What makes feminist knowledge legitimate for therapists? A study of Swedish child psychotherapists

Abstract

This study investigated what it is like to be a feminist clinical psychologist in a country with a long commitment to gender equality. We studied how two Swedish clinical child psychologists committed to promoting gender equality talked about issues of gender and inequality in their clinical work. We identified three interpretative repertoires that formed the basis of these clinicians' talk about gender and gender equality: a repertoire built on ideas about basic inherent differences between boys and girls, but nonetheless valuing boys and girls equally; a repertoire emphasizing similar treatment, built on the assumption that gender is of no importance, and that everybody has equal value; and a repertoire built on views of girls and boys as unequally valued by society at large. Both clinicians drew upon all three repertoires. However, they used the repertoires in starkly different ways depending on whether they assumed that knowledge that presupposes gendered power structures can be considered legitimate professional knowledge.

Keywords

child psychologists gender equality gender therapeutic work sex stereotypes discursive psychology Sweden

Introduction

What is it like to be a feminist psychologist in Sweden, a country committed to gender equality? This is a question that we—two Swedish feminist psychologists with many years of professional experience—are often asked by colleagues from other countries. In this article we explore issues that face Swedish clinical child psychologists who want to promote gender equality and integrate knowledge about gender issues into their therapeutic work. Child psychologists and therapists in Sweden work in a national context that emphasizes equality between women and men (Gemzöe, 2002; Hirdman, 2001). Sweden has a well-developed public childcare, a gender-neutral parental leave program, gender equality legislation, and regulations for health care that emphasize the impact of societal factors on health (Discrimination Act, 2008; Parental Leave Act, 1995; Stockholm County Council, 2006). However, the political concepts “gender equality” and “feminism” often lose their critical potential as they travel into practical arenas such as health care (Eduards, 2002). Psychotherapy is included under the gender equality policy that regulates public health care in Sweden; however, there is little discussion among psychotherapists of how this policy affects the practice of psychotherapy (Stockholm County Council, 2006).¹ The silence in the profession, in contrast to the political emphasis on equality, triggered our interest in how clinical psychologists give meaning to gender equality, gender, and feminism in their therapeutic work.

In a previous article we explored how a number of clinical child psychologists, who were not selected for any interest in gender equality issues, talked about gender and gender equality in their work (Eskner-Skoger, Lindberg, & Magnusson, 2011). The dominant pattern was as follows: When they spoke about their profession generally, gender equality meant gender neutrality, expressing an ideal of the psychologist as value neutral and a reluctance to bring their values into their work. In talk about symptoms and therapeutic practices, they construed gender as difference, arguing that girls and boys have different symptoms, so they should be treated differently. Gender equality issues were not made to seem relevant, nor did the clinicians show concerns about the risk of reinforcing gender stereotypical norms for girls and boys (Eskner-Skoger et al., 2011). However, there were some interviews that diverged on all the above points. These divergences, we felt, merited further study. For this article we selected the only two interviews in which the participants spontaneously expressed an engagement in gender equality issues (an expression that in the Swedish context is equivalent to expressing engagement in feminist issues). We analyzed these interviews in order to explore how clinicians committed to gender equality formulate their critique of gender stereotypes in therapy and also the clinical strategies that their critiques may enable. Further, we wanted to explore whether their expressed commitment to gender equality meant that they regarded knowledge about societal subordination of girls and women as relevant for therapeutic strategies. In other words, in the eyes of two clinicians committed to gender equality (i.e. feminism), what kinds of knowledge about gender, feminism, and gender equality could be legitimately brought to bear on clinical work?

We were inspired by earlier feminist studies of dominant ways of conceptualizing gender in psychology (Burman, 1994, 2008; Crawford & Marecek, 1989; Diamond, 2006). Feminist critics have argued that an important reason for the limited integration of feminist theory and other gender-theoretical understandings into conventional psychology (e.g. developmental psychology) is a divergence between their epistemological allegiances (Marecek, 1995). Of special importance for this study are the consequences for developmental psychology of such a divergence. Code (2000), for instance, argued that in much developmental psychology, an objectivist view of science combines with the ideal of universal knowledge, perpetuating assumptions and practices that may contribute to maintaining social inequalities. Further, Burman (2008) problematized the combination of a universalist aim and an exclusive focus on the individual in many theories of psychological development. She argued that this has led to a failure to theorize the contexts of children's lives.

