Gender Competency Principles in Clinical Practiceby Richard Kensinger, MSW | October 2, 2012
Though we are of the same species and in some ways alike, women and men are uniquely different. In this article, I highlight some of the key qualities of this “differentness” as it directly relates to clinical care in behavioral health. One of my most popular trainings is the one on “Brain Sex” which focuses in depth on these ideas.
There are a number of prominent distinguishing features between the genders that are reflected in physiological and psychosocial expressions. More males are conceived yet show a higher mortality rate across the lifetime. Men are far more likely to die in accidents and via suicide. Body size, strength, and power afford men certain advantages and disadvantages. The primary male hormone testosterone accords a higher degree of risk in men. On the contrary, the primary hormones of women, such as estrogen and oxytocin, accord women a degree of protection.
Men are permitted to show more dominant aggression in social situations. Women exhibit more submissive actions, posses a lower pain threshold, and are far more proactive about seeking healthcare; while men tend to be more “involuntary” in seeking care and services.
The development of gender role assignment is a potent factor in shaping the life trajectory of women and