Women and Therapy

Women and Therapy:
A Survey on Internship Programs

Joy Anne Kenworthy, Corinne Koufacos,
Julia Sherman*
Women’s Research Institute of Wisconsin
Two hundred and ninety-nine internship programs and selected psychology

graduate schools were surveyed by mail regarding their opinions and practices
relevant t o training in psychotherapy for women. The 94 usable replies included
55% of all APA approved programs. The results indicated that only a minority
of training facilities deal in a systematic way with issues o f sex bias and sex-role
stereotyping in psychological practice. About 20% o f the respondents expressed
a need t o improve their programs. Respondents’ answers are detailed and the
suggestion is made that egalitarian group supervisory meetings afford more
opportunity than individual sessions to deal effectively with issues o f sex bias
and stereotyping.
It has become increasingly apparent that (a) psychology is

strongly influenced by cultural values (Buss, 1975); (b) psycho-
therapy and the attribution of emotional disturbance is a value-laden
process (Laing, 1967; Szasz, 1961); (c) women more than men are
psychotherapy clients/patients; (d) psychotherapy can be used as a
means of political control; (e) mental health workers harbor negative
attitudes toward women (Broverman, Broverman, Clarkson, Rosen-
krantz & Vogel, 1970; Fabricant, 1974; Nowacki & Poe, 1973); and
(f) the political control of women by men i s recapitulated and
facilitated in the psychotherapy institution in which most o f the
*The research reported here was supported in part by the Wisconsin Humanities
Committee of the National Endowment for the Humanities. A preliminary version o f this
research was presented at the Annual Convention o f the American Psychological Associa-
tion, Chicago, August 1975. The authors wish t o thank Joy Colelli, Stephanie Golan, Mary
Kirlin, Elaine Martin, Helena Wilkening for their work in collating the data and preparing
the manuscript. Requests for reprints should be sent to J o y Anne Kenworthy, Women’s
Research Institute of Wisconsin, Inc., 923 West Dayton S t . , Madison, Wisconsin 53715.
Psychology of Women Quarterly, Vol. l(2) Winter 19 76 125
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126
WOMEN AND THERAPY
patients/clients are women and most of the psychotherapists are men

(Brodsky, 1973; Cheder, 1972; Costrich, Feinstein, Kidder, Maracek
& Pascale, in press; Tennov, 1975; Maracek, 1975). The nature, if not
the extent, o f women’s discontent with psychotherapeutic practice
has been spelled out in the report of the APA Task Force on Sex Bias
and Sex-Role Stereotyping in Psychotherapeutic Practice (1975). I n
essence this report showed that psychoanalytic concepts have been
misused, that sex-role stereotyping has been promoted, that women
in therapy have been sexually exploited, and that women have been
derogated and treated as sexual objects.
The ethical code of the American Psychological Association
requires i t s members to promote the human welfare and dignity of
all human beings. This ethical imperative is in obvious conflict with
the picture emerging in the scientific and feminist literature regarding
the manner in which psychotherapy is experienced by women.
Since the internship is the primary training period for psycho-
therapists, we were interested in learning how internship programs
have responded to the discrepancy between the ethical ideal and the
reality of psychotherapeutic practice with women. Specifically, we
were interested in the extent to which internship programs are
attempting to cope with these problems.
METHOD
A questionnaire regarding training practices was sent in March 1975 to all

known clinical or counseling internship programs in the United States and to
several graduate programs that might have an internship program. A total o f 299
questionnaires were sent by third-class mail, which does not guarantee that all
mailings reached the addressees. Names and addresses were secured from the
Internship Programs in Clinical Psychology, 1974-1 975 (published by the As-
sociation of Psychology Internship Centers), the American Psychologist, Novem-
ber 1974, and the APA Graduate Study in Psychology, 1973-1 974.
The return rate for the known internship programs without follow-up was
40.6%. Return rate including the graduate programs was 36.4%. Since these
programs do not necessarily include internships, however, it can be expected
that many never replied. Nine programs replied that they did not actually train
students and six replied that they needed authorization t o respond by the
deadline.
The 94 usable replies include 55% o f all APA approved programs. Of these
replies, 79 were from clinical internships (84.0), 4 were from counseling intern-
ships (4.3), and 11 combined clinical-counseling (1 1.7). In analyzing the results,
since the last two groups were small, they were combined with the clinical

