Cross-Gender Therapy: Female Therapist Meets Male Clients
If I were asked to describe my gender I would probably do so like this: I am a cisgender female – I identify with the gender I was assigned at birth. I also like being a woman. If I were to expand on how I relate to my gender and the ways I believe I conform or don’t conform to traditionally female stereotypes and presumed values, I would add the following: I am unquestionably and unflinchingly feminist in my values and am an activist who at times aggressively defends human rights. I am very independent and self-sufficient and I am non traditional in the way I prefer my relationships and home to run. I value intellectual pursuits and feel best when I am challenging myself through work. I have also typically been drawn to typically feminine interests and preferences; I like clothes and shoes, makeup and skin care products. I’ve never been an athlete nor played any sports to speak of and I generally try to avoid physical challenge when possible. I crave connection despite my introverted tendencies, and family and friendship are my first priorities. I speak using the language of emotions and am, by nature or nurture, a caretaker. Am I a typical woman? There is no such thing.
As I grow as a woman, I more and more place high value on my female relationships. Most of my clients are women, which is not surprising considering that I publicly identify as feminist and list women’s identity development and sexuality as an area of specialization. I also work with many couples. Comparatively, I work with relatively few individual males. This gender asymmetry in my practice evolved gradually. When I first became a counselor the demographic was the opposite, heavy on the male side. At this time I was working at an agency and the majority of my clients sought services to address and treat addictions. I have come to believe that addiction is still the reason many men seek counseling. For men, an addiction somehow serves as a legitimate reason to ask for help. Depression, anxiety, relationship challenges, struggles with loneliness or isolation, persistent feelings of inadequacy or low self-esteem? Not so much. These are issues that so many of my female clients come in to address, but are rarely broached by male clients. Are men unaffected by these issues? Absolutely not. It is just because it is not socially or even personally acceptable for them to admit it.
A few years ago I came to the realization that I struggled to work with single, heterosexual males. This was a hard thing for me to admit. Even harder was the need I felt to somehow ensure that my private practice was not brimming with this demographic. Coming to terms with these difficulties, I needed to take a hard look at why that was the case. In doing so, I sought to understand why in fact gender was at all an issue in the context of therapy. And I am not referring to the questions clients posed regarding their relationships with gender. I mean, why was it something that was playing out in the room in a way that made me so uncomfortable, to the point of questioning my desire and ability to work successfully with some male clients?
The quick and easy answer is transference. I simply had some very challenging cases in which the development of feelings, directed from client to counselor, that reflected a familiar past relationship, ended up being a large part of the content of our work. And as a therapist, it is more challenging to work through an issue with a client when you yourself become part of the material. I have written about this fairly extensively so I will leave it mostly at that. I will, however, point out that it became clear to me early on that a male client is more likely to develop romantic or sexual feelings of transference than a female client, including a client that is lesbian. My theory on this is simply that women, often having had closer and more intimate friendships with other women, are less likely to confuse the deep feelings of being seen, heard, validated, and cared for by their therapist as romantic.
But what else was present in the male-female dynamic that was making me wary? I since have come to several conclusions. There seems to be, for most men, an inherent discomfort in occupying a relational position that they feel is not the position of power. And while I strive for my therapeutic relationships to feel equal, balanced, and collaborative, the fact remains that clients seek a counselor because they believe him or her to be an “expert,” or, at the very least, someone who can help them achieve something that thus far they have not been able to master themselves. Furthermore, only one person is getting paid in this dynamic. For a single male, coming in to see a female therapist is already a potentially humbling experience; consequently some men try to level the playing field. They do this by overemphasizing asking about me in order to make the relationship feel more balanced, or they may bring small gifts or posture and sometimes minimize their pain and need. Yet addressing these dynamics often leads to profound growth. I am able to show the client that it is okay to be vulnerable in this setting. It is safe. They don’t need to take care of me. And sometimes they can carry this over beyond my office to other parts of their lives to great benefit. This is good stuff.
Knowing this, why still do I hesitate? This is where the dynamic starts to get a little more complicated. Because it is about me and “my stuff.” And that’s where counter-transference (the therapist having his or her own emotional reaction to a client based on past, familiar associations) can come into play. Allow me to preface by saying that there are many men in my life for whom I have a deep love and profound respect. My husband and my father are two such people. I am also the mother to an 11-year-old boy and currently pregnant with, you guessed it, another son. Understanding men and learning to love even the parts I don’t understand about them has been something of a life goal and project of mine. And like any goal, it has come with its own challenges. My relationship with these and other men have been, it is safe to say, harder than those with my female friends and family members. In part this is because the men in my life are strong and, pretty uniformly, stubborn. They also all have what I would characterize as “a temper.” They also all happen to be smart, creative, and at times incredibly nurturing people. Each can be soft. Each can also be intimidating. And I’m not particularly fond of feeling intimidated.
