Systems of Psychotherapy: A Transtheoretical Analysis

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Systems of PsychotherapyA Transtheoretical
Analysis
Chapter 12. Gender-Sensitive Therapies
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A Sketch of Sociopolitical Forces

• Modern psychotherapy created by White men in
  their own image and acc to their own values
• Gilligans In A Different Voice illuminated
  sexist bias in psychology
• Rise of feminism (commitment to equal social,
  economic, political rights for men and women)
  in the 60s and 70s
• Women denied equal rights and an equal voice in
  mental health care
• N single person responsible for feminist tx a
  collaborative effort

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Feminist Theory of Personality

• Identity is influenced by prevailing environment,
  including social learning and gender roles
• Gender roles and discrimination influence
  cognitive structures and behavior patterns
• Differences between gender due in part to women
  primarily raising children (Chodorow)
• Children bombarded with messages of gender
  expectations
• Gender roles deeply ingrained in personality

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Theory of Psychopathology

• Psychological distress is often environmentally
  induced and culturally determined
• Many disorders (e.g., self-destructive behs) are
  coping efforts in oppressive, inescapable
  environment
• Disorders caused by
• Sex-role stereotyping
• Gender-role expectations
• Role strain and conflict
• Sexual trauma
• Gender-related economics

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Role Strain Conflict

• Strain multiple demands of different roles
• Conflict clashing or conflicting roles
• Women subscribing to traditional sex role have
  higher incidence of depression anxiety as well
  as lower self-esteem
• Stress created by societys antagonism toward
  changing roles

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Sexual Trauma

• Major contributor to psychopathology
• Approx ¼ of American women have experienced
  childhood sexual abuse
• About 60 of rapes are acquaintance rapes only
  30 of rapes are reported
• Rage related to sexual abuse manifests itself in
  pathological symptoms

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Gender-Related Economics

• Women clustered in lower paying, lower status
  occupations
• Divorced women and their children constitute an
  increasing proportion of the poor
• Average woman worker with same education receives
  76 to a dollar for a man
• 40 to 90 of working women have been sexually
  harassed
• Professional women assigned to mommy track or
  hit the glass ceiling

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Feminist Theory of Therapeutic Processes

• Consciousness raising one's suffering due to
  gender restrictions discrimination
• Choosing can be achieved even within a
  patriarchic society
• Social liberation increasing alternatives for
  equality the personal is political

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Guidelines for Therapy with Women

• Therapist should
• Be free of gender-defined roles stereotypes
• Recognize reality and variety of sex
  discrimination and facilitate options for clients
• Be knowledgeable about current research
• Not use derogatory labels
• Not reinforce stereotypic dependency of women
• Respect the clients assertive behavior
• Recognize that abused or assaulted clients are
  victims of crimes
• Recognize the clients right to define sexual
  preference

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Therapeutic Relationship

• Characterized by 2 Es empowerment and
  egalitarianism
• Empowerment therapist helps instill power, both
  social and individual, in client
• Egalitarianism comparatively equal relationship
  between therapist client
• Tx goals are mutually generated

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A Major Alterative Male-Sensitive Psychotherapy

• Traditional therapy designed by men to treat
  primarily women
• Psychotherapy for men based on an accurate
  understanding of male personality development
• Men are negatively effected by gender role
  expectations and suffer from role stain (as do
  women)
• No sissy stuff avoid anything feminine
• The big wheel must be successful, respected,
  family breadwinners
• The sturdy oak exude confidence, strength,
  self-reliance
• Give em hell behave aggressively and daringly

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Gender-Role Expectations

• Men must achieve or exceed masculine standards or
  accept failure
• Men hide feelings behind façade of toughness,
  resistance, and violence
• Male problems (e.g., aggression) are often
  byproducts of typical socialization
• Men find it difficult to seek help seen as
  admission of weakness
• Men often genuinely unaware of their emotions
  (normative male alexithymia)

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Systems of PsychotherapyA Transtheoretical
Analysis
Chapter 13. Multicultural Therapies
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A Sketch of Multicultural Therapy

• Psychotherapy developed by upper-class, white
  heterosexuals in western Europe
• Therapy originally and erroneously envisioned as
  transcultural
• Traditional therapies are increasingly
  inappropriate for addressing the problems of
  minority and oppressed groups
• Changing demographics signal need for cultural
  awareness competence

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100 Person World Village

• 57 Asians
• 21 Europeans
• 14 from Western Hemisphere
• 8 Africans
• 70 non-white
• 70 non-Christian
• 50 of world wealth would be in hands of 6
  Americans

