Guidelines for Psychological Practice with Girls and Women

Introduction

During recent decades, women and girls of diverse ethnicities, social classes, sexual orientations, and life experiences have encountered dramatic and complex changes in education, health, work, reproductive and caregiving roles, and personal relationships. Although many of these changes have resulted in increased equality, opportunity, and quality of life, girls and women are also at risk for a variety of health concerns and life stresses (National Healthcare Disparities Report, 2005). Stressors in the lives of women and girls include interpersonal victimization and violence, unrealistic media images of girls and women, discrimination and oppression, devaluation, limited economic resources, role overload, relationship disruptions, and work inequities. Violence against girls and women is often predicated in sexism, racism, classism, and homophobia (Glick & Fiske, 1997; Koss, Heisi & Russo, 1994; West, 2002). Salient mental health statistics reveal that women are two times more likely than men to be depressed, and girls are seven times more likely than boys to be depressed (Lewinsohn, Rhode, Seeley, & Baldwin, 2001). Women who are subject to group and individual discrimination are even more likely to experience depression (Klonis, Endo, Crosby, & Worell, 1997). Girls and women are also roughly nine times more likely to have eating disorders than boys and men (Stice & Bearman, 2001; Stice, Burton, & Shaw, 2004). Compared to men, women are two to three times more likely to experience many types of anxiety disorders (U.S. Department of Health and Human Services, Office on Women's Health, 2001). The abuse and violence in our society (e.g., abuse, battering, rape) may contribute to the development of dysfunctional behavior such as eating disorders, depression, anxiety, and suicidal behavior, while discrimination against women and girls of color can result in lowered self-expectations, anxiety, depression, and negative attitudes toward self (Keith, Jackson, & Gary, 2003). In general, the physical and mental health concerns of women and girls are related to complex and diverse economic, biological, developmental, psychological, and sociocultural environments. The concerns, behaviors, values, attitudes, and feelings of women and girls also arise from myriad interactions among their multiple identities related to age, race, ethnicity, class, sexual orientation, marital, partnership and parental status, gender identity, ability, culture, immigration, geography, and other life experiences (Sparks & Park, 2000; Stewart & McDermott, 2004).

Although many psychologists and members of the general public may believe that women's issues in psychology were dealt with and resolved in the 1970s and 1980s, the changing and increasingly complex life experiences of girls and women and the intersection of their gender roles with ethnicity, sexual orientation, ability, SES, etc. demonstrate compelling evidence and need for professional guidance for helping psychologists (a) avoid harm in psychological practice with girls and women; (b) improve research, teaching, consultation, and psychotherapeutic and counseling training and practice; and (c) develop and enhance treatment efforts, research, prevention, teaching, and other areas of practice that will benefit women and girls. In addition, although blatant forms of sexism and racism have decreased over time (Campbell, Schellenberg, & Senn, 1997), researchers have noted the continuing presence of more subtle forms of sexist and racist bias (e.g., ambivalent, symbolic, or unintentional racism/sexism) (Glick & Fiske, 1997; Swim & Cohen, 1997). Given that the majority of those seeking mental health services continue to be females (e.g., Rhodes, Goering, To, & Williams, 2002), special attention to the unique treatment needs of girls and women of diverse backgrounds is warranted (Trimble, Stevenson, Worell, & CEMRRAT2 TF, 2003). The majority of those seeking treatment remains women and girls, and the demographics of the United States population are rapidly changing to increase more diversity in women and girls needing psychological services. Not only is potential harm reduced, but improved treatment will also likely benefit women and girls, particularly through greater awareness, education and prevention fostered by guidelines for psychological practice with girls and women.