A Study of the Role of Gender in Family Therapy Training

Fam Proc 29:365-374, 1990

A Study of the Role of Gender in Family Therapy Training

SANDRAB.COLEMAN, Ph.D.

JUDITHMYERSAVIS, Ph.D.

MINDYTUREN, M. Ed.

A survey of the role of gender in family therapy training programs was conducted by the Women's Task Force of the American Family Therapy Association (AFTA) in order to determine the extent to which gender issues were included in the curriculum. Questionnaires were sent to 285 programs in the U.S., Canada, and overseas. Only 19% (n = 55) of the original sample participated, with the East Coast representing the largest proportion of respondents. Findings revealed that the three most frequently addressed gender issues are: 1) the impact of cultural and economic conditions on single, female-headed families; 2) gender issues associated with wife abuse; and 3) an examination of the implications of the therapist's gender in therapy interventions. Only 27 programs identify with a feminist model or have a clearly defined sense of gender awareness. A significant finding associated with the introduction of feminist content was the difficulty of integrating gender issues with major theoretical models. Trainee resistance and lack of faculty awareness were also considered obstacles to including gender in program curriculum.

Gender issues, particularly those pertaining to women, and their influence on family interactions, are a relatively new focus in the field of marital and family therapy. After virtually ignoring gender, family therapists during the past 6 years have written in excess of 100 articles and 10 books, and are also publishing a separate journal on the subject of gender (4). In its new guidelines for program accreditation, the American Association for Marriage and Family Therapy (AAMFT) now requires that "particular emphasis should be given to sexism and gender role stereotyping and its impact on the individual (males and/or females) as well as on the family" (1). It is not known, however, whether this literature and its major concepts have permeated the training institutions, which exercise considerable control over the beliefs and behaviors of tomorrow's family therapists. To examine this question, a subcommittee of the American Family Therapy Association (AFTA) Special Task Force on Women conducted a survey of family therapy training programs to investigate

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the current role of gender in family therapy training.

A REVIEW OF THE LITERATURE

The lack of responsiveness in family therapy training to issues of gender and the literature on women is illustrated by Winkle, Piercy, and Hovestadt's (20) study of graduate-level curricula for marriage and family therapy education. Their national panel of 25 directors of graduate-level family therapy programs and 20 AAMFT Approved Supervisors mentioned gender in only one of 63 clinically related content areas they considered important, and that was in the form of "gender identity and sex roles." Forty seven of the 63 areas were listed as being more important. No mention was made of gender socialization, gender inequality, or gender-based power imbalances. Under content related to ethics and professional development, no mention was made of gender sensitivity or non-sexist practice. Under content related to human growth and development, areas of child, adult, and adolescent development and of aging were listed, with no mention of areas related specifically to women's development. The panelists presumably subsumed women's development under the general umbrella of "adult" development. They apparently did not realize that most developmental theory is based on a male norm (from which women are then found deviant) and does not adequately account for women's experience (7, 17).

Family therapy training has been accused not only of failing to address gender concerns, but also of actively teaching theories and interventions that disadvantage women. Weiner and Boss (17, p. 14) discuss the gender bias in most of the "male-derived, male-focused ideas about behavior and relationships," which have been an integral part of professional therapy training. Calling for conceptual affirmative action, these authors urge the study of new research and theory regarding women's psychosocial development, as well as a critical reexamination of the dominant theories that have shaped professional thinking. They suggest that, to be responsible, family therapists must be knowledgeable about current research, theory, and intervention strategies related to gender, and that to proceed "without this new scientific knowledge is analogous to a surgeon operating with outdated procedures" (p. 20). Similarly, Jacobson (10) argues the importance of therapists becoming sensitive to sex roles and their impact on marriage, as well as to their own gender biases and assumptions, and "coming to terms with their own sexism" (p. 21). The most highly endorsed single item in Wheeler's (18) survey of feminist-informed family therapists is a statement that "there is a lack of knowledge and education in the family therapy field about gender issues, sex roles, women's experience, or feminist theory."

In spite of the recent attention given to gender in the family therapy literature, and in spite of the importance of training in addressing these concerns, only seven articles to date (2, 3, 6, 11, 14, 15, 19) have specifically discussed gender issues in the training of family therapists. These authors suggest that because sex-role stereotyping has a strong effect on trainees' views of family structure and pathology (6), as well as on the therapist's own personal authority and competence (15), and because gender issues are inevitable both in family therapy and in supervision (2, 4, 11, 14), content related to gender issues and sex roles is essential to family therapy curricula and training. Okun (14) suggests that therapists are usually unaware of the gap between their espoused theories and what they actually do in practice when faced with emotionally laden gender issues. Consequently, most therapists mistakenly believe that their practice is "gender free and sex fair" (p. 45). Okun contends that

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supervisors must be aware of gender issues themselves and sensitive to their presence in trainees in order to help trainees acknowledge and deal with them. Avis (3) and Wheeler and colleagues (19) contend that therapists must be trained to think differently about gender before they will be able to intervene differently in families.

