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Journal of Marital and Family Therapy

1997, Vol. 23, NO. 4,421-437



Carmen Knudson-Martin
Montana State University

This article provides an overview of the political implications of various approaches

to gender within the clinical literature. It emphasizes the process of therapy within
the social context of gender relations and identijies the political consequences of
various clinical responses. Issues surrounding the appropriate role and stance of
therapists relative to gender are identijied, ethical issues such as neutrality and
client welfare are re-examined, and suggestions for practice are addressed.

This article addresses political questions associated with gender in the practice of mari-
tal and family therapy. In this paper, “political” refers to those processes maintaining or
changing power relations within any social or interpersonal system. To examine the politi-
cal aspects of an issue is to ask whose interests are served by a particular set of social
relationships and practices, how our assumptions, beliefs, and values reflect and support
particular social structures, and how our theories and processes for scientific inquiry are
embedded within or are part of political processes. It is also to examine how professional
decisions and interventions affect political processes. Until recently it has been unfashion-
able, perhaps even unethical, to openly acknowledge political agendas within our clinical
practices. Yet, what we do as marriage and family therapists is not separate from the ongo-
ing power relations between social groups (e.g., races, classes, genders, etc.).
Because politics are part of ongoing personal and social relationships they are often
difficult to see. For example, though gender, a social category ascribed at birth (Lindsey,
1997), affects nearly every aspect of our lives and results in different expectations, roles,
behaviors, and status for women and men, the politics associated with gender statuses are
often beneath the surface and not openly addressed. This is true for therapists as well as
their clients. The purpose of this paper is to make visible the political implications of vari-
ous approaches to gender within family therapy and to examine the ethical issues raised by
them. As agents unavoidably engaged in the political arena of social change we must con-
sider how our theories and strategies support one agenda or social structure or another and
we must make conscious decisions about them. Basic ethical principles such as neutrality
and client welfare also require re-examination and redefinition.

Portions of this paper were presented at the 1996 annual meeting of the National Council on Family
Relations, Kansas City, MO.
Carmen Knudson-Martin, PhD, is an Associate Professor and Program Leader of Marriage and Fam-
ily Therapy, Department of Health and Human Development, Herrick Hall, Montana State Uni-
versity, Bozeman, MT 59717.


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The recognition of gender as a key component ordering family life has had a major
political impact on the field of family therapy. It has increased attention to the experiences
of women, raised areas for study that had previously been ignored or deemed unimportant,
and challenged many established clinical practices. It has caused us to examine ways that
our practices and theories, developed within an androcentric context, have been biased
against women, and it has stimulated the development of new theories and practices that do
not disadvantage women. Yet, a recent study (Leslie & Clossick, 1996) found that training
in gender did not necessarily result in practices that discriminated less against women; that
is, not all approaches to gender had the same political impact.
One of the most debated and potentially political topics within gender studies is how to
define the nature and extent of gender differences. While most scholars agree that there is
a large overlap between the traits, skills, and abilities of men and women and that variations
within each gender are considerable (Lindsey, 1997; Lips, 1997), the explanatory models
used to guide research questions and interpret the findings have different political conse-
quences. For example, models that emphasize the biological elements differentiating the
sexes without also taking into account institutionalized power differences between the gen-
ders almost inevitably transform male-female differences into female disadvantage (Bem,
1993). Similarly, “gender-neutral” models that minimize, discount, or individualize gender
differences also support the status quo by ignoring the power of the social order to affect
individual experience according to gender. In contrast, models that critically examine the
social context tend to promote social change by emphasizing gender inequalities and the
limitations accompanying culturally reinforced gender stereotypes.
Conclusions about appropriate clinical responses to the research and discourse regarding
gender differences differ according to which literature one reads and which political agenda
one supports. To help marital and family therapists sort through this dilemma, the first part of
this paper examines how contradictory forces within the social context affect gender and
power relations in ways that both support and inhibit change toward gender equality. The
second part looks at how approaches to gender and power issues differ within the clinical
literature and have different political implications. The third part outlines ethical issues asso-
ciated with the political dimensions of practice and suggests ways to respond to them.



There are three ways the social context of gender relationships is important to the poli-
tics of gender in therapy. (1) Most clients are unaware of the ways social conditions and
collective images of appropriate behavior for men and women influence the patterns of
their lives. They experience themselves and their partners as making their own unique and
personal decisions and creating their own successes and failures, joys and disappointments.
(2) The social influences on gender patterns and relationships are contradictory and confus-
ing. There are social factors that encourage gender equality and social factors that inhibit it,
resulting in hidden gender dilemmas, which women and men must in some way resolve.
(3) Clinical symptoms and relationship issues may be related to the tension stemming from
contradictory social forces, yet therapists may be reluctant to raise political issues that cli-
ents themselves do not see or consider a problem.