Research questions

Our aim was to explore the meanings of gender available to Swedish child psychologists who want to promote gender equality in their work as therapists. We asked the following analytical questions: When psychologists who want to promote gender equality talk about their work, what meanings of gender and gender equality do they recruit? In what specific professional contexts does gender become relevant? How does their meaning-making about gender relate to their ideals of a competent practitioner? What are the consequences of different ways of thinking about gender for how clinicians perceive their ability to counteract gender stereotypes?

The interviews

The two interviews were done in 2007. The interviewers contacted managers of public child psychiatry clinics, maternal and child health clinics, and primary schools to recruit clinical psychologists working in those organizations. The managers furnished the names of possible participants; an interest in or knowledge about gender issues and gender equality was not a selection criterion. All the interviews were conducted in the practitioners' workplace. The interviewers presented themselves to participants as licensed psychologists and researchers interested in interviewing psychologists about their therapeutic methods, their views on their role as psychologists, and their view on working with issues of gender and gender equality.² Information about protection of anonymity was given at the beginning of the interview. The interviewers aimed for an open and listening stance, encouraging reflections by the participants about their work. The two psychologists whose interviews indicated that they were especially committed to gender equality were chosen for this study. Both were women.

The interview guide

We developed an interview guide that covered five topics: (1) The psychologist's clinical tasks, working methods, and theoretical framework; (2) the types of practical psychological work with families and children that each psychologist engaged in; (3) the participant's views on psychology and psychologists in society; (4) the participant's views on gender and gender equality issues; (5) the participant's reflections on her role as a psychologist. The interview conversations were organized around these five topics, with ample space for the participant to expand on issues that she deemed especially important.

Interview analyses

Our analytical procedures were inspired by critical discursive psychology with its emphasis on words and language use as ongoing sites of negotiation (Wetherell, 1998; 2007). We adopted the analytical approaches developed by Edley (2001) and Wetherell and Potter (1992). They argue that, when people speak, they do so within a framework of existing culturally based arguments and understandings, which they have termed “interpretative repertoires.” Not all understandings and arguments are equally available, however. Consequently, our analyses focus on, first, on how participants position themselves in relation to the different possible understandings, and second, what discursive processes may underlie their positionings. The terms discourse and interpretative repertoire are often used interchangeably to denote patterns of meaning-making and specific ways of talking and thinking about a phenomenon. According to Edley (2001), the term interpretative repertoire tends to be used when researchers want to emphasize people's activities in identity production. Here, we use the term interpretative repertoire to denote the different ways of talking about aspects of clinical psychological work.

Our analytical questions focused on how the two psychologists reflected on their approaches to therapy and their awareness of various meanings of gender. We studied their reflections on the theoretical tools at their disposal as therapists, and how useful they found these tools to be when dealing with the assumptions about gender that surround the clinician. We also explored the knowledge ideals that the participants expressed and whether the ideals seemed to have consequences for the participants' ability to integrate their commitment to gender equality with their therapeutic work. To do this, we mapped the assumptions about gender on which each participant based her commitment to gender equality and observed how these assumptions related to ideals of a proper professional approach. Finally, we studied how the participant's assumptions related to a core question for feminist approaches to psychological treatment: in what circumstances can knowledge about gender, power, and social dominance be counted as legitimate clinical knowledge?

Reading through the two interviews, the first author noted each participant's reflections as they were related to the analytical questions. We then used the full interview transcripts to construct maps of the discursive surroundings in which each participant moved in her daily working life. Following on this, we analyzed the participants' reflections as they tried to reconcile the different, and often contradictory, repertoires and positions that were activated in their attempts to deal with the meanings of gender in the professional setting.

Results and discussion

A first finding was that the two participants used different strategies to justify their commitment to gender-equal therapeutic work. These differences, in turn, seemed to have consequences for their views on gender in therapeutic work. In what follows, we describe and compare their strategies and their consequences. We first describe how the two participants reflected on and argued about gender issues. We then discuss the strategies for reasoning and the discursive tools that the participants drew on.