127
JOY ANNE KENWORTHY, CORINNE KOUFACOS, J U L I A SHERMAN
group. The responding institutions included a total of 803 interns (264 female,
539 male), and 1,I 99 training staff (397 female, 802 male).
RESULTS AND DISCUSSION
The results are presented under the following categories: (a)

description of the respondents and some basic information regarding
responding programs; (b) results of inquiries regarding provisions for
training to work with women clients both in postdoctoral programs
and during predoctoral internship training; (c) related projects parti-
cipated in by interns; (d) relevant training and experience for work
with women considered necessary before the internship program; (e)
efforts to alleviate discrimination problems for female interns; (f)
changes respondents would make in their current programs; (g)
qualities respondents thought would qualify or disqualify a therapist
to work with women; and (h) reactions to licensing/certification for
work with women.
I n presenting the findings only the categories with the highest
percentages are given, and percentages not given refer to scattered
responses. Instances with a no response rate (n.r. 5%) will be given. >
The no response rate is based on percent of respondents; some
figures listed are based on percent of responses to a particular
question. Hence figures listed for each question will not always add
up to 100%. Summaries of respondent characteristics and of impor-
tant results can be found in Tables 1 and 2 respectively.
R esponden ts
The questionnaire was answered by 36 females and 58 males. The
training director answered in 46 instances (32.6% female, 67.4%
male). The 48 other respondents held various other positions ranging
from intern to chief psychologist (43.7% female, 56.3% male). I n
two instances a male training director turned the questionnaire over
to female interns to answer, saying that he did not know about such
matters. Two-thirds of the staff and the interns were male. O f the
internship programs, 67% were APA approved, 45.7% were affiliated
with a university, and 48.9% offered postdoctoral training.
Training to Work with Female Clients

In response to a query about content of postdoctoral programs

I 28
P O M E N AND T H E R A P Y
relevant t o work with women clients, 4.3% o f the respondents

reported such programs as seminars on psychotherapy with women,
seminars on abortion, pregnancy and parenting, and workshops on
career planning for woman.
I n response t o a query regarding special training during the
internship period t o work with women, 29.8% described programs
such as research on sex-role stereotyping, assertiveness training,
career planning for women, and supervised consultation t o an Ob-
stetrics-Gynecology clinic. Most respondents, however, referred t o
supervision o f therapy as the primary vehicle for training. I n reply t o
a question about increasing awareness toward women’s and men’s
issues, 23.4% mentioned workshops and/or groups, including groups
for divorced and divorcing women, assertiveness training, workshops
for midcareer women, human sexuality workshops. Many re-
spondents referred in a general manner t o discussions; women
Tahle 1
Description of Respondents and Responding I n s t i t u t i o n s ( n - 94)
-
Total -
Female -Male
x x x
S ex 33.0 67.0
Posit ion
Director of Training 49.0 32.6 67.4
Staff and Interns 51.0 43.7 56.3
Type of Internship and Status of Program

Clinical Internships 84.0
Counseling Internships 4.3
Combined 11.7
A.P.A. approved 67 .O
A f f i l i a t e d with University 45.7
Offering Postdoctoral Training 48.9
Staff and Interns -

Total -
Female -Male
Interns 803 264 539

Training Staff 1,199 397 802

129
JOY ANNE KENWORTHY,CORINNE KOUFACOS, J U L I A SHERMAN
Tahle 2
Summary of Important R e s u l t s
O f f e r p o s t d o c t o r a l seminar o r i e n t e d toward work

w i t h women 4.3%
O f f e r s p e c i a l t r a i n i n g i n work w i t h women 29.8%
O f f e r sessions t o i n c r e a s e awareness toward

women and f e m i n i s t issues 23.4%
S u p e r v i s i o n s i n g l e most common method of

coping w i t h s e x - r o l e i s s u e s Range: 31.9% - 59.hX
C l e a r e v i d e n c e of s p e c i f i c r e l e v a n t
issues discussed i n supervisjon 16.9%
Explicit, s p e c i f i c provision f o r discussing

