Why Focus on Women's Issues?
As women, we have a unique life experience and a unique perspective on life. Although there is a great deal of variety in each of our lives, cross-cultural and anthropological studies highlight that in general we share a great deal in common with our sisters around the world and across time by simple virtue of our biology. Women's issues also deserve a specific focus because the mental health profession so often does an incredibly poor job of recognizing the weaknesses in our own training. Despite the fact that women are the greater consumers of mental health services, most of the classic models of therapy, theories about what constitutes psychological health, and the research about the effectiveness of different methods of treatment were conducted largely on men. Furthermore, many of the foundational therapy models for working with families or couples do not take into account the often significant imbalances in power, finances, and expectations of household and relationship responsibilities. Ignoring real power differentials can be especially problematic in marital or couples therapies that treat each member as equally responsible for the problem. This can be incredibly invalidating if you are dealing with relationship violence or a major betrayal. My awareness of the experiences, issues, and focus for therapy with women was heightened during my doctoral training at Texas Woman's University. As you might guess, women and their unique psychological needs were an important focus of my training at TWU.
WOMEN and DEPRESSION
Why is Depression a Woman's Issue?
The short and not so sweet answer is that depression is the leading cause of disability for women worldwide. There is little difference in the rate of depression between boys and girls in childhood. However, girls experience a sharp increase in rate of depression starting at 11-13. By age 15, females are at twice the risk. This rate remains consistent from this point on with women twice as likely to become depressed as men, regardless of race, ethnicity or socioeconomic status. It is estimated that 1 in 8 women will experience major depression in her lifetime. Multiple factors have been suggested as reasons for the higher rate of depression in women. These include: hormonal, interpersonal life stresses, sex role socialization, victimization, and poverty.
What Role Do Hormones Play?
Women experience fluctuations in hormones across the life cycle, only some of which may play a role in greater vulnerability to depression. Hormones associated with reproductive cycles, such as estrogen and progesterone, can affect mood. For most of these reproductive events, women who are prone to recurrent depression are at greater risk for depressive episodes. In contrast to popular belief, menopause does not appear to be associated with an increased risk for depression, except in women who are already prone to recurrent depression. The hormonal changes associated with pregnancy are not depression markers. Although pregnant women who are prone to recurrent depression may be at higher risk, studies indicate that, in general, pregnancy is often associated with the lowest incidence of depression. In contrast, women experiencing infertility and miscarriages do experience higher rates of depression — although it's not clear to what degree those higher rates are due to hormonal changes as opposed to the frustration and grief associated with these events.
What Role Does Relationship Stress Play in Depression?
Interpersonal stress may also play an important role in creating a greater vulnerability to depression for women, especially due to the number of different, sometimes underappreciated, roles women play across their lifespan — otherwise known as juggling too many responsibilities. Many of the responsibilities that women juggle are associated with increased risk for depression: caring for children, caring for aging parents or in-laws, greater share of household responsibilities, and caring for marriages. Marriage creates a double risk because in general married women experience higher rates of depression and marriage also puts women at risk for other life events associated with increased depression — divorce and widowhood.
What Other Factors Account for Higher Rates of Depression in Women?
One of the unfortunate realities we face as women is that we are often the targets for abuse and violence. Victimization and depression go hand in hand, for both men and women. But as women, the statistics tell us that we face a greater likelihood of experiencing rape, relationship violence, sexual harassment, and a history of trauma, especially sexual abuse in childhood. Whether it's at work, at home, or on the streets, we are more likely to be victimized. Even those of us who don't experience victimization, live in a society that has different expectations of men and women. From childhood, we are surrounded by messages that a woman's worth is based on physical appearance or being in a relationship, any relationship is better than none. Families and society have expectations for our behavior, including the pressure to be a 'good girl' or 'nice,' which often places restrictions on expressing anger or setting clear limits on inappropriate behavior by others. Despite the very busy and complicated lives we live these days, our contributions often go unappreciated. The contributions women make to childrearing and managing the household are still undervalued. We may have made great strides at entering the workforce, but we still have miles to go before we get our fair share. Women still only earn 77 cents for every dollar a man earns. Given that 2/3 of mothers are responsible for at least a quarter of their family's income, and in many families the woman is the sole breadwinner, that pay gap causes serious economic hardship. Looking forward to your 470 day work year? That 470 represents the 110 extra days we would have to work to earn what our male counterparts earn in their standard 360 day year. Across our lifespan, it's estimated that we lose $700,000 due to unequal pay. That gap is even worse for women of color. No wonder we are more likely to be depressed than men!