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Theory of Personality

• Culture is a major determinant of personality
• Culture is constellation of human knowledge,
  belief, behavior passed down from earlier
  generations
• No single theory of personality for multicultural
  tx we require multiple perspectives rooted in
  particular cultures

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Defining Race Ethnicity

• Race category of persons related by common
  heredity or ancestry and whose features are
  perceived in terms of external traits
• 2 meanings of race Social construct (1) a way
  of grouping people into categories by perceived
  physical attributes and ancestry (2) associated
  with power, status, and opportunity
• All people have multiple groups, and not all
  members have same characteristics
• Avoid the myth of uniformity (all members of a
  group will have the same characteristics)

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Theory of Psychopathology

• Expression manifestation of pathology are often
  culturally determined
• Psychopathology is behavior that predominant
  culture consensually deems unusual or maladaptive
• Etiology is mix of biology, culture, psychology
• Impact of race/ethnicity due less to biological
  vulnerability and more to social inequality

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Social Causes of Psychopathology

• Social, political, and economic inequality
• Stress resulting from prejudice and
  discrimination
• Internalized racism low self-esteem and
  self-hatred caused by discrimination
• Problems with acculturation
• Failure to be accepted by dominant culture

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Some Culture-Bound Disorders

• In Malayan culture, Amok sudden, wild homicidal
  aggression
• In Western cultures, Anorexia nervosa
  preoccupation with thinness and refusal to eat
• In Caribbean cultures, Ataques de nervios
  impulsivity, dissociation, anxiety
• In central American cultures, Susto loss of
  soul causing depression and somatic symptoms
• In Japanese culture, TKS intense fear of
  offending other people through social awkwardness
• In Algonquin Indians, Windigo anxious, agitated,
  convinced of bewitchment

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4 Stages of Psychotherapy with Minorities

• Reactive effectiveness and appropriateness of
  traditional tx questioned
• Inquisitive conducted research to see how
  minorities can benefit from psychotherapy
• Revisionist examined process variables of race,
  gender, and culture in psychotherapy
• Integrative comprehensively addresses daily
  reality of minorities

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Theory of Therapeutic Processes

• Consciousness raising understanding how culture
  has oppressed shaped self-views
• Catharsis expressing healthy anger recognizing
  that anger is normal justified
• Choosing channeling new-found liberation and
  pride

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Therapeutic Relationship

• Empathy, regard, collaboration are foundation
• Relationship can be challenging if therapist is
  of different race ethnicity
• Meaning of therapist varies by culture
• Racial/ethnic matching of therapist and patient
  may be preferred
• Therapist adapts to cultural preferences
• Therapist is advocate empowers client for social
  change

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A Major AlternativePsychotherapy with LGBT
Clients

• Lesbian, gay, bisexual, transgender (LGBT)
  clients are oppressed minority group
• Homophobic attitudes toward LGBT clients persist
• Reparative/sexual conversion therapy attempts to
  convert clients to heterosexual orientation
• Gay Affirmative Therapy celebrates and advocates
  for LGBT

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LGBT Tx Guidelines Attitudes

• Homosexuality is not indicative of mental illness
  
• Recognize how therapist attitudes may be relevant
  to tx seek consultation or make referrals
• Understand the ways social stigmatization poses
  mental health risks to LGBT clients
• Understand how inaccurate or prejudicial views
  may affect clients view

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LGBT Tx Guidelines Relationships Families

• Be knowledgeable about and respect the importance
  of LGBT relationships
• Understand the circumstances and challenges
  facing LGBT partners
• Recognize families of LGBT may include people not
  legally or biologically related
• Understand how same-sex orientation impacts on
  clients real with family of origin

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LGBT Tx Guidelines Issues of Diversity

• Recognize particular challenges experienced by
  bisexual individuals
• Understand special problems and risks of LGBT
  youth
• Consider generational differences within LGBT
• Recognize challenges experienced by LGBT with
  disabilities

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LGBT Tx Guidelines Education

• Support the provision of education training on
  LGBT issues
• Increase knowledge of homosexuality via
  education, supervision, consultation
• Familiarize self with mental health, educational,
  community resources for LGBT

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Effectiveness of Multicultural Therapies

• Conclusions of reviews on multicultural tx tend
  to reflect the race of the reviewer
• Many racial ethnic minorities are underserved
  in mental health
• Most minority clients prefer same-race
  therapists, but no consistent differences in
  outcome when so matched