Sexism in family therapy: Does training in gender make a difference?
Leslie, Leigh A
The purpose of this study was to investigate the clinical decision making of marriage and family therapists who had no training in gender compared to those who had such training, either through a separate course or by having gender issues integrated throughout the curriculum. Specifically, levels of feminism and sexism in the clinical assumptions and interventions of therapists were evaluated using clinical vignettes. Participants for this study included 150 beginning or entry-level therapists from marriage and family therapy training programs in academic settings. Of the 102 participants with some training in gender issues, 64% reported having received gender training from a feminist perspective, Contrary to expectations, a multivariate analysis of variance revealed that training in gender issues alone did not significantly influence levels of feminism and sexism in clinical decision making. However, the levels of sexism in clinical interventions were significantly lower if therapists had received gender coursework from a feminist perspective, whether in a separate course or integrated throughout the curriculum. These findings raise a question as to the utility of teaching gender issues if what is taught and how it is taught are not also considered.
No observer of the field of family therapy in the last decade could escape the widespread call by feminists to rethink and revise our assumptions and models for working with families. Specifically, the call has been to recognize gender as a central organizing feature of family life and to challenge traditional ways of working which ignore, and therefore reinforce, gender-based power imbalances (Luepnitz, 1988. Along with the call to revise how gender is addressed in the way we work has come the call to incorporate gender as a critical substantive area in the training of family therapists (Avis, 1989; Weiner & Boss, 1985).
Studies of the content of family therapy training programs in the 1980s confirmed not only that it was rare for gender issues to be addressed systematically (Avis, 1989), but also that training directors arid supervisors did not see it as a particularly important content area to include in clinical training (Winkle, Piercy, & Hovestadt, 1981). In light of data such as these, the calls of feminists to address gender, and the recognition that all other major professional disciplines had established training and practice guidelines to ensure nonsexist practice (e.g., APA in 1975, Council of Social Work Education in 1982), the Commission on Accreditation for Marriage and Family Therapy Education and Training revised its Accreditation Manual in 1988 to require all AAMFT approved programs to offer coursework in gender issues relative to the practice of marriage and family therapy.
Although the incorporation of gender training in family therapy curricula was a major shift, the guidelines presented in the Manual on Accreditation (1991) do not actually spell out what the shift is to. It is noteworthy that only three content areas, sexuality, sexual functioning, and sexual identity, are specified as required material to be addressed in gender training. Given the extensive literature documenting how gender organizes all aspects of life for women and men, from communication patterns to division of labor to use of leisure time to physical safety, it is striking that sexuality would be so prominently emphasized as a major focus of gender training. Such guidelines do little to assist faculty in developing courses which convey a rich appreciation of the influence of gender in peoples’ lives.
In addition, the objective or goal of such a significant change in curriculum requirements was not clearly articulated. The accreditation guidelines state that “content in this area
should emphasize sexism and gender role stereotyping” (Manual on Accreditation, 1991, p.15), implying that training in gender is intended to reduce sexism in clinical practice. However, as Jacobson (1983) points out, gender biases are largely unconscious and accepted as “reality” instead of as the sexist beliefs that they actually are. Thus, these biases are deeply entrenched and highly resistant to change. It is not difficult to imagine that without some attention to what is to be taught, a mandate to incorporate coursework on gender may simply reinforce the teaching of stereotypes of “how men and women are.” Thus, it is possible that, although well-intended, the guidelines may do little to change what is taught in clinical training.
In questioning what is taught in gender coursework, the theoretical orientation on which the course or material is based seems important. The Manual on Accreditation states that gender issues should be addressed “within a theoretical-clinical context” (p. 15), but the nature of that “theoretical-clinical context” is unspecified. When gender is taught from a feminist perspective, there are fairly clear guidelines on what material should be included (see Avis, 1989; Leslie & Clossick, 1992). Stated concisely, gender taught from a feminist perspective would address the social construction of gender and the interplay of gender and power in families. If gender is not taught from a feminist perspective, however, there are no clear guidelines on the material to be presented. The literature is replete with examples of the stereotyping or misuse of gender found in many theoretical-clinical orientations in the family therapy field (Luepnitz, 1988; Walsh & Scheinkman, 1989).
