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Counseling survivors of human trafficking

By Lamerial McRae and Letitia Browne-James October 9, 2017

Millions of human trafficking victims exist across the globe. In the United States, hundreds of thousands of victims experience trafficking. As society expands and evolves, human trafficking perpetrators find new ways to recruit and victimize others. The evolution of perpetration ensues because of increases in accessing technology, shifting state and federal laws, and changing criminal investigation methods within communities. Human trafficking continues to evolve into a new way of enslaving human beings, stripping individuals of basic rights and freedoms, while skirting the legal issues of slavery and ownership.

Human traffickers often recruit individuals by offering the fantasy of increased happiness, stability, relationship success and financial freedom. Human traffickers, often referred to as “pimps” or “playboys,” may recruit a female or male victim with promises of a better quality of life, including, but not limited to money, security and safe shelter. These perpetrators often present as charming and recruit their victims using lies and manipulation. They prey on victims from vulnerable populations, including those with low socioeconomic status (SES), biological females, children and adolescents, immigrants and LGBTQ+ youth. The fact that these vulnerable populations often remain dependent on others or experience institutionalized marginalization allows for perpetrators to paint the picture of a better life, both in terms of finance and social support. Thus, counselors must understand the cycle of perpetration and victimization to pinpoint potential victims among clients.

As a starting point, counselors must understand the nature of the phenomenon and seek ways to identify potential risk and protective factors. Counselors must learn to assess and address possible victimization with effective rapport building and intervention. For example, youth may display delinquent behavior (e.g., truancy, sexual misconduct, drug use) as a symptom of coercion and threats by a perpetrator. Perpetrators often experience greater ease when recruiting teenagers because of their tendency to be influenced by others. Sadly, when teenagers fall victim to a human trafficker, they are subjected to the victim-blaming phenomenon.

Thus, to build therapeutic rapport from a nonjudgmental framework, counselors need to understand the true source of teenagers’ behavior rather than labeling them as inappropriate or delinquent. As counselors increase their understanding of risk and protective factors, the profession may be able to conceptualize human trafficking as a systemic problem from a broad perspective.

 

Risk and protective factors

Several risk and protective factors exist for those falling victim to human trafficking. Risk factors include the following demographics and experiences. Risk factors, which are not limited to the list provided, may change over time with the help of counselors.

  • Low SES
  • Previous or current substance abuse
  • Social vulnerability (e.g., children, females, LGBTQ+ individuals)
  • Limited education.

Protective factors, referred to as strengths in counseling, include the following demographics and experiences. Counselors must foster protective factors and strengths in clients to reduce the risk of falling victim to trafficking.

  • Education
  • Family stability
  • Strong social support networks
  • Mental and emotional health

Counselors should understand these risk and protective factors to assess potential risks for human trafficking and to focus on increasing protective factors in counseling. For example, counselors may use a family counseling approach when working with survivors to increase their connections to loved ones and family. Throughout the process of recruiting and selling human trafficking victims, counselors may notice several risk and protective factors playing a role in the process.

 

Human trafficking business model and counseling implications

Human trafficking remains a mysterious and misunderstood phenomenon. Because of a lack of understanding about the effects of human trafficking on our society, counselors are charged with educating themselves to best address and assess individuals for victimization.

Counselors should recognize that survivors of sex trafficking require additional techniques (to those used with other clients) to build rapport with them and to reduce the mistrust that they commonly have about people. To best serve survivors, treatment approaches need to remain centered on survivors, empower them, provide safety and involve a multidisciplinary approach. In addition, professional counselors working extensively with sex trafficking survivors hold legal and ethical responsibilities to provide appropriate services and identify strategies to overcome barriers to their treatment, including specialized and intensive training.

To begin, counselors must understand the human trafficking business model to conceptualize the systemic issue and the moving parts that contribute to the continuing cycle. To highlight some of the societal and professional impacts, consider the parallel of the human trafficking business model to the process of manufacturing goods. The human trafficking business model includes the following stages of grooming and distribution:

1) The supplier recruits the victim.

2) The manufacturer grooms the victim.

3) The retailer determines price and then markets the victim.

4) The retailer sells and the consumer purchases the victim.

The human trafficking business model is a sophisticated process, not always linear in nature, and it functions as a well-established industry. Thus, the need exists to explore each of the model to better understand how to help victims and break the cycle.

Stage 1: Supplying victims. The supplier, also known as the initial human trafficking perpetrator, displays high levels of mental health concerns (e.g., antisocial personality traits) and shows little concern for the basic human rights of others. When victims enter this stage, counselors may find that these individuals report troubles at home, low SES, depression, anxiety and truant behavior. These factors contribute to their need to survive. Unfortunately, this may result in a perpetrator using charm or manipulation to attract the victims. Perpetrators remove victims’ identification, passports and other valuables to trap them in the world of human trafficking.

Clinical assessment is vital at this stage and remains an ongoing process. Counselors may want to ease survivors into telling their stories, paying special attention to the therapeutic relationship. Thus, the most valuable interventions at this stage include active listening and reflection. When administering specific assessment instruments, counselors will want to measure attitudes about victimization and perpetration and prevalence rates of violence. Counselors must use both open- and closed-ended questions to directly address potential victimization. Nonverbally, counselors will want to avoid direct eye contact and limit their use of touch because of victims’ trauma and abuse history.

Stage 2: Grooming victims. This stage involves moving human trafficking victims from the supplier to the manufacturer. Perpetrators continue to display high levels of antisocial behaviors and major mental health concerns; survivors present with mental health concerns such as depression, anxiety and addiction. Substance abuse concerns usually present when perpetrators force their victims to engage in substance use to coerce and control their behaviors, often resulting in addiction.

Counselors must use clinical assessment and maintain that ongoing process. In addition, because survivors have been manufactured as a human trafficking product, their levels of abuse and mistrust often appear high when they present to counseling. Therefore, counselors must focus on the therapeutic relationship as victims provide information about their experiences in trafficking. Counselors should pay special attention to reducing the stigma of substance use and mental health concerns, especially considering that victims develop these concerns because of coercion and violence.

Stage 3: Marketing victims. This stage involves moving survivors from the manufacturer to the retailer. At this stage, human trafficking perpetrators focus on the marketing and sales aspect of their exploitation. For example, based on the quality of their goods (i.e., victim age, appearance) and market demand, perpetrators determine the price for selling each of their victims. At this stage, survivors present with major depressive, dissociative and addiction disorders.

At this stage, counselors again use clinical assessment to understand the survivor’s story while maintaining a trustworthy therapeutic relationship. As previously stated, severe mental health concerns present because of the violence and abuse that victims experience. Thus, counselors need to use evidenced-based practices to treat depression and dissociative symptoms. Some of the most helpful interventions to treat these mental health concerns include grounding and relaxation techniques.

When focusing on grounding, counselors must engage the client’s physical world to assist the person in becoming present in the moment. For example, counselors may ask clients to locate an object in the room and provide an in-depth description. Relaxation techniques to practice include deep breathing and mindfulness meditation. Both types of techniques allow clients to practice coping skills during sessions that can translate to their everyday life experiences.

Stage 4: Selling victims. As retailers push survivors toward the consumers, the perpetrators continue to focus on marketing strategies and targeting potential consumers. Perpetrators often target large events (e.g., the Super Bowl, national political conventions) to take advantage of the crowds and high demand for paid sexual services. Those paying for the sex services, the consumers, exhibit low levels of depression and anxiety. These consumers often report avoiding relationship concerns or other mental health concerns, resulting in a desire to seek out sexual activity.