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Contradictory Social Factors
On the one hand, collective relationship ideals in the United States have shifted toward
an increasing preference for gender equality, particularly within intimate relationships
(Fleming, 1988; Rossi, 1996). Laws that used to institutionalize male dominance are being
changed. Men and women enter relationships expecting to be equal partners and expecting
that their relationships will provide emotional closeness and intimacy. Attitudes regarding
employment outside the home and the division of labor within the family are more egalitar-
ian, especially among women, younger persons, urban residents, and higher socio-economic
groups (Keith & Schafer, 1991).
Changes in the economic environment have also promoted new gender definitions and
expectations. Today female labor force participation is the norm. Economic conditions and
social expectations encourage both mothers and fathers to work outside the home. Since
working for wages represents a change from traditional constructions of the female role,
working outside the home requires behavior change for women, shifting what it means to
be female. It also redifines masculinity, though how it does depends to a large extent on
what happens within couple relationships. Thus, changing gender ideals and labor force
participation challenge the traditional construction of gender, encouraging women and men
to devise new gender patterns.
On the other hand, there continue to be social factors that make the achievement of
gender equality difficult. Traditional gender socialization continues to be a strong force in
the construction of gender relationships (Horst & Doherty, 1995). Individuals absorb a set
of expectations early in life, which structures their social experience according to gender
and which women and men bring into their day-to-day interactions without being fully
aware that they are doing so. As a result of this socialization, women tend to enter relation-
ships more oriented toward maintaining the relationship and are, therefore, more likely to
make accommodations and to attend to their partners’ needs. Men are likely to have less
perceived need for the relationship, which gives them greater power to define the relation-
ship in a way that serves their needs (Zimmerman & Dickerson, 1994). Gender socializa-
tion also teaches people that women and men are responsible for different tasks and that
women’s tasks are less important than men’s (Chafetz, 1988; Crosby, 1991).
Because we are all socialized to some extent within a male-dominant social context in
which women hold lower status, the assumptions underlying and maintaining gender in-
equalities often feel natural and are difficult to see. Yet, the economic environment contin-
ues to support a division of labor based on gender and offers different economic opportuni-
ties to women and men (Coleman, 1988; Davis, 1988; Moen, 1992; Stobber, 1988). Women
usually earn less than men-even when they do the same work-and carry these economic
disadvantages into family life. Thus, women and men seldom enter relationships with equal
power, though that is often their ideal.
Socialized gender differences combine with unequal power to reinforce traditional gender
patterns even though the ideals and circumstances of people’s lives may require changes.
These contradictory forces create tension, i.e., gender dilemmas, which must be resolved
within the day-to-day course of living. However, since gender issues tend to be masked or
beyond awareness, these tensions are likely to be expressed in other ways such as fatigue,
stress, relationship conflict, depression, or low self-esteem. For example, Mary and John
sought relationship therapy because they are having frequent arguments. Mary is very
angry that John does not spend more time with her, and she wants “more communication.”


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John is confused. He reports loving his wife and making efforts to be with her, but finds her
demands for togetherness irritating. Though they want a close, intimate relationship be-
tween equals, they are unaware of the ways in which their responses to each other and the
structure of their relationship have been influenced by traditional gender and power differ-
ences, making achievement of their goal difficult. Similarly, Susan, who called for help
because she “is about to fall apart,” is also unaware that her depression and anxiety are in
large part related to her conflicting role expectations. Instead, she describes herself has
“having low self-esteem and feeling incompetent.”

Dealing with Gender Dilemmas

Previous studies have found that most people avoid dealing directly with gender and
power issues (Hochschild, 1989; Hood, 1993; Stelmack, 1994; Whitbourne & Ebmeyer,
1990; Zvonkovic et al., 1996). Only when people consciously negotiate their relationship
patterns is it likely that they will devise patterns less influenced by traditional gender train-
ing (Blaisure & Allen, 1995; Mahoney & Knudson-Martin, 1996; Zvonkovic et al., 1996).
Even then, gendered ways of perceiving and responding tend to limit their ability to achieve
the egalitarian and intimate relationships they seek. As Horst and Doherty (1995) have
described, traditionally gendered scripts tend to discourage the sharing of power, and with-
out structural relationship equality intimacy is unlikely.
Tension from the conflicting pulls of contradictory social forces affect individuals and
relationships at multiple levels and in many ways. At the relationship level, men and women
tend to give each other mixed messages. There is often disparity between beliefs about
gender relationships and behavior (Blaisure & Allen, 1995). Decisions about work and
family life may be based on a set of values and beliefs that conflicts with values of equality,
partnership, and intimacy. Women and men may hold themselves and each other to both the
traditional and new standards, falling short of each. At the individual level, women need
their experiences to be valued, judged, and understood within their own terms, yet also need
to gain power within the larger social and economic context. Men, too, need their experi-
ences understood within their own framework, yet may also need to examine ways in which
masculine socialization toward independence and control can be harmful to relationships
(Meth, 1990). Being unaware of the internal and relational conflicts fostered by contradic-
tory social forces, people frequently respond to the stresses in their lives in ways that leave
in place the unexamined inequalities, but maintain relationship stability and, politically, do
not threaten the status quo (Hochschild, 1989; Mahoney & Knudson-Martin, 1996; Zvonkovic
et al., 1996). Unfortunately, these responses create a myth of equality, but leave in place the
tensions, symptoms, and disappointments that tend to accompany gender inequality.
The family practitioner must, then, decide how to approach gender issues. To what
extent will he or she recognize and validate the different developmental experiences of
women and men and help them to understand each other, reducing instability and conflict?
When will he or she raise issues of inequality or power, potentially challenging relationship
structure and internalized, gendered ways of seeing and responding to the world and to each
other? Are gendered characteristics and identities the property of the individual or are they
part of a process that is socially maintained and constructed? How would the practitioner
decide if his or her approach better serves one gender than the other?