q u e s t i o n s of s e x u a l intimacy in t h e r a p y 2.17%
Need s e e n f o r s p e c i a l i n t e r n s h i p t r a i n i n g
t o work w i t h women 36.7%
Need s e e n for s p e c i a l p r e - i n t e r n s h i p t r a i n -
i n g t o work w i t h women 53.8%
P r o v i s i o n s made t o a l l e v i a t e s e x - r o l e and
s e x d i s c r i m i n a t i o n problems f o r women
interns 33.0%
Spontaneous mention of no s e x d i s c r i m l n a t i o n
i n program:
Of female responses 13.9X
Of male r e s p o n s e s 32.87
Sex h i a s marks t h e r a p i s t as u n a u a l i f i e d :
of female responsefi 17.9%
OC m a l e r e s p o n s e s 12.8X
Need seen for c e r t i f i c a t i o n / l i c e n s ~ n gt o wort

w i t h women 4.3%
respondents were noticeably more explicit about the types of pro-

grams being provided.

130
WOMEN AND THERAPY
I n response to a question asking “How has this internship pro-

gram been planned so interns can explore and learn about sex-role
issues?” the following answers were given: (a) Relative to their own
functioning, 28.7% listed nothing in particular while 31.9% referred
to the individual or group supervisory process. Some methods re-
ported included films, didactic therapy, consciousness raising groups,
occasional lectures, and workshops (n.r. = 9.6%). (b) Relative to sex
role issues in professional functioning, 27.7% o f the programs made
no provisions, while 31.9% mentioned handling these issues in in-
dividual supervision, with scattered responses in other categories.
Four respondents mentioned that their programs were structured in
such a way that they militate against discrimination (n.r. = 13.8%).
(c) I n terms o f sex role issues with clients, 16.0% had no special
program, while 52.1 % handled these issues in supervision (n.r. =
18.0%). A few women respondents mentioned more specific ap-
proaches such as group meetings, experiential sessions, and a con-
sciousness raising (CR) group.
I n response to a more detailed question about what issues regard-
ing sex bias and sex-role stereotyping were handled in supervision,
only 16.9% of the responses indicated specific awareness of social/
political issues, changing roles of women, alternative l i f e styles,
exploration of sexual aspects of the therapist-client relationship, sex
role versus development of self realization, problems of goals for
women (e.g., assertiveness, independence). One program examined
intern sex bias as seen on videotape. While other programs may deal
with these issues, the vagueness of responses to a specific question
was not encouraging (n.r. = 14.9%).
Experiences that respondents considered necessary for working
with women included having female patients, 27% of the responses,
and having female supervisors, 9% of the responses (n.r. = 17.0%).
Among the many scattered responses were training therapists in
awareness to further the client’s autonomy and interaction with
feminist interns. Four women respondents explicitly mentioned
knowledge of the historical and social context o f women, experience
in dealing with women’s issues, and awareness of traditional female
roles and expectations.
In regard to the “aspects of the psychology of women and the
changing social scene” which respondents thought were impor-
tant to work effectively with women clients, 17.9% o f the male
responses f e l l into a category that can be described by the phrase
“Being able to treat people as people,” compared to 8.8% of the female
responses. The problem, o f course, i s that often persons are not aware