An additional question raised by the new curriculum requirement is how the material should be offered. The choice of format may have implications for the impact of the material. The guidelines allow gender issues to be integrated throughout the coursework or taught in a separate course (or a combined course with ethnicity), yet an important question remains unanswered. If the goal is to develop gender sensitive, nonsexist therapists, is this best achieved by a course on gender issues or by integrating gender throughout the curriculum? This question of pedagogy has been widely discussed in academia relative to women’s studies and African-American studies (e.g., Bowles & Klein, 1983; Goodstein & Gyant, 1990), and the arguments are relevant to the question of gender training for family therapists. Although a specific course insures that the material is presented, it may also contribute to the material being divorced from other substantive areas in the field (Avis, 1989; Leslie & Clossick, 1992). Furthermore, unless this course is required, students can complete their training without systematically addressing gender issues in families. On the other hand, integration is difficult to monitor, sometimes beyond the expertise of all faculty, and often leads to a “diluted and sanitized” version of the material (Schmitz, 1983, p.17).
As the field of family therapy attempts to address the issue of gender in an informed and comprehensive manner, more information is needed about the impact of gender training on clinical practice. it has en assumed that requiring gender training decreases sexism in clinical practice. However, the validity of this assumption needs to be examined, as does the. impact of the theoretical underpinnings of the material and the format in which it is offered. It is the purpose of the present study to begin to provide answers to some of these questions. In particular, the following questions will be addressed: (a) What impact does gender coursework have on clinical decision making? and (b) Are there differences in effects based on what is taught and how it is taught? Differences in clinical decision making will be examined based on whether or not the material was taught from a feminist perspective and whether or not it was taught in a separate course or integrated throughout the curriculum.
Participants for this study were 150 entry-level marriage and family therapists or marriage and family therapy students. Forty-seven of the participants (31%) were currently enrolled in marriage and family therapy programs In academic institutions; 153 (69%) had completed their clinical training in an academic program in marriage and family therapy within the last 5 years. The participants were from 48 different training programs in the United States and Canada. One hundred and twenty-six (84%) were from AAMFT accredited academic programs, and 22 (14.7%) were from nonaccredited programs. Two participants did not identify their training program as accredited or nonaccredited.
There were 48 males (32%), 101 females (67.3%), and 1 person who did not identify his/her sex. Participants ranged in age from 21 to 64 years, with a mean of 38.6 and a mode of 29 (SD = 8.76).
Three separate procedures were used to identify therapists for participation in this study. The first two involved a general mailing to 500 Student and Associate members of AAMFT, identified through a computerized printout of all AAMFT Student and Associate members. First, in order to identify students receiving their training specifically from marriage and family therapy academic training programs, AAMFT members with zip codes matching the first three digits of the zip code of an AAMFT accredited academic training program were targeted as potential participants. This procedure identified 702 members; of these, every other name was selected, resulting in 351 potential participants. Since the total number of participants identified was less than 500, every 25th name still on the list was selected until a total of 500 subjects was obtained.
Since few marriage and family programs have separate courses in gender, it was likely that the previous methods would not provide a large enough sample of therapists who had taken a separate course in gender issues in family therapy. Thus, we contacted faculty in marriage and family therapy training programs in the United States and Canada who were known to have taught a course in gender and who were willing to provide the names and addresses of students and entry-level therapists who had received such training. Five faculty provided names and addresses of 62 therapists. Three of the these names had already been randomly selected from the AAMFT mailing list, so the final list included 559 individuals.
These individuals first received a letter requesting their participation in a study on clinical decision making and a postage-paid return postcard. The postcards indicated the kind of training they had received and their level of interest in participating in the study. Two hundred ninety five of the 559 postcards were completed and returned. Interested respondents who were currently enrolled in or had received their training within the last 5 years from a marriage and family therapy program in an academic institution (n = 193) were then mailed a consent form, the instrument on clinical decision making, and a questionnaire regarding the participant’s training. Of the 152 questionnaires returned, 2 were not usable because training had occurred more than 5 years ago. Thus, the final sample consisted of 150 completed surveys.
Independent variables. Two independent variables were identified. The first was the type of gender training the participants had received in their MFT program. The second was whether or not gender coursework was taught from a feminist perspective.
In order to assess the first variable, participants were asked, “Which most accurately describes how the topic of gender was addressed in your training in marriage and family therapy?” Response options were: (a) “I took a course in gender issues in family therapy (or a course with gender as a major focus, such as gender and ethnicity issues in family therapy),” (b) “Training in gender issues was integrated throughout the coursework in my family therapy training program,” or (c) “I received no specific training in gender issues in my family therapy program.”
