A question I have often either been asked or has come up up is whether the gender of the clinician matters (or should matter) to the client?
The answer, as with most questions relating to the intricacies of psychotherapy is not categorically ‘yes’ or ‘no’. However, the question opens up other questions which may themselves be more interesting such as, what are your beliefs about psychotherapy and why should the sex matter?
To start with, there are clearly cases and instances where it is entirely appropriate for a patient or client to want or need to work with a therapist of a particular gender. Aside from the fact that this may simply be the wish of the client (and therefore to be respected) valid reasons may include a history of sexual abuse by one gender leading to the client feeling safe with the other gender (often their own).
However, if we drop beneath the obvious, the question takes on more of a philosophical slant and how it is answered gives much insight into what a clinician believes about psychotherapy – let me explain.
There are many ‘schools’ of psychotherapy and many methods, however most of these have more in common than they don’t and secondly, most clinicians are to a greater or lesser extent ‘integrative’ in that they use different models in their clinical work. The greatest distinction, or divide, perhaps lies in whether or not a method, and thus a practitioner, believe in unconscious process or not (and spoiler alert – I do profoundly).
As a psychoanalytically informed psychotherapist, I work with the unconscious which means to say that I take very little on face value and work with my clients to understand why they think, behave and act in the way they do; in other words, how is their past experience influencing their perception of the present without their knowledge. Through therapy the past can be uncovered, worked through, grieved and its hold on the present reduced. This frees clients up to make informed and thought through choices based on their reality as it really is now rather than where they were previously stuck.
Those who don’t believe in the unconscious (namely behaviourists or person-centred therapists to name a couple) take things on face value. They do not believe in unconscious process and work very much in the ‘here and now’.
How does the unconscious link to the sex of the therapist?
Those of us who work with the unconscious will, to a greater or lesser extent, work with transference – that is, work with whom we represent to the client in the room. And whom we represent will invariably be one of the client’s caregivers, usually a parent.
Transference is very similar to projection, which is something we all do at times – we ascribe values to a person based on prior assumptions rather than on the reality of who they are. The difference with transference is that the clinician, if trained well enough, will receive the client’s projections and be thinking about who they are (represent) for the client.
Freud believed (and rightly so) that transference occurs irrespective of gender/sex. We will therefore ‘transfer’ our unfinished business relating to either or both parents onto the therapist. This too is my experience as I work in the transference and so recognise that how the client relates to me tells me something important about how they learnt to relate as a child and I can represent their mother just as easily as their father in the transference.
Therefore, whilst in some cases the sex of the therapist may matter, in most, it does not. And I believe that has also been my clients’ experience over the years whereby they may have had a preference in working with a female, have ‘ended up with me’ and we have done excellent work.
Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy. Mark is available at the Lewes and Brighton & Hove Practices.
Further reading by Mark Vahrmeyer