How Therapists Can Address Gender Inequality

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The oppression of women perpetrated by existing social structures impacts health and the practice of mental health care. Yet, the field of mental health, cut from the cloth of society, provides few clinical frameworks for assessment and treatment of the traumatic effects of oppression such as racial, homophobic, and religious prejudice and sexism. Gender inequality and its harmful impact on health require proactive intervention from mental health clinicians.

Psychotherapists may be guilty of minimizing and ignoring our society’s social stigmas and oppression. They often fail to ask clients about prejudicial and discriminatory experiences as they might do with asking about exposure to types of earlier abuse (Korn, 2021).

The Impact of Sexism

Gender inequality or sexism is prejudice or discrimination formed by a person’s attitudes toward sex or gender. It can lead to a wide range of injurious behaviors, from acts of violence and abuse to subtle comments that reinforce stereotypes.

All manifestations of sexism are harmful and have a negative effect on society. Women are most severely affected, but sexism also impacts people of other marginalized genders. Less directly, it also hurts men (Leonard, 2021). Although sexism is harmful, its impact can be worse for some women and men owing to ethnicity, religion, age, disability, social origin, gender identity, sexual orientation, or other contributing factors.

Sexism and Health

A 2019 study of gender inequality and health found that gender inequality in the U.S. is bad for everybody’s health–women and men. Homan, the study’s researcher, concludes that gender inequality in the U.S. is not only a human rights issue but also a public health problem.

Structural sexism looks at how the degree of systematic gender inequality in power and resources in a society–unequal distribution based on gender–can affect people’s health. Homan measured structural sexism at a macro level such as the US states; a meso level such as a marital dyad; and at the micro level, the individual (Irby, 2019).

Briefly, Homan’s findings identified:

• Women exposed to more sexism at the macro and meso levels are associated with more chronic conditions, worse health, and impaired physical functioning. Women in their home state exposed to high levels of structural sexism had twice as many health issues and appeared seven years older in their health profile than their counterparts in home states with lower levels.
• Men exposed to macro-level structural sexism are also associated with chronic conditions, worse health, and impaired functioning. Greater gender inequality at the meso level such as an intimate partnership is associated with better health among men.
• Micro-level, internalized sexism, was not related to the physical health of women and men.

Given these findings, it’s noteworthy that where men’s health benefits the most from sexism is in the home, the place that women’s health is at greater risk.

Recognizing Sexism

Societal stereotypes frame a sex or gender as inferior and that fuels sexist behavior and practices toward that sex or gender. Various types of sexism have been distinguished and can include hostile, benevolent, and ambivalent sexism (Leonard, 2021).

• Hostile sexism seeks to protect male dominance and comes from negative attitudes toward individuals who step outside of their traditional gender stereotypes. The view toward women can be of misogyny or hatred. Hostile sexism explicitly keeps women in an inferior place and is a precursor for sexual harassment and violence toward women (Mastari, et al 2019). Hostile sexism is dangerous and a powerful influence of abuse in intimate relationships.
• Benevolent sexism also seeks to protect male dominance with the belief that women by nature are weaker. Although the perception of women holds some positive traits, the overall stereotype is that the female sex or gender is the less capable sex. Some beliefs and practices that perpetuate benevolent sexism include the idea that a woman’s value is based on her role as a wife or mother; a woman’s appearance is more important than her attributes; and policies that make it harder for women to work. This type of sexism is less obvious, can be held by both men and women, and definitely is not benevolent.
• Ambivalent sexism is a combination of benevolent and hostile sexism. Those who endorse this type of sexism flip flop between seeing women as positive and good and viewing them as deceitful and manipulative, often dependent on the situation. Ambivalent sexism is reflected in the cycle of abuse and keeps women as subordinates.

Sexism of all types exists at various levels in our society such as institutional, interpersonal, and internalized (Leonard, 2021). Interpersonal and internalized sexism are particularly important to mental health practice.

• Interpersonal sexism takes place in interactions such as relationships with intimate partners and with family members. This is a place where stereotypes of women are reinforced such as demeaning comments about one’s appearance or dictating how they should look; talking down to someone based on beliefs or assumptions about their gender; expecting or engaging in unwanted sexual attention or physical touch.
• Internalized sexism refers to sexist beliefs that an individual has about him or herself. Often, these beliefs are adopted involuntarily resulting from their environment where sexist behaviors and opinions of others existed. From research, we know that internalized sexism can cause feelings of self-doubt, powerlessness, incompetence, and shame.

Sexist beliefs are learned, internalized, and can have multiple effects on work, self-esteem, quality of relationships, and overall mental health.

Sexism and Psychotherapy: ­Making the Implicit Explicit

For 28 years, I’ve facilitated recovery groups for women with controlling partners. Many women who found their way to the groups reported unhelpful and sometimes hurtful experiences in psychotherapy. Some reported feedback included:

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• Therapists did not help them recognize the coercive tactics at play in their intimate partner’s behavior that led to overpowering them and fueling their self-blame, low self-esteem, depression, anxiety, and other PTSD symptoms.
• At times, women were encouraged to be more patient with their male partner’s past trauma although that trauma contributed to behavior of an abusive nature that wasn’t identified, and therefore, not helped.
• In couples therapy, many women reported that the therapist never called their partner out on his hurtful behavior by labeling it for what it is: abuse. One woman met alone with her couples’ therapist after deciding to end the relationship and asked, “Why not?” The therapist said that her husband would have left treatment. Keeping the resistant partner in treatment in this way–at the cost and risk to the other partner–is not good practice nor helpful to either one.

In the service of addressing sexism, here are a few things to keep in mind:

• Knowing the types of sexism, one can easily see inroads for questions and exploration with a client.
• Inquiring about power dynamics in a relationship can uncover issues related to sexist beliefs and stereotypes of male dominance and the negative impact on the individual or couple.
• Regarding hostile sexism, when exploring a relationship, include questions about safety: ask about behaviors that cause them to be intimidated, afraid, or feel in danger. Exploring not just physical violence or abuse but the threats of violence is important.
• Although benevolent sexism is less obvious, it does contribute to mental health issues. Having a partner with the attitude of maintaining dominance, for example, it’s likely that education, professional work, or other ways to benefit oneself will be discouraged or prevented from pursuing altogether. Explore her beliefs about relationships and help her see that she in fact can have choices where she feels, given her identity as a woman, she has none.
• It’s important to keep in mind that subordination can come from a place of conscious compliance in an effort to avoid conflict, anger, and abuse. In time, it’s not so conscious but automatic, out of self-protection. It might appear that she buys into her role when, in fact, she is entrapped by it.
• Past relationships need to be examined to determine any lasting traumatic effects that could continue to interfere with a client’s wellbeing.

Addressing gender inequality in our clinical work is critical and responsible. It’s up to therapists to become educated, acquire clinical skills, and fully embrace the fact that addressing sexism will help their clients.

©Lambert