Because survivors have been a part of ongoing abuse and a cycle of victimization that they cannot break, counselors must use a systemic approach to providing services. For example, counselors need to provide information on shelters and building connections with family. Counselors may incorporate the use of technology and location services, safety words and discussing location with loved ones at all times.

 

Case example         

Toney, an 18-year-old multiracial, cisgender male, moved away from his caregivers’ home about one year ago and currently lives with a friend. He moved because of safety issues in his home and within the nearby neighborhood. When Toney was 16, his father died during a gang-related shootout at their home. Thus, Toney often felt afraid of engaging in a similar lifestyle and enduring similar consequences. Toney’s mother suffered from a severe substance use disorder that led to eviction from their rental home because she could not afford the rent. Toney and his mother became homeless.

While Toney was homeless, Kevin, a childhood friend, suggested that Toney come live with him temporarily as long as Toney obtained a job and contributed to the rent and utility bills. One day, Toney answered the front door, and a young adult male appearing to be about Toney’s age attempted to sell him a magazine subscription. Toney disclosed to the salesman that he was financially strapped. The young man told Toney about the large sums of money he made while selling magazine subscriptions and offered to put him in contact with the owner. Toney was intrigued by the idea of alleviating his financial troubles, and the young male immediately scheduled a meeting with the owner for later that night.

That evening, Toney met with the young salesman and the business owner in an abandoned parking lot, bought their sales pitch and decided to go to work. The business owner told Toney that he would need to move six hours away to another state because there was a high demand for work there and he would not have to pay any rent or utility bills. The business owner promised Toney the opportunity to travel and see many areas of the country while working in the job.

Thus, Toney left a day later to live in a weekly hotel in a new city with his new manager and several others. Upon arriving, the manager took them to a warehouse to pick up the product. They all began working the next day.

After a few weeks, Toney began grasping the reality of his situation. The job of trying to sell magazine subscriptions was strenuous and exhausting. He often worked 10- to 12-hour days while receiving limited rest and food. When Toney voiced concerns about the number of work hours he put in each day, his manager threatened him. The threats later escalated to physical assault when Toney again voiced his concern and when the manager perceived him to be underperforming at the job.

No matter how hard Toney tried, he could not meet the daily sales goal that the manager set for employees. When Toney failed to meet the daily sales quota, the manager either denied him his nightly meal or forced him to sleep outside of the hotel on the streets. As a result, Toney rarely ate and often did not receive the money he had earned while working. He was told that he would receive the money once the team had completed its sales goals for the area and had moved on to another city.

One day, while trying to sell magazines to a homeowner who declined to buy anything, Toney became agitated and started crying. He told the homeowner that he was in trouble and begged her to help him get home, across state lines. The homeowner had recently watched a documentary on human trafficking and invited Toney to use her phone to call the authorities.

The police arrived and took Toney’s statement about his work experiences. Fortunately, the responding officer had recently attended a departmental training on human trafficking, and she took Toney to the police station for further questioning and support. The officer connected Toney with a local nonprofit organization that provided multidisciplinary services, including professional counseling, to survivors of human trafficking. The organization offered shelter and provided Toney with career development services to help him obtain legitimate work. The shelter’s ultimate goal was to move Toney back to his hometown.

In counseling sessions with Toney, the counselor focused on direct questions to assess the nature of the human trafficking Toney had experienced. For example, “Did anyone threaten you or your loved ones?” and “Did you have difficulty leaving the work that you did selling door-to-door merchandise?” While initially reluctant, Toney eventually responded with answers that indicated his victimization. For example, he reported that his manager used threats and power and control tactics (such as denying Toney food, money and shelter) to force him to work.

Following assessment, Toney received counseling services focused on recovering from the abuse he had endured. Toney felt validated because he was not alone while accepting that he had fallen victim to human trafficking. The counselor and Toney focused on crisis intervention and stabilization in the beginning, which included discussions about adjunct services and basic needs assessments (e.g., food and clothing, job obtainment). Next, the counselor and Toney addressed the trauma, focusing on decreasing anxiety-provoking cues and scaffolding into addressing more severe cues and triggers. All the while, Toney and the counselor developed several grounding and relaxation techniques to use both in their sessions and in Toney’s real-world experiences.

One of the most valuable grounding techniques made use of a rock that Toney could hold whenever he felt distressed. The counselor taught Toney how to become present, while holding the rock, through discussions about the texture, shape and weight of the rock. Discussing these tactile experiences allowed Toney to focus on the here-and-now rather than attempting to escape feelings and thoughts.

Toney and the counselor also used a breathing method in which Toney would take a deep breath through his nostrils for at least three seconds and exhale through his mouth for three seconds. They determined that he needed to take at least three deep breaths during the exercise so that he could calm down.

In the final stages of counseling, Toney and the counselor developed an action plan to help him avoid falling victim to trafficking. That does not mean, however, that Toney took responsibility for the actions of others. Toney and the counselor reviewed the different needs he may have and how to meet those needs in a helpful manner.

While focusing on the trauma from human trafficking victimization, the counselor worked with Toney on obtaining a job at a local fast food restaurant. They chose this restaurant so that he could easily transfer to another store in his hometown once he felt comfortable with the transition. After three months, Toney finally returned home and moved back in with his friend, Kevin. He remained employed as a fast food line cook and began seeking education at a local culinary institute.

 

 

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Lamerial McRae is an assistant professor at Stetson University and a licensed mental health counselor in Florida. Her research and clinical interests include counselor identity development and gatekeeping; adult and child survivors of trauma, abuse and intimate partner violence; marriages, couples and families; LGBTQ issues in counseling and human trafficking. Contact her at ljacobso@stetson.edu.

Letitia Browne-James is a licensed mental health counselor, clinical supervisor and national certified counselor. She is a clinical manager at a large behavioral health agency in Central Florida and is in the final year of her doctoral program at Walden University, where she is pursuing a degree in counselor education and supervision with a specialization in counseling and social change. She has presented at professional counseling conferences nationally and internationally on various topics, including human trafficking.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Helping female clients reclaim sexual desire

By Alicia Muñoz October 2, 2017

If you see women in your counseling practice, it will be hard to ignore the issue of female sexual desire in your work together, even if the focus of treatment is something that appears unrelated to sexuality. In fact, a woman’s relationship with her own experience of sexual desire is often inextricably linked to her sense of identity, self-esteem, personal agency, energy levels, self-care habits and interpersonal relationships. Her desire issues and how she feels about them will weave their way, often implicitly, into your sessions.

The more that counselors can increase their awareness of the nuanced issues related to female sexual desire, the easier it will be to create a space in which clients can explore these issues safely and productively. Working with women more explicitly on understanding, experiencing and sustaining sexual desire can empower them to proactively regulate their moods, reduce stress levels and decrease symptoms of anxiety and depression. Furthermore, reconnecting with the motivation to feel sexual desire has the potential to help transition trauma survivors from “survival to revival” (in the words of couples therapist Esther Perel) as they access the enlivening energy of their own erotic life force.