Of the 150 participants, 102 (68%) had received gender training and 48 (32) had no training in gender. Of those receiving gender training, 33 (22%) had a separate course in gender as pan. of their clinical training and 69 (46%) had gender integrated throughout the curriculum. Given the modest number of training programs offering separate gender courses, it was anticipated that there would be fewer participants in the first group.
In order to assess the second variable, participants who indicated that they had received training in gender issues were asked, “If you received training in gender issues either in a separate course or integrated throughout coursework, was it taught from a feminist perspective? Response options were: “Yes,” “No,” and “Uncertain.”
Of the 102 participants who received training in gender, 65 (64%) received gender training from a feminist perspective; 23 (23%) received gender coursework, but not from a feminist perspective. Fourteen respondents (14%) were not certain whether the training they received was taught from a feminist perspective or not. For purposes of analysis, this last group was not assumed to have received training from a feminist perspective. This decision was based on the assumption that an instructor teaching from a feminist perspective would be likely to identify the foundations of the course as feminist (Allen, 1988; Leslie & Clossick, 1992)
Dependent variables. The degree of sexism and feminism in the assumptions and interventions participants reported they would likely use in clinical practice were assessed. In order to assess clinical decision making, we developed an instrument which included three family therapy vignettes. The feminist clinical case literature (e.g., Goodrich, Rampage, Ellman, & Halstead, 1988; Walters, Carter, Papp, & Silverstein, 1989) was reviewed to identify common situations in which gender is inadequately attended to by therapists. Three problems frequently identified in feminist writings as being widespread in family therapy are: (a) attributing children’s problems to mothers’ “overinvolvement” (Holten, 1990), (b) treating men and women as “equals” with the same options and choices in a relationship (Hare-Mustin, 1991), and (c) assuming that the roles of wife and mother will be fulfilling to all women (Carter, 1991). The three vignettes developed to represent each of these problems can be found in the Appendix.
These vignettes were then given to nine marriage and family therapists representing a variety of therapeutic orientations who had been employed full-time in either practice or teaching and supervision for a minimum of 5 years. Each of these therapists was informed that the researchers were beginning work on clinical decision making and the therapists were requested to use their “clinical expertise” to “generate response options” for each of the vignettes in two ways. First, they were asked to identify clinical assumptions they would make for each case, that is, how “you perceive the situation” or “the working hypotheses you would begin treatment with given the information you have.” These therapists were then asked to identify “issues to be addressed or interventions you would be likely to use during the course of therapy in each case.” Additional feminist assumptions and interventions were developed by the researchers based on literature addressing the application of feminist principles in family therapy (e.g., Braverman, 1988; Ellman, Rampage, & Goodrich, 1989; Goodrich, 1991).
For each of the vignettes, a list was compiled of the assumptions and interventions identified by the nine family therapists. Although some of the responses were reworded or combined because of overlap, an attempt was made to include all but duplicated assumptions and interventions in order to avoid dropping items arbitrarily. Following these revisions, 37 assumptions and 52 interventions remained on the instrument.
In order to determine the extent to which the assumptions and interventions were feminist, neutral, or sexist, the instrument (three vignettes and all assumptions and interventions) was sent to eight experts in feminist family therapy. Criteria identified by Avis (1986) for identifying participants who are knowledgeable in both family therapy and feminist/ gender theory were used to identify experts. Criteria included:
1. Have published at least one article or chapter in gender issues in family therapy or in feminism and family therapy.
2. Have made at least one national conference presentation on this topic.
3. Have at least 5 years of clinical experience in family therapy, with at least 1 year spent in integrating feminist or gender-sensitive ideas into their work.
4. Have at least 3 years experience teaching and/or supervising family therapy, with at least 1 year spent in integrating feminist or gender-sensitive ideas into their teaching and/or supervising.
5. Possess a degree in a mental health discipline (pp. 56-57).
Each expert for this study met at least four of the five criteria. Each was informed that the assumptions and interventions were generated by nine experienced clinicians who had participated in the first part of the research. The feminist therapists were then informed that the researchers needed to identify those items which “experts agree represent a feminist perspective.” Each was asked to indicate whether each assumption and intervention was feminist in nature, sexist in nature, or neutral. The term neutral was defined as follows:
it is an assumption/intervention that might be used by a wide spectrum of therapists and is not indicative of either feminist or sexist principles….Your response to some items might be that it could be feminist or sexist depending on how a particular therapist used it. In those cases…try to determine if the assumption/ intervention, as stated in this context, represents feminist or sexist principles. If this cannot be determined, the appropriate rating…would be “neutral.”
