Fam Proc 29:365-374, 1990
A Study of the Role of Gender in Family Therapy Training
SANDRA B. COLEMAN, Ph.D.
JUDITH MYERS AVIS, Ph.D.
MINDY TUREN, M. Ed.
A survey of the role of gender in family therapy training programs was conducted by the
Women's Task Force of the American Family Therapy Association (AFTA) in order to
determine the extent to which gender issues were included in the curriculum.
Questionnaires were sent to 285 programs in the U.S., Canada, and overseas. Only 19%
(n = 55) of the original sample participated, with the East Coast representing the largest
proportion of respondents. Findings revealed that the three most frequently addressed
gender issues are: 1) the impact of cultural and economic conditions on single, femaleheaded families; 2) gender issues associated with wife abuse; and 3) an examination of
the implications of the therapist's gender in therapy interventions. Only 27 programs
identify with a feminist model or have a clearly defined sense of gender awareness. A
significant finding associated with the introduction of feminist content was the difficulty
of integrating gender issues with major theoretical models. Trainee resistance and lack of
faculty awareness were also considered obstacles to including gender in program
curriculum.
Gender issues, particularly those pertaining to women, and their influence on family
interactions, are a relatively new focus in the field of marital and family therapy. After
virtually ignoring gender, family therapists during the past 6 years have written in excess
of 100 articles and 10 books, and are also publishing a separate journal on the subject of
gender (4). In its new guidelines for program accreditation, the American Association for
Marriage and Family Therapy (AAMFT) now requires that "particular emphasis should
be given to sexism and gender role stereotyping and its impact on the individual (males
and/or females) as well as on the family" (1). It is not known, however, whether this
literature and its major concepts have permeated the training institutions, which exercise
considerable control over the beliefs and behaviors of tomorrow's family therapists. To
examine this question, a subcommittee of the American Family Therapy Association
(AFTA) Special Task Force on Women conducted a survey of family therapy training
programs to investigate
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the current role of gender in family therapy training.
A REVIEW OF THE LITERATURE
The lack of responsiveness in family therapy training to issues of gender and the
literature on women is illustrated by Winkle, Piercy, and Hovestadt's (20) study of
graduate-level curricula for marriage and family therapy education. Their national panel
of 25 directors of graduate-level family therapy programs and 20 AAMFT Approved
Supervisors mentioned gender in only one of 63 clinically related content areas they
considered important, and that was in the form of "gender identity and sex roles." Forty
seven of the 63 areas were listed as being more important. No mention was made of
gender socialization, gender inequality, or gender-based power imbalances. Under
content related to ethics and professional development, no mention was made of gender
sensitivity or non-sexist practice. Under content related to human growth and
development, areas of child, adult, and adolescent development and of aging were listed,
with no mention of areas related specifically to women's development. The panelists
presumably subsumed women's development under the general umbrella of "adult"
development. They apparently did not realize that most developmental theory is based on
a male norm (from which women are then found deviant) and does not adequately
account for women's experience (7, 17).
Family therapy training has been accused not only of failing to address gender concerns,
but also of actively teaching theories and interventions that disadvantage women. Weiner
and Boss (17, p. 14) discuss the gender bias in most of the "male-derived, male-focused
ideas about behavior and relationships," which have been an integral part of professional
therapy training. Calling for conceptual affirmative action, these authors urge the study of
new research and theory regarding women's psychosocial development, as well as a
critical reexamination of the dominant theories that have shaped professional thinking.
They suggest that, to be responsible, family therapists must be knowledgeable about
current research, theory, and intervention strategies related to gender, and that to proceed
"without this new scientific knowledge is analogous to a surgeon operating with outdated
procedures" (p. 20). Similarly, Jacobson (10) argues the importance of therapists
becoming sensitive to sex roles and their impact on marriage, as well as to their own
gender biases and assumptions, and "coming to terms with their own sexism" (p. 21). The
most highly endorsed single item in Wheeler's (18) survey of feminist-informed family
therapists is a statement that "there is a lack of knowledge and education in the family
therapy field about gender issues, sex roles, women's experience, or feminist theory."