The political dimensions of approaches to gender in the literature vary primarily ac-
cording to whether existing gender differences are reinforced or challenged. Some ap-


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proaches emphasize understanding the biological, psychological, and interactional differ-
ences between men and women and using that information to more effectively relate to
each gender and resolve communication differences. Other approaches focus primarily on
structural power differences between men and women; these approaches tend to emphasize
the social and political context of gender relations and see gender differences as reflections
of social inequalities between women and men that need to be changed. A third, more
integrative approach is to focus on the ongoing interactional processes between men and
women in which existing gender and power differences are either reinforced or challenged.

Focusing on Men and Women as Different Cultures

A culture is a group of people who share particular interpretations of the world because
shared circumstances lend a degree of homogeneity to their perspectives (Pare, 1996). The
gender as culture approach focuses on how collective socialization experiences for males
and females are internalized within individual identity structures. According to this view,
women and men come to see the world through different lenses and develop different styles
of relating, primarily because of differences in separation-individuation processes. Though
the degree to which these kinds of differences are “real” or perceptual and their relevance to
other ethnic and socioeconomic groups continue to be questioned (e.g., Pratt, Panck, &
Hunsberger, 1990; Skoe & Diessner, 1994; Walker, 1989), this strain of literature has re-
sulted in the introduction of a female psychology that emphasizes and values traits com-
monly associated with femininity and has popularized a view that misunderstandings be-
tween women and men are common because they “come from different places.”
Among the first to articulate different processes for male and female identity develop-
ment was Margaret Mead (1949), who observed that learning to be a boy involves having to
do things to transcend being female. Later, Nancy Chodorow (1978) suggested that men
and women develop different internal psychic structures because parenting of both girls and
boys is usually done by mothers. The most influential contributions to the gender as culture
perspective, however, have been studies focusing on processes through which women de-
fine and construct a relational, connected sense of self (Belenky, Clinchy, Goldberger, &
Tarule, 1986; Gilligan, 1982; Jordan, Kaplan, Miller, Stiver, & Surrey, 1991; Josselson,
1987; Miller, 1976). These authors suggest that developing a relational self requires a
complex integration of self with other based on empathy, caring, and interdependence. They
contrast this self construction to a more masculine one based on independence, justice, and
power. Similar male-female differences in conversation patterns have been identified by
the sociolinguist Deborah Tannen (1990).
The practical implications and political consequences of the gender as culture approach
depend on whether the practitioner validates or challenges the different cultures. Though
Chodorow (1978) argued that we need to change the social conditions that perpetuate these
gender differences, most cultural feminists advocate reconstructing what constitutes healthy
development by developing new models for thinking about and conceptualizing mental
health and relational issues that emphasize and utilize the positive aspects of qualities, such
as connection and caring, associated with women (Jordan et al., 1991; Worell, 1996). The
most change-oriented seek to replace previous “separation-individuation” models with newer
“connection-mutuality”models. Bergman and Surrey (1992), for example, frame their work
with both women and men within a relational paradigm.
For many clinicians, however, the challenge is how to validate and interpret the expe-
riences of both genders so that clinical interventions are more effective and “gender appro-