Participant 1—An uneasy position between positions

In the profession: Women and men are equally professional but asymmetrically valued

This participant worked as a clinical psychologist in a school setting, basing her work mainly on cognitive behavioral theory. She had about five years' work experience. When the interviewer brought up gender issues and gender equality, this participant immediately commented that they were important. When she was asked to reflect on how such matters were dealt with at work, she answered:

P³: One just takes it for granted that male psychologists are so very much more – I may exaggerate a bit – but it feels as if they are so very much more sought after. Because being a man in a female profession is terrific – “Guys!” Not so much in the other direction: if you were a female truck-driver – “We want her”… but somehow also one takes it for granted that I will also be pleased: “Oh, God, a male psychologist, great! Really good!” Three thousand crowns more per month than me.

For this participant, gender and gender equality at work seemed initially to refer to the differential valuing of female and male psychologists. Her account referred to structural asymmetries between men and women, such as salary differences. It seemed based in a view that society values men more highly than women though not featuring them as “different.” This could be read as drawing on the repertoire “similar but differentially valued.”

In the therapy room (1): Girls and boys are different and given asymmetrical resources

Later, the interviewer probed for reflections on gender and gender equality in relation to therapeutic treatment procedures and the allocation of resources to girls and boys. The participant then told of her impression that professional attention and resources were unequally distributed between boys and girls, and that boys were given support and treatment earlier than girls. She said:

P: Well, my spontaneous general feeling, and I don't know if it's correct, but it feels as if one is pretty quick in paying attention to the classics – boys who act out. And girls are left without attention much longer, because their problems don't demand so much from their surroundings, or because they often turn inwards.

In the therapy room (2): Seeing girls and boys as different but valuing them equally

The participant gave several accounts of introverted and silent girls and troublesome, acting-out boys. She sought explanations of the imbalance of resource allocation mainly in inherent differences between girls and boys, not in the societal devaluation of girls. For instance, when asked what happens when girls' introverted patterns create difficulties, she proffered the internally focused explanation that girls' symptoms create the problem, thus focusing on assumed differences between girls and boys (“girls are too quiet”). This disconnection of the unequal resource allocation from the societal devaluation of girls contrasted with her earlier statements about the inequitable salary allocation and societal evaluation of female and male psychologists. When the participant spoke about the girls and boys she saw clinically, the repertoire “similar but unequally valued” was replaced by an approach to speaking about gender that was based in inherent differences between boys and girls. Her own view came across as affirming that boys and girls were different but ought to be given equal resources. We called this repertoire “different and equally valued.” Later, the interviewer broached the possibility of including a societal-level analysis in clinical work:

I: Different groups in society have different access to power and resources. Could such power and resource circumstances be of any importance for the psychological problems that you treat? Do you think, in a societal perspective, that those circumstances might have psychological consequences or …?

P: Yes. I do. In a way, of course, but it becomes, it is on such an enormous – yes it – on a political level it is, certainly, certainly.

We interpret the unfinished expressions “it is on such an enormous–” and “on a political level it is …,” as indicating that this participant found it difficult to connect the clinical issues she encountered in her daily work with gender issues on a political and societal level. To explore this difficulty, we reread the interview and traced a repertoire based in an ideal of psychological knowledge as neutral; we call this the neutral knowledge repertoire. This neutral knowledge repertoire indirectly informed another account:

P: I think gender equality is important. But I sometimes think, “Stop, that will do now!” That there's, there's sort of too much. And I sometimes also think that one – I really don't think one has to apply a gender perspective to everything, it becomes a bit [sighs]. That's not where the problem is, in a way, I think. No, I don't know.

I: How do you mean …?

P: Hmm. It, that is to say, the difficult thing is, it's a bit like this – well in principle it [a feminist perspective] is perhaps after all meant to fill the function to be a bit more exploratory. But it becomes – I often think there is a very dogmatic, judgmental tone. That it so to say – there's no unprejudiced inquiry or hypothesis-testing, but it's “Now these bastards are going to get paid for hundreds of years, thousands of years of oppression!”