In spite of the recent attention given to gender in the family therapy literature, and in
spite of the importance of training in addressing these concerns, only seven articles to
date (2, 3, 6, 11, 14, 15, 19) have specifically discussed gender issues in the training of
family therapists. These authors suggest that because sex-role stereotyping has a strong
effect on trainees' views of family structure and pathology (6), as well as on the
therapist's own personal authority and competence (15), and because gender issues are
inevitable both in family therapy and in supervision (2, 4, 11, 14), content related to
gender issues and sex roles is essential to family therapy curricula and training. Okun
(14) suggests that therapists are usually unaware of the gap between their espoused
theories and what they actually do in practice when faced with emotionally laden gender
issues. Consequently, most therapists mistakenly believe that their practice is "gender
free and sex fair" (p. 45). Okun contends that
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supervisors must be aware of gender issues themselves and sensitive to their presence in
trainees in order to help trainees acknowledge and deal with them. Avis (3) and Wheeler
and colleagues (19) contend that therapists must be trained to think differently about
gender before they will be able to intervene differently in families.
The training process itself is replete with gender issues. Caust, Libow, and Raskin (6)
state that awareness of sex-role processes in supervision is critical and should include
frequent examination of the expression of authority and power in the supervisory
relationship. Similarly, Libow (11) maintains that "gender as it affects both the
supervision and the therapy process should be an explicit dimension of the supervisory
contract" (p. 20). Avis (4) and Wheeler et al. (19) suggest that instructors be alert to the
spontaneous enactment of the male-female power differential in the classroom or
supervisory group, and that they use such instances to demonstrate feminist concepts and
sex-role behavior.
These authors also emphasize the isomorphic relationship between feminist-in-formed
training and feminist-informed therapy. They argue that the way therapy is taught is
crucial, with "more positive and less oppressive attitudes towards women, and an
understanding of power and gender roles ... taught by example as well as by theory" (19,
p. 60). Avis (4) examines key issues in planning gender-conscious training and provides
guidelines for developing a course on gender, for facilitating a gender-conscious training
process, and for integrating gender into family therapy training and supervision.
In spite of the burgeoning literature on the subject of gender, both inside and outside of
the discipline, a consciousness of gender, gender-based power, and gender bias is not yet
found in the mainstream family therapy literature. A recent study (5) found that the
amount of mother blaming in four major family therapy journals had actually increased
slightly between 1978 and 1988. This finding supports Taggart's (16) contention that
"there is little evidence that, apart from other feminists and a few sympathizers, the field's
writers are even aware of what feminists have written" (p. 100).
METHOD
A questionnaire was designed to elicit information about how, and to what degree, family
training programs address gender issues. (The terms "institute" and "program" are used
interchangeably in the context of this study.) The first half of the questionnaire elicited
general information about the background of each institute or academic setting, its
program demographics and training characteristics, and the major theoretical model(s)
and supervisory methods used (for example, live versus videotaped supervision). The
second half of the questionnaire explored the extent to which gender is a curriculum
component.
Information was sought on the degree to which gender is seen as relevant to the program,
and through what specific process gender issues are addressed, for example, through
lectures and/or required readings, personal exploration of trainees' own sex biases and
belief systems. Gender content issues were also assessed as were attitudes of supervisors
toward the issue of gender. The last seven questions applied only to those programs
adhering to a feminist model or claiming to have developed a specific gender component.
They addressed the following: 1) when the gender component was initiated; 2) the major
impetus behind it; 3) level of student interest; 4) whether courses are designated as
required or optional; 5) the proportion of men versus women students participating in the
gender coursework; 6) information on whether treatment families are aware of the gender
focus; and 7) problem areas associated with offering a feminist or gender component.
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RESULTS
Training Program Demographics
A total of 285 questionnaires were sent to the entire list of AAMFT approved training
institutes (N = 41) and 244 additional family therapy training programs from the United
States, Canada, Europe, and several other countries, including England, Wales, the
Netherlands, West Germany, Switzerland, Italy, and Australia. Only 57 questionnaires
were returned, two of which were not completed because the programs were no longer
functioning. Thus, from the original sample of 285, only 19% participated. The largest
proportion of respondents were from the East Coast, where 19 programs participated. The
Midwest/ Central region accounted for 8 responses, the West Coast had 7, the South had
6, the Northwest had 4, and the Southwest was represented by 2 programs. There were 4
Canadian participants along with 7 foreign programs.
The majority of participating family therapy training programs have been in existence
from 6 to 10 years (35%), although the range is from 4-67 years. The latter (67 years)
was reported by a university that in all probability offered a specialization in family
sociology, as it is most unlikely that either family therapy or training in it could possibly
have existed in 1920. Another 22 programs (39%) have existed for 11-20 years. Only 5
programs have been functioning for 5 years or less. There is no apparent relationship
between the number of years a family training program has existed and whether it has a
definite focus on gender. The range is from less than 1 year to 4 years, with one-third
having 2-year programs.