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priate.” The goal here is to include female experiences in reformulations of developmental
and clincial theories and to re-examine constructions of both masculinity and femininity
(Betcher & Pollack, 1993; Boss & Weiner, 1988; Knudson-Martin, 1994, 1996; Luepnitz,
1988; Meth, 1990). Efforts are made to appreciate, accept, and value both masculine and
feminine experiences, and neither is held out as “better” or “more mature.” These thera-
pists attempt to open awareness that appropriate, healthy behavior does not automatically
approximate traditionally “male” behavior (i.e., separated, individuated, less influenced by
others) and help to make visible the limitations of each gender’s typical ways of relating
(i.e., too much focus on others for women, too much emphasis on independence for men).
For example, such a therapist might explicitly frame Mary’s desire for togetherness as
positive, rather than as a sign of poor differentiation (as a non-gender-sensitive approach
might), and challenge the idea that John’s autonomy and independence are more mature
(and therefore “better”) than Mary’s desire for togetherness. If he or she encouraged John
to be more attentive to Mary’s needs, the political impact of the therapist’s actions would be
toward realigning or challenging social inequalities between men and women. Such action
would require a deliberate departure from more prevalent “separation-individuation” ap-
proaches that tend to equate healthy relationship functioning with the autonomy of its mem-
bers (Fowers & Richardson, 1996; Knudson-Martin, 1996).
More often, however, gender culture approaches are less change-oriented. In this case
the differences between men and women are not considered inherently problematic. The
focus is not on changing the differences but on how to appreciate and work with them.
According to this strand of literature, communication differences and conflicts are inevi-
table because women and men hold different world views. Thus, the goals of practice are to
understand and validate both orientations, so as to work more effectively with each gender
and to help men and women to understand each other and communicate more effectively.
Heterosexual partners can be encouraged to be more accepting of each other, and behavior
that feels hurtful can be reframed as misunderstanding.
For example, during the course of therapy Mary and John could be helped to under-
stand their behavior and relationship struggles as the result of different orientations to rela-
tionships typical of their genders (i.e., she seeks togetherness and he seeks independence)
without attempting to challenge these orientations. The outcome of this therapy would likely
be that the relationship patterns change very little. Mary still spends most of her day alone,
taking care of their home and child. The amount and type of time the couple spends to-
gether is still largely determined by John’s schedule and needs. But Mary now has a differ-
ent way to think about their relationship, is less angry, and the couple reports more relation-
ship satisfaction. This outcome, which serves to maintain the existing status quo between
women and men, would not be an unusual for therapy that focuses on reducing misunder-
standings and communication impasses by working with gender differences (Hawkins et
al., 1994; Knudson-Martin & Mahoney, 1996).
A problem with cultural differences approaches to gender is that collective social influ-
ences tend to be reduced to the level of the individual, confounding individual and social
processes and making it difficult to address their interaction. Individual gender-influenced
identities can seem predetermined by the social context and rather inflexible, making it
easy to perpetuate stereotypes and difficult to think and work in ways that do not reinforce
existing power relations between women and men. The gender as culture approach can
challenge the existing merit or worth apportioned between traditionally masculine and femi-
nine styles of thinking, being, and relating, and if men and women relate from positions of


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more equal value as a result, the outcome may be political change. However, this approach
seldom directly addresses issues of power or how stereotypical differences between women
and men can reinforce existing gender inequalities in the larger social context.

Focusing on Power Differences

This perspective sees power as the “true” difference between men and women. Ac-
cording to this view, gender differences such as those described above are reflections of
unequal power. If women seek more connection and attend more to others, it is because
they hold lower status within society. This strain of literature has roots in the feminist social
construction of reality literature focusing on how collectiveknowledge bases are constructed
and maintained (e.g., Flax, 1983; Harding, 1983; Hartman & Messer-Davidow, 1991;
Hubbard, 1983). These authors revealed ways that even scientific knowledge is shaped by
the beliefs, values, and ideals of those who have the power to define what is “real” and what
is “true.” From this perspective women must function in a male-defined world and learn
that their experiences are not real or are wrong. To be female, according to Kaschak (1992),
is to be second-class, invisible, or defined by illusion.
Gender theorists who focus on power differences suggest that male separateness is an
illusion that ignores female supports. They emphasize that women and men are both social-
ized in ways that maintain the status quo. For example, women seek to maintain relation-
ships at the expense of their own autonomy and men learn that power or control over women
is central to the definition of masculinity. Family therapists such as Judith Meyers Avis
(1985), Virginia Goldner (1985), Rachel Hare-Mustin (1987), and Thelma Goodrich (1991)
have argued that culturally defined differences in power between men and women are cen-
tral to expectations and behavior within relationships and our theories about them. For
example, femininity is defined such that powerlessness is appealing and women believe
they are completed by men and expect to attend to them.
Practicing from the power differences perspective tends to be a consciously political
enterprise with deliberate attention to correcting inequalities between women and men and
to addressing ways that family life can be destructive to women physically, emotionally,
and economically. From this perspective the goal in therapy is to create new, more equal
relationship structures. Attention to biological and psychological “gender differences” are
viewed as counterproductivesince they reinforce existing power differences,therefore serving
more the interests of men than of women.
In the case of Mary and John, the therapist would interpret Mary’s anger in context of
a power imbalance in the couple’s relationship. He or she would help John and Mary to
examine and change those behaviors and patterns that foster relationship inequality at Mary’s
expense, such as Mary’s focus on John’s needs, their automatic acceptance of traditional
gender roles, and John’s expectation that his work and school needs take priority. Mary
would be encouraged to increase her ability to define the relationship in a way that supports
her well-being, and John would be helped to become more comfortable with less power and
to be more attentive and responsive to Mary.
The power differences approach to gender in therapy focuses on the ways the social
context shapes lives. Politically it is oriented toward changing the status quo. One of its
limits, however, is that like the cultural differences approach, the power differences ap-
proach tends to be deterministic and linear (i.e, power differences cause individual behav-
ior), making it easy to lose sight of the contributions of individual processes and the possi-
bility of individual differences and personal choice. Another problem is that this approach


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can result in a victim-aggressor construction of gender relationships. This can make it
difficult to address reciprocal aspects of masculine and feminine roles and identities and
can limit options available to clients and their therapists.