We interpret this passage as implying a collision between the participant's knowledge about unjust societal structures and asymmetrical valuing of men and women on the one hand and her ideal of neutral knowledge, on the other hand. This ideal she seems to find wanting in a feminist perspective. Although she speaks of her awareness of unequal societal structures, the “non-neutral” consequences of such awareness seem to lose legitimacy in the face of an ideal of knowledge as neutral and unprejudiced. Her exclamation “Stop, that will do now!” and the sentences following directly after it indicate that she wanted to limit the issues for which gender equality (i.e. feminism) is relevant. When asked to elaborate, she moved between valuing impartial explorations (“be a bit more exploratory”) and balking at what she sees as dogmatic and judgmental ways of talking about inequalities. The participant, after beginning with reflections from a feminist knowledge position based in her awareness of unequal valuing of male and female psychologists, seemed to encounter a roadblock at questions about what kind of knowledge can legitimately be brought into the therapy room. Our interpretation is that, in her view, a therapist will land in the wrong place if she attempts to explore a clinical issue without remaining neutral. In her view, feminist knowledge is nonneutral, and as we read her position here, knowledge seeking should always be neutral (“unprejudiced”). We interpret her account as based on the neutral knowledge repertoire. In this repertoire the knower needs to keep a neutral stance toward that which she is learning about.

For this participant, knowledge that begins with an assumption of gendered power structures could not be neutral and therefore cannot fulfill the requirements for a legitimate grounding for professional work. When she spoke about education and professional knowledge, knowledge that was informed by an explicit agenda (such as women's demands to be equally valued) was therefore suspect.

Trying to counteract sex stereotypes using gender-neutral means

This participant did express a wish that the inequalities in the valuation of male and female psychologists, and in the gender-stereotypical approaches to therapy with children, would be rectified. However, because she did not consider it legitimate to interpret inequalities between girls and boys in treatment as due to differential valuing, a value-neutral repertoire about gender seemed to be activated in her accounts of therapy. In this repertoire, also, she spoke from a commitment to gender equality, but reframed gender equality as being treated similarly. For instance, when asked if she sometimes worried that she might contribute to strengthening gender stereotypes in her treatment work, she answered:

P: Yes. Though I try, that is, I try not to, I try to think more freely and more widely, to, as it were, be the one who argues for a sort of more gender-neutral approach. So that I hope that I don't actively contribute to painting children into corners.

In this account, the participant brings forward a gender-neutral approach as the preferred way to avoid restricting children to gender stereotypes. This neutrally “enabling” approach to gender and therapy, in which she, in her own words, “think[s] more freely and widely,” seemed to make it possible for her to combine her feminist commitment and her ideal of neutral clinical knowledge. The interpretative repertoire “similar and equally valued” seemed to work as a compromise that enabled the participant to stay within the bounds of legitimate knowledge in her profession, while also enabling her to present herself as being in favor of gender equality.

When, soon after the above passage, the interviewer asked if the participant felt that she had access to resources that helped her avoid getting stuck in gender-stereotypical thinking, she replied:

P: What's good about learning theory is that it is very contextual; that there isn't any intrinsic problem or any intrinsic strength in being either the one or the other but it – in relation to one's surroundings and the expectations one is subject to …. Yes, support to the extent that one has to see things in their context, and in what way it makes difficulties for this pupil in this situation ….

I: Do you feel then, that you have support for … also daring to be able to go beyond these issues of gender or …?

P: Yes, I think so, because that's nothing self-evident.

When this participant was asked about her access to helpful resources in treatment of girls and boys, she pointed to what she called the contextual character of cognitive behavioral therapy and learning theory. She portrayed this as the main strength of her approach in helping to avoid gender-stereotypical thinking: “there isn't any intrinsic problem or any intrinsic strength in being either the one or the other.” This response can be read as an acceptance of the possibility of a gender-neutral stance that focuses narrowly on what a person encounters in daily life. However, to do this, the stance will have to disregard the fact that what children of different sexes encounter will not be “neutral” (cf. Grant, 2011; Kantrowitz & Ballou, 1992; Pilgrim, 2011; Wolfson, 1999). In what follows, we trace how this stance, and its lack of connections between societal levels, left this participant's accounts about her clinical work wavering between focusing on differences between girls and boys and arguing for gender-neutral practices. Immediately after the passage given above, she talked about gender-specific practices in her own clinical work:

P: You may think, say what you want – I mean things are so incredibly gender equal and yet one talks differently to one's, to little boys and little girls. There is an expectation for how one ought to be as a little girl and a little boy. And I – for as I said that I might react to acting-out girls who don't sort of – for me it is easier to deal with boys who are a little girlish. I think that is nice and sympathetic, but acting-out girls who are boyish, that is sort of: “It's just not done to behave that way!” I, instinctively, I react like that. So, I can sort of intellectually see that it's OK to act in whatever way, that there is neither the one nor the other, or one way is not more right than the other, and yet I react in this way.