Six of the eight experts in feminist family therapy returned the instrument with their feedback. The decision formula for retaining items was as follows:
1. Feminist. To be retained as a feminist assumption or intervention, 80% of the expert respondents had to identify the item as feminist. In other words, all respondents with the exception of one had to agree that an item was feminist in order for it to be retained on the instrument. In addition, the individual not identifying the item as feminist had to label it as neutral; that is, no item was retained as feminist if even one respondent identified it as sexist.
2. Neutral. To be retained as a neutral assumption or intervention, at least 67% of the expert respondents had to identify the item as neutral. That is, at least four of the six respondents had to agree that an item was neutral in order for it to be retained.
3. Sexist. To be retained as a sexist assumption or intervention, at least 67% of the expert respondents had to identify an item as sexist. That is, four of the six respondents had to agree that the item was sexist. No item was retained as sexist if even one respondent identified it as feminist.
It should be noted that a more rigorous standard was established for identifying feminist items than neutral or sexist items. Because the application of the feminist perspective to family therapy is still in its early stages, discrepancies exist even among feminist scholars regarding the application of feminist principles to family therapy. Avis (1986) reports that the greatest discrepancy of opinion about what constitutes feminist family therapy occurs as a consequence of the theoretical orientation of the therapist. Consequently, the feminist items which remained on the instrument were those which generated the highest level of agreement among feminist family therapists, regardless of theoretical orientation.
This second stage of instrument development resulted in the deletion of 32 items, leaving a total of 24 assumptions and 33 interventions. The final instrument contained 57 items: 10 sexist, 26 neutral, and 21 feminist. Examples of the feminist, neutral, and sexist assumptions and interventions for each vignette can be found in the Appendix.
Each participant was given four scores: a feminist assumptions score, a sexist assumptions score, a feminist interventions score, and a sexist interventions score. These scores were computed as follows. For each set of clinical assumptions, participants were asked, “How likely is it that you would make each of the following CLINICAL ASSUMPTIONS about the case presented in Vignette 1 (2 or 3)?” For each set of clinical interventions, participants were asked, “How likely is it that you would make each of the following CLINICAL INTERVENTIONS about the case presented in Vignette 1, (2 or 3)?” A score of 1 through 5 was assigned to each item on the instrument, using a Likert scale, where 1 indicated very unlikely to make this assumption (use this intervention) and 5 indicated very likely to make this assumptions (use this intervention). For each participant a total score was assigned for all of the feminist assumption items and the feminist intervention items according to the Likert scores. Sexist scores were tallied in the same fashion.
Before conducting the primary analyses, it was important to test for the independence of sexist and feminist assumptions and interventions. A provocative theoretical point made by many feminists is that if you are not challenging the status quo, you are supporting it. In a patriarchal society such as ours, the status quo is that men’s experiences and perspectives dominate and women’s ways of knowing or experiencing are less valued. Gender, as an organizing principle of life, is often ignored. Thus, the argument has been made that if addressing how gender constructs a family’s life is not a major dimension of one’s therapy, the therapy supports the patriarchal norm. We wanted to see if there was a psychometric equivalent of this argument; that is, are therapists who do not use feminist assumptions and interventions using sexist assumptions and interventions? Put in more direct psychometric terms, would an individual’s score on feminist assumptions/interventions predict a sexist assumptions/interventions score in the opposite direction?
In order to examine this question, correlations were computed between sexist variables and feminist variables for each of the three types of gender coursework groups. Correlations were run separately for each of the three groups (those having a separate course in gender, gender integrated throughout the curriculum, and no gender coursework) because it was expected that the relationship between sexist and feminist variables would be influenced by the type of training one had received.
No significant correlations were found between sexist and feminist variables for participants who had had a separate course in gender issues. Three of the four correlations were significant for participants who had had gender integrated throughout the curriculum. For those participants who had not had gender in their coursework, two of the four correlations were significant. All significant correlations were moderate, ranging from r= .39, p
Multivariate analysis of variance was used to examine the questions of interest in this study. The MANOVA technique was used to control for overall error. Each dependent variable was not tested independently. Instead, the significance of the independent variable (e.g., type of course) on a group of dependent variables was tested.
It appears that gender training has no significant effect on feminist or sexist assumptions and interventions in clinical decision making, F(8, 280) = 1.14, p = .34. That is, no significant differences were found in levels of feminism and sexism in clinical decision making among participants based on whether they had a separate course in gender, gender integrated throughout the curriculum, or no training in gender at all.