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), female sexual interest/arousal disorder is characterized by a lack of sexual interest or sexual arousal for at least six months. Whether a woman is upset or distressed by her lack of interest or arousal is a crucial criterion for the diagnosis. The disturbance can be moderate, mild or severe, lifelong or acquired, generalized or situational. Furthermore, according to the DSM-5, “Women in relationships of longer duration are more likely to report engaging in sex despite no obvious feelings of sexual desire at the outset of a sexual encounter compared with women in shorter-duration relationships.”

Rosemary Basson, director of the University of British Columbia’s sexual medicine program, has noted that other than in the early stages of a new relationship, women’s arousal doesn’t always follow the traditional model of spontaneous sexual desire. Rather, women’s desire tends to be more responsive, with a deliberate choice to experience sexual stimulation required before an actual experience of arousal.

Estimates on how many women suffer from female sexual interest/arousal disorder vary widely, in part because there is so much complexity, variability and subjectivity to how sexual desire issues and arousal problems are measured and experienced. According to an article by Sharon J. Parish and Steven R. Hahn in the April 2016 issue of Sexual Medicine Reviews, issues with sexual desire or arousal are present in 8.9 percent of women ages 18 to 44, 12.3 percent of women ages 45 to 64 and 7.4 percent of women 65 and older. These percentages translate into a significant portion of the female population. It is hard not to wonder what sociocultural circumstances are contributing to making problems with desire so pervasive and systemic for women.

In Standard E.5.c. of the 2014 ACA Code of Ethics, counselors are reminded to “recognize historical and social prejudices in the misdiagnosis and pathologizing of certain individuals and groups and strive to become aware of and address such biases in themselves or others.” This ethical consideration comes into play when counselors treat women with desire issues.

With the work of Helen Singer Kaplan’s triphasic sexual response cycle and an ever-expanding body of nuanced research on women’s sexuality, studies have come a long way from the male-centric, Freudian view of women’s sexual and psychological functioning and even from Masters and Johnson’s linear model of spontaneous sexual response. Researchers today strive to be more objective and aware of the physiological and psychological reality of women.

Even so, systemic prejudices related to gender and gender identity continue to saturate every area of girls’ and women’s lives, creating unique challenges in female clients in the areas of desire and sex. Fostering the safety and trust necessary to explore your clients’ desire issues can move issues of female sexuality and desire from an implicit undercurrent in your work to an explicit focus of therapy. This can help clients separate the wheat of their erotic potential from the chaff of limiting, destructive or shame-based gender and sexual conditioning.

Take Louisa, a 30-year-old client who has been married for two years. (Note: Louisa isn’t an actual client; however, her situation illustrates common sexual desire issues experienced by clients who seek counseling.) Although Louisa initially seeks treatment for depression and anxiety, a few sessions into treatment she begins referring in passing to life stressors that are “TMI” (too much information). Following these TMI comments, Louisa deflects the conversation to other topics with a shrug and a laugh.

Counselors can be attuned to these “throwaway” comments and to dismissive humor, gently inviting clients to elaborate by expressing interest in the information the client is editing out. When the counselor gently points out Louisa’s “TMI” reference and explores what she thinks might be too much information for the therapist, the issue of Louisa’s sex life begins to surface. Counselors may need to reassure clients who experience shame around sexual desire and sexuality that it can be of great benefit to focus on and explore heretofore off-limit topics and the memories, beliefs, thoughts and feelings connected to those topics.

Interventions

The following interventions may provide springboards for exploring desire issues in counseling sessions with female clients.

1) Provide psychoeducation on the connection between relaxation and sexual arousal, and work with your client to identify ways she can relax. Maureen Ryan, a sexual health coach in Amherst, New York, says, “The first step to a great sexual experience is to relax. Pleasurable touch helps facilitate this process. The body becomes aroused, and then the desire follows. For most women, sexual intimacy precedes desire.”

Explore the thoughts, fears and behavioral patterns that inhibit relaxation. Work on helping your client identify how she might create an external environment that would facilitate her transition into a sexually receptive or erotically engaged state. This might include activities that allow her to feel present or “in the flow” or connect more with pleasurable sensory input (tastes, sounds, smells, visual stimuli, touch).

2) Invite your client to create a body map. Sex therapist Aline Zoldbrod suggests using this technique with couples to facilitate a dialogue about current preferences. However, it can also be used one-on-one with female clients who may struggle with shame issues related to their bodies and their experiences of sexual desire.

Your client draws a body shape, back and front, and then uses red, yellow and green crayons to color the shapes in. Green means “I like to be touched here always,” yellow means “I like to be touched here sometimes,” and red means “I never like to be touched here.” This map can serve as one starting point for a deeper exploration of a client’s relationship to her body and her history with touch.

3) Introduce the “prop” of a velvet vulva into your arsenal of psychoeducational tools and use it to help clients understand the anatomy of the vulva, the clitoris and what movements and sensations typically stimulate arousal. This prop can also be used to instruct women on arousal as counselors model a clear, sex-positive language for expressing needs and preferences to a partner.

4) Introduce your client to the concept of “sexual blueprints.” You may want to provide a client with a handout summarizing sexologist Jaiya’s five erotic blueprints: energetic, sensual, sexual, kinky and shapeshifter. Reading about and discussing these blueprints can reduce shame, normalize a client’s experience of her own sexual predilections and help her consider new possibilities. Jaiya’s website (missjaiya.com) has a quiz to help women and men identify their blueprints.

5) Explore the meaning of pleasure for your client. What turns her on? What charges her up and connects her to her own sense of flow or aliveness? A counselor can coach a client to say, “I feed my own desire when …” and then complete the sentence with different activities, thoughts and behaviors that enliven her. Encourage your client to begin developing a running list of whatever it is she can proactively do to power herself up, delight herself and revitalize herself.

Also be sure to have an extensive list of your own desire-feeding activities. This will help you menu ideas for your clients.

6) Help clients develop awareness about the sex-negative and body-negative influences that have shaped how they see and experience themselves and their bodies. Encourage them to limit the sex- and body-negative influences in their lives. This may mean avoiding certain magazines, being mindful about television shows and choosing not to watch certain movies or videos. It may mean setting clearer boundaries with select people in their lives.

Also help clients explore ways that they can take in more sex- and body-positive messages, either through reading different magazines, limiting their exposure to narrow standards of beauty, increasing their vigilance of the kinds of advertising or body imagery they expose themselves to, or regularly and intentionally appreciating their own bodies through pleasurable body rituals and experiences.

A shift in attitude

Over time, Louisa begins to understand that the lack of sex in her marriage underlies her anxiety and depressive symptoms. She fears it means that she and her husband are on their way to divorce and that it’s “all her fault.” Here, the counselor helps Louisa increase her awareness of this critical inner voice and develop greater self-compassion.

Louisa’s husband has become more vocal about their sexual problems and grown increasingly more irritable and withdrawn in their day-to-day life. As a result, Louisa is no longer able to continue pretending the problem is just situational, temporary or unimportant.

In therapy, she examines her sexual misconceptions and beliefs and the influence of her family’s cultural and gender-based expectations of her. To her surprise, she realizes she has limited awareness of her actual bodily sensations. She often “lives in her head” and ignores the signals her body sends her. As a result, she has never really tuned in to what she feels leading up a to sexual encounter. Her low sexual desire is just the tip of an iceberg of denial related to sensations and emotions.

Part of Louisa’s work in therapy becomes learning how to “listen” to her body. She practices doing this in session and also sets aside time outside of sessions to sit quietly and observe her own sensory experience.

