‘Are female clients more comfortable with a female therapist, or does it not matter? And vice versa for males?’
This was a question on Twitter last week. It’s always tempting to distil down every thought I’ve ever had into just 140 characters … it’s also tempting to reply simply ‘YES!’ or ‘NO!’ with a random emoji, with the sole purpose of causing an outrage-outage on social media. But I resisted and decided to write about it, in slightly more than 140 characters, in a blog post instead.
To date I’ve worked with over half a dozen therapists, both men and women. My very first encounter with a therapist was when I was at University, having my first mini-breakdown. The experience of being taken up countless flights of stairs into what felt like a ‘back bedroom’ by a man I’d never met before triggered unremembered memories of similar contexts for abuse in childhood. I didn’t ‘remember’ this as a visual image – it would take another decade for that to occur. I remembered it simply in my implicit, procedural response firstly of freeze, of please-and-appease and submit and do-whatever-he-says, smiling sweetly, telling him what I thought he wanted to hear, agreeing to practice this oh-so-clever breathing-and-counting technique which, he assured me, would transform my life; and later, of ‘escaping’, of flight – and never returning.
Undoubtedly, in hindsight, it may have been less triggering had the therapist not been male. But also it might have been less triggering if I hadn’t been taken up multiple flights of stairs to a dingy ‘back bedroom’. Who knows how the session might have rolled had it taken place in a bright and airy downstairs room opposite the main door? It’s easy to jump to the conclusion that it was the therapist’s gender that was triggering, but many other factors were also at play.
I’ve worked with other men too. And in some respects I’ve actually found them less triggering, especially to my attachment system. Because I was abused by both men and women: the most terrifying person in my life, for me, has always been my mother. Thus my greatest challenges in therapy have always been attachment issues. I’ve been raped, tortured, and multiply abused by multiple perpetrators on multiple occasions, often in organised settings. And yet I am haunted more by the pain of not being loved by my mother than by what any stranger has ever done to me.
So a decision based simply on gender just doesn’t cut it for me. There are pros and cons either way. There are many male therapists that I would rather work with over some female therapists, and there are many female therapists that I would rather work with over some male therapists. The questions I ask about a therapist are much more nuanced:
- Are they safe? And I mean, really safe? Safe enough for me to be me? Safe enough for me to brave my shame? Safe enough to tell what I cannot tell, and think what I cannot think, and feel what I cannot feel? Will they abuse me in any way – psychologically, emotionally, physically, sexually, financially? Are they secretly (and perhaps not so secretly) judgmental, patronising, standoffish, critical, or manipulative? What does it mean, actually, for a therapist to be safe?
- Are they professional? Do they conduct themselves as trained professionals, members of a professional body, not just ‘doing a job’, but also very definitely ‘doing a job’ – not amateur, not ‘nod enthusiastically and say ‘aww’ a lot’, but at the top of their game as a professional thinking deeply about what they do, always stretching forwards in their own development?
- Can they regulate themselves? Do they know what they’re feeling when they’re feeling it? Can they be aware of it without being overwhelmed by it? Can they use their feelings as insight into their own and their client’s process, or do their emotions present raw and ragged in the room, dumped back onto the client? Can they stay in their window of tolerance, in the green zone? Do they have effective ways of managing their emotions between the sessions so that they can be fully present, fully alive, to ensure that the client feels seen and feels heard and feels felt? Or do their emotions dominate? Are they skittish on the inside whilst faking serenity on the outside? Are their emotions squished into nothingness and so do they expect the same from their client? Or do they have a friendly relationship with their emotions, and they’re fully able – no matter what the client says or does or feels – to regulate their emotions?
- How good is their supervisory and self-supervisory process? Do they have an inner critic constantly shouting ‘Imposter!’, constantly whispering that they’re no good, or that the client is no good, or that everyone in the world is no good? Or are they aware of their thoughts, their feelings, their biases? Are they able to notice what they’re thinking and feeling, and reflect on it, and be honest about it, and respond ethically in the face of it? Do they seek out an external supervisor to uncover their blind spots and their shadow side, to stretch them, to challenge them, to hold them to account, or are they echo chambers of self-criticism or self-congratulation?
- What will they do to minimise the power imbalance between us? Will they assume their power, and wield it unconsciously, and ensure that I stay forever one-down? Will they concede their power, and abdicate responsibility, and play victim to my trauma? Will they rescue me? What will they do to be aware of the power dynamics in the room, especially with exceptionally vulnerable clients (the pleasers-and-appeasers) to mitigate them? And I mean, what actually will they do? How will they protect me from their shadow side? How will they protect me from their need to alleviate my suffering?
- Will they give me autonomy? Or do they have an agenda for therapy? Am I their case-study? Am I proof to their supervisor or CPD group of their excellence? Do they need me to ‘recover’ to feel good about themselves? Do they need to impose their ethics, their morals, their politics, their religious beliefs on me? Am I simply making up the numbers in their therapy session – another client to ‘deliver a good outcome’ to? Or are they willing if necessary to subdue their own wishes, perhaps sometimes uncomfortably so, to deliver back to me the autonomy that abuse robbed from me and which is so vital to my wellbeing?
- Will they learn from me, or do they think that they are the expert on me? Will they tell me what I’m thinking, will they tell me what my actions mean, will they tell me what I need to do to change my life? Will they make assumptions based on rigid theory or previous clients? Or will they be curious about me and my experience, and will they encourage me to do the same rather than giving me the ‘answers’?
- Will they collaborate equally with me in the work, or do they see me as the subject of their work? Will they encourage me to work hard in the work, or will they try to do the work for me? Will they impose on me a plan concocted with their supervisor, or will they encourage me to develop a plan for my own therapy, my own recovery, my own life, and support me in it (with sound supervision)?
- Can they help me move from where I am to where I want to go, and how will they do that? With clever tricks and techniques, with subtle coercion, with sighing impatience? Or through compassionate, empathic presence, through unconditional positive regard, through believing in me, through supporting me, through challenging me?
- Do they have qualities that I respect and want to further develop in myself? – compassion, empathy, warmth, wisdom? We become the average of the people we spend most time with, or the most intensive time with. Do I want to become like them in some way? Do I respect them? Do they have integrity? Are they a thoroughly decent human being? Do I like them?
- Are they working out their stuff by being a therapist? Or have they worked out their stuff and are they continually working out their stuff? Is the therapy going to be about their stuff or mine? Have they had their own therapy? Do they have unresolved trauma? Do they have unresolved attachment issues? Do they in some way need to be needed by me?
- Will they hold appropriate boundaries? Not a set of rules with no negotiation or reflection or collaboration, but real, proper ethical boundaries that they are the therapist and I am the client and everything they do ought to be done in my best interests? Will they be ethical? – truly, actually ethical? Not just paying lip service to a professional body’s ethical framework, but decision making on the basis of it every step of the way, every session, in everything they say or don’t say, do or don’t do? Or do they use their boundaries and their ethical framework to protect only themselves?
Gender is one issue. These are many more, and this isn’t an exhaustive list. What makes a good therapist? With whom are we as clients most comfortable working? What are the red flags? What are the shout-out signs of commendation? Who would YOU work with?