This same multivariate analysis, however, indicated a significant effect of gender of participant, F(4, 139)= 2.73, p
A second MANOVA was run to examine the effects of gender training taught from a feminist perspective, whether in a separate course or integrated. Participants who had no training in gender issues were dropped from these analyses. Results indicated a significant effect for type of gender training, F(4, 96) = 3.46, p
It is interesting to note that those taking a separate course in gender were more likely to have gender training from a feminist perspective than those having gender integrated throughout the curriculum, t(98) = 2.17, p
DISCUSSION AND CONCLUSIONS
Research, like teaching and therapy, is a political act. It is not done in a neutral, value-free vacuum. This study, like all others, reflects the values of the researchers. We undertook this study because we Here concerned about the lack of follow-up in the field to assess the effects of the required training in gender. Although much has been made of the significance of adding the requirements, we were concerned that the impact might be more symbolic than real. Thus, this study was designed as an initial investigation of the impact of training in gender on levels of feminism and sexism in the clinical decision making of marriage and family therapists. The results have implications not only for how marriage and family therapy is conducted, but also for the training of marriage and family therapists.
Prior to considering those implications, however, the limitations of the study must be acknowledged. First, respondents did not describe their gender training in their own terms but were presented with forced choice categories which were rather broad, particularly the category “gender was integrated throughout the curriculum.” Responding positively to this description could have indicated that a given participant was sensitive to gender issues, that there were items on several course syllabi relating to gender issues in families, or that a participant perceived gender as “naturally” integrated into coursework because it is a “natural” component of families, even if not overtly addressed. Furthermore, there was not a category for those who had gender training taught separately and integrated. Future work in this area should be structured to allow respondents to report fully the kind and amount of training they have received in gender.
Second, although participants were asked whether or not they received their training from a feminist perspective, “feminist perspective” was not defined. Consequently, respondents could have interpreted this to mean a variety of things. For example, someone unfamiliar with feminist theory may have assumed that if the course was taught by a female, it must have been taught from a feminist perspective. It was assumed, however, that those teaching from a feminist perspective would identify themselves as doing so (e.g., Allen, 1988; Leslie & Clossick, 1992; MacDermid, Jurich, Myers-Walls, & Pelo, 1992). Since the results indicated a significant effect of receiving gender coursework from a feminist perspective, it seems likely that there was accurate recognition of the theoretical foundation of the classes. It is important to note that the recognition that a course is taught from a feminist perspective still does not identify the exact content of the class; it merely defines the orientation toward gender.
In a similar vein, every attempt was made to ensure that the feminist items on the instrument were those for which there was most agreement from a feminist perspective, regardless of clinical model. However, it must be acknowledged that there is not uniform agreement on what constitutes a feminist perspective of therapy. This is a result, in part, of the attempt to integrate feminism into different models of family therapy and the fact that there are different types of theoretical feminism (e.g., liberal, marxist, radical). The fact that the experts sometimes disagreed demonstrates the difficulty in defining a feminist perspective when specifically identifying assumptions and interventions in clinical decision making. This disagreement further demonstrates the importance of context. Unfortunately, vignettes, no matter how well-developed, cannot fully capture context. In conclusion, the feminist perspective of family therapy is still developing and, consequently, there is not consistent agreement about what specifically constitutes a feminist perspective. However, for purposes of this study, every effort was made to include only those items for which there was most agreement among experts on feminist family therapy.
The sample may have been an additional limitation. As with all survey research, it is difficult to ascertain the representativeness of those who chose to respond. Although approximately 35% of those receiving requests to participate both responded affirmatively and met the criteria, the final response rate was approximately 27%. It may be noteworthy that the actual response rate can not be determined because although 559 letters were sent out, not all letters reached their intended addressee. Many of the addresses on the mailing list were no longer valid, and numerous letters were returned as addressee unknown. It also seems se to assume that additional letters never found the addressee but were never returned to the researchers. However, it seems appropriate to use 27% as the best possible estimate of the response rate. Although this is an acceptable response rate for a mailed questionnaire, it is possible that those responding differed systematically in some way from those who did not. For example, those responding may simply have had more time, may have been more interested in research, or may have been more intrigued by the question of how clinical decisions are made. However, given the structure of the questionnaire (i.e., vignettes were presented prior to any questions about training in gender), it seems safe to assume that respondents’ interest in the topic of gender was not a motivating factor in return of the questionnaire.