In the past, when Louisa lost her motivation to have sex with one of her boyfriends and couldn’t recreate the feeling of strong, active arousal with him, she would interpret it as “falling out of love” or the boyfriend “not being right for her.” It wasn’t until Louisa married her husband that she was faced with the stark truth of her own sexual experience: She had a hard time experiencing spontaneous, robust arousal once the novelty of a relationship wore off. Mostly, later in a relationship, she simply responded to her partner’s desire for her.

This insight signaled a shift in Louisa’s attitude toward sex and herself. She started to mourn her lack of erotic engagement with her past partners and current husband and to commit to cultivating a relationship with her own erotic experience. She began recognizing her own inhibitions, her lack of erotic accountability and the expectation she had always carried that her partner should know what pleased her without her assistance, guidance or willingness to explore the ways that their needs and desires met or diverged.

Because Louisa loved her partner and wanted to make their marriage work, she committed to learning how to experience her own desire and arousal more regularly. Her motivation to feel desire for her own pleasure and sense of wholeness shifted her approach to the sexual disconnection in her marriage from that of a burdensome problem to an adventure.

Untapped potential

When it comes to working effectively with female sexuality and desire, remaining neutral about larger cultural biases can stall your work as a counselor. In a culture saturated with narrow and distorted models and templates of beauty, it is nearly impossible for human beings who emerge from their mothers as female babies to grow up free of misconceptions about their core selves, their bodies, their sensuality and their eroticism.

Some women may manage to stay intuitively connected to their erotic core throughout childhood and adolescence despite the social, relational and societal risks involved, perhaps even making it into adulthood relishing the full range of their sexual experiences on their own terms. A great number of women, however, wouldn’t have survived physically, much less psychically, without shutting off their sexual circuit boards.

Usually, this shutdown isn’t a conscious choice. It is something that girls learn to do within the context of their relationships as a way of maintaining caregivers’ and others’ love and approval. Even for girls growing up in progressive, supportive families, fitting in with peer groups or feeling socially rooted can sometimes cost them some important piece of connection to their core sexual selves. Girls may grow up lacking erotically vibrant, powerful female role models. Sometimes their families and circumstances don’t allow them the luxury of maintaining a strong, healthy, intact relationship with their bodies.

When girls suppress aspects of their deepest erotic impulses and experiences, layers of judgment and shame encase not only what and how they feel, but also who they are. Like a seed trapped in amber, a woman’s erotic potential can remain untapped even as she develops and grows in other areas. It waits for the right conditions to emerge.

Counselors can provide those conditions in therapy. Here are some key ways that counselors can help women reclaim their erotic selves.

1) Take continuing education courses on sexuality.

2) Read progressive, inclusive books on women’s sexuality and women’s sexual empowerment, such as Getting the Sex You Want by Tammy Nelson, She Comes First by Ian Kerner, Mating in Captivity by Esther Perel, Woman on Fire by Amy Jo Goddard, Pussy: A Reclamation by Regena Thomashauer, Come as You Are by Emily Nagoski and Women’s Anatomy of Arousal by Sheri Winston.

3) Familiarize yourself with the facts regarding the unique challenges that women continue to face today locally, nationally and globally, particularly as they relate to physical safety, fiscal equality, political representation and reproductive issues and rights.

4) Learn to talk about all of the parts of women’s bodies with ease. Practice with your children, spouses, colleagues and friends. Learn the exact locations of women’s body parts, study how they interact and learn to identify a woman’s body parts by their correct names (e.g., distinguishing between a woman’s visible genitals — her vulva — and the internal, muscular tube that leads from her vaginal opening to her cervix — her vagina). Learn to discuss sex, sexuality and sexual acts correctly and comfortably.

5) When you pick up on a client’s reactivity, defensiveness, shame or self-consciousness related to a sexual topic, bring warmth and compassion to the moment through attuned interventions. For example: “I noticed that you covered your eyes just now as you mentioned having sex with your boyfriend. Can we be curious about what just came up for you?”

It is important to keep in mind that low desire and lack of sexual interest are issues that many women won’t openly admit to, even when these experiences are their daily reality. There is a lot at stake. Just as a man’s sexual identity and sense of competence can get tied up with his ability to pleasure his partner to orgasm or to maintain an erection, a woman’s sense of sexual self-worth can be intricately connected with her ability to both stimulate and quench her partner’s sexual desire.

When the impetus or the drive to engage in sex with her partner or spouse wanes, a woman’s sense of sexual self-confidence can waver. It can feel as if she is failing at an essential aspect of her being: loving and being loved sexually. It can also inspire terror. Will she lose connection to this person she depends on and loves? How will this affect her family relationships? Is this a prelude to something worse? What changes lie around the corner as a result of her inability to match her partner’s sexual needs with her own authentic responses and initiatives?

Counselors are in a privileged and important position with their female clients at this particular historical juncture. Women are feeling pulled to take up leadership positions and exert influence in spheres of power previously dominated by men, from political offices to corporate headquarters to influencing the ecological trajectory of the planet. To experience the fullness of their emotional range, the force of their uniquely feminine values, priorities and principles, and the vitality of their full aliveness, many women need help developing a healthier relationship with their erotic selves. Because many women have adapted and suppressed aspects of themselves to function in a world that prioritizes the more traditionally masculine values of strength, dominance, competition and self-protection, they need to find ways to access the more traditionally feminine priorities of sustainability, vulnerability, connection and empathy to feel truly like themselves again.

Counselors can safely, warmly and sincerely support the exploration of women’s low sexual desire or inhibited arousal by first prioritizing a woman’s desire as an essential energy source in her life. They can help their female clients navigate the unique, nuanced challenges of low desire and the ways it manifests in a woman’s relationship to her own self, her body and those she loves. Once this issue is prioritized in treatment, it can be made explicit and explored. From there, it becomes easier to disentangle the negative beliefs that women harbor about their bodies and themselves from their inalienable, noncontingent worth as women.

Because many women have come to experience their own desire as beyond their control, they may fear that they are the problem — outliers on the graph of normative human sexual desire doomed to disappoint and frustrate the people they love and need most. Helping women take control of their own experience of sexual desire through explicit counseling interventions has the potential to shift clients’ views of what’s possible for them erotically and, in so doing, what’s possible for them as vibrant, entitled human beings with desires that matter. This shift is seismic and can transform all aspects of women’s lives.

 

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Alicia Muñoz is a licensed marriage counselor and desire expert in private practice in Falls Church, Virginia. She is also a speaker, author, blogger and frequent contributor to various print and online publications. Visit marriedtodesire.com for more of her writing on desire, or sign up for her weekly Relational Growth Challenge at aliciamunoz.com.

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Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Is it OK to have it all?

By Kathleen Smith December 21, 2016

As Lindsey Mitchell approached the end of her doctoral program in counseling at George Washington University, she wasn’t quite sure what was next. After a decade of intense focus on her education, she found her career options in the field both exciting and intimidating. When Mitchell began talking to other women in her program about career choices, she realized that questions about ambition, leadership and family were common among female counselors.

Energized by these discussions with her colleagues, Mitchell decided to take the conversation to the American Counseling Association’s 2016 Conference & Expo in Montréal. Her idea took shape as a panel session called “To Lean In or Not to Lean In: The Diverse Experiences of Women in the Counseling Field.” The title alone was enough to catch the attention of many women at the conference and set the stage for an engaging talk between four ambitious and thoughtful counselors.

