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Book Forum: WOMEN’S HEALTH   |    
Women and Group Psychotherapy: Theory and Practice
NADA L. STOTLAND, M.D.
Am J Psychiatry 1999;156:153-153.
View Author and Article Information
Chicago, Ill.

edited by Betsy DeChant. New York, Guilford Publications, 1996, 511 pp., $48.95.

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Does the infusion of a sociopolitical agenda into psychotherapy subvert treatment? Does it subordinate the patient’s interest to the interests of the therapist? Or does ignoring sociopolitical realities, or assuming that the intrapsychic world is the core of psychological problems, cast us and our patients into a make-believe world, one in which they are likely to suffer further harm? These are important questions, and this book is a good place to learn why they are important—and to explore the answers.

Every human being operates on the basis of a set of assumptions that grow out of his or her particular experiences and circumstances. Becoming aware of one’s own assumptions is enormously difficult. For a psychotherapist, however, it is crucial. Unexamined assumptions can stymie the therapeutic process and possibly harm the patient. Even as we empathize, we must realize that we can never really know what it is to be in our patients’ shoes.

This is especially true for "majority" therapists treating "minority" patients, because members of minorities must understand something of how the dominant majority thinks and behaves in order to survive. The converse is not true; it is perfectly possible to live a life, or have a professional career, as a member of the majority culture, full of misconceptions and biases about members of minorities. Dominant group prejudices and misconceptions can, and obviously do, persist and are inevitably enshrined in psychotherapeutic theory and practice as in every other aspect of life. Although women constitute a majority of the world population, their universally subordinate sociopolitical positions make these issues relevant to their treatment. Assumptions of therapeutic gender neutrality are unrealistic and, when not frankly damaging, make for lost opportunities for female patients to realize their creative and productive potentials.

Hence this rich and ambitious edited book. Ranging from the philosophical to the clinical, it is a demanding read, providing a high-level, integrated introduction to feminist scholarship and the psychodynamic group psychotherapy literature. Most chapters refer, from various perspectives, to the differential developmental experiences and gender roles of men and women. Men’s identity is predicated on separation, power, and autonomy, and women’s on relation and nurturance. Women are not uniquely, but more likely, to have suffered, or be suffering, outright discrimination and abuse. Several authors discuss the pros and cons of mixed-sex and same-sex group composition, bringing to bear careful literature reviews demonstrating that female patients in mixed groups tend to follow cultural stereotypes, suppressing anger and deferring to male patients. All-women groups, on the other hand, arouse anxieties related to unresolved and powerful issues with mothers and insulate female patients from the opportunity to work out problems with men in vivo. Male and female therapists, likewise, elicit different transferences and manifest different countertransferences, to each of which they must be alert. In our multicultural society, cultural and assimilative factors must also be addressed. There is also a chapter on boundary issues: ethics, risk factors, and enforcement. Specific research questions for the future are identified.

The editor provides extensive commentary on each section of the book. This is worthy but a bit confusing. She cites a great deal of literature not found in the chapters themselves and sometimes lapses into what amounts to a book review of her own book. A more rigorous editorial approach to the contributors’ manuscripts would have reduced the chapter-to-chapter repetition and increased the flow from one chapter to another. However, repetition is an educational tool, and this book has a great deal to teach us.

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