Combination of patients and therapist’s gender has impact on psychotherapy, including erotic feelings

Gender can have an influence on psychotherapy. This is backed up by the latest analysis and long-term research carried out by the director of the Psychotherapy and Counselling Science BA-degree programme at Karl Landsteiner University of Health Sciences in Krems (KL Krems). The results show that gender identity affects the emotions of both patients and therapists. This can give rise to specific dynamics in the therapeutic relationship, for instance in terms of power, and can also lead to sexualised atmospheres. A recent publication focusing on psychotherapeutic practice describes how such developments can come about.

Psychotherapy is all about emotions –regarding patients of course, but also their therapists. They need to “resonate” with their patients’ feelings and react on the basis of their own emotions. In an article in the latest edition of the journal Psychotherapie im Dialog, published by Thieme Verlag, Prof. Brigitte Schigl, director of the Psychotherapy and Counselling Sciences degree programme at Karl Landsteiner University of Health Sciences (KL Krems), outlines the significance of this point for day-to-day practice.

Her analysis is based on a theory known as “doing gender”, which has become a key component of social sciences over the past few decades. According to this theory, people are creating their gender identities – i.e. femininity or masculinity, or another gender identity – by means of interaction with others. This process usually occurs subconsciously, and has a strong influence on our behaviour. Classifying the person we are interacting with as “masculine” or “feminine”, for example, gives us indications as to how we should behave, and this also applies to therapeutic processes.

As Prof. Schigl points out: “Therapists respond emotionally to patients, and vice versa. Analysing this interaction in terms of doing gender gives us a better understanding of therapeutic processes.” In her recently published article, Prof. Schigl describes examples of situations that highlight potential problems, which in turn can be explained using the perspective of doing gender.

For instance, male therapists can encounter emotional resistance from male patients if the latter perceive them as being too emotional, and therefore too “feminine”. This behaviour does not fit with the “masculine construct” and can even be seen as a threat in the eye of some male patients. However, an all-female therapy situation brings together two individuals who have been socialised to be sensitive to feelings. This can create a strong emotional interaction and lead to a sense of trust. But it can also make it harder to deal with confrontation, resistance and detachment.

Eroticism and psychotherapy

“In mixed-gender situations – but not only in such contexts – erotic or sexualised atmospheres can play a part,” explains Prof. Schigl, referring to another problem associated with doing gender. “Female therapists often speak about challenges they face from male patients who flirt with them. They find it unpleasant and many of them at first feel helpless.” In contrast, male therapists generally see flirtatious atmospheres with female patients as less problematic. This setting of female patient and male therapist actually entails the highest risk of sexual assault, as Prof. Schigl notes in her article.

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