The phrase “lean in,” made famous by Facebook Chief Operating Officer Sheryl Sandberg’s 2013 book, Lean In: Women, Work and the Will to Lead, is rife with connotations and criticisms. Sandberg encouraged women to take risks, not make sacrifices based on hypotheticals, and to pursue leadership by taking a seat at the table. A former chief of staff for the U.S. Treasury secretary and a leader in the tech industry, Sandberg draws from her years of experience in male-dominated fields.

But when Mitchell and others considered this philosophy of leaning in, they faced an important question: What does “sitting at the table” mean in the counseling profession when the majority of counselors and ACA members are already female? Weren’t they already at the table?

A colleague of Mitchell’s recommended that she recruit Desa Daniel, a doctoral counseling student at Kansas State University, as a compelling voice for the ACA Conference panel discussion. Daniel thinks that numbers alone aren’t enough to change leadership dynamics. Although ACA and the counseling profession as a whole may be filled with women, she notes that leadership positions within the profession don’t always mirror those numbers. “We still have a long way to go until women hold positions in universities and governance that reflect their presence,” says Daniel, adding that she’d like to serve as president of ACA in the future. She currently serves as the student representative for Counselors for Social Justice, a division of ACA, and as student liaison for Division 45 (the Society for the Psychological Study of Culture, Ethnicity and Race) of the American Psychological Association.

Jessica Jackson, a licensed mental health counselor and a doctoral candidate in counseling psychology at New Mexico State University, also joined the discussion. She points to the male-dominated foundational and theoretical influence in the field as a real challenge. “When you look in the texts, our foundational knowledge is coming from men of European descent, and the structure of the training is based on that,” she says. “No one deviates from the blueprint, so to me, that doesn’t feel like a field dominated by women.”

Jackson also points out that texts such as Sandberg’s, as well as feminist psychology and various waves of the feminist movement, typically failed to include black women in the conversation. Part of her role on the panel, she says, was to help remind counselors that women of color can still be forgotten or excluded in a space that is predominantly female.

Having it all

Comedian Tina Fey wrote that the rudest question someone can ask a woman is, “How do you juggle it all?” Fey suggested the question operates on the assumption that, for women at least, success in one arena of life (e.g., the workplace) implies failure in another (e.g., family life). The question is rarely posed to men. Members of the conference panel set out to consider what “having it all” looks like in the counseling profession and whether balance between multiple arenas of life is possible.

“Can women have it all? I think yes, but we may have to package what that looks like in a different and creative way,” Mitchell says. Currently serving as an Americans with Disabilities Act counselor at Houston Community College, Mitchell points to the male-dominated workplace models that create impediments to women who desire balance between work and family life. For instance, she observes, when their children are ill, some mothers in the workforce will hide that fact and instead claim a sick day for themselves because they don’t want their parenting responsibilities to hurt how they are perceived at work.

“You would think that in a female-dominated field like counseling, it would be better,” Mitchell says. “But we’re still using these male business models instead of thinking about how we can be greater leaders to women that maybe we didn’t have. Sometimes we don’t have a model for what that looks like, so we have to start creating our own.”

These sentiments reflect a common critique of Sandberg’s idea — namely that Lean In ignores systemic obstacles that are present and remain unchanged in the workplace, regardless of whether women make it to the top playing by the current rules. So what rules do counselors need to change to make the workplace and the classroom more flexible and empowering places for women?

Mitchell asked Megan Doughty Shaine, an assistant professor of psychology and counseling at Hood College in Maryland, to bring her voice to the panel as a professor and parent. Shaine shared how her desire to have a multifaceted career and also be a mother affected her path. “It does change the way you move through your education, from the internships you accept, to the jobs you consider, to how you prioritize things,” she says. For example, Shaine limited her search for doctoral programs to the East Coast because she wanted to be close to her family when she started one of her own.

Shaine recommends that women in counseling leadership model how conversations about “having it all” are OK and even encouraged at work. “You’re more likely to have a female supervisor than a male supervisor, at least in the clinical world,” she says. “We have to really evaluate how open we are with these issues of work-life balance.”

Jackson agrees, pointing out that real pressure still exists to choose between focusing primarily on career or family in academia. “People don’t feel comfortable choosing a middle ground because that looks like you don’t know what you want,” she says. “But I don’t think it’s impossible to integrate and have both. My idea of success is being able to acknowledge and appreciate the many roles that I have as a black professional woman without having to sacrifice what means the most to me.”

Finding balance

Members of the panel also considered how to model what good mental health looks like for women trying to balance multiple roles in life. “So many of the conversations that we have about self-care feel fake,” acknowledges Daniel, who does CrossFit every day as a self-care measure. “We have to show tangible examples of what it looks like and how people manage it over the course of their careers. We need to lead by example but also help people set objectives and deadlines for self-care.”

Mitchell suggests that establishing and maintaining boundaries is an important piece of achieving balance. “I feel the pressure to be everything to everyone, and I know that is not a realistic expectation,” she says. “There will be stages in my life where my professional career has to take priority and other times when it will take a step down in importance. I know I entered this profession because I care about people and want to help, so there can be a conflict when I have to put myself first and inadvertently disappoint somebody in another area of my life. So it is a bit of a Catch-22. But this conflict will have to be resolved by continuing to reevaluate my values, my stage of life and what my goals are at the time. It’s an ever-changing process.”

Rather than a detour from success, Jackson sees the pursuit of balance as integral to achieving her goals. “I’m a happier and better person when I can feed the many different parts of who I am,” she says. “By engaging in prayer, checking in and being honest with myself, and being present in the moment, I am better prepared to achieve my idea of success. Potential conflicts may arise due to this expectation that to be successful in your career, you must dedicate your entire life to your career. But I don’t believe in that. I don’t believe that I have to achieve burnout in order to be successful.”

An intersectional approach 

Another critique of the philosophy behind the “lean in” movement and second-wave feminism is the relative lack of examination of women’s intersecting identities. At the ACA Conference, panel members wanted a significant amount of the conversation to focus on the diverse roles and identities of women in the counseling field and the impact this reality has on what it means to lean in.

Jackson points out how traditional advice given in books such as Sandberg’s, including the call to be assertive, may not work for every woman. “As a black woman, being assertive comes across as being the angry black woman. So how do I navigate the need to be assertive without also coming across as angry, even when I’m not angry? Because as soon as I’m assertive, that’s what everyone assumes,” Jackson explains. “When people give you advice, it’s coming from their social identity: their privilege, their background, etc. So you have to figure out what you can take from that and what you can leave.”

Jackson also recommends that female counselors gather both mentors who share their identities and those who do not to help them better navigate the field. When her interest in pursuing a research career led her to apply to the National Research Mentoring Network, she decided to choose a white male as one of her mentors to give her a different perspective. “He gave some insight on how to approach challenges rather than simply focusing on why people don’t understand things the way I do,” Jackson says.

For Jackson, who aspires to improve pipelines for people of color into academia and the mental health field, leaning in also includes starting conversations about the changing landscape of counseling and the reality that counselors don’t provide services to just one population. “We have to expand our ability to provide therapy to people with multiple identities and make room for them at the table as well,” she says. “If the path to leadership was really so linear, there would be a more diverse group of people stepping into those roles.”