131
JOY ANNE KENWORTHY, CORINNE KOUFACOS, JULIA SHERMAN
when they are not treating people as people. This obtuseness is well
demonstrated by Kovacs (1974). The need to work with changing roles
and cultural stereotypes was noted in 19.6% o f the male response
compared to 38.2% o f the female response (n.r. = 23.4%). None o f
the men mentioned information relevant to bodily functioning, while
three women did. No one mentioned specific psychological knowl-
edge; the closest response was a general statement about the need for
awareness of the psychology of women made by three persons. Other
responses from both sexes included: sensitivity to socio-economic-
political issues; problems o f self image, career plans; sex bias-con-
scious and subconscious; various ways women manifest societal pres-
sure; accepting aggression in women as natural; historical and/or
sociological perspectives on women and their roles; changing marital
and sex roles; need for identity; need for dignity; need for equal
opportunity; awareness that women need help labeling feelings re-
garding roles; women and the law; and awareness o f the women’s
movement.
I n relation to handling questions of sexual feelings and/or inti-
macy with clients, only two programs mentioned this as an issue
dealt with specifically in training, and 59.6% indicated it was dealt
with in supervision or as the need arose up (n.r. = 12.8%). One
respondent indicated that this problem did not arise with mature
people. Three mentioned seminars. Curiously, no one explicitly indi-
cated discussions o f ethics as part of the internship program.
In regard to issues relevant to sex bias and sex-role stereotyping
in psychological testing, 27.7% indicated there was no provision for
this in training, 31.9% said that they discussed this in supervision or
when relevant, three dealt with the question in seminars, and one
indicated that students study all forms of potential bias in testing.
Six respondents indicated that it did not seem to be an issue (n.r. =
19.1 %).
I n response to a question of whether there was a need for special
training for women interns, 81.0% of the male respondents and
72.2% o f the female respondents said “No” (n.r. = 8.3%). One male
responded “Yes,” and “men should know about women, men,
blacks, Chicanos, short and tall people,” and another mentioned that
I1
seminars on issues in therapy (i.e., gays, minorities) are for every-
one’s benefit.” Two male respondents indicated that women interns
needed female supervisors as role models. Some female respondents
mentioned CR, the need to develop methods of counteracting stereo-
typing, the need for assertiveness, and the need for administrative
training. I n general, the male respondents seemed to respond more

“\
132
WOMEN AND T H E R A P Y
negatively to the idea of special training for women interns than the
female respondents. Males may have felt they would sound sexist no
matter what they said.
In regard to “a need for special training for women and/or men
interns to work with women clients,” 38.9% of the female and 34.5%
of the male respondents replied “Yes.” It is interesting to note that
the majority of respondents o f both sexes did not see the need for
special training. Only three women respondents mentioned exposure
to theoretical issues regarding the psychology o f wornen.
Intern Projects
Of the responding institutions, 39.4% reported that in the last
three years interns had worked in or initiated projects specialized to
meet the needs o f women. In twenty percent of the institutions such
programs were part of the formal internship program-these involved
31 female and 5 male interns. Activities reported were role playing,
study meetings, seminars, rape counseling, assertiveness training,
staff-intern CR groups, CR groups, weekly meetings on women’s
problems, human sexuality, research career conversation services,
abortion counseling, school consultation on female discrimination,
surveys o f therapists’ attitudes toward female clients, activities in
getting ordained female ministers into the church, therapy for di-
vorced women, courses or didactic presentations on the psychology
of women, consultation to Obstetrics-Gynecology clinics, workshops
for women clients, and problems of Army women. This question
drew the most diverse and specific answers, suggesting that when
there i s activity in internship programs specialized to meet the needs
of women, it is likely to be associated with the interns themselves.
Training andlor Experience Needed Before Internship

In regard to the need for training and/or experience related to
women’s issues prior to the internship program, 28.6% o f the re-
sponses indicated that nothing special was needed, while 53.8%
indicated that awareness of women’s and minority issues, courses and
workshops, legal knowledge, and work with female role models was
important. Other responses were vague or referred to sundry other
courses and experiences such as readings in human sexuality, experi-
ence with personal therapy, dating and marriage experience (n.r. =
23.4%).

133
JOY A N N E K E N W O R T H Y , C O R I N N E KOUFACOS, J U L I A S H E R M A N
Discrimination Problems of Interns

I n regard to a question about making provisions to alleviate sex
role and sex discrimination problems for female interns, 33.0% o f the
programs made some provision, while 60.6% made none (n.r. =
6.4%). It is interesting to note that 13.9% o f the female responses
indicated that there was no discrimination in their programs, com-
pared to 32.8% of the male responses.
Changes in Current Internship Programs

.
In regard to “. . changes in your internship program to develop
the skills of women and/or men interns in work with women cli-
ents,” 20.2% indicated a need for change. The changes suggested
included more female supervisors, more female trainees, more read-
ings in the psychology of women, more discussion and awareness o f
sex-role issues, and working with community women as consultants.
Qualities of Competent Therapists for Women