Training facilities include considerably more men than women. Of the total 600 faculty
members associated with the sample population, 57% are male and 43% are female,
while of the full-time faculty, 64% are male and 36% are female. Men account for 51%
of the ranks of the part-time faculty, and women represent the other 49%. Information
was also sought about the gender of the executive board members; however, due to
insufficient information, these data could not be analyzed. The gender of the students
approximates that of the part-time faculty (males 51% and females 49%). The total
cumulative population of trainees in the sample programs is estimated to be 1,624.
The majority of respondents described their programs as using both didactic and
practicum training methods; however, one respondent described his or her program,
which contained only two students, as "all practicum, no formal didactics." Eight, or 14%
of the respondents, saw their training as "... more didactic than clinical."
Two major family therapy orientations dominate training regardless of whether the
respondents report using a feminist model and/or trying to develop gender awareness in
their programs. Structural/ strategic and structural family therapy account for 45% of the
total number of possible responses to the question regarding training orientation. The
Milan approach is most frequently used and, when it is added to structural/strategic and
structural approaches, these three models represent 60% of all current training methods.
When examined by individual region, these three approaches account for 40-100% of all
training models. An intergenerational model was considered significant for 8% of all
programs: for 16% of foreign programs, 12.5% of the East Coast participants, and 10% of
the participants from the Southern region.
Participants were asked to rank the preferred method of supervision in their programs.
Although videotape supervision is most often used, it was not selected as "most
preferred." It appears that the major
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proportion of programs much prefer "live supervision through the mirror."
Gender Content
Respondents were given 13 gender-relevant content areas and asked to describe the
extent to which they are addressed in their programs. Results (see Table 1) indicate that
the following three issues are most frequently considered as important program
components: 1) the impact of cultural and economic conditions on single, female-headed
families (73%); 2) gender issues in treating situations of wife abuse (70%); and 3) an
examination of the implications of the therapist's gender in various therapeutic
interventions (67%). It is interesting that there is only minimal difference between
training programs that claim to have specific gender components and those without them.
Particularly noteworthy is the finding that programs which identified themselves as
having gender-specific curriculum are far less apt to examine gender issues implicit in the
training process. This ranked tenth in importance out of the 13 gender issues for those
espousing gender programs and
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fourth for those that did not have a gender program. One possible explanation is that
programs with a gender curriculum have moved beyond this point and are focused on
more advanced gender issues, such as those listed in Table 1.
Table 1
Importance of Gender Content Areas for Training as Ranked by Programs
Programb
Item
Rank
Frequencya (in percent)
With Gender (n = 27)
Without Gender (n = 28)
The impact of cultural & economic conditions on single, female-headed families
1
72.7
22
10
Gender issues in treating wife abuse
2
70.2
19
7
An examination of the implications of the therapist's gender in therapy interventions
3
67
20
9
Assumptions, stereotypes, and myths about women
4
60.5
18
5
The feminist critique of family therapy
5
44.7
11
6
Theory and research on sex roles and socialization
6
36.5
11
4
Theoretical and empirical work on the relationship between gender, marital status, and
mental health
7
35.8
10
4
Contemporary theories regarding female psychology and psychosocial development
(Miller, Chodorow, Gilligan, Dinnerstein, Caplan, etc.)
8
35.1
9
4
Feminist theory and critique of the family
9
35
9
5
An examination of gender issues implicit in the training process (male instructors, female
trainees, etc.)
10
32.5
9
4
The politics of psychotherapy
11
31
7
4
Research on sex differences
12
25.6
7
3
Other*
13
a Applies to items rated as either "very important" or of "strong importance" to program.
Thus, Table does not represent total sample population in study.
b Ns vary due to inconsistency of response frequency per item.
* Responses were too varied to include this information.
When asked about the attitude of supervisors, 49% of the respondents reported that their
supervisors are moderately interested in gender issues, 24% described their supervisors as
having only a mild interest, 22% reported their supervisors to have more than a moderate
level of interest, and only 2% reported no overt interest.
Finally, the most frequently cited problem in introducing feminist/gender content to a
training program was the difficulty in integrating gender issues with major theoretical
models, a problem cited by 25% of the respondents. Trainee resistance and lack of faculty
awareness were the second most frequently reported reasons, although 5 of the 40
respondents saw no problem in this area. Four programs cited faculty resistance as a
problem.