Gender as Process
For many years theorists and practitioners whose focus and interest was on the relation-
ship system tended to ignore the influence of gender. Within the last decade awareness re-
garding the centrality of gender to family processes has been increasingly recognized, yet
often remains not well-integrated into ongoing research and systemic theory (Ferree, 1990;
Thompson &Walker, 1995). Within family therapy much of this awareness was made vis-
ible by Walters, Carter, Papp, and Silverstein (1988) and by McGoldrick, Anderson, and Walsh
(1989). Helpful to the integration of gender within family theory is a process view of gender,
emphasizing both the institutional and interactional levels of analysis, which explains how
gender is created in the day-to-day social relations between women and men (Ferree, 1990;
Risman & Schwartz, 1989). Such a view allows a therapist to validate clients’ experiences by
recognizing and understanding developmental differences between males and females, yet to
also acknowledge the social context in which such differences occur.
The gender as process perspective defines gender as a part of interpersonal processes.
It focuses on the interactional context in which people experience being male or female and
how existing, ongoing relationship patterns construct and maintain gender (Knudson-Mar-
tin, 1995). Since the experience of gender always occurs in relation to others, the psycho-
logical and power aspects of gender roles and identities are not merely properties of the
individual, but are integral to their overall system of relating. Since they exist reciprocally,
masculinity and femininity cannot be understood apart from each other or the power struc-
ture within which they are embedded.
Viewing gender as a process lends itself well to working within a family systems frame-
work, but requires making the gender construction processes visible. While family systems
therapists are used to considering individual traits and identities to be maintained or changed
within ongoing, day-to-day relationship patterns, many do not automatically think of these
processes as also created by and maintaining existing gender patterns. Yet, internalized
constructions of gender identities and social structures that accord more power to men typi-
cally serve as “metarules”defining behavior within the relationship (Knudson-Martin, 1995).
When rules such as “Mary notices John’s stress and tries to attend to him” or “John re-
sponds to Mary’s attention with irritation and distance” are made visible and understood
within their gender context, constructing new gender patterns is more possible.
A process view of gender would see John and Mary struggling within relationship
patterns that were influenced by, yet reinforce and contribute to, gendered individual iden-
tity constructions and societal power differences between men and women. The therapist
would believe that it was important to understand the clients’ issues within both the cultural
differences framework and the power differences framework, but would be most interested
in the unique way Mary and John construct gender between them and would expect that
their established gender patterns be somewhat flexible and open to change. Thus, Mary’s
anger would be seen as reflecting her disappointment that the relationship is not satisfying
her needs for connection and as a reaction to established relationship patterns in which
Mary has shaped her life around John’s and he has expected such accommodation.
To understand the political implications of this therapy, however, the therapist must
also consider how Mary and John’s responses to each other are part of larger social patterns.


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For example, Mary’s reluctance to allow John to define the amount and types of couple
involvement is likely influenced by contemporary societal ideals promoting equality and
intimacy among partners. How they resolve their relationship dilemma will contribute to or
inhibit social change in gender equality. From a gender as process perspective, the marital
conflict is a potential challenge to existing gender relations. How the therapist responds
and what happens next for the couple has political consequences; that is, the resulting rela-
tionship structure will either reinforce previous gender differences and inequalities or move
toward more equality and shift what it means to be male or female in relation to the other.
Let us imagine that in the course of the therapy the therapist attempts to help the couple
consider options different from their existing pattern (e.g, Mary feels ignored, gets angry,
and insists on John’s involvement, to which John responds by feeling irritated and distanc-
ing, making Mary feel more ignored). Politically, this is a pattern in which Mary is not able
to define the relationship in a way that serves her needs. If, during the course of therapy,
Mary learns that John finds her demands irritating and backs off, making John less irritated
and more comfortable with his space, though her anger has been mollified and the relation-
ship is stabilized, the gender construction process has actually intensified a gender experi-
ence in which John’s needs are more important than Mary’s. A therapist who does not want
to unwittingly collude in recreating gender inequality would point out to the couple that
they made the relationship more comfortable in a way that required that Mary give up her
need, making the gender construction process visible. If, during the course of therapy, John
was challenged to find ways to respond to Mary on her terms, the therapy would help to
create new, more equal gender constructions.
An advantage of the process view of gender is that it encourages a more unique and
fluid view of gender relationships. Gender differences and power differences are recog-
nized as part of relatively stable, socially influenced patterns of behavior, but with each
interaction new ways of relating are potentially possible. Since gender is considered to
reside within or be experienced within the relationship, how individuals experience them-
selves as women and men may change. A potential problem in the process view of gender is
that the therapist might focus primarily on the dynamics of the couple and ignore the social
context in which the relationship occurs or minimize the role of gender. Yet, since the ongo-
ing interaction patterns either reinforce or change existing gender patterns within their rela-
tionship and within the larger social context, what happens in therapy is political whether
consciously so or not.


If we accept Goldner’s (1985) suggestion that family therapists view gender as a cen-
tral, organizing force shaping family life, gender is not merely one of many potential “out-
side influences” on a particular situation or problem but is intrinsic to the very nature of the
relationship. Just as one cannot not communicate, one also cannot not do gender. To not
place the symptom or problem in its gender context is as incomplete as not placing it within
its systemic, relational context. The meaning of the client’s behavior and experience does
not make sense unless understood within its gender framework. Therapists who accept this
premise, therefore, find themselves in the position of having no choice but to think about
and respond to clinical problems in relation to gender. The question is not whether to
address gender, but how.


