Understanding Context of Women’s and Girls’ Lives Key to Providing Good Psychological Care, According to Updated Practice Guidelines

Urge psychologists to avoid pathologizing problems of girls and women


WASHINGTON — Girls and women face considerable adversity due to the effects of sexism, oppression, discrimination and prejudice, but some are also well-equipped and have the right resources to confront and surmount challenges in their lives, according to psychological practice guidelines released by the American Psychological Association.

The ”Guidelines for Psychological Practice with Girls and Women” encourage psychologists to “incorporate a strengths-based perspective in their work with girls and women without denying the adversities they face,” the authors wrote. “They accomplish this by being especially cautious of the tendency to pathologize girls and women …; employing diagnoses sparingly while considering the gendered, multicultural context of girls’ and women’s lives; and initiating discussions about coping mechanisms, resources, resilience, agency and hardiness.”

“An emphasis on resilience is embedded throughout many of the guidelines,” said Lillian Comas-Diaz, PhD, a clinical professor of psychiatry and behavioral sciences at the George Washington University School of Medicine and executive director of the Transcultural Mental Health Institute. “It’s important for psychologists to recognize this so they don’t over-diagnose or pathologize the problems of girls and women.”

Comas-Diaz co-chaired the working group that developed the revised guidelines, along with Debra Mollen, PhD, a professor of counseling psychology at Texas Woman's University, and Sharon Lamb, EdD, PhD, a professor of counseling psychology at the University of Massachusetts, Boston. A diverse group of more than 40 experts, scholars, graduate students and practitioners contributed to the guidelines.

The guidelines — an update of guidelines issued in 2007 — acknowledge that women and girls face many challenges, from discrimination in the workplace to lack of access to parental leave and affordable child care to continuing high rates of sexual violence and sexual harassment. They urge psychologists to be aware that girls and women form their identities in contexts with multiple, contradictory and changing messages about what it means to be female.

Resilience is no inner trait girls and women are born with. Instead, “Psychologists endeavor to be attuned to the ways that these processes are connected to sociocultural factors, multiple and intersecting group memberships, and individual difference variables that may influence the degree to which a girl or woman internalizes societal pressure to regulate her behavior according to often inflexible gender standards,” the guidelines state. They suggest that psychologists may help women and girls become more aware of the discrimination they may face in order to create strategies to overcome the effects of those experiences.

“When a Latina client discusses an experience of sexual harassment and blames herself, the therapist explains the law, normalizes self-blame and challenges it by putting the client’s experience in the context of greater structural inequities,” the guidelines say in one example. “The therapist brings empathy to the situation in helping the client discuss whether to report the harassment, empowers the client to make her own decision about reporting or talking to the individual, [and] supports the decision the client makes …”

The guidelines encourage therapists to use psychological approaches that are affirmative, developmentally appropriate, gender and culturally relevant and effective. They also direct practitioners to reflect on their own experiences with gender and how their attitudes may affect their treatment of girls and women. “Because implicit gender stereotypes are ubiquitous, they can affect a psychologist’s perceptions of others without intent or the conscious realization that they have done so,” the guidelines state.

The updated guidelines include more research on girls and a greater emphasis on what they refer to as the intersectionality of identities, including racial and ethnic identity, sexual identity, age, size and nationality. They include gender-variant and transgender girls and women and underscore the importance of global context and transnational issues.

APA has developed several sets of guidelines for psychological practice with particular populations, including LGBT clients, boys and men, people with post-traumatic stress syndrome and older adults, for example. All APA practice guidelines are developed by task forces of experts, reviewed by APA boards and committees, and shared with the public for comment before they are accepted by APA’s governing Council of Representatives. APA guidelines do not take precedence over a psychologist’s informed professional judgment. 

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA's membership includes nearly 118,400 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve lives.

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