A far from gender-neutral practice

In spite of her previously expressed desire to treat girls and boys in the same way, and to ascribe no importance to the sex category of a child, this participant noted that she did react differently to a behavior depending on whether the actor was a boy or a girl. She also noted the disparity between a gender-neutral ideal and a gender-specific treatment approach. However, we found no reflections in her interview on why such a disparity existed or how it might be removed. Further, in her reflections about these disjunctions, which she found “disturbing,” she directed no criticism against the knowledge base of psychology or her training as a psychologist and their treatment of issues of power and gender. Rather, her choice of words (“I, instinctively I react like that”; “and yet I react in this way”) indicates that she seemed to see her reactions as due to her individual shortcomings.

In some of the passages in which she spoke about gender equality, the participant expressed uncertainty and discomfort about how to act “correctly.” In one such passage, talking about her own approach to gender equality, she expressed a sense of not being able to “stand up for it” when things came to a head. She described her own shortcomings in handling asymmetries and injustices and gave vent to reactions of frustration, depression, and fatigue:

P: Perhaps one thinks that – of course, gender equality [is important] – but when things come to a head, maybe one doesn't stand up for it, somehow.

I: You seem a bit resigned.

P: Yes, well, yes, that's what I think, it is double, because it is sort of [sighs] on the one hand there are injustices and then at the same – on the other hand it feels like, well but it's just that it's sort of a part of this large whole to do with how we become the people we become and what it means to be a girl and a woman, sort of. Then it's also, I get completely depressed [laughs] – no, but if one has to know so much, be so much and also keep fighting for things, it gets so exhausting.

We interpret the above account as signaling that the participant wavers between emphasizing awareness of existing injustices and knowledge about inherent differences between the sexes that influence identity development. The tension caused by her wavering was wearisome and uncomfortable, as evidenced by her expression of a sense of fatigue and depression. She eventually moved into a position—see the next extract—that emphasized sex differences. Here, as she continued to reflect, the emphasis on sex differences that she had earlier rejected came across as necessary, giving prominence to the repertoire of inherent sex differences, “different but equally valued”:

P: But somehow it feels like – but yes it is – there is some difference that is desirable or sought after in some way. For I am thinking that if there were no difference, if it didn't matter, then it would – then it wouldn't matter if one had only male or female work mates or lived with men or women or – so there is something in the existence of differences that makes things interesting. And yes, no – yes, arrgh!

As the participant shifted to put forward a view of the sexes as intrinsically different, her concern about inequalities receded into the background. This movement seemed connected with discomfort or annoyance, as signaled by the interjection “arrgh!” This participant showed several indications of discomfort in relation to the theme of inequality (see earlier extracts). She appeared to shift among different positions on equality issues, none of which could be applied to all topics. In this participant's discursive surroundings we have identified, as described earlier, a repertoire about gender inequality based on structural asymmetries: “similar and unequally valued.” This repertoire seemed to be brought forward when she talked about society at large and about herself as a member of a profession. However, when the interview focused on her thoughts about gender equality and clinical treatment, there were no traces in her accounts of the idea that girls and boys might be given differential treatment and resources because they are valued differently in society. We argue that the ideal of neutral professional knowledge may have forced this participant to choose between acknowledging injustices in how girls and boys were treated or being professional (which implied “neutral knowledge”). For her, the latter position seemed to be preferred, thereby excluding the consideration of injustices and asymmetrical social conditions.