Shaine asserts that counseling programs also have to address intersecting identities for their students, particularly those who are considered nontraditional. She points to the young women in her classroom who also work full time and the middle-aged mothers who are returning to school after a long hiatus or a career change. “We have to support them and try to be creative in helping students navigate a program,” she says. “Otherwise, we’re going to lose their voice and we’re going to end up with this monolithic student body, which I don’t think any of us want. That feels very antithetical to the counseling profession, where we want a diversity of perspectives.”

Counseling education programs could also use creativity and a focus on intersectionality to prepare women for a variety of roles in the field. Daniel points out that these programs rarely focus on issues such as licensure, starting a business or management roles. “Counselor ed programs need to step up their game and talk to people about what’s possible on the ground,” she says. “It’s socially unjust to send women out into the field without the full resources of what it really means to have a clinical practice.”

Advice from the panel

When asked what advice they would give to women entering a counseling education program or their first job as a counselor, panel members provided a variety of suggestions.

Mitchell, who aspires to a major leadership role in university student services, says that surrounding herself with the type of women who prompted these conversations in the first place was her best resource. “Sometimes we’re afraid to do that because we don’t want to feel like the least intelligent person in the room,” she says. “But you have to put your insecurities aside and see what you can learn from these women because, someday, you’ll be the person in the room somebody else is looking up to.”

Jackson says that advocating for your interests can go a long way. “If other people have that interest, then maybe you have enough people to request a class on that subject,” she says. “To me, that’s how change starts — being vocal and advocating for yourself.”

Shaine says women in the counseling profession shouldn’t lose sight of the flexibility they possess. “You can make a choice and change your mind later. We have an incredibly flexible field that gives us many different options. Be gentle with yourself,” she advises, “and know that the choices you make now can always be adjusted if they don’t suit you in the future.”

Daniel, who aspires to be a faculty member in a counselor education program, says that supporting other women can be empowering in itself. “We need to be better about supporting all women in their journeys, even if it doesn’t look like [our] own,” she counsels. “At the end of the day, we are creating pipelines for little girls to be what they want to be.”

 

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Kathleen Smith is a licensed professional counselor and writer in Washington, D.C. Her book, The Fangirl Life: A Guide to All the Feels and Learning How to Deal, was published earlier this year. Contact her at ak_smith@gwmail.gwu.edu.

Letters to the editor: ct@counseling.org.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Girls feeling pressure to be ‘sexy, famous and perfect’

By Laurie Meyers April 5, 2016

In our culture, women receive many messages that can eat away at their self-esteem. For example, self-worth equals youth and beauty. Perfection in all areas of life — professional and personal — is not only achievable, but expected. Women begin to learn these “lessons” as girls, say counseling experts.

American Counseling Association member Laura Hensley Choate says girls are taught that their value is connected solely to what she calls the “three A’s” — appearance, attention and Vgu1RUfKT3WN1ZYxSWaR_14672519443_13d8873062_kaccomplishments. The expectation they take away is that not only must they look their best, but they must also be noticed and popular, all while achieving high grades and earning recognition and awards in sports or other extracurricular activities, Choate explains. In addition, these messages are trickling down to girls at younger and younger ages, so that now even the youngest girls feel the pressure to be, as Choate puts it, “sexy, famous and perfect.”

This pressure has harmful effects on girls’ social and academic development, says Michelle Bruno, a counseling professor at Indiana University of Pennsylvania whose research interests include trauma and resiliency in adolescent girls. Bruno had the opportunity to work with girls on these issues through her involvement in an empowerment program designed by the nonprofit organization Ruling Our eXperiences (ROX), which began as a research study by counselor educator Lisa Hinkelman at Ohio State University.

ROX programs are designed for elementary, middle and high school girls. The programs target areas such as confidence, self-esteem and body image, healthy relationships, effective communication, social media, cyberbullying, sexual violence prevention, stress and coping, academic and career development, and leadership. Bruno, an ACA member, helped bring ROX to several schools in western Pennsylvania, coordinating with school counselors and serving as one of the onsite supervisors.

“Girls [as young as 9] are navigating peer relationships and beginning to be able to choose more independently their participation in classes and activities in school,” she says. “How they perceive and feel about themselves plays an important role in such tasks. Younger children often display higher levels of confidence than what we see in adolescents. We see younger children believing they can do anything, believing that they are the best at whatever fun activity they are trying out. During the preteen and teen years, many girls experience comprised levels of optimism and decreased healthy risk taking. They value acceptance by others and work hard to achieve it among their peer groups. Girls may not want to try new things for fear of failure or standing out.”

Bruno, like Choate, decries the tremendous pressure placed on girls regarding appearance. “The prominent messages about female beauty depict unrealistic and even unhealthy images,” Bruno explains. “Body image struggles are exacerbated by the sexualization of girls in the media, which teaches girls that their value stems from sexual appeal, to the exclusion of other traits. Young girls may end up engaging in self-objectification to achieve attention from others. How one looks becomes a significant focus for young girls, who of course are also in the midst of physical changes.”

Girls are also constrained by what they learn about “acceptable” female behavior, Bruno continues.

“Girls may be oversocialized with regard to expectations around relationships, with a need to please others being paramount over other behaviors,” she says. “This may lead to a perceived need to regulate emotions such as anger, which can result in relational aggression. This is often a result of when girls experience anger or other difficult emotions but mask it because of negative consequences seen as ‘unladylike.’ This creates incongruence and the message that being authentic is not always OK. Taken together, girls in their preteen years are forming all of these ideas around self-worth, how to define it and how to be worthy.”

ROX is a 20-week program that aims to help girls “unlearn” — or not learn in the first place — these “lessons,” Bruno notes. During the course, school counselors or other facilitators work with small groups of girls in what Bruno describes as “interactive psychoeducation” that focuses on building skills such as communication through practice and role-play. The girls also receive homework to work on in between sessions.

Bruno’s involvement with ROX was brief — her role was simply to help introduce the program into Pennsylvania schools — but she remains a big proponent.

“I saw the ROX program as unique and empowering because it is built upon a framework that examines the interrelatedness of all of these factors [appearance, appropriate behavior, etc.] and creates a safe space for girls to examine these topics while building concrete skills,” she says. “The program is highly successful because it addresses the very issues that many women can continue to struggle with throughout their adult lives. Learning these skills at 11 or 12 years old provides opportunities to support girls in defining themselves by internal standards, to help them exercise the ability to communicate feelings in an appropriate manner and to recognize the impact that outside factors can have on them.”

One of the predominant outside factors influencing today’s girls is social media, and Choate is very concerned about its effect. Although she does not view social media as the root of all negative messaging, she is concerned about certain aspects of it.

“Social media is … a new and constant pressure for girls as they feel they must be ‘on’ and perform at all times in order to get noticed and not to miss out on anything,” says Choate, whose book on cultural influences and young girls, Swimming Upstream: Parenting Girls for Resilience in a Toxic Culture, was recently published by Oxford University Press. “They tend to measure their worth on their numbers — their number of friends, followers and likes for each picture. This leads to the development of an inauthentic self that is focused on pleasing others instead of what is authentic to her.”

“We have not yet seen the long-term effects of these pressures on girls because they are so new,” she continues. “It will be interesting to see today’s young girls, who have grown up on social media and who experience a lack of face-to-face communication, in terms of their mental health. What we do know is that rates of depression, anxiety, substance use problems, eating disorders and self-injury are all on the rise for adolescent girls and young women. So I am concerned about these trends and how they will affect girls’ future development and mental health.”

