The American Psychological Association (APA) Monday issued a fresh set of guidelines to help therapists who treat girls and women, noting that changes to "education, work, reproductive and caregiving roles, and personal relationships" in the last several decades have led to greater equality, but have also changed the ways in which women encounter adversity in the U.S. and around the world.
The guidelines include:
- Recognizing women's resilience and using affirmative approaches
- Understanding multiple layers of identity and oppression (race, disability, sexuality, economic background, etc.)
- Being aware of contradictory messaging around what it means to be female
- Confronting their own personal and institutional biases
- Offering diagnosis only when necessary and using unbiased assessment tools
- Knowing about alternative forms of healing, including indigenous methods and community resources
These guidelines come after guidelines on male treatment were issued earlier this year, sparking an uproar from conservatives for its characterization of toxic masculinity.
Sharon Lamb, Lillian Comas-Díaz and Debra Mollen served as co-chairs of the committee that developed the "APA Guidelines for Psychological Practice with Girls and Women." USA TODAY spoke with Comas-Díaz and Mollen about key takeaways:
Therapists are sexist and racist, too
Therapists are human, and no human is impervious to cultural attitudes about gender or race. The guidelines encourage practitioners to think about how their own experiences and beliefs may impact their treatment.
The guidelines note that psychotherapy often includes biases, such as overvaluing autonomy while undervaluing relationships or "basing definitions of positive mental health on behaviors that are most consistent with masculine stereotypes or life experiences."
In addition to self-awareness, the guidelines encourage diversity and gender sensitivity training and for therapists to "build their knowledge about racial, sexual orientation, elitist, ablest, ageist, and other types of microaggressions and how these intersect with their beliefs and attitudes about girls and women."
Microaggressions aren't so micro
The guidelines focus heavily on the persistence of subtle forms of sexism, including microaggressions. Harvard psychiatrist Chester Pierce, who coined the term in 1970, described them as racially charged "subtle blows ... delivered incessantly." A little more than a decade ago, Columbia psychology professor Derald Wing Sue expanded the concept of microaggressions to include its affects on other marginalized groups, including women.
"There have been changes in how racism and sexism are exhibited. Now it can show up more in terms of microaggressions and sometimes the person who is engaging in the behavior — whether a hetero-sexist, an ageist, a racist — may not be aware they're doing that because of their implicit biases," Comas-Díaz said.
A therapist asking a Korean American woman what country she's from is an example of a microaggression, the guidelines note, making the assumption that she is foreign.
"The sexism a white woman experiences is going to show up differently than the sexism an African American woman experiences because of her race," Comas-Díaz said.
The new guidelines give more attention to women with diverse marginalized identities.
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"We may identify as women, but we may also identify as women of color, as women with disabilities, as lesbian, queer, bisexual women. There's been incredible attention — much needed — on folks who identify as nonbinary and trasngender," Mollen said. "It's so important for psychologists to conceptualize girls and women with their complex identities."
Sexual violence remains a primary issue
The guidelines note United Nations data indicates that 70% of women experience some form of violence in their lifetime, with more recent research estimating this figure at 90% for the United States.
While the guidelines don't specifically mention #MeToo, both Comas-Díaz and Mollen say the movement shows how the cultural understanding of violence against women is changing.
"The statistics we have around the epidemic against sexual violence are startling and thank goodness for #MeToo which has brought widespread attention the issue," Mollen said. "In the guidelines, we don't talk solely about sexual violence, but everything that accompanies it: physical abuse, financial abuse, human trafficking, emotional abuse in addition to sexual harassment. We're talking about widespread persistent trauma."
Women need to be able to talk honestly about motherhood
As women continue to be primary caregivers of children, it's important to note the transition to motherhood can be much more difficult than women are led to believe.
"When you become a mother, you're supposed to be happy. Look at all this attention paid to Meghan and the royal baby. Society does not give women permission to explore the wide range of feelings and experiences that motherhood brings," Comas-Díaz said.
The new guidelines state that "for many women, there is a disconnection between the discourse around the joys of motherhood and the lived experience of parenting."
"Motherhood has become incredibly romanticized and idealized, yet a lot of mothers are suffering profoundly and in silence and I don't think that's adequately and accurately discussed. I think what we get presented with is motherhood is inherently satisfying, that it will complete women, that it will provide a source of joy for women," Mollen said. "Mothering puts tremendous pressure on women. If things aren't working well in your life, if you're feeling overwhelmed, the message you get is you need to be trying harder. ... It's a profoundly toxic perspective, and for mothers in particular it fails to take into the account the systemic factors that we don't have the language or vision to explain. These forces that have a profound impact on the places we live, the jobs we hold, the number of children we have and on mental and physical health."
Call your girlfriends
Women and girls tend to have healthier more supportive friendships than boys and men, and these relationships can help them lead happier lives. However, the guidelines state "difficulties in girls’ and women’s relationships can engender and/or exacerbate mental health issues."
"When we are with female friends there's a psychological reaction. We release oxytocin and serotonin, the wonderful feel good hormones," Comas-Díaz said. "When you feel the best of you is there in that friendship, it's absolutely healing and affirming."
Girls and women have a lot to overcome — and they can
Girls and women around the world face sexism, oppression, discrimination, prejudice — but the guidelines are clear that they're also well-equipped to overcome these adversities. Women are more willing to talk about their problems, more likely to self-report when they feel they have a problem, and tend to have much healthier personal relationships than boys and men.
Without minimizing the challenges girls and women face, therapists are encouraged to focus on their resilience and on their identities as survivors.
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This article originally appeared on USA TODAY: Therapists need to check their sexism, too (and other recommendations from the APA's new guidelines)