The training process itself is replete with gender issues. Caust, Libow, and Raskin (6) state that awareness of sex-role processes in supervision is critical and should include frequent examination of the expression of authority and power in the supervisory relationship. Similarly, Libow (11) maintains that "gender as it affects both the supervision and the therapy process should be an explicit dimension of the supervisory contract" (p. 20). Avis (4) and Wheeler et al. (19) suggest that instructors be alert to the spontaneous enactment of the male-female power differential in the classroom or supervisory group, and that they use such instances to demonstrate feminist concepts and sex-role behavior.

These authors also emphasize the isomorphic relationship between feminist-in-formed training and feminist-informed therapy. They argue that the way therapy is taught is crucial, with "more positive and less oppressive attitudes towards women, and an understanding of power and gender roles ... taught by example as well as by theory" (19, p. 60). Avis (4) examines key issues in planning gender-conscious training and provides guidelines for developing a course on gender, for facilitating a gender-conscious training process, and for integrating gender into family therapy training and supervision.

In spite of the burgeoning literature on the subject of gender, both inside and outside of the discipline, a consciousness of gender, gender-based power, and gender bias is not yet found in the mainstream family therapy literature. A recent study (5) found that the amount of mother blaming in four major family therapy journals had actually increased slightly between 1978 and 1988. This finding supports Taggart's (16) contention that "there is little evidence that, apart from other feminists and a few sympathizers, the field's writers are even aware of what feminists have written" (p. 100).

METHOD

A questionnaire was designed to elicit information about how, and to what degree, family training programs address gender issues. (The terms "institute" and "program" are used interchangeably in the context of this study.) The first half of the questionnaire elicited general information about the background of each institute or academic setting, its program demographics and training characteristics, and the major theoretical model(s) and supervisory methods used (for example, live versus videotaped supervision). The second half of the questionnaire explored the extent to which gender is a curriculum component.

Information was sought on the degree to which gender is seen as relevant to the program, and through what specific process gender issues are addressed, for example, through lectures and/or required readings, personal exploration of trainees' own sex biases and belief systems. Gender content issues were also assessed as were attitudes of supervisors toward the issue of gender. The last seven questions applied only to those programs adhering to a feminist model or claiming to have developed a specific gender component. They addressed the following: 1) when the gender component was initiated; 2) the major impetus behind it; 3) level of student interest; 4) whether courses are designated as required or optional; 5) the proportion of men versus women students participating in the gender coursework; 6) information on whether treatment families are aware of the gender focus; and 7) problem areas associated with offering a feminist or gender component.

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RESULTS

Training Program Demographics

A total of 285 questionnaires were sent to the entire list of AAMFT approved training institutes (N = 41) and 244 additional family therapy training programs from the United States, Canada, Europe, and several other countries, including England, Wales, the Netherlands, West Germany, Switzerland, Italy, and Australia. Only 57 questionnaires were returned, two of which were not completed because the programs were no longer functioning. Thus, from the original sample of 285, only 19% participated. The largest proportion of respondents were from the East Coast, where 19 programs participated. The Midwest/ Central region accounted for 8 responses, the West Coast had 7, the South had 6, the Northwest had 4, and the Southwest was represented by 2 programs. There were 4 Canadian participants along with 7 foreign programs.

The majority of participating family therapy training programs have been in existence from 6 to 10 years (35%), although the range is from 4-67 years. The latter (67 years) was reported by a university that in all probability offered a specialization in family sociology, as it is most unlikely that either family therapy or training in it could possibly have existed in 1920. Another 22 programs (39%) have existed for 11-20 years. Only 5 programs have been functioning for 5 years or less. There is no apparent relationship between the number of years a family training program has existed and whether it has a definite focus on gender. The range is from less than 1 year to 4 years, with one-third having 2-year programs.

Training facilities include considerably more men than women. Of the total 600 faculty members associated with the sample population, 57% are male and 43% are female, while of the full-time faculty, 64% are male and 36% are female. Men account for 51% of the ranks of the part-time faculty, and women represent the other 49%. Information was also sought about the gender of the executive board members; however, due to insufficient information, these data could not be analyzed. The gender of the students approximates that of the part-time faculty (males 51% and females 49%). The total cumulative population of trainees in the sample programs is estimated to be 1,624.

The majority of respondents described their programs as using both didactic and practicum training methods; however, one respondent described his or her program, which contained only two students, as "all practicum, no formal didactics." Eight, or 14% of the respondents, saw their training as "... more didactic than clinical."