Participant 2—From gender stereotypes to “elbow room” in therapy

The ill effects of sex-stereotypical expectations on girls

This participant worked in a child psychiatric clinic and had many years of experience of work as a clinical psychologist. Her work was based mainly in a psychodynamic framework but she sometimes drew on cognitive behavioral methods in her work. She explicitly stated her ambition to counteract gender stereotypes in her therapeutic work. When talking about her therapeutic work, she described how she had gradually changed from aiming to adjust her clients' behavior to accord with gender stereotypes to aiming to change gender stereotypes:

P: Earlier I would have thought that it was strange, or more strange, that a girl was acting out than that a boy was. I would probably have reasoned just as I thought about myself when I was young, that “That's not done!” Also about shame and guilt and how one may, if one is allowed to, take sexual initiatives and so on. But I don't think now that I value them in that way. I actually see now, when I have been seeing girls who have turned inwards on themselves and deteriorated and become withdrawn. Even a girl I followed for many years, who became psychotic and spent many years in a psychiatric ward. So I think that it is actually a sign of health if girls can be prickly and be angry, and can help themselves.

This participant talked about how her insights about the ill effects of gender-stereotypical expectations on girls led her to change her stance, alluding to her earlier therapeutic approach as hindering young girls from moving away from stereotypes. Seeing the destructive processes that may occur when girls with psychological problems turn their anger inwards had led her to question her earlier therapeutic approach. A gender-neutral stance did not move her forward, she told the interviewer, because it did not tally with what she observed in the life conditions of the girls. She also argued that girls' psychological distress is connected to their subordinate position in society:

P: So…. I think that long ago, I would have been a little afraid of working with these angry girls, but not afraid of working with angry boys, not at all…. Yes, I remember when I worked at [X residential treatment centre]…, there were drug-dependent girls there, and they really acted out. I remember being quite afraid…. But later I knew. They weren't dangerous…. But they really got into trouble, they did, in this whole thing of being subservient to the boys.

Opening your eyes to power within and outside the therapy room

In this depiction of a residential treatment center for troubled teenagers, after first commenting on her earlier prejudiced attitudes, she noted that she had seen that the same behavior had asymmetrical consequences for girls and boys. This is a typical example from her many accounts of how she learned that sex category made a difference and of how she came to see the power asymmetries that were involved. Another example is her description of what made her begin working with children who had been sexually abused:

Well, I think it was because one – there was one girl whom I saw…. And I felt that I didn't understand anything!… But then, as I started seeing other children who, well, who said things and told me, then I began to think, “But I have to learn more about this. I really know nothing about this!”

When talking about her therapeutic work with sexually abused children, she again described the inadequacies of her earlier therapeutic tools. As shown in the next extract, she found herself becoming aware of how these tools often seemed to make things worse for the children:

P: But, you know, there were, I saw how they worked there and I thought, “Why do they take …?” I sometimes thought, “How can they imagine that they ought to bring the abuser into the same room as the child?”….

I: They actually did?

P: Sometimes they did. Female therapists didn't, it was more men who did. And then later, it was found out that over the years quite a few male care providers who had abused girls had been coming there… for supervision, because they worked in family treatment homes. Eventually this was discovered and several were sentenced to long terms in prison. But there we were, in good faith, thinking that – even if the children were telling things – one thought, “He is such a nice man, he couldn't have done such a thing, god, how they are fantasizing.”….

I: How do you understand this? Do you think in terms of gender, or knowledge, or…? How they could act –

P: I think, “How could one have such blinkers on?” But I don't quite think that the blinkers are there today. (I:No.) Fear, ignorance. Sort of like. Or, I haven't felt fear of working with any kind of problem, but I have been ignorant. Many times I have felt “I don't know enough, I really have to learn more.” And open my eyes.

Becoming aware that power issues were ignored in therapy with sexually abused children led this participant to question the professional approaches in her discipline. Seeing the shortcomings of available therapeutic tools also made her ask increasingly critical questions of herself as a therapist. Together, these experiences brought to light power asymmetries involved in defining children's problems—between therapist and child, as well as between abuser and child. Such insights about power and knowledge production and about her profession's power to define children's experiences and problems seemed to pave the way for this participant to ask new kinds of questions about her professional role. Today she asks, for instance, how therapeutic tools can be used to redistribute power and thereby help to improve the mental health of sufferers. Immediately after the above account, the participant gave examples from other parts of her practice, illustrating how her new approach enabled her to be less restrictive and more supportive of girls in therapy:

P: So, I do think that I work more to make them get tougher, these anxious and timid girls. I get really worried when I work with these kind of withdrawn girls, who say that “I only want a boyfriend, and I don't mind if he makes all the decisions, and I will always be with him, and I will never move from here”.