Finally, as with all clinical research utilizing vignettes, we must allow for the possibility that what respondents say they will do is not a completely accurate representation of their behavior as clinicians. Forced-choice responses such as these cannot capture the creativity of clinicians as they attempt to be both helpful to and respectful of their clients. To determine more fully how training in gender affects clinical decision making, we must ultimately hear from clinicians about their struggles to address gender and observe them in their work. Given that the empirical method chosen will constrain what can be known from any particular study, it is important to understand why we chose the method we did.
As stated previously, we wanted to provide empirical follow-up on the effectiveness of AAMFT’s requirement that training be provided in gender. We knew that calling into question the usefulness of current requirements on gender training would be controversial and might be met with resistance from many quarters. In an effort to reduce resistance we chose to utilize the empirical method which is accepted by the broadest spectrum of MFT trainers and researchers.
Harding (1986), Riger (1992), and a host of others have identified three stances toward methodology which feminist researchers can take. The first, feminist empiricism, maintains that the bias found in knowledge is not inherent in the scientific process. This approach utilizes traditional positivistic methods but replaces androcentric values with an appreciation of the perspective of women and an attempt to challenge the status quo. Second, feminist standpoint methodologies acknowledge the subjectiveness of truth. This approach utilizes qualitative methods to allow respondents to describe their own experiences based on their social location. Third, feminist postmodernism is based on the assumption that science does not reflect reality, but creates it. Thus, the deconstruction of current knowledge and an evolving reconstruction of knowledge with women in the center of the analysis is the intent of feminist postmodernist methods. Although feminist writings of the 70s and early 80s argued strongly for the virtues of the qualitative, standpoint methodologies, there has been widespread recognition in recent years that any methodology can be sexist, and any methodology can be used to further the feminist agenda (e.g., Reinharz, 1992; Stacey, 1988). A more complete knowledge comes from the integration of all available methods (Peplau & Conrad, 1989).
Thus, for this initial study of the effects of gender training we chose feminist empiricist methods in order to make the findings accessible to the largest number of researchers in the field. These findings are, of course, incomplete; a more complete knowledge will be developed only when additional work is done from both a standpoint and a postmodernist perspective.
Returning to the implications of this study, no significant differences were found in levels of feminism and sexism in clinical decision making among participants based only on whether they had coursework in gender. This is a case of a nonsignificant result being potentially quite meaningful. The major curriculum shift instituted by the AAMFT Commission on Accreditation requiring marriage and family therapy training programs to address gender was intended, we assume, to affect clinical practice. What these data suggest is that such training does not reduce sexism, at least as measured by the items in this study. It is possible that the lack of difference based solely on gender training reflects the diversity in how gender is currently being addressed in marriage and family therapy coursework. That is, the effects of teaching gender issues may be inconsistent or neutral because the courses vary so much in content and approach.
The results are even more complex when type of training is taken into consideration. Those receiving gender training from a feminist perspective were more likely to make feminist assumptions, although gender training from a feminist perspective did not affect their reported likelihood of using feminist interventions. This finding is consistent with Avis’s (1989) suggestion that attitudes, beliefs, and values about gender are fundamental to beliefs about ourselves, our relationships, and the world. Introducing feminist consciousness necessitates rethinking these fundamental beliefs and challenges us to reorganize and reconceptualize all that we thought we previously knew. Incorporating feminism into therapy first requires a conceptual shift, but then a great deal of additional effort and experience is needed to incorporate this shift effectively into interventions. Therefore, it is not surprising that students and beginning therapists with feminist training had incorporated feminist assumptions but had not yet fully integrated feminism into specific interventions.
Training from a feminist perspective also had an impact on sexism. Those who received feminist gender training were significantly less likely to use sexist interventions, but such training did not affect reported sexist assumptions. Perhaps it is easier for therapists to learn what “not to do” than what “to do” as they are sensitized to gender issues from a feminist perspective. As Avis (1989) suggests, we are all sexist and racist to a certain degree, given the cultures in which we have grown up. Through awareness, therapists may be better informed about what constitutes sexist behaviors and interactions, and consequently, about what “not to do.” It is more difficult to erase underlying sexist assumptions, however, since they pervade every aspect of our lives.
Although the data do seem to make a rather strong point about the relevance of theoretical orientation in teaching gender in ways that reduce sexist practice, they are not as clear on the question of whether it is better to teach gender in a separate course or integrated throughout the curriculum. No differences in feminist and sexist practice were found based on whether gender was taught separately or integrated. However, having gender taught from a feminist perspective did make a difference and such an orientation was more likely to be found in a separate course. Thus, drawing conclusions would require rather circuitous reasoning. We think it better to say that at this point the question of course structure definitely merits more attention, and the advantages and disadvantages of each approach should be further evaluated.
