Taking the Podium

Look around any therapy conference or training, virtual or in person, and the audience demographic is clear: despite an increasing diversity in race and ethnicity, the room will be primarily filled with women. This is a growing trend, a reversal that’s taken place over the last 50 years. Statistics back this up. Today, the largest group of therapy providers—clinical social workers—is more than 80 percent women. The trend of feminization is unmistakable. Women now own this profession, at least as therapeutic providers and frontline workers. Should we, as some do, bemoan the lack of male therapists, or might this be a positive change for the profession, signaling an opportunity to connect with our growing therapy market in new ways?

We’re two baby boomer, white, cisgender women, who are approaching the third stage of our careers as therapists. And in the late 1970s through the 1980s, we found the therapy profession to be highly male influenced. Most cutting-edge trainings promoting new methodologies and most influential books and conferences were spearheaded by men, white men.

The white male mindset came through loud and clear. With our master’s degrees in hand, we remember watching women trainees, supervised behind a one-way mirror, get criticized for not being more like their male teachers. Women were instructed to be more concise, confrontive, and direct, even though they privately worried such attitudes could shock or alienate clients. Those methods favored cognitive, short-term interventions that relied on terse statements, biting humor, and breakthrough moments; however, this was not necessarily how women we knew thought or talked when trying to work through difficult issues.

We were taught to set a stringent framework around each session. Formulaic protocol and a rigid adherence to method was considered the mark of mastery, with tight boundaries that allowed for no last-minute cancellations. Yet we felt empathy for mothers with unexpected conflicts or sick children and saw the helpfulness of a softer, slower-paced, empathic intervention. What we thought of as necessary flexibility didn’t fit the model of those times. This seemed especially the case in situations where women needed to attend addiction-recovery groups or receive hospitalization but couldn’t get time off work or find childcare. The commonly held stance was that such women could find the time and help if only they would—a reflection of the financial and social support for treatment far more available to men than women.

Gender Economics

If the methods we learned in our early years of practice favored a more masculine approach, the economics of practice unfortunately followed suit. Back then, we were part of the cohort of “second-wave” feminists. We attended feminist support groups, read Betty Friedan and Gloria Steinem, and challenged traditional career roles. However, we needed to support both ourselves and our families, so while the purpose of our chosen career as therapists was important, money mattered too.

In the ’80s, we saw that men in organizational positions got paid more than women. Then, when insurance became prevalent and HMOs and managed care were on the rise, men left the mental health field in droves, looking elsewhere for careers that offered more money and status. Women, ready to take on professional careers even while balancing roles as homemakers and mothers, stepped into the void.

Social work, always a woman-dominated profession, began to offer a master’s degree in clinical social work. Clinical social workers then lobbied for licensure and the right to diagnose and treat independent of approval by a psychiatrist; they became a major provider of therapy. Also, the addition of the PsyD degree allowed those of us who were more interested in providing therapy than doing research to become psychologists. Other types of licenses emerged, like MFTs and LPCs, offering options to the many women seeking master’s degrees. More women therapists opened private practices, gaining further autonomy. As these new educational and licensure opportunities emerged for them, women began to dominate the field.

Economics, however, didn’t keep up with new roles. In agencies and academia, gender inequality has persisted. Women social workers in agencies today still earn 10 percent less than men in similar positions and are less likely to be in managerial roles. Women psychologists earn 30 percent less than men, except for the relative parity in government salaries, and are hugely underrepresented in the influential positions of editors for journals and in academia. Yet, while room remains for women to pursue influence and economic parity, we posit that the shift toward feminization may be benefiting the profession.

Clinical Opportunities from Feminization

The benefit of feminization may be clearer if we look not just at the providers, but at those receiving services. In 2020, more than 52 million people sought mental health services in the United States, and most of those in treatment were women. Studies show that women seek services between 20 to 50 percent more often than men do, and the same percentage of women say they prefer to talk with a woman therapist; it promotes their sense of comfort and understanding. If women value receiving therapy more than men, and prefer to get help from another woman, why wouldn’t they also benefit from having more woman-led methods of therapy to rely upon?

Women bring a different perspective to research and treatment.

Researchers at the Stone Center during the ’80s and ’90s, like Carol Gilligan, examined how influential theories—such as Erik Erickson’s male-centered personality stages and Lawrence Kohlberg’s male-focused moral development theory—caused misunderstandings about women and their psychological health. For instance, Erickson denied the importance of women’s autonomy and self-actualization as developing apart from marriage, dependency on men, or parenting functions. And Kohlberg placed male-defined justice and rules above the importance of caring and relationships, which led him to proclaim that women were morally stunted. Gilligan and other feminists insisted that gender-based differences were not deficits.

Fortunately, during the past 40 years in psychology, a feminist model of mental health and social wellness has emerged, and major methodologies—such as EMDR, DBT, and Sensori­motor Psychotherapy—have been primarily developed by women. Continuing to foster women’s leadership in our profession is critical. So is it time for women to direct even more of the content, methods, and path of the profession—not just as providers, but as the primary leaders, developers, writers, speakers, trainers, and influencers? We’d say, yes. And in many ways, this is already happening.

Next-Generation Leaders

We anticipate that women will become even more intentional in driving our field toward greater inclusiveness and more creative methodologies. As more women take their place in leadership, we hope they’ll continue to put forth values often associated with femininity, such as nurturing, healing, recovery, collaboration, and compassion.

We hope younger women will continue to be ultra-creative in using social media platforms without being restricted to the limited, formal path of publishing their work to be heard. They’re deftly promoting psychotherapy via newer modes of communicating with the market of potential clients using podcasts, YouTube videos, and Instagram. Nedra Tawwab, Adriana Alejandre, and Brené Brown, to name but a few, have been hugely successful in reaching the public at large and bringing mental-health topics and conversations into the mainstream.

Women therapists need time to do this kind of work: to write, to speak, and to take leadership roles in organizations and associations that promote the field. And to fulfill these potentials, they must make the hard choice to prioritize themselves.

How can we help them? As we pull back from the rigors of full-time clinical work, we can find ways to encourage their creativity. When we meet at conferences and trainings and in our local communities, we can talk directly with each other about how we’re supporting our female colleagues and clients. Many men in our field consider themselves feminists and can support these goals and advances. We can increase our role outside the field too, advocating for legislation that will advance treatment availability to all, promote healthcare coverage, and influence pay from insurance companies, so that highly trained, educated, and necessary professionals in our field will be compensated fairly for the work they do.

We’re poised to meet this moment, ready to serve the needs of an increasingly anxious, depressed, and traumatized population with an evolving, creative, and adaptive psychotherapy profession.

PHOTO © ISTOCK/JOHNNY GREIG