Why Seek Counseling for Depression?
Women are most likely to seek help for depression from their primary care physician, usually for complaints about the physical symptoms of depression. And while I certainly encourage you to talk with your doctor, please be aware that it's estimated that health professionals miss half of the depression seen in primary care. Even more alarming is that they miss the depression even when the symptoms are severe. Given that depression in women can look different than in men, it's even less likely to recognized and treated properly. For example, our thyroid gland functions differently, we tend to sleep more, and our depression is more likely to be accompanied by anxiety, panic attacks and eating disorders. The experience I have had with my clients is that women are more likely to respond to depression with overeating and weight gain, and then to feel even worse about themselves as a result.
How Does Medication Compare to Psychotherapy for Treating Depression?
While medication will be invaluable for some of you, others will have only a partial improvement, your improvements will short-lived, or the negative side-effects will lead you to discontinue. In fact, recent research suggests that drugs may be little more effective than placebo, or 'sugar pill' for treating mild to moderate depression. Talking this over with a trusted doctor will help you to weigh the pros and cons of taking a medication approach. For many of you, psychotherapy will be your treatment of choice. Regardless of your decision about medication, you should be aware research indicates that overall psychotherapy is roughly equal to medication-only approaches for treating depression. The main differences in effectiveness are that medication only begins to bring relief faster, but also leads to faster relapse. In comparison, it takes slightly longer for clients to feel the benefits of therapy, but it also results in longer lasting relief and a higher functioning lifestyle.
So What's the Common Sense Approach to Treating Depression?
The term 'combination treatment' refers to combining the benefits of both medication and therapy for the quickest and longest lasting improvements. I encourage my clients to practice a number of mood boosting self-care behaviors that will not only help you recover from depression, but will also help prevent a return of the depression. If you would like to speak with me further about how therapy can help you or a loved one fight depression, feel free to contact me.
WOMEN and ANXIETY
How are Anxiety and Stress a Women's Issue?
About 13% of adult Americans struggle with anxiety disorders every year. However, women are twice as likely to be diagnosed with an anxiety disorder as men, and 2-3 times more likely to be diagnosed with some specific anxiety disorders. Anxiety also appears to begin earlier in females.
Why are Women Vulnerable to Anxiety?
This increased vulnerability is likely due to a variety of biological, psychological, and cultural reasons. Differences in male and female brain chemistry may account for some of the vulnerability. The brain system involved in the fight-or-flight response may be activated more easily in women and stay activated longer than in men. This is in part a result of estrogen and progesterone, hormones associated with the female reproductive system. Women may also respond differently to stress due to the role of a neurotransmitter in the brain called serotonin. There is some evidence that suggests serotonin is processed more quickly in the male brain. Serotonin is also believed to play a role in the spike in anxiety that some women experience in the 7-10 days before menstruation. Serotonin is lowered as estrogen levels drop during the premenstrual, resulting in increased anxiety.
Does Life Trauma Affect Women's Anxiety?
Absolutely! The high rates of stress that women experience in daily life are also speculated as a cause for higher rates of anxiety. It is estimated that 69% of women will be exposed to a traumatic stressor in their lifetime, and will be more than twice as likely to develop PTSD as men. For example, girls are victims of child abuse 2-2½ times more often than boys. The rates for women who are the victims of rape or physical assault by a spouse, partner or date is more than 3 times that for men (25% for women vs. 8% for men), while 90% of the violence that both males and females experience is perpetrated by men. Even when men's higher exposure to military service and combat are factored in, women still experience higher levels of traumatic stress in our lives, resulting in higher rates of PTSD diagnosis.