When asked to l i s t “qualities and behaviors” that would “mark a
therapist/counselor as qualified or as unqualified to work with
women clients,” most respondents mentioned general characteristics
such as sensitivity, empathy, and maturity; 12.8% o f the male re-
sponses (n.r. = 8.5%) and 17.9% of the female responses (n.r. =
14.3%) specifically stated that evidence o f sex bias marked therapists
as unqualified. One female respondent listed as unqualified
‘ I . . . angry women who say they’ve overcome bias.”
Certificationf Licensing
Respondents overwhelmingly rejected the idea that the Board o f
Professional Affairs and/or state licensing/certifying agencies should
specifically certify candidates as able to work adequately with female
clientslpatients: 93.7% said ( ‘ N o ” and 4,3%, (‘Yes” (all these were
female respondents). Reasons for rejection ranged from the notion
that a “good therapist can work with anyone” to the feeling that
certification would imply that “women aren’t a strong enough con-
sumer group to pick their own therapists” or that this would pro-
liferate specialists. One male respondent, however, favored strength-
ening the existing requirements.

134
WOMEN AND T H E R A P Y
CONCLUSIONS
The inferences that can be drawn from this survey are limited by
the fact that it i s based on 94 replies, perhaps from 94 of the more
progressive institutions. On the other hand, the responses represent a
considerable percentage of the APA approved internship programs
(55.0%) and a considerable number o f psychologists and interns
working within these institutions.
A fundamental issue is whether those individuals with power to
influence the structure of internship training believe that it is impor-
tant for future therapists to learn how. cultural influences have
affected males and females and how therapists themselves are af-
fected as they relate to patients. Where an acceptance o f the im-
portance of sex role issues exists, there will be a concomitant
willingness to improve training for psychotherapy at the level of the
internship.
On the whole, it is clear that only a minority of the training
facilities deal with issues of sex bias and sex-role stereotyping in
psychological practice on any sort of systematic basis. Supervision,
the most typical vehicle of psychotherapy training, is also the most
frequently mentioned method of handling these issues. Supervision
by women and/or use o f women as role models represents a very
simplistic approach to improving training. Supervision by a woman
who i s not keenly aware of sex-role issues would be of little value.
Likewise the aware woman supervisor who i s embedded in a profes-
sional setting in which she and her sex are devalued and discounted
could hardly be expected to be effective. To function effectively
with regard to sex-role issues, the supervisor must be extremely
aware of how these issues affect her personally, how they influence
her relationships with patients and colleagues, and how sex-role
expectations influence the attitudes o f patients and colleagues
toward her. If the setting in which the aware female supervisor
functions is open to learning, there will be a basic attitude of support
in her attempts to explore with the intern sex-role issues influencing
personal functioning and work with patients.
Another difficulty with individual supervision i s that it i s based
on the assumption that hinders important learning experiences. 1 t is
not a cliche or mere rhetoric when feminists declare the “personal is
political.” Individual supervision subtly supports the basic assump-
tion that problems are personal and personal solutions are possible.
Internships have not yet begun to question seriously whether the

135
one-to-one, teacher-learner supervision model i s the best model for

developing skills and abilities to practice psychotherapy. A t best it
represents a hierarchical system based upon a paternalistic model of
relationships; it is a closed system, locking the intern and supervisor
into a model with little opportunity for input from numerous other
sources.
Even group supervision can have similar implicit limitations.
However, since the informational base of most psychologists regard-
ing the psychology of women is likely to be inadequate, and since
consciousness levels probably vary with sex, cohort, and status posi-
tion, it i s likely that supervisory sessions dealing with issues of
sex-role stereotyping and sex bias would be more profitable if they
were structured as egalitarian group sessions with participation by
staff, interns, and faculty. The breadth of input provided by this sort
of situation might compensate, at least in part, for individual blind
spots and curricular deficits.
Whether to attack the problems of internship training from the
top or the bottom i s problematic. Improved licensing and/or certifi-
cation requirements most certainly would require future practi-
tioners to attain a minimal intellectual level o f knowledge relevant to
sex-role issues and the psychology of women. Graduate schools and
internship programs are not anxious to have their inability to trans-
mit such knowledge show up in their students’ failure to pass these
examinations. American Board of Examiners in Professional Psy-
chology requirements should be strengthened in this regard. One is
hard pressed to defend current weaknesses in either training or
certification.
Given a climate during internship training that encourages more
active learning about sex-role issues and problems, many training
programs may feel a t a loss because of inadequate training materials,
or even inadequate knowledge on the part of their staff. Scales are
now available that assess sex-role attitudes. A training staff could use
such instruments to promote fruitful interaction between staff and
interns in discussing the results.
In addition, just as reading is considered useful during traditional
training, it is also relevant to the problems confronting women. Such
reading needs to be incorporated into conceptualization, understand-
ing of dynamics, and development of intervention techniques con-
gruent with new awarenessess about sex-role issues. There is no
shortage o f feminist therapists with a wealth of untapped ideas for
work with women. Internships could plan seminars with these in-