An interesting point to note, however, is that men made up approximately one third of this sample and one third of the participants receiving training in gender. Yet of the 32 participants who had a separate course in gender, only 4 (12.5%) were men, suggesting that when a separate course in gender is available, women are more likely than men to enroll. Hence any discussions of whether gender should be taught in a separate course or integrated throughout the curriculum will need to consider the question of whether the separate course is required. If not, gender biases may occur in patterns of enrollment. One solution would be both to offer a separate course on gender and to address gender issues throughout the material on other substantive areas (e.g., violence, substance abuse, sexuality).
This study is an initial effort to examine the impact of training in gender issues on the practice of family therapy. Despite its limitations, this study offers preliminary evidence that the desired outcome of reducing sexism in clinical practice may not occur simply by “adding gender and stirring.” Talking about gender in the classroom and in the supervision room is an important first step, but we also need to attend to what is taught and how it is taught. Those interested in decreasing sexism in marriage and family therapy, in particular the AAMFT Commission on Accreditation, need to consider not only whether or not training in gender is provided but also the content and the theoretical orientation of the training. This, of course, raises the controversial issue of whether an accrediting body should be authorized to dictate how material is taught. If additional research supports our initial findings that simply addressing gender has no impact on sexism in clinical practice, it seems that those with the responsibility for setting training guidelines must face this issue. If the field of family therapy is dedicated to reducing sexism, as well as racism, in practice, it may be naive to think that adding content areas alone (i.e., gender and race) will be sufficient. This study questions whether the training guidelines are really doing enough. And perhaps even more importantly, it points out the pressing need for further research to assess the impact of training. If curriculum requirements were changed because of a real concern about the level of sexism in clinical practice, we as a field must focus on assessing whether adding gender coursework has brought about the desired results. If not, additional action may be needed. Only when those elements of training which are critical to reducing sexism and racism are identified can informed decisions about training guidelines be made. The outcome, hopefully, will be to make family therapy a nonoppressive experience for all.
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Martha and Allen are both 27; they have been married 9 years. They were high school sweethearts and married shortly after graduation. They have two children: Tiffany, 7, and Andrew, 4. Allen works as an electrician and Martha is employed part-time as a receptionist in a dentist’s office. Martha has contacted you about therapy for her “depression.” She states that during the last 2 years she has had numerous periods when she feels “unhappy and sad and nothing seems to help.” She is very concerned that during these times she is not being a good mother since she alternates between not paying much attention to the children and being very angry at them. Both she and Allen come to the first session. He states that he is certainly willing to be involved if it helps Martha. He expresses his own confusion and frustration at seeing his once “fun-loving and happy” wife become increasingly withdrawn and “moody.” He states that “nothing I do seems to please her anymore.” One year ago when the oldest child started school, Allen suggested that Martha go back to work part-time thinking that it would “lift her spirits.” Although she admits she has enjoyed being employed, the job is starting to get monotonous. She does not plan to leave, however, because the hours are excellent and allow her to be home in the afternoon with the children. She states that she feels “so guilty” about not being happy because she has a “wonderful husband who is very supportive and two great kids.”