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If gendered beliefs, ideals, and behaviors were the result of conscious choice, the asso-
ciated ethical issues would be mostly about balancing client values regarding gender and
power against one’s own. What makes dealing with the politics of gender more difficult is
that the gender and power aspects of issues are usually invisible to clients and not likely to
be raised by them. Therapists must decide if and how to respond to the hidden gender
implications of a case. The ethical issues involved are complex, sometimes contradictory,
and part of larger debates regarding the therapist’s use of power and self, neutrality, and the
moral consequences of our therapeutic stance for clients and for the larger society.

The Social Context of the Therapeutic Role

Clients seek the help of a therapist. Therapy begins, therefore, with a hierarchial premise.
Clients and therapists alike hope the therapist or the therapeutic process will have some
power to improve the clients’ lives or help them make the changes they desire. How thera-
pists should handle the power implicitly associated with their roles is currently a subject of
intense interest within family therapy (Amundson, Stewart, &Valentine, 1993; Fine &Turner,
1991; Flemons, Green, & Rambo, 1996; Pare, 1996; Zimmerman & Dickerson, 1994). At
issue are political questions: Who defines what is real? Who should define the problem and
the direction of the therapeutic conversation? To what extent does the professional hold a
privileged position relative to the client, allowing the therapist’s voice more power? As
therapists attempt to address these issues they necessarily also define the nature of the
therapist’s responsibility,determining some kind of resolution between respecting and trusting
the client’s power to define his or her own “truth” and the therapist’s responsibility to hold
and use professional knowledge in the service of clients.
Frequently, the “politics of therapy” debate is limited to the relative power between
client and therapist as if therapy were occurring in an otherwise neutral context. Yet the
constructions and meanings clients bring to the therapy room are not neutral. They are
influenced by the social and political contexts within which they are situated (Knudson-
Martin & Mahoney, 1996; Pare, 1996; Zimmerman & Dickerson, 1994). Depending on the
number of contexts within which a particular client is embedded, he or she may hold many
different cultural selves, not all of which may have equal voice or expression (Pare, 1996;
Penn & Frankfurt, 1994). The individual stories of women and other subordinate groups
include self perceptions based on the dominant culture as well as their own. Thus, not all
persons are equally free to define or re-author their own stories and not all selves have
voice. Thus, responding to the political consequences of gender in therapy requires some
way to address the therapist’s role in relation to both the client and the larger context. The
therapist becomes a broker or sorts, standing between or bringing together many different
voices and cultures, even if the client is only one individual. Ethical decision-making re-
quires determining how to deal with silent but influential gender voices.

The Power to Define the Conversation

One of the major sources of power available to the therapist is the ability to direct the
therapeutic conversation. Therapists respond to some of the client’s statements and not to
others. The therapist may introduce hidden, cultural voices. These are political positions,
determining which voices get heard and whether new ones are introduced into the conver-
sation. If the therapist elects to introduce only those voices already visible to the client, the
therapy will tend to support the status quo. If the therapist raises gender issues visible to
him or her, the political consequences depend on how gender is framed within the therapy.


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Talking about gender from the cultural differences perspective suggests that the differ-
ences between women and men are natural or to be expected and encourages clients to
respect and understand each other within that frame. This way of talking tends to be ori-
ented toward stability and first-order change, i.e., helping people develop better ways to
deal with their situation without questioning or challenging their basic relationship struc-
ture. But this depends on the extent to which the therapeutic conversation encourages
clients to question their gendered behavior and to think and behave in less typical ways.
Talking about problems or issues from the power differences perspective encourages
clients to look at the structural conditions within their relationships. Clients may see in-
equalities they did not previously see or be motivated to take actions that could disrupt the
stability of their relationships. The therapist may be faced with how to address the tension
between the clients’ desire for relationship stability and the political implications of not
helping them examine the ways unequal relationship patterns may be serving the well-
being of one partner at the expense of the other. Revealing hidden inequalities can open
new options and relationship possibilities for clients, but also opens potential areas for
conflict and challenges the status quo.
Talking about gender as a process avoids some of the problems associated with the
other two approaches. The therapist can take the stance of a curious observer rather than an
interpreter. The focus can be on what is happening within relationships, how one person’s
behavior is connected to another’s and to the larger social context, and how the patterns are
working for the clients. Discussion of the outcomes or consequences of these processes for
each gender can be facilitated. In this case, the therapist is not taking an expert position by
labeling the problem, but does become a part of the gender construction process. His or her
observations and contributions are influenced not only by what the clients say and do but by
what the therapist knows, says, and does. Thus, though the therapist’s role may be more
collaborative, it is not really neutral (Becvar & Becvar, 1996).