136
WOMEN AND THERAPY
dividuals, as they frequently do for other issues relevant to psycho-

therapy. Also, programs could encourage interns to involve them-
selves in conferences, projects, and cases related to women, just as
they are encouraged and supported in such areas as children, the
aged, alcoholism, and mental deficiency. However, a t the present
time, it is the senior author’s impression that a high level of activity
specifically related to women, or strong expressions o f such interest,
may even function as something of a liability for individuals applying
for acceptance into an internship program.
The apparent lethargy on the part of internship programs is in
sharp contrast to the expressed needs and interest o f practicing
therapists (Sherman, Koufacos & Kenworthy, 1975). Seventy
percent of a sample of practicing therapists (n = 184) expressed the
need for better knowledge and training for work with women.
Concomitantly, they also provided numerous specific suggestions as
to how this could be attained. This would certainly seem to suggest
that internship programs on the whole are not particularly responsive
to needs perceived by those in the “real world” as pressing.
One encouraging note i s that 20.2% o f the programs indicated
that they wish to make improvements in their programs. I n fact, four
respondents indicated that simply answering the questionnaire gave
them the opportunity to confront the issues involved in more detail,
making them aware of a need for change.
REFERENCES
Brodsky, A. The consciousness-raising group as a model for therapy with women. Psycho-
therapy: Theory Research and Practice, 1973, 70, 24-29.
Broverman, I. K., Broverman, D. M., and Clarkson, F. E., Rosenkrantz, P. S., and Vogel, S.
R. Sex-role stereotypes and clinical judgements in mental health. journal o f Consulting
and Clinical Psychology, 1970,34, ( l ) , 1-7.
Buss, A. R. The emerging field o f the sociology o f psychological knowledge. American
Psychologist, 1975,30 ( l o ) ,988-1002.
Chesler, P. Women and madness. New York: Doubleday, 1972.
Costrich, N., Feinstein, I., Kidder, L., Maracek, I., and Pascale, L. When stereotypes hurt:
Three studies o f penalties for sex role reversals. journal of Experimental Social Psy-
chology, in press.
Fabrikant, B. The psychotherapist and the female patient: Perceptions and change. I n V.
Franks and V. Burtle (Eds.) Women in therapy. New York: Brunner/Mazel, 1974,
83-1 10.
Kovacs, A. The valley of the shadow. Psychotherapy: Theory, Research and Practice, 1974,
71, 376-382.
Laing, R. D. The politics o f experience. New York: Pantheon Books, 1967.
Maracek, J . Power and women’s psychological disorders: Preliminary Observations. Paper
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Nowacki, C. M. and Poe, A. The concept o f mental health as related t o sex o f person
perceived. Journal o f Consulting and Clinical Psychology, 1973 40(1), 160.
Sherman, J., Koufacos, C., and Kenworthy, J . A. Women and therapy: a survey o f attitudes
and information. Manuscript submitted for publication, 1975.
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Women and Therapy:

A Survey on Internship Programs

Two hundred and ninety-nine internship programs and selected psychology

It has become increasingly apparent that (a) psychology is

Psychology of Women Quarterly, Vol. l(2) Winter 19 76 125

Downloaded from pwq.sagepub.com at PENNSYLVANIA STATE UNIV on September 16, 2016