How Can Daily Stress Lead to Anxiety?
As women, we often lead what I call a 'juggling lifestyle.'? Our days are filled trying to juggle lots of responsibilities, sometimes too many responsibilities. We tend to take on a disproportionate amount of responsibility for our relationships, the marriage, the kids, the household, the job, the bills, and sometimes for elderly parents or in-laws. Depending on what stage of life your children are in on any given day you may also take on the role of the homework drill sergeant, chauffer, sports coach, family receptionist, housekeeper, cook, nutritional counselor, hygiene inspector, ego booster. That's a lot of balls to juggle, and because we care about our loved ones and we care about our responsibilities, we worry about dropping one of those balls. That's not only anxiety provoking, it's exhausting!
What Does Therapy for Women's Anxiety Involve?
Therapy for the stress and anxiety in women's lives depends to some degree on the nature and severity of the stress. For example, for women dealing with traumatic events or PTSD, therapy might involve EMDR. Therapy typically includes the same focus on learning and practicing anxiety coping skills and relaxation techniques as for the anxiety that men experience. However, I also help clients to take a realistic look at the responsibilities they are juggling to determine how some of those responsibilities can be shifted. You learn how your anxiety can be a warning for pending engine trouble. You learn how to gauge your own emotional gas tank, before the anxiety escalates. As a woman, you're probably pretty good at monitoring the tanks of those you love and refilling them before they get down to critical levels. When was the last time you paid attention to your own emotional tank? If you are poor at consistent self-maintenance, then learning to how to make self-care a priority, how to fill your own tank, will be important for you. If you would like to speak with me further about how therapy can help with anxiety and stress contact me.
WOMEN and RELATIONAL/BETRAYAL TRAUMA
How are Relational and Betrayal Trauma a Woman's Issue?
As women, we are socialized to value relationships, to sacrifice our own wants and needs for our relationships, and sometimes to base our self-worth on being in a relationship. Because we value and put so much of ourselves into our relationships, we are more vulnerable to the outcome of those relationships. Unfortunately, many of us experience betrayal trauma in the very place we are taught to turn to for safety and support — our relationships. Sometimes those betrayals involve Big T
traumas, such as violence, sexual abuse, abandonment, infidelity, or discovering your spouse's pornography or sexual addiction. Sometimes the betrayals are more subtle little t
traumas, but because they occur repeatedly they weaken your sense of emotional safety in the relationship nonetheless. You may not recognize it as trauma at the time, but the hurts have a cumulative effect that damages trust. Repeated lies, gaslighting, blame shifting, emotional blackmail, and intimacy anorexia insidiously lower your expectations of what you will or won't tolerate in a relationship and undermine your belief in yourself. Little t
traumas can be deceptively destructive because they tap into our history of developmental trauma, or the hurts from across our lifespan. Our template for trust is established early and shaped by our experience of emotional safety in our history of relationships. The foundation for trust is what psychologists refer to as attachment. The hurts of today can get mingled with our entire history of attachment wounds. When relationships include both big T
and little t
traumas, those trust wounds can be chronically activated. Although both men and women experience relational trauma, statistics indicate that throughout our lives females are at greater risk for relationship violence, abuse and a variety of other traumatic life events — and since we tend to live longer, the odds of experiencing relational and betrayal trauma is significant. That is why relational and betrayal trauma are a woman's issue.
How Do You Work with Women Experiencing Relational and Betrayal Trauma?
Depending on your unique circumstances, EMDR, Somatic Experiencing, and/or Post-Induction Therapy might be the treatment of choice. I work with women in individual therapy as well as marital or couples therapy. Because I believe healing happens most rapidly and deeply when it occurs in a community of women, I offer the Partners Empowerment Group, a low-cost therapy group for women dealing with a loved one's pornography or sex addiction. To learn more about treatment for relational and betrayal trauma contact me
WOMEN & PTSD
WOMEN & CODEPENDENCY
WOMEN & GRIEF AND LOSS