an anti-oppressive practice. How my identity as a male-coded individual affects others continues to be a priority for my inward gaze, and involves attentiveness to both my client’s and my own reactions, facilitated by an awareness of my own values, assumptions, and biases.
American Psychological Association (2012). Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients. American Psychologist, 67 (1), pp. 10–42. doi: 10.1037/a0024659
Graham-LoPresti, J. R., Gautier, S. W., Sorenson, S. & Hayes-Skelton, S. A. (2017). Culturally Sensitive Adaptations to Evidence-Based Cognitive Behavioral Treatment for Social Anxiety Disorder: A Case Paper. Cognitive and Behavioral Practice, 24, pp. 459-471
Henderson-Daniel, J., Roysircar, G., Abeles, N. & Boyd, C. (2004). Individual and Cultural-Diversity Competency: Focus on the Therapist. Journal of Clinical Psychology, 60 (7), pp. 755-770. DOI: 10.1002/jclp.20014
Hughto, J. M. W., Clark, K. A., Altice, F. L., Reisner, S. L., Kershaw, T. S. & Pachankis, J. E. (2017). Improving correctional healthcare providers' ability to care for transgender patients: Development and evaluation of a theory-driven cultural and clinical competence intervention. Social Science & Medicine, 195, pp. 159–169. http://dx.doi.org/10.1016/j.socscimed.2017.10.004
McSorley, K. (2020). Sexism and cisgenderism in music therapy spaces: An exploration of gender microaggressions experienced by music therapists. The Arts in Psychotherapy, 71, pp. 1-9. https://doi.org/10.1016/j.aip.2020.101707
Straiton, M., Powell, K., Reneflot, A. & Díaz, E. (2015). Managing Mental Health Problems Among Immigrant Women Attending Primary Health Care Services. Health Care For Women International, Vol. 36. 10.doi: 1080/07399332.2015.1077844.
Thoughts on Therapy and Mental Health