We interpret this participant's interview as evidencing a change in the knowledge base that she draws on for her therapeutic practice. In the interview she described her earlier assumptions as evaluating behaviors mainly in relation to sex category, and concluded that she had come to consider such evaluations as contributing to creating and upholding inequalities in mental health treatment, as well as oppression of girls and young women. She now seemed to consider knowledge about inequality as legitimate evidence in therapeutic work with children. This meant that she had taken the step of bringing her knowledge of gender inequality into her therapeutic work and of working actively to counteract inequalities. Her move from a focus on inherent traits to contextual evidence seemed to increase her elbow room when defining children's problems. This, in turn, seemed to lead her to a therapeutic practice that enabled increases in the children's freedom of action. When asked to exemplify her practice, she described how she has used such a widened focus when working with withdrawn boys:

P: I am thinking about two tough young men – boys. They are like that… they may cry, they can feel, and they can – There it may instead be that they have a girlfriend who makes the decisions.

I: How do you work then? [laughs] How do you think?

P: Well, I try to listen to them, and say, “Is this good for you? Does it make you feel good? Do you think this is okay?” [They reply:] “No, you know, I don't know if it's so good, for I can't …” [I ask:] “How would you like things to be?”, and then they may say, “I would like to play with my band, and exercise with my buddies, but I can't, you know, because she becomes so cross.” [I say:] “Well, but tell me how she is cross, what happens when she becomes cross and what happens with you and how do you deal with the trouble?” And then I can, for instance, work with “the empty chair,” placing her there, and then swapping places, and so on.

In this story and several others in her interview, this participant talked about having developed an approach where she was able to focus both on structural asymmetries and their impact on children's problems, and on each child's specific individual situation and identity.

This participant did not show any signs of the discomfort that was present in the first participant's interview. Rather, she seemed to have arrived at a position that allowed her to see herself as simultaneously a proper psychologist and a critical feminist who acknowledged societal power asymmetries. What made this possible? One decisive factor may have been her awareness of the paucity of meaningful ways for clinical psychologists to talk about the power dynamics involved in children's mental health problems. We found no indications in her talk of commitment to an ideal of neutral knowledge nor of notions of mental health as divorced from values and power processes. In her interview she recounted numerous experiences that made it legitimate to look outside psychology proper to find additional knowledge. In this process, she seems to have replaced a neutral and individualizing view that is typical of traditional psychology with a contextualizing view typically found in feminist theory and gender studies. This participant did not repudiate psychological methods and theories but seemed to aim to integrate them into a contextualizing framework that takes societal structures into account. Where then, outside psychology, had she found tools to understand that for which she found no tools in psychology? When asked about this, this participant emphasized her long experience of being part of the women's movement:

P: I had been part of the women's movement from when it started, in X town … And therefore I brought a little bit of this along with me, because I was socially and politically engaged.

I: Tools to understand the situation, in a way?

P: Yes. And this had – I noticed that this had – the female psychologist who worked there – they also had those eyes.

This participant thus had experiences of working politically with women's issues. She also talked with great enthusiasm about her close relationship with a fellow psychologist who worked actively with such matters. Such experiences, she claimed, had been pivotal for the changes in her professional approach.

Stepping back and concluding

In the two interviews that we have analyzed, we identified two different ways of talking about integrating feminism in clinical work. In the first interview, we saw the participant attempting to integrate awareness about gender issues into a psychological frame of reference. Our analysis showed how her talk moved away from her original stance on gendered societal inequalities into a difference-focused stance. In the second interview, we saw that the participant attempted instead to integrate psychological knowledge into a gender-theoretical frame of reference, enabling critical reflections on clinical work and leading to a desire to change existing power relations through the use of therapy. Both participants expressed difficulties that can be seen as related to the integration of different views of knowledge with their clinical tools. However, they talked in quite different ways about how they dealt with these difficulties. In our view, it is likely that the bases for these differences are to be found in their discursive surroundings.