Sample Clinical Assumptions:
* There is some type of stress occurring in Martha’s family of origin. (Neutral)
* Martha’s belief that caretaking should be enough to make her happy contributes to her depression. (Feminist)
* Martha uses her depression to get attention from Allen and keep him involved in family and household activities. (Sexist)
Sample Clinical Interventions:
* Assign the couple activities or “dates” to get them spending more time alone and having fun together. (Neutral)
* Develop Martha’s assertiveness skills and evaluate with the couple the impact of her increased assertiveness on couple interaction and marital satisfaction. (Feminist)
* Reframe Martha’s depression as her attempt to get Allen more involved with the family. (Sexist)
Charlotte and Bob are in their late 40s and have three children: Deborah, 22; Michael, 19; and Robin, 16. Bob is a successful attorney and partner in a prestigious law firm. Charlotte has been a full-time housewife and mother since the children were born and is very active in volunteer community service and church activities. Deborah has just graduated from college and is starting law school. Michael is a sophomore in college majoring in finance. Robin is a junior in high school and lives at home. Charlotte has contacted you concerning family therapy because of the problems they are having with Robin. Formerly an A and B student in honors classes, in the last year Robin has fallen to a C and D student and is beginning to get in trouble with the law. She has been picked up twice for shoplifting, and the school has notified the parents that she has missed 17 days of school in the last semester. Due to Bob’s efforts, Robin has not been charged when apprehended but has been turned over to her parents. He has announced, however, that he is “finished rescuing her and she will just have to live with the consequences of what she does.” Charlotte says that Bob’s approach may be the wisest thing to do, but “I can’t just turn my back on a child of mine.” However, she does report being “at my wit’s end about what to do with Robin.” She states that both she and her older daughter, who is quite close to Robin, are willing to come in with Robin. Michael is too far away to participate, and she is doubtful whether Bob will come. At the first session, however, mother, father, and the two daughters are present. Charlotte and Deborah provide most of the information with Bob frequently nodding in agreement. Robin stares at the wall and says only that “therapy won’t help, nothing will help until I can get out of their stupid house with their stupid rules.” Family relationships are described as having been “pretty close with the normal share of disagreements.” All agree that the most conflictual relationship in the family has always been Charlotte and Robin, with arguments ranging from curfews to style of dress to choice of friends. In the last 2 years these arguments have become more frequent and intense. Charlotte now states, “No matter what I do, I can’t reach Robin; she is out of control.”
Sample Clinical Assumptions
* Bob and Charlotte have led fairly separate lives and may have little to hold them together except a child that needs attention. (Neutral)
* The mother-daughter relationship is inherently conflictual because of the incompatible demands of raising a daughter to be a good wife and mother (i.e., affiliative and interpersonal) and a successful adult (i.e., autonomy and achievement). (Feminist)
* Charlotte is too dependent on her relationship with her children and her caretaking role; this makes it difficult for Robin to individuate and separate from the family. (Sexist)
Sample Clinical Interventions:
* Find out what Robin means by “stupid rules.” Have her identify rules that would not be “stupid” and what she thinks are appropriate consequences for breaking them. (Neutral)
* Reframe Robin’s behavior as communicating her desire for Mom to be strong in her own right. (Feminist)
* Request that the family keep things the way they are a while longer and use the time to note more clearly how they interact around Robin’s behavior problems. (Sexist)
Angela is 34, Ted is 37; they have been married 8 years. She is an account executive with a major advertising firm, he is an electrical engineer and works for an architectural consulting firm. Each earns between $45,000 and $55,000 annually. They have been in agreement both before and during their marriage that they did not want children. However, neither ever chose to be sterilized, and instead Angela has used oral contraceptives throughout their relationship. Angela has become pregnant, and they have come to you seeking professional help in making a decision about what they want to do. Angela still feels very strongly that she does not want children, and she wants to have an abortion. Ted, however, is questioning their earlier decision now that Angela is pregnant. Although he still supports their previous decision “if I look at it rationally,” he explains that he feels an excitement about the prospect of a child that he “can’t quite explain or understand.” It is he who has suggested that they come to therapy to reconsider their choice of childlessness. Angela has agreed, believing that whatever they do should be a joint decision. Each acknowledges that they could be good parents and that in fact they enjoy their friends’ children. Yet they had both always envisioned a fairly independent and spontaneous lifestyle that they thought would not be conducive to having children. Angela also expresses her fear that no matter how well-intentioned Ted is, the bulk of the responsibility for raising a child will fall on her. Ted maintains they will be equally responsible and is “a little hurt” that Angela thinks otherwise. Although she believes she will be most affected by this decision, Angela would find it difficult to have an abortion without Ted’s agreement and support.
Sample Clinical Assumptions:
* Revising lifelong decisions in the face of a crisis is ill-advised. (Neutral)
* Angela would most likely lose power in her marital relationship if they have a child. (Feminist)
* No Sexist assumption was given for this vignette.
Sample Clinical Interventions:
* Explore each partner’s idea of what life with a child would be like, pro and con. (Neutral)
* Help couple identify the short- and long-term economic impact of having a child on each of them individually and as a couple. (Feminist)
* Reframe Ted’s new desire to have a child as an extension of his love for Angela. (Sexist)
Leigh A. Leslie, PhD, is an Associate Professor, Department of Family Studies, University of Maryland at College Park, College Park, MD 20742.
Michelle L. Clossick, MS, is Director, Centre County Women’s Resource Center, State College, PA.
The authors would like to thank Dr. Kenneth Hardy for his helpful comments on an earlier version of this paper.
Copyright American Association for Marriage and Family Therapy Apr 1996
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