Training Programs with a Focus on Gender
The final section of the questionnaire pertains solely to the 27 training programs that
identify themselves as adhering to a feminist model or providing a clear opportunity to
develop gender awareness. Thus, the following information was derived from a
maximum of only 27 (49%) of the survey respondents. However, due to the variation in
the number of subjects answering each question, the information often derives from a
smaller number of participants. Twenty-six programs reported that they have integrated
some gender components into their curricula within the last 15 years. Somewhat
surprisingly, one program reported that it developed a feminist perspective in 1972, and 6
additional programs reported initiating a gender focus between 1972 and 1977. Ten
programs began their gender awareness components between 1978 and 1982 and 9 more
began during the period from 1983 to 1987.
The major impetus for developing a gender focus was multidetermined. Eleven programs
attribute the focus to the effects of extramural workshops or professional meetings, while
8 ascribe it to trainees' requests for including a gender component. Thirteen respondents
state that suggestions by staff were responsible, while 5 believe that the hiring of a female
faculty member was responsible. In three cases, the gender component is a result of the
impact made by a guest lecturer.
When questioned about the level of student interest in the gender/feminist aspects of the
program, 11 of the respondents describe the women students as having much enthusiasm
and interest, while another 9 describe them as having only moderate interest. In contrast,
16 view the male students as moderately interested, with 5 stating that the men have
much enthusiasm and interest.
Only 12 respondents indicate that they provide a specific course on gender issues. Of
these, 3 report that the course is required, 2 indicate that it is only a part of a required
course, and 6 report that the gender course is optional. Further questions about the degree
to which students actually choose to take the course when it is optional produced an
insufficient number of responses to provide any meaningful interpretation.
Few answers were obtained when programs were questioned about the participation of
male versus female faculty in gender courses. Only a very rare program indicates that any
appreciable number of staff of either sex actually participate in these courses.
Less than half of the sample programs (n = 14) report that treatment families are not
likely to be aware of the program's interest in gender, while 5 believe that
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families know of the gender focus because of the program's reputation. It is interesting to
note that 4 participants believe that families discover the program's gender focus through
the course of therapy.
DISCUSSION
The following discussion must be understood as deriving from a skewed and limited
sample of survey respondents. Thus, at this time, conclusions from this effort to examine
the role of gender in family therapy training must be viewed as only exploratory and
tentative.
Response Rate
The first factor for discussion about this study is the poor response rate. This was a highly
specialized sample population of family therapy training programs, and the initial
expectation was that the research interest level would generate a better than average
survey response rate (generally estimated at approximately 33.3% ). Unfortunately, the
return rate of 19% clearly indicates that our original optimism was premature. The low
response leads one immediately to speculate that the topic of gender does not stimulate
enormous interest. Similarly, gender issues may be viewed as not having a sufficient
impact on family therapy training or practice to warrant giving the survey the precious
time required, and programs without any gender component may have felt they had little
to contribute to the survey. Another explanation may be that the topic of gender is too
laden with controversy and may even elicit a certain amount of guilt or fear: to answer a
questionnaire if one's program does not focus on gender issues might lead to some loss of
support, status, or even recriminations from some governing board. It may have been
perceived as "safer" to refrain from disclosing such a training void, with nonparticipation
constituting protection against program disclosure. Further, gender issues may provoke
rather personal ambivalence that respondents and their respective institutions might
prefer to avoid.
Other explanations include the fact that all institutions are bombarded with surveys and
requests to participate in research. The time it takes to be involved in these studies can be
considerable. Although our questionnaire was not especially lengthy, some of the
questions required more than a superficial effort on the part of the participating staff
member.
Several colleagues of one of the investigators of this study (SBC) revealed that they
participated because her name was on the cover letter, and they felt a personal obligation
to respond. This further suggests that motivation, at least in some cases, was based on a
personal bond rather than on a genuine interest in gender issues. Thus, any of the results
of this exploration of the role of gender in family therapy training institutes must be
viewed with caution.
Feminist Movement and Cultural Shifts
The results indicate that more than half of the family therapy training programs in our
sample population were initiated between 1973 and 1982. This period of time clearly
parallels the height of the women's movement, thus causing some speculation about why
the effects of feminist activism were not particularly felt within the training programs.
One might view this as due to the fact that there were more men in positions of power
and management within the programs. However, at this time, men were also more apt to
be in control in college and university settings, and this did not deter women students
from demanding that their voices be heard. After all, this was the era when women
students were raising their voices on campuses across the nation. Were women students
in family therapy training less willing to risk such confrontations with senior faculty? The
issue of gender bias, as Weiner and Boss
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(17) discuss, may certainly apply here. For example, if male-derived, male-focused ideas
about behavior and relationships prevail in professional training situations, one could
assume that the same influences apply to family therapy students who, when faced with
gender-relevant dilemmas, may feel it is safer to remain quiet, be "good girls," and not
make waves.