Because of these concerns, Choate, a professor of counselor education at Louisiana State University, also wrote a book for mental health professionals, Adolescent Girls in Distress: A Guide for Mental Health Treatment and Prevention, in 2013. In it, she recommends that counselors focus on the following areas when helping adolescent girls navigate cultural pressures:

  • Parenting: Working with parents to improve communication and family support.
  • Authenticity and self-awareness: Encouraging girls to take time for self-reflection to gain a strong understanding of who they are and what they value. Possessing this level of self-awareness can encourage adolescent girls to stand up for who they are and what they believe in rather than giving in to the pressure of meeting cultural expectations.
  • Wellness, spirituality and gratitude: Encouraging girls to maintain balance in all life dimensions, not just the ones valued by culture (such as the physical). In addition, recognizing meaning and purpose in their lives and being grateful for what they have rather than focusing on what they do not have.
  • Problem-solving and decision-making skills: Promoting problem solving versus ruminating about problems and learning to have the confidence that they can take action to solve their own problems.
  • Coping skills for emotional resolution: Teaching girls how to manage intense emotions without harming themselves or others.
  • Social skills for communication, assertiveness and conflict resolution: Teaching girls how to develop healthy relationships first with peers and then with romantic partners.
  • Cognitive skills for cognitive restructuring and self-regulation: Helping adolescent girls learn to delay gratification and think through the consequences of actions.
  • Body acceptance and positive physical self-concept: Teaching girls to love the changes in their developing bodies and to appreciate their bodies for what they can do, not just for how they look.
  • Media literacy skills: Teaching girls how to critique the cultural messages they receive through the media and to recognize and resist the intent of the messages.
  • Goal-setting skills and perseverance: Encouraging girls to develop goals and a positive outlook for the future.

 

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Related reading: For more on women, body issues and societal pressure, see “Falling short of perfect” in the April issue of Counseling Today

 

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Laurie Meyers is senior writer at Counseling Today. Contact her at LMeyers@counseling.org

Falling short of perfect

By Laurie Meyers March 28, 2016

This past December, a major pop culture event occurred for which millions of people had been waiting longer than three decades: Star Wars: Episode VII was released. Finally, the story from 1983’s Return of the Jedi was continuing. Many fans reserved tickets two months in advance, while others camped out in line overnight to be part of the audience for the first of the film’s showings. Individuals active on social media reasoned that it was essential to see this latest installment of the Star Wars series as soon as possible to avoid tripping over spoilers.

As with any work of art, people held widely divergent views of the film. In print and online — particularly on social media — passionate discussions were held on virtually every facet of the new movie, but one of the most frequently broached topics involved actress Carrie Fisher. People weren’t usually talking about how Fisher’s character, Princess Leia, was now a general or how great it was to see one of the original characters in the newest film or even the quality of Fisher’s performance though. Instead, the comments most frequently referred to her graying hair and extra weight. The overall sentiment was that Fisher was not aging “well.”

At the same time, no significant accompanying discussion took place about Harrison Ford’s (Han Solo’s) graying hair or Mark Hamill’s (Luke Skywalker’s) prodigiously grizzly beard. Instead, the refrain heard throughout social media was: What happened to the princess in the gold bikini?! (For those who have somehow managed to resist the force of the original Star Wars trilogy, Fisher — as Princess Leia — had two scenes in Return of the Jedi in which she was held prisoner while dressed in a gold-colored leather and metal bikini. The image of Fisher in the costume has become iconic.)

As Fisher herself said in a 2011 blog post discussing her decision to become a spokesperson for the weight loss company Jenny Craig: “You know, I swear when I was shooting those films, I never realized I was signing an invisible contract to stay looking the exact same way for the rest of my existence.”

Fisher’s “invisible contract” is representative of the expectations that women face in American society today: to remain young and beautiful forever, to work harder to be considered equal to men (and yet be paid less) and to be a perfect daughter, mother and wife or partner — all while doing the majority of the housework, child rearing and caregiving. Despite the significant strides women continue to make toward equality, societal expectations still lead many women to think that they can (and should) “have it all.” But that picture is acutely unrealistic, say counselors.

“Having it all means being able to fulfill multiple expectations simultaneously — the perfect appearance, perfect relationships, perfect mother and perfect career,” says Laura Hensley Choate, a licensed professional counselor (LPC) who has written extensively about women’s and girls’ issues. “It means being perfect according to societal standards for each of these roles, but even if this were possible, it also means achieving them all simultaneously.”

The problem, counselors say, is that these standards are perniciously presented to women not just as goals that can be achieved but as expectations that must be met. And when women fall short of these standards, they often view their unsuccessful attempts as personal failures rather than as an understandable inability to meet unreasonable expectations. This perspective can cause feelings of frustration, inadequacy and shame and, in some cases, lead to more serious problems.

“These expectations are so unreasonable and unattainable, and much of it is out of an individual’s control,” comments Vanessa McLean, an LPC from Richmond, Virginia, whose specialties include women’s issues. “It is easy to see how women become plagued with anxiety, self-doubt and negative cognitions that can easily spiral into anxiety disorders or depression.”

By identifying and countering these harmful societal influences, counselors want to help women separate self-image from societal expectations — and perhaps even start changing and setting the expectations themselves.

Chasing eternal youth and beauty 

Throughout much of history, women were valued only for their beauty and fertility, says Choate, a member of the American Counseling Association. Although these qualities are no longer the sole sources of a woman’s worth, youth and beauty are still the most valued, she continues, and once a woman ages and those qualities are diminished, she loses value. In contrast, Choate says, research has shown that the characteristics most prized in men — wealth, power and status — increase with age, meaning that men generally gain value as they age. This disparity is evident in popular culture, particularly in films, which frequently pair young women with much older men, but not vice versa, she notes.

In society at large, this translates into an internalized mandate for women to fight against aging by any means necessary: products, diets, surgery and so on, says Choate, a professor of counseling education at Louisiana State University. Although we live in a youth-obsessed society, the pressure Branding-Images_Falling-Shortis mostly one-sided, she notes. “Men do not feel this same pressure. Certainly not to the same extent that women do,” Choate says.

The youthful ideal that women are supposed to maintain is in itself unrealistic, McLean says. “It isn’t just attractiveness that is the ideal but an obsession with physical perfection,” she explains. “Perfect hair, perfect skin, perfect body, perfect teeth. … And the message is not only geared to young single women but to all women.”

“Women now have equal rights and opportunities to pursue education and careers,” McLean continues, “but if you consider the message that mainstream media send, both overtly and covertly, the message is still that women’s primary value is sex, [which equals] physical attractiveness.”

Working more for less

Women have largely seized the opportunity to pursue advanced education and careers, but on a societal level, their contributions in the workplace are not as highly valued as those of men — not just symbolically but also literally, experts contend.

According to a 2014 study by the U.S. Census Bureau, the median annual salary for women is 79 percent that of the median annual salary for men. That’s 79 cents for every dollar a man makes. A 2015 comparison by the U.S. Department of Labor measuring weekly salaries found that women make 81 cents for every dollar that men make. “Women often feel more pressure in the workplace to perform, simply to get equitable recognition and pay,” McLean says.

Many women’s wages are affected by factors such as maternity leave and child care, as are their career trajectories, which are often linked to making better wages, says Nadine Hartig, an associate professor and chair of the Department of Counselor Education at Radford University in Virginia. Beyond the physical demands of pregnancy, giving birth and raising children, women are often confronted with choices related to balancing their work and life roles. These are choices that men generally do not have to make, Hartig points out. Even if a woman’s husband or partner assumes some of the child-rearing and household responsibilities, the bulk of those responsibilities will typically still fall on the woman, says Hartig, a member of ACA.