Neutrality in a Non-neutral World

In family therapy, as in nearly all mental health disciplines, therapist neutrality and
objectivity are time-honored principles. Though many therapists today question our ability
to achieve either, being able to differentiate our own agendas from our clients’ is still an
important ethical issue and being as neutral and objective as possible is still important to
many. In working toward this end and in an effort to avoid imposing our own partial,
subjective reality on clients, we may easily confuse neutrality with passivity and silence
with objectivity. However, maintaining a neutral position in a politically non-neutral world
must be a deliberate and active endeavor. If neutrality is defined as using theories and
practices that support equally both genders, neutrality requires active involvement and par-
ticipation on the part of the therapist. To be neutral may therefore require making visible the
gender and power aspects of a case and actively correcting clinical practices that reinforce
gender inequalities (Knudson-Martin & Mahoney, 1996). Furthermore, as Flemons, Green,
and Rambo (1996) have argued, ethical and responsible decision-making in the context of
subjective truth may require making one’s position visible and taking a clear stand.
There are both objective and subjective ways to be actively neutral. The more subjec-
tive way suggests that therapists bring their whole person into the therapy room. Advocates
of this approach to gender and power tend to de-emphasize the therapist as expert and
emphasize the therapist as human. As a human in relationship with other humans, the
therapist is called upon to bring into the therapy process his or her thoughts, images, ideas,


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and responses. The therapist might say, “When I see you so focused on how he thinks and
feels, I wonder how you do that day in and day out?’ Or, “It’s been my experience that
when women and men have unequal relationships, the kind of intimacy you talk about is
almost impossible.” In these examples, the therapist does not avoid sharing his or her ideas
about gender and power, but they are presented as contributions to the therapeutic pot rather
than as directives or facts. The therapist brings new, previously invisible, or under the
surface issues into the therapy, but sees it as the client’s responsibility to decide what to do
with them. Clients have access to the therapist’s experiences and perspectives. Thus, what
happens in the therapy is highly dependent on the particular therapist, making it difficult to
dissociate client outcomes from the therapist’s beliefs, values, and experiences.
The more distant, objective approach attempts to limit the intrusion of the therapist’s
self into the therapeutic process, but uses professional knowledge to guide and direct the
conversation. Such a therapist might adopt an educator’s stance, sharing information from
research and other more objective sources, but trying to limit the emotion and values asso-
ciated with gender and power. The therapist might say, “Your experience of not being able
to relax when other people are in the house fits research that shows that women seldom
report being able to relax at home because their sense of their responsibility for others in the
household is nearly always present.” Or the therapist’s knowledge about gender and power
might shape his or her questions, for example, “You say your mother was a strong woman.
How did other people react to her strength? How is it for you, being strong?’ In this case,
how the therapist responds to what he or she hears is shaped by his or her gender conscious-
ness. Though the therapist’s opinion may not be overtly expressed, he or she is actively
including gender within the core of the therapeutic conversation in ways that make possible
challenge of traditional gender constructions. To not do so would limit gender neutrality
and be likely to politically disadvantage women.

Moral Consequences of Therapy

When we examine client welfare in relation the political consequences of our work, we
must ask whose welfare we serve. Even when we are clear that do not want to promote one
gender’s advantage over another, this is not always a simple question. Is it in a woman’s
interest to raise issues that could make achieving relationship stability more difficult when
maintaining the relationship is important to her? Should she be encouraged to develop the
skills necessary to make it in a “man’s world” if this means she must give up or hide parts of
herself that are less valued in a male-dominated culture? Should a man be encouraged to
deal with his stress and anxiety by “following his own dream” when his family is finan-
cially dependent on him? The consequences of how we respond to these questions are
political. Embedded within them are moral issues regarding how our own behavior affects
clients and how clients’ behavior affect others.
Doherty (1995) persuasively argues that when therapists disassociate themselves from
moral issues or refuse to take stands regarding appropriate human behavior they justify
flights from responsibility and moral accountability. Thinking about the therapist’s role as
including that of a moral consultant challenges previous professional ideals and raises new
questions. The question is not so much whose morality is introduced or who decides what
is right or wrong, but how to include responsibilities and ethics within the heart of therapeu-
tic dialogue. The idea is to help clients to identify and explore issues of right and wrong,
rather than escape or avoid them. Within this framework, helping clients to identify injus-
tices and inequalities within their relationships and examine them in relation to questions of


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right and wrong is part of the therapist’s role, as is examining the consequences for clients
of using one theoretical approach to gender versus another. A therapist does not have to tell
clients how men and women should behave, or act as a moral judge. Rather, he or she has
to be willing to recognize gender and power issues as having moral consequences that are a
legitimate focus of therapeutic conversation.
Not all would agree that it is appropriate to raise the moral aspects of gender and power
issues in therapy. Yet, as I have shown earlier in this paper, men and women today make
decisions about the day-to-day aspects of their lives with little awareness of how their deci-
sions regarding who does what and how they relate to each other are influenced by social
structures, traditions, and economic forces, and with little awareness of how those decisions
may favor the well-being of one gender more than another over the long term or limit the
intimacy and equality that they seek (Mahoney & Knudson-Martin, 1996). The decisions
for clients are complex, often with no easy solutions. Whose career shall we follow? How
will the needs of children be met? When is a relationship so unsatisfactory that it justifies
foregoing one’s commitment and obligation? How much of one’s own “nature” should be
put aside for career advancement or for the well-being of a spouse or child? When the
moral aspects of these issues are not addressed, gender and power issues are either ignored
or over-simplified. Few would suggest that it is the therapist’s role to make these decisions
for people. Yet, unless a therapist has a way to make these issues visible and address them,
he or she may contribute to decisions that perpetuate inequalities between men and women,
fail to recognize the unique experiences of each gender, and support the well-being of some
family members over others without their conscious agreement.