Family Systems Theory
Perhaps more salient than speculations about the lack of a significant response rate or the
cultural influence (or lack thereof) are the issues related to the profession of family
therapy itself. Why, argues Goldner (8) is there no viable room for gender in our
theories? Goldner believes that the answer to her question is embedded in the way
systemic theory uses "context" and "circularity" to conceptualize the family. Proponents
of the "systemic aesthetic," she feels, are offended by the idea that power in the family is
socially structured by gender. Further, the notion of complementarity, and of circularity,
ignores the fact that wives are regularly and ultimately at a disadvantage. Notions of
neutrality or multilateral partiality perpetuate inequality by assuming equality in power,
thereby blinding therapists to power imbalances based on gender, and ultimately resulting
in maintaining and reinforcing the wife's subordinate position.
Is it perhaps more comfortable and less complicated to eliminate gender from our
constructs than it is to make an attempt at integration? Do we fear that, if we addressed
gender, we might have to rethink too much of what we hold dear, that we will risk
experiencing the confusion that attends the dismantling of sacred icons and the resulting
paradigm shift? As Taggart (16) has commented, "putting feminists, and their potentially
disruptive commentaries, outside the pale allows the orderly production of traditional
family therapy to proceed with the minimum of interference. This way of defending the
'established order' of closed systems is as well known to establishment theorists as it is to
establishment politicians" (p. 101). Certainly, if family systems theory cannot be
expanded to allow gender to find a place in its formulations, we cannot expect any of the
resulting interventions and therapy practices to be anything but gender blind. It may be
that what this study really discovered has more to do with the role of gender in our
theoretical formulations than with the role of gender in training.
For gender to sit high on the list of a required curriculum, it must first have a seat on the
substantive shelf from which all good theory derives. Whether or not a theoretical shift
that includes gender will emerge is questionable. One thing that appears to be happening
in the epistemological arena at present is bound to preclude such an event. Emerging
trends in the epistemological arena appear to threaten the possibility of such a shift as the
field moves toward understanding family systems from a linguistic perspective (9, 12,
13). Vital as this may be in extricating ourselves from the theoretical binds of role and
structure, the focus on how we relate vis-à-vis our "languaging" will most likely continue
to obscure and suppress any opening for gender to gain attention, let alone a respectable
position in new theory construction.
SUMMARY
In summary, results of this study of the role of gender in the training of family therapists
suggest that the subject of gender is absent in most family therapy training. If gender is
included at all, it is most often addressed solely when gender issues emerge in class or in
supervision. Gender is least apt to be taught through a regularly scheduled course or
lecture. Even in cases where a respondent feels his or her institution is "feminist" in its
orientation, gender is most often associated with a
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discussion of therapist interventions. Supervisor interest in gender is described at best as
only mild or moderate. Only female students are felt to be more enthusiastic and
interested than their male colleagues.
The most often cited problem associated with introducing feminist or gender content is
that of integrating these issues with the major theoretical orientation of the program. This
problem crosses all major theoretical lines; no single orientation appears more amenable
to gender constructs. Thus, it appears that the task of integration and of exposing aspects
of preferred family therapy theories as sexist must be undertaken by both trainers and
trainees, in both the classroom and in supervision. Supervision should focus on the
gender content within the family, the therapist/ family relationship, and the supervisor/
therapist relationship. Lack of faculty and student interest, as well as an absence of
faculty awareness, seem to be major blocks to integrating gender issues into training
curricula. This may relate to the disproportionate number of full-time male/female
faculty. It certainly points to the need for faculty and supervisors to inform themselves of
the issues and to take a leadership role in raising awareness among their trainees. Without
such action, continuing gender blindness among the next generation of family therapists
is assured.
It is hoped that this beginning investigation of the role of gender in family therapy
training will have an impact on the programs that served as our sample population, and
will further encourage them to develop what they have already expressed an interest in
doing. Perhaps even more important is the possibility that the questionnaire will serve as
an intervention for those programs that did not respond. That this has already occurred
was reported to one of the authors (JMA). Thus, we expect and hope that a followup
study will reveal markedly different results.
As a final note, we need to remember that not too many years ago we had to sneak
families through a back entrance in order to include them in treatment. Now that we view
working with families as a matter of course, we must open the front doors of our training
programs so that the full range of influential issues, including gender, can enter.
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Manuscript received March 19, 1990; Accepted June 4, 1990.
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