Two major family therapy orientations dominate training regardless of whether the respondents report using a feminist model and/or trying to develop gender awareness in their programs. Structural/ strategic and structural family therapy account for 45% of the total number of possible responses to the question regarding training orientation. The Milan approach is most frequently used and, when it is added to structural/strategic and structural approaches, these three models represent 60% of all current training methods. When examined by individual region, these three approaches account for 40-100% of all training models. An intergenerational model was considered significant for 8% of all programs: for 16% of foreign programs, 12.5% of the East Coast participants, and 10% of the participants from the Southern region.

Participants were asked to rank the preferred method of supervision in their programs. Although videotape supervision is most often used, it was not selected as "most preferred." It appears that the major

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proportion of programs much prefer "live supervision through the mirror."

Gender Content

Respondents were given 13 gender-relevant content areas and asked to describe the extent to which they are addressed in their programs. Results (see Table 1) indicate that the following three issues are most frequently considered as important program components: 1) the impact of cultural and economic conditions on single, female-headed families (73%); 2) gender issues in treating situations of wife abuse (70%); and 3) an examination of the implications of the therapist's gender in various therapeutic interventions (67%). It is interesting that there is only minimal difference between training programs that claim to have specific gender components and those without them. Particularly noteworthy is the finding that programs which identified themselves as having gender-specific curriculum are far less apt to examine gender issues implicit in the training process. This ranked tenth in importance out of the 13 gender issues for those espousing gender programs and

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fourth for those that did not have a gender program. One possible explanation is that programs with a gender curriculum have moved beyond this point and are focused on more advanced gender issues, such as those listed in Table 1.

Table 1

Importance of Gender Content Areas for Training as Ranked by Programs

Programb

Item

Rank

Frequencya (in percent)

With Gender (n = 27)

Without Gender (n = 28)

The impact of cultural & economic conditions on single, female-headed families

72.7

Gender issues in treating wife abuse

70.2

An examination of the implications of the therapist's gender in therapy interventions

Assumptions, stereotypes, and myths about women

60.5

The feminist critique of family therapy

44.7

Theory and research on sex roles and socialization

36.5

Theoretical and empirical work on the relationship between gender, marital status, and mental health

35.8

Contemporary theories regarding female psychology and psychosocial development (Miller, Chodorow, Gilligan, Dinnerstein, Caplan, etc.)

35.1

Feminist theory and critique of the family

An examination of gender issues implicit in the training process (male instructors, female trainees, etc.)

32.5

The politics of psychotherapy

Research on sex differences

25.6

Other*

a Applies to items rated as either "very important" or of "strong importance" to program. Thus, Table does not represent total sample population in study.

b Ns vary due to inconsistency of response frequency per item.

* Responses were too varied to include this information.

When asked about the attitude of supervisors, 49% of the respondents reported that their supervisors are moderately interested in gender issues, 24% described their supervisors as having only a mild interest, 22% reported their supervisors to have more than a moderate level of interest, and only 2% reported no overt interest.

Finally, the most frequently cited problem in introducing feminist/gender content to a training program was the difficulty in integrating gender issues with major theoretical models, a problem cited by 25% of the respondents. Trainee resistance and lack of faculty awareness were the second most frequently reported reasons, although 5 of the 40 respondents saw no problem in this area. Four programs cited faculty resistance as a problem.

Training Programs with a Focus on Gender

The final section of the questionnaire pertains solely to the 27 training programs that identify themselves as adhering to a feminist model or providing a clear opportunity to develop gender awareness. Thus, the following information was derived from a maximum of only 27 (49%) of the survey respondents. However, due to the variation in the number of subjects answering each question, the information often derives from a smaller number of participants. Twenty-six programs reported that they have integrated some gender components into their curricula within the last 15 years. Somewhat surprisingly, one program reported that it developed a feminist perspective in 1972, and 6 additional programs reported initiating a gender focus between 1972 and 1977. Ten programs began their gender awareness components between 1978 and 1982 and 9 more began during the period from 1983 to 1987.

The major impetus for developing a gender focus was multidetermined. Eleven programs attribute the focus to the effects of extramural workshops or professional meetings, while 8 ascribe it to trainees' requests for including a gender component. Thirteen respondents state that suggestions by staff were responsible, while 5 believe that the hiring of a female faculty member was responsible. In three cases, the gender component is a result of the impact made by a guest lecturer.

When questioned about the level of student interest in the gender/feminist aspects of the program, 11 of the respondents describe the women students as having much enthusiasm and interest, while another 9 describe them as having only moderate interest. In contrast, 16 view the male students as moderately interested, with 5 stating that the men have much enthusiasm and interest.

Only 12 respondents indicate that they provide a specific course on gender issues. Of these, 3 report that the course is required, 2 indicate that it is only a part of a required course, and 6 report that the gender course is optional. Further questions about the degree to which students actually choose to take the course when it is optional produced an insufficient number of responses to provide any meaningful interpretation.