Suggestions for Practice

The social context encourages new gender patterns but also inhibits such change. Women
and men are influenced by contradictory but invisible social forces. How they respond to
the tensions created by these contradictory forces affects their personal and relational well-
being and either reinforces existing societal patterns or challenges them. Since gender and
family can not be separated, family therapists find themselves inevitably engaged in the
social construction of gender (Knudson-Martin, 1995). How we respond has political con-
sequences for our clients and for the larger society. My view integrates an appreciation of
the different developmental experiences of women and men within a changing societal
context that advocates gender equality but makes it difficult to achieve. Politically, I posi-
tion myself so as to avoid unintentionally reinforcing existing gender biases and inequali-
ties and to encourage personal and relationship patterns that equally serve both genders.
The suggestions that follow are based on my understanding of gender as process and my
view of the therapist’s role as making invisible processes visible, so that women and men
can make more conscious decisions regarding their patterned ways of relating.
Develop sensitivity to how gender shapes experience and infuses relationship struc-
tures. Because gender is intrinsic to us all, developing sensitivity requires standing back
and asking how gender is part of what is happening. If we fail to look or ask, previous
gender patterns will remain unexamined and are likely to be reinforced. This includes
recognizing at the personal level how gender constructs what we see or understand and
questioning our own assumptions.
Do not assume equality or no gender bias. If we respond to people as though they are
equal when they are not, the unequal person will be at a disadvantage. Within systems
theory this means recognizing that even though patterns may be reciprocal, it does not mean


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that each person has equal power to shape the pattern or benefit by it. It also means recog-
nizing how interventions focusing on helping people separate or individuate may miss the
positive aspects of affiliative, attentive behavior (Knudson-Martin, 1996) and how fre-
quently used interventions, such as reframing unfairness to something more acceptable,
may sometimes reinforce relationship inequality (Knudson-Martin & Mahoney, 1996).
Do not confuse neutrality with no response. If a therapist’s intention is to not take one
person’s side over another, this may require deliberate action. For example, the female
tendency to accommodate or be satisfied by understanding the other person’s side may be
easily exploited in order to create relationship stability (Hawkins et al., 1994). Avoiding
gender bias may requiring actively encouraging male accommodation as well.
Ask “gendercentric” questions. This is a form of circular questioning that is informed
by placing gender in the center of relationship processes. It includes questions such as who
is attentive to whom, how the relationship encourages one partner to be more stressed than
another, or who benefits by a particular relationship pattern. It means asking how decisions
were made, how experiences differ when viewed through the other gender’s eyes, or how a
particular response is related to being male or female. These questions are not more impor-
tant to therapy than other kinds of questions, but they are ones that frequently are not ad-
dressed directly.
Focus on process. When we address gender in the context of the ongoing interactions
in daily life, there is less opportunity for moralizing and theorizing and more opportunity
for making invisible interaction patterns visible. As in other areas, when clients see their
relationship patterns it is possible to see other options and there is an opportunity for con-
scious decision-making.
Articulate the issues. Part of the therapist’s role is to help identify and put into words
the gender construction issues at hand. Perhaps a woman or man is struggling to fulfill both
new and old constructions of gender. Perhaps a couple caught in a power struggle is trying
to determine whose needs are more important. Perhaps partners are having a difficult time
understanding each other’s gendered experience, language, and behavior. Perhaps a woman
is struggling to incorporate a divorce into her vision of herself as a relationship maintainer.
Depending on how the therapist chooses to use himself or herself in the therapy, articulating
the issues may involve an educational role, a leap into the expert role, or a collaborative
role. But failure to articulate the gender and power issues embedded in the therapeutic
conversation means they will probably go unnoticed and unaddressed.
Externalize. One of the benefits of framing issues in the context of gender is that
problems can be linked to the larger culture. This helps clients to see their problems as
more than their own personal struggle-as part of collective struggles. Without externaliz-
ing, a woman may experience herself as incompetent rather than as carrying more than her
share of the burden; a man may experience himself as powerless in relationships rather than
as having not learned how to attend to others. Externalizing makes the social context vis-
ible and change more possible.


Discussions about gender in therapy can stir strong passions and disagreements. While
there is usually consensus regarding issues such as the value of clear communication or the
harmfulness of child abuse, the issues relating to the politics of gender in therapy are still


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sensitive and the appropriate role or stance of a therapist not clearly defined. That these
issues remain controversial is not surprising since the political implications of our actions
either support or challenge the societal status quo regarding gender relations. The purpose
of this article has been to bring some clarity to the political dimensions of gender in therapy
with the hope that it will help therapists to determine the response they find most appropri-
ate. I have offered suggestions for ways to respond when utilizing a process approach to
gender that avoids reinforcing gender inequalities. It is important that individual therapists
consciously address their roles in relation to the politics of gender. Otherwise, we respond
to gender not on the basis of professional judgment and a clearly defined position but on the
basis of social influences beyond our conscious awareness.


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