by Velleda C. Ceccoli Ph.D. on May 23, 2011

After I finished reading the Sunday New York Times article on the feminization of psychotherapy (click the following – Need Therapy? A Good Man is Hard To Find), I was once again reminded of how wedded we have become, particularly in America, to the idea of equality. Don’t get me wrong, we have had to work hard to leave stereotypes behind, and advance our thinking regarding inequality in many areas-  work, pay, gender roles, – all the stuff that has been at the heart of the battle of the sexes. But, when it comes to psychotherapy, it has always seemed to me that gender can make a difference in treatment. An important difference. Good to see it in the New York Times!

It goes without saying, that a good therapist should be able to work in all areas of human behavior regardless of their gender. Furthermore, many believe that it should not make any difference whether a patient works with a woman or with a man. One’s personal dynamics will play out in the therapeutic relationship regardless. Perhaps this has come to be a commonly held belief in my profession because we like to think that as therapists, who we actually are, (including our gender) is of little consequence. What matters is how we listen, respond, who we are and become in the clinical hour. Yet, for all the hours that I have spent sitting with patients, I have always been aware of who and what I am (a woman), and the fact that this makes a very important difference to my patients, men and women alike. Sometimes a man needs a man to talk to, and sometimes only a woman will do. And vice-versa. It may have to do with the patients’ preference in regard to their need for safety and understanding. It also, may have to do with particular issues, usually to do with sexuality and identity. And it is not only patients who have gender preferences. Many a time I have received a call from a colleague, which started with, “ I am calling to refer Mr. or Ms X, I think they would benefit from working with a woman”. So it turns out that there are many of us out there, who believe that gender does make a difference, and that it should be observed in our work. In fact, the person of the therapist makes a difference. Gender is just one of the factors. Age is another factor that seems to affect the choice of therapist.

From a clinical perspective, there are various gender dependent dynamics that may be difficult to work out in same or different sex, patient-therapist dyads. Take for example, a man who struggles with his masculinity and finds other men too aggressive, or competitive, or downright frightening. He might choose to work with a woman. Or a woman, who has difficulties accepting her body and does not identify with what being female, means or implies to her. Sometimes we need our therapist to embody our experience, and this is easier to do when the therapist is the same gender we are. Granted, patients are making an assumption on the basis of sex- he will understand me better because he is a man, or she must know how this feels, because she is a woman. Such assumptions are not necessarily always true, there is the person of the therapist to consider, but they do influence the course of an analysis. Patients’ often endow their therapists with abilities that they need to believe in, in order to do their work.

As an analyst my education served to consolidate my belief that women and men work differently in the consulting room, and that they do so because of their sex and its identity defining implications. This is quite a feat in a profession that has minimized sexual difference and grew out of Freud’s notion that we should attempt to be blank screens for our patients. Aha, blank screens, that’s right. This idea always seemed a little wacky to me, even though I admit I tried it. I tried, but it never worked for me, or for my patients. We might attempt to provide a blank screen, but the original canvas it is stretched upon makes a considerable difference.

Early in my career, I developed an interest in, and explored the issue of the analyst’s gender as an important variable that can facilitate the expression of certain aspects of the patient’s experience of masculinity and femininity (click – see Ceccoli, 1999; 2000). Analytic listening is necessarily filtered through gender, and the differences between men and women reveal themselves at the level of listening.

As men and women we have very distinct and different experiences growing up. Yes, many of them are culturally determined. But many of them are biologically pre-set.  Biology is a sexed reality and is reinterpreted psychically on the basis of socio-cultural realities. Furthermore, the psychic representation of sexual difference, and the maturational unfolding of physical femininity and masculinity have particular (and different) developmental consequences for sexual subjectivity and desire. For example, sexuality and aggression are experienced in gender specific ways.

All of this to say that gender makes a difference. We cannot ignore our bodies, their sex, and developmental histories, and we cannot privilege them over our social and cultural experiences. They go hand in hand despite the tension this might create. Contemporary psychotherapy and psychoanalysis has come to address the person of the therapist as an important variable in treatment. It has begun to look at the many factors, which constitute and go into the therapeutic relationship and the facilitation of emotional growth. As such, who the analyst is, including their gender, age, level of experience and therapeutic orientation are factors to be considered in every analysis .

Differences are important. Vive la difference!


{ 4 comments… read them below or add one }

Lewis Aron, Ph.D. May 24, 2011 at 4:22 PM


Great piece and I very much agree. Two things I have been thinking about in relation to the NY Times article. First, what message is sent to the culture when psychotherapists are now almost all women? Doesn’t it convey that talking about feelings and relationships is feminine? making it even harder for men to seek therapy? And then, while clearly gender matters, and so does age, as you point out, what about so many other variables? what about people wanting referrals to a Jewish analyst, a black or Asian analyst, but what about a democrat or republican analyst, or homosexual analyst? Once we acknowledge that it IS personal then doesn’t this open up quite a lot that we have kept under raps? Do we confront the potential patient with their underlying bias or prejudice or do we accommodate and even reinforce that they are right to want someone like themselves? Do we analyze this choice as a pathological symptom expressing cultural prejudices or do we recognize the inherent truth in the preference and respect perhaps even encourage it?



Velleda C. Ceccoli Ph.D. May 24, 2011 at 8:36 PM

Thank you Lew, for your very pertinent questions. I think that what we are seeing in terms of the message that talking about feelings is a feminine quality is a reflection of the impact of culture on gender and stereotypes of gender. In our culture, it is still more “acceptable” for women to seek therapy than men, and it is these biases that may make it more difficult for men to seek treatment or to be reluctant to do so, unless it is with a male therapist.
As you point out, there are many variables having to do with the person of the analyst, that affect and go into the decision of working with a specific someone. Gender is but one of them, and again, I think, a most important one because of all the reasons that I state in the blog. Given that the analytic relationship is constituted by two subjectivities, (which are gendered among other things) we have to acknowledge that IT is personal and play our cards up. I do not think that this means we have to confront our patients with their potential biases, or accommodate them. We simply have to continue our work in the exploration and elucidation of what these mean in relation to their experience. Nothing pathological about it, rather, as you say, there is an inherent truth in the patients’ criteria and choice of analyst. Whether the expectations of the patient vis-a-vis their criteria for their analyst turn out to be true or false, they are important in initiating a relationship within which their authentic experience (and ours) provides a space to consider the meaning of gender -among many other things.


Erika Schwartz,MD May 24, 2011 at 7:49 AM

The gender difference is crucial in all healing fields. Agreed. Focusing on gender and the inherent differential approaches to life in general will lead us to specific expectations and outcomes in interaction. Whatever they may be. Those differences and their understanding can leave us empowered or not. Excellent blog Dr. V. The choice is ours!!!


Velleda C. Ceccoli Ph.D. May 24, 2011 at 8:35 PM

Indeed, the choice is ours and hopefully we are working with someone that understands this as an important communication.


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