Intimidating, threatening, controlling. Most of us do not respond well to being in the presence of a person who possesses these qualities. And though they can, without question, describe a person of either gender, more often than not these are more commonly male dominated traits. Why? Because they are traits that are historically valued and therefore taught to our boys and men. While women get the short end of the stick in many, many ways, this is one case in which men are given a bad deal. As a culture we value strength, power, fearlessness, toughness, lack of emotion, and ambition in our men. We don’t like men who are seen as passive, weak, or highly sensitive. This translates to the limitation of boys’ emotional repertoires. It is more socially acceptable for boys to show anger than other emotions. Anger can manifest as aggression.Thus we get a lot of angry, violent boys and young men. As adults, many men learn the benefits of channeling their aggression into healthier outlets, but it comes at a cost, with many men feeling that in doing so they sacrifice some fundamental part of their masculinity or pride.
We make assumptions about men’s internal traits based on observation of their external traits: men are generally larger and have deeper voices than women.
It would be impossible for me to work with male gendered and identified clients if I did not seek to further my understanding of the male experience both individually and universally. In doing so, I need to look at gender as a whole and as well as my assumptions about women. Fortunately, I have many clients whose presentation and identification manifest in countless ways on the gender spectrum, from cisgender (an individuals perception of their gender matches the gender they were assigned at birth), to transgender (gender identity does not match gender assigned at birth), to identifiers that reflect a sense of gender fluidity including the use of a gender-neutral pronoun such as them or they (rather than him/her or he/she). Because of this, I have had the opportunity to have wonderful and complex conversations with many people about what their gender means to them. For the most part of course, those individuals who have questioned their gender, changed their physical appearance to align with the gender they feel they are, or rejected gender stereotypes, have generally put a bit more thought into their self-concept than those who haven’t. But even those cisgender folks who have never felt conflicted about their gender are usually not at a loss for words when prompted to think about the ways in which they believe their gender has impacted their sense of self, options and choices in life, and relationships.
Gender socialization begins before birth. As parents we identify a baby as a boy or girl and start creating his or her environment accordingly, from the color of the baby’s nursery, to clothing, to our own fantasies of the kinds of activities we will share with them as they grow. We do this partly because other people do so and we don’t question it.
We also do this because we do not desire our children to face any additional hardship or pain, so we condition them to live according to societal values of heteronormativity. Nor do we ourselves want our parenting choices to be questioned or challenged.
For most people, it is profoundly uncomfortable to be uncertain of a child’s gender. It can feel as if we don’t know how to talk to them or treat them. Transgender adolescents and adults are discriminated against, marginalized, and often the victims of violence. And therein lies the problem. We often see gender first and consequently miss or dismiss a new person’s unique qualities. With repetition, these qualities tend to atrophy with time, a lost or severed part of ourselves, or worse, these qualities can be used against us for harm. And as we grow, we use our gender as the dominant factor in the development of our personalities and actions because we are generally approved of when we do so and disapproved of when we don’t. What begins as externally motivated can become internally motivated, a refuge and road map for providing us a perception of structure around the highly complex processes of self-discovery and identity formation. Gender also provides us with a group to identify with, something as humans we tend to gravitate towards because we all like to feel like we belong.
Because gender socialization affects every person, it becomes incredibly difficult to determine what constitutes genetic wiring and what does not. The concept of gender is tremendously important yet rarely discussed culturally unless one actively seeks it out, and most people don’t do so unless the topic actively pertains to them. Thus, we get some pretty gender-savvy people who challenge gender norms because of their own intrinsic forces, and a lot of people who haven’t spent a whole lot of time thinking about it, aside from perhaps noticing some differences in the way male and female genders differ in their primary romantic relationships, for example. As a therapist, this dichotomy is especially strong and noticeable. This brings me back to where we started.
As a counselor I enjoy working with complex thinkers and norm challengers. So I guess it would be fair to say that I also find my work with cisgender, heteronormative females at times challenging as well. But the shared experience of being a woman at this place in time facilitates more intersections of commonality with females than with males.
In delving deeper with this question I originally assumed that my cisgender, heterosexual, female clients partner with cisgender, heterosexual males and that these traditional male/female dynamics are what I dislike working with. Yet while many of my cisgender female clients do describe highly controlling and imbalanced relationships, the same dynamics often play out in same-gendered couples as well.
Ultimately, I seem to resonate more with people in both my professional and personal life who are courageous in the way they move through the world, who take the time to explore the way different aspects of our culture impact them personally, and who are willing to advocate for change if they see something wrong. These are tendencies that I value. However, it is both unfair and impossible as a therapist to only work with clients who share aspects of your own value system.
It continues to be my work to question and challenge my own assumptions and expectations around gender, and to be not just open to, but excited about, working with clients who may have different values than my own. This is learning. This is growth. And it comes from different perspectives. Despite my instinctual hesitation in taking on a new male client because of past challenges in both professional and personal relationships, I can say with certainty that I have learned a great deal from cisgender male clients. Things I couldn’t have possibly learned through academic study. Things I am grateful they trust me enough to share. They allow me the opportunity to understand their experience and, through this, find greater acceptance of and appreciation for both our differences and our similarities. This process, I believe, promotes acceptance, compassion, and also a willingness to change assumptions for both of us and for all those with whom we share our learning.