The first interview was suffused by a belief that it is desirable, or even necessary, for clinicians to draw only on neutral knowledge in their practice. Inserting gender-equality issues into this overarching frame allows the clinician to be interested in furthering gender equality, while still adhering to the ideal of neutral knowledge that is dominant in (developmental) psychology (Code, 2000; Miller & Scholnick, 2000). In conjunction with the shift away from acknowledging the unequal valuation of women and men to instead asserting that gender should be of no importance in therapy, much of the critical impetus of a feminist position was lost. This in turn led to the conclusion that feminism, in the sense of paying attention to asymmetrical social conditions associated with girls and boys, should be left out of therapeutic work. Our interpretation is that the ideal of value-neutral professional knowledge was so dominant and so taken for granted that the alternative of acknowledging injustices in how girls and boys were treated did not appear as a possible choice. This type of reasoning gives a good illustration of how dominant discourses are often so taken for granted that they make other discourses impossible to assume (Gavey, 1989).

Feminist researchers have noted that attempts to change injustices from the inside of such a knowledge ideal put the practitioner in a dilemma: To be a credible professional, one needs to stay within the bounds of “mainstream psychology.” However, the tools offered by the mainstream are insufficient to counteract dominant, hindering, assumptions. The feminist therapists Bruns and Kaschak expressed the dilemma thus: “Feminist researchers and therapists need to take care that they do not fall into the trap of privileging the scientific discourse that values symptom reduction over human connection and meaning making … quick fixes over witness, and privatization of pain over social change” (Bruns & Kaschak, 2010, p. 214).

The second participant had access to different resources. When speaking about the meanings of gender in the life situations of the children she saw in therapy, she drew on the same repertoire as when speaking of herself as a member of her profession: the repertoire “similar and unequally valued.” She told about how her experiences of having failed to help children moved her from a neutral knowledge base to a knowledge base that made power visible. The driving force in this change seemed to have been the insight that the discipline of psychology lacked a language for the experiences of subordination and abuse that she saw as implicated in children's psychological distress. Her repeated experiences of these and other deficiencies of the tools of her profession seem to have spurred her search for a better framework. She found this outside her discipline, in theories and practices that made it possible to speak about power and power processes. This framework enabled reflections about how to integrate knowledge about societal injustices as well as values into psychological treatment, seeing neither her own nor the client's position in neutral terms. Furthermore, when this participant described boys' and girls' problems, she emphasized that a child is never just male or female, but that the therapist's understanding needs also to take account of many other categorizations and conditions such as ethnicity, socio-economic situation, etc. (cf. Wetherell, 2008).

Our analysis of the first interview points out how efforts to promote gender equality that are based in an ideal of neutral knowledge lead to a focus on “equal treatment” and seem to work to conceal the asymmetries in valuation and freedom of action of girls and boys. Our analysis of the second interview points out how efforts to promote gender equality that are based in an ideal of justice as the outcome opens possibilities to maintain attention on injustice and power issues related to gender. The latter is in line with what Bruns and Kaschak (2010), in their overview of contemporary feminist therapy, point to as one of its main tasks: “the reparative psychological redistribution of power inside and outside the therapy relation” (p. 189).

Overall, our analyses indicate how child psychotherapists' ideals regarding legitimate therapeutic knowledge impact their thinking about whether, and how, to counteract gender stereotypes through therapy. If therapists cordon off knowledge about societal inequalities from the practice of therapy, it seems unlikely to us that their clinical work can promote gender equality. Therapy that starts in an awareness of the existing inequalities in the lives of girls and women will inevitably be a better base than therapy that assumes what is still only a wished-for state: everybody's equal value.

Footnotes

Acknowledgements

We would like to thank the psychologists who participated in our research project for their courage and willingness to develop a deeper understanding with us in a difficult and dilemmatic terrain in psychological practice. We would also like to thank Katarina Blume, licensed psychologist and doctoral student, who conducted one of the interviews analyzed for this article. Finally, we would like to thank Jeanne Marecek and anonymous reviewers for their encouraging and helpful readings.

Notes

Author Biographies

Ulrika Eskner Skoger is a doctoral student at the Department of Psychology, Umeå University, Sweden and Centre for Epidemiology and Community Medicine (CES), Stockholm, Sweden. Her research topic is the social construction of gender within the framework of developmental psychology.

Eva Magnusson has a PhD in Psychology and is Professor of Psychology and Gender Studies at Umeå University, Sweden. Her recent research has focused on the everyday lives of heterosexual couples in the Nordic countries and on the discipline of psychology as producer and upholder of gendered identities and understandings.

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