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Section 20
Therapist Gender Issues, Abuse, & Boundaries

Question 20 | Test | Table of Contents

Clients who have been abused will unconsciously project their past experience onto the present; in many cases, their relationship with the abuser, or some aspects of it, will be projected onto the therapist. These projections, or transferences, need to be decoded and understood in order for the client to become aware of his unconscious patterns. The therapist's gender, as well as the therapist's personal behavior or characteristics, can be responsible for eliciting transferential projections. Gender-focused transference will have unique aspects for each client, depending on his perpetrator's gender, his own sexual orientation, and idiosyncratic aspects of the abuse experience.

There is some debate in the treatment community about the importance of the gender of the therapist who treats male survivors. Some say that men who have been abused by a male must be treated by other men in order to restore a healthy sense of masculinity; others, and I am one, believe that the gender of the therapist is a relatively minor issue compared to his or her competence.

Therapists who believe male survivors are best served by male clinicians put forward arguments based in social learning theory and gender politics. They believe that men who have been injured by other men need to heal from these injuries by receiving nurturance and skillful assistance from a male clinician. An implicit message of male support is present when a male client works with a male therapist, and the male therapist is a role model for appropriate, nonabusive male caring. A male clinician has a similar set of cultural gender experiences to inform his work with male clients, and this makes him a more appropriate helping agent than a female clinician. When a male client works through his issues about his sexual vulnerability or his discomfort with his gender identity with a male clinician, these issues can, according to this position, be more deeply resolved than they would be if the therapist were female. (Female clinicians who work with female survivors have used almost identical arguments to support a female client/female therapist model of treatment.)

In some cases, practical rather than theoretical reasons are given to support the position that male clients are better served by male therapists. Since many males, including male survivors, have internalized misogynist, or sexist, cultural beliefs, it is proposed that men enter the therapeutic process more easily when they can engage with another man. According to these views, a woman therapist will not have the same credibility in the client's eyes, and clients will either dismiss the therapy process as "feminine" or attempt to turn it into a social event. Some suggest that adolescent clients are too embarrassed to discuss their sexuality or sexual abuse with a female therapist and that such clients are better served by male clinicians.

Clinicians who believe that the therapist's gender is an irrelevant or minor variable in the healing process tend to use humanist arguments to endorse their practices. Their position is based on the belief that the safety, respect, empathy, integrity, openness, competence, and experience that a therapist brings to his or her work are more important than his or her gender. For these clinicians, everything a client presents is grist for the mill of therapy. When a client's transference is elicited by a clinician, male or female, the transference provides good therapeutic material to work with.

In group therapy, members of this school of thought use a mixed gender leadership team because they believe that such a team has the added benefit of modelling appropriate male/female relationship and that both leaders can provide nurturing, respectful support irrespective of their gender.

There is a range of opinion about the importance of the respective genders of the therapist and the client amongst the contributors to this study. Some firmly believe that although the therapeutic process may initially be slower, a survivor who was abused by a male will ultimately be better served if therapy is provided by a male clinician. Others are adamant that gender issues are political rather than therapeutic; their overriding concern is that clients receive good therapy.

All theoretical considerations aside, decisions about which clients receive therapy from which clinicians often reflect administrative rather than therapeutic concerns. A client's financial circumstances may limit his therapeutic choices. Some agencies process clients on a "first come, first served" basis, and decisions about client/therapist fit are accordingly compromised. In other agencies, the only staff who are knowledgeable about sexual abuse issues are female and, for better or worse, these are the clinicians who serve male survivors.

Ideally, each client should have free choice about the gender of his therapist. Clients' fears, conscious or unconscious, about revictimization and their sense of whom they feel safe with are very idiosyncratic. Both client and therapist need to trust the client's intuition about which gender initially feels the most comfortable, because therapy needs to begin with the greatest possible sense of safety.

Eventually, survivors need to embrace both genders; at some time in the recovery process, they will probably find it helpful to work with their less preferred gender. The only rule that must be followed is that clients must never be forced to work with a clinician they don't feel safe with, be this gender-based or otherwise, because this replicates the original abuse dynamic.

Gender fit between a client and a therapist should ideally be based on the client's needs. In a similar fashion, a client's sexual orientation and ethnicity are other variables that must be considered when selecting a therapist. The gay subculture has unique norms governing sexuality and relationships. Given the heterosexist nature of our culture, many therapists are unfamiliar with the mores and nuances of gay subculture. Therapists who are working with gay clients must be willing to examine their own heterosexist attitudes and assumptions and to learn about their clients' subculture. Ethnic diversities also need to be discussed in the process of choosing a therapist; again, the client's choice of therapist ethnicity must be honored in order for him to reestablish his personal power.
- Crowder, Adrienne, Opening the Door: A Treatment Model for Therapy with Male Survivors of Sexual Abuse, Brunner/Mazel Publishers: New York, 1995.

Personal Reflection Exercise #6
The preceding section contained information about therapist gender issues. Write three case study examples regarding how you might use the content of this section in your practice.

What views often discredit a woman therapist's credibility in a male client's eyes? To select and enter your answer go to Test

Section 21
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