Hartig notes that she made a career choice herself because of the demands of motherhood. “I chose not to go into a tenure track right away mostly because I thought it would kill me to do that at the same time as raising children,” she says.

Many women wrestle with the challenge of how or if to try balancing motherhood and work, knowing that the decisions they make could mean delaying or even derailing a career. Women are sometimes judged negatively for taking time away from work, even for maternity leave, but they are also susceptible to being judged for returning to work as quickly as possible and continuing to pursue their careers, note Hartig and Choate.

When a woman who is a mother seeks a promotion, her dedication to her children may be questioned, along with her ability to get the work done, says Hartig, an LPC who also maintains a small private practice. “This can be done in really insidious ways, with comments such as, ‘I’m concerned you won’t have enough time for your family [if given the promotion].’ Generally, men do not face this same kind of judgment. No one questions a man’s commitment as a father if he takes a promotion.”

McLean says that when parenting and household duties are factored in, research has shown that women perform 50 percent more daily work than men.

“The reality is that working mothers still tend to serve as ‘managers’ of the home,” agrees Choate. “They are the ones who keep up with the schedules, the tasks that keep the household running, the doctor’s appointments, the school needs. And while research shows that fathers do help out, it is the mothers who tend to assign the tasks to keep everything on schedule.”

“So, the mothers have to manage the home tasks — which of course take a great deal of mental energy for planning and can lead to worrying — while fathers tend not to carry this burden with them,” Choate continues. “And the societal expectation is that a good mother will keep the family’s schedule flowing seamlessly. If things don’t run well in the home, the expectation is that the mother is not doing her part well. And for single mothers, this pressure is even greater because they are not only the managers of the home, but they also have to carry out all of the tasks with very little help or support.”

Sadly, for many women, the harshest critics they face are themselves, Choate says. They try to have it all and then feel like failures when they can’t achieve the impossible. In essence, she says, “having it all” boils down to “figuring out a way to look young, thin and beautiful, be home with the kids as much as possible, be a superstar at work, have lots of successful friendships, have a blissful romantic relationship, have a perfectly decorated, always clean home [and] cook fresh, organic meals daily.”

Breaking free of the mold 

Choate says counselors can help their female clients uncover the unrealistic expectations they are operating under. “What are the actual standards they hold up for themselves in order to feel they are a success? Actually putting these expectations into words is the first step in helping to change them,” she says. “Where did they learn these expectations? How did they come to internalize these expectations? Did they learn them from parents? Teachers? Coaches? Popular media? Whose approval are they seeking?”

Once a client realizes she is responding to outside forces rather than considering options that might be right for her, the counselor can help her identify ways of creating a healthy balance that fits her life, Choate says. The counselor should have the client ask herself what makes sense for her given her personal strengths and resources.

“This will look different for everyone,” Choate says. “What are realistic and meaningful goals that respect self-care and balance versus living up to a never-ending treadmill of others’ expectations? Helping our clients separate the difference between societal ‘shoulds’ versus what each client actually wants for herself will be very freeing for her.”

In Choate’s book Girls’ and Women’s Wellness: Contemporary Counseling Issues and Interventions, published by ACA, she talks about strategies couples can use to strike a balance in household duties. Rather than trying to decide how to divide tasks exactly 50-50, she suggests that couples talk about particular duties that each partner prefers. For instance, one might prefer folding laundry to vacuuming, or washing dishes rather than taking the trash out. Couples should also talk about who will keep track of items such as bill paying, appointments and other deadlines. The most important goal is for both partners to be satisfied with the division of labor, Choate says. It is also important for partners to be flexible enough to temporarily take on more or less responsibility when needed, she adds, such as one partner tackling extra household tasks when the other partner has a project that requires extra hours.

Hartig also helps her clients re-examine the stereotypes they have been taught, particularly as they relate to body image. “I believe the first step is assessing where clients’ narratives about their bodies began,” she explains. “For example, was the client told she was fat by a parent, or did the client gain a significant amount of weight and feel differently about his or her body? Identifying the struggles a client has about his or her body is important to begin working toward self-acceptance. Often, a negative body image is indicative of feelings of inadequacy and shame. Working on these feelings can lead clients to finding peace with their bodies.”

“Some of the ways that we work with clients on self-acceptance is to explore the negative self-talk they experience and where this self-talk originated,” Hartig continues. “Coaches, parents, teachers and friends all can have an immense impact on self-talk. Counteracting this self-talk with CBT [cognitive behavior therapy] can be very helpful. Creating a new narrative about the client’s self and body is also helpful. For example, a client who can say ‘My body is strong and my body helped me escape some pretty hard situations’ is on the road to appreciating her body.”

Hartig also notes the importance of counselors being aware that negative societal messages about appearance and body image are even greater for women who are not white or heterosexual. “Women of color face even greater assaults on a positive body image [because] our culture has an ideal that is rarely inclusive of all women — or people,” she says. “Women who identify as lesbian or bisexual are also often marginalized and misunderstood with regard to body image.”

“Internalized self-loathing is a natural consequence of media and other outlets that do not embrace the beauty of diversity and realness of people,” Hartig says. “Understanding these issues specific to different cultural groups is key to helping clients with body image issues.”

McLean uses brain-based psychoeducation to help women understand why they feel they need to meet society’s unrealistic expectations. For instance, she explains that humans are hard-wired to seek social approval, so it is normal for people to want to conform. McLean then helps clients to understand their own expectations and fears and to recognize and reframe cognitive distortion. She encourages women to explore how to balance their lives around their personal values rather than around social expectations.

Hartig likes to use narrative therapy to examine her clients’ struggles with the expectations they feel they need to meet. As she listens to clients’ stories, she finds it particularly important to note losses — for example, dreams or plans a woman may have had to let go of in one part of her life, such as her career, to attend to an aspect in another domain, such as family.

For instance, Hartig had a client who had decided not to have a second baby because she wanted to pursue tenure. However, after achieving tenure, she didn’t find it particularly satisfying and felt that she had given up the chance to have another child for nothing. It was important for the woman to grieve this loss, Hartig says.

Hartig encourages clients to grieve such losses by helping them develop rituals for letting go. This might involve a client writing a letter to herself and then burning or shredding it, releasing balloons, journaling or even holding a “funeral” for what was lost. The funeral ritual might include gathering pictures or symbols of what the woman lost, putting them in a box and burying them.

Once the client is ready, Hartig helps her to “reimagine and recreate,” building a narrative around what she wants her life to be going forward and how she can make that happen.

“For some, writing this plan down makes sense and is helpful,” Hartig says. “This can take the form of a ‘letter from your future self’ or free writing/journaling about hopes for the future. This process can also be done in the therapy session, as some clients do not respond well to written homework. I think the crucial element is to gently invite the client to envision a life that looks different than what … she originally planned, once the grief has dissipated.”

Until society rejects the picture of perfection that is “having it all,” counselors can play an important role in helping women strike a balance that allows them to have what they need.

 

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To contact the individuals interviewed for this article, email:

 

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Related reading:

See Laurie Meyers’ companion article to this piece, “Girls feeling pressure to be ‘sexy, famous and perfect’,” for more on how counselors can help young girls defy societal stereotypes and pressures.

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

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