Gender Issues in Couples Therapy

Gender Issues in Couples Therapy


“Gender Issues” has been a difficult area for couples therapy. In 1988 the AAMFT required that accredited programs had to include gender issues in their curriculum. “Feminism” is initially what this meant, as women argued that traditional couples therapy maintained the sexist status quo, both by blaming women for violence and by maintaining therapeutic neutrality in the face of power differences in the couple. Even as late as 1997, studies of therapists still indicated that many did not see the need for a focus on gender issues, and still maintained the view that marital partners are really equal. In many studies, therapists still missed signs of domestic violence and show little response to it in treatment planning, or still saw it as a couple-shared responsibility.

I think men who have a pierced ear are better prepared for marriage. They’ve experienced pain and bought jewelry. — Rita Rudner

Talk of “equity” and “patriarchy” upset many who defensively reacted. Think about having power/privilege, and then admitting this and ceding it to others. This I think has been more problematic for male therapists as they find themselves increasingly in a female dominated field. Others used the changing perspective brought about by the feminism movement to start a focus on understanding men, and so “women’s issues” and “men’s issues” were areas of concern, with no real overlap, that became “Gender Issues.”

“Gender sensitive therapy” isn’t just doing things different. It’s about thinking and rethinking in new ways. Rampage points out therapists interrupting women during interviews, spending more time in discussion with men, and those sorts of things. However, consider inviting clients to recognize the same processes. Telling your opposite sex client “If there’s every a time in therapy you think ‘it’s just a guy/gal thing and you don’t understand’ that’s exactly when you need to let me know that I’ve missed something.” It means sometimes being an advocate for one side or the other, sometimes offering that there is another way they have not considered, and sometimes being a critical evaluator when it comes to risk for sexual abuse or violence. While we may agree couples therapy is not the right therapy for domestic violence, one in two couples comes to you having experienced some violence–and Jacobson and Whisman (2004) found 73% of their distressed sample had experienced some violence, with 44% having experienced severe violence—and so the fact is that if you are doing couples therapy, you are doing couples therapy with some violent couples and just don’t know it.

Power Differences

Gender sensitive therapy also tackles power (or, as Gottman called it, “influence”) head on. Whisman et al. (1997) found therapists rated power struggles as the fourth most difficult issue in therapy, right after lack of love, affairs, and alcoholism. Addressing this is done by 1) getting women to take power and feel they have the right to do so, 2) getting men to cede power and feel it is wise to do so, and 3) getting both to see the culture that supports this. It’s not that “he” is sexist or power hoarding and that “she” is weak and submissive (I really hate the sexism in gender sensitive therapy), but that he and she have been raised in a culture that supports this, and bucking the system is never easy. One of the best places to model this is by tackling power in the therapist-client system, and in the therapist-supervisor system.

All this is convoluted, as effective therapy often means catering a bit to the men. Women bring the couple in more often, but if the men don’t think it is helping, they are likely to leave and end therapy. Consider the power balance to be a narrative that you help them construct – help them see the re-balance of power to be a good thing. For both men and women, this may mean thinking “I’m not baby sitting; I’m bonding with my children, giving my son the father-son time he needs, or teaching my daughter about the kind of man that’s good to marry.”

Rampage says, “In working with heterosexual couples, gender will always be considered.” This seems to imply that in non-heterosexual couples it might not be. That’s the problem with this view. Two men or two women in a relationship with traditional gender roles either must eat out every night because neither is supposed to cook, or can never spend any money because they don’t know how to do so wisely. She also brings up Gottman’s ideas of harsh startups and stonewalling, gentling dinging him for not realizing the power differences in the relationship that support this. She, however, doesn’t give much credit to the social structures that support men shutting down emotionally. Sure, we pay men more, but they also have more stress-related health problems, more health problems that stem from ignoring their health, and shorter lives as a result.

When talking about power differences, be thoughtful though that neither member of the couple may have been taught how to talk about these issues. Women may have been taught not to take power or demand the practical aspects of power, and men may have been taught not to attend to the emotional aspects of power. Consider too that they likely will not think “power differences” is the real reason for coming to therapy. Women tend to rate communication problems, emotional affection, and fears of divorce as the prime reasons for therapy, and come to therapy hoping for a significant change. Men rate emotional affection, fears of divorce, and general relationship improvement as the prime reasons for therapy, and come to therapy hoping for a return to the previous status quo, since it is all they know. While men and women agree across couples, husbands and wives within a couple agree very infrequently on the reasons for therapy. This means that talking about power differences as the primary problem may be dead on, but likely satisfies neither partner.

Interviewing Couples about gender differences

To be more concrete, there are a number of areas you can interview about to learn more about gender issues for the specific couples (from Haddock et al., 2000):

  • Decision Making
    • who is responsible for what?
    • who is responsible for the “big” decisions and who is responsible for the “small” decisions?
    • who makes unilateral decisions?
    • what did you learn from your families about gender?
    • is this what you want? is this what you want to teach your children?
    • could this be done differently?
  • Work/Career
    • whose career is prioritized?
    • how are gender differences in pay handled?
    • how has gender impacted your career paths? how have you handled career conflicts?
    • how do you prioritize career and work with family and relationship?
  • Housework
    • who does what at home? how many hours a week does this translate to? (women do about 5 hours more a week, or if there are kids, 10 hours more a week, leading to the idea of a “second shift”)
    • educate on the impact of this sex imbalance – Gottman talks about relationship satisfaction
    • how do they want this to work out?
    • beware of language like “helping around the house,” “baby-sitting the kids,” and “visitation” as they diminish the role of male partners and fathers – be careful though in mother-centered step-families though
    • how are skill differences handled? Rampage says it has to be done the woman’s way, and the husband should admit her power and skill, after throwing out the cursory admission that the husband might sometimes do it differently. This sounds sexist.
  • Money
    • how are decisions about spending being made? how do differing income levels play a part in this?
    • who knows more about finances? can they learn more?
    • who has to ask for money?
    • are there other ways to do this (“mad money,” separate accounts, 60/40 split…)
  • Sex
    • what have you learned from your family about it?
    • what is sex and what is intimacy?
    • what are your individual desires and needs (speaking them aloud does not obligate the partner to meet them)?
    • have you discussed pornography, and the internet?
    • is there a history of sexual assault or abuse?
    • discourage sex on demand or “make up sex”

Cultural differences can mean that the couple views power differently from you. However, keep in mind that cultural differences in power have developed over centuries, and while they may not be a 50-50 balance, there is some balance. A case coming into the office is likely to have become out of balance from the majority perspective, as well as their own cultural perspective. Attack the problem through that vein, then in terms of what they want to teach their children who will grow up half in their culture and half in majority American culture.

Power differences can be active, what Whiseman and Jacobson called “dominant talking” or passive, what they called “dominant (not) listening,” and both are associated with greater relationship dissatisfaction. Similarly, rigid adherence to traditional gender roles is also associated with relationship dissatisfaction.


Rampage, S. Working with gender in Couple Therapy. In Alan S. Gurman and Neil S. Jacobson (eds), Clinical Handbook of Couple Therapy (3rd Edition) 2002. New York: Guildford Press.
Journal of Marital and Family Therapy
The power equity guide: Attending to gender in family therapy. Haddock, S. A., Zimmerman, T. S., MacPhee, D. (2000) Vol. 26 (2), 153-170.
Journal of Family Psychology
Power, marital satisfaction, and response to marital therapy
Whisman, M. A. & Jacobson, N. S. (1990)
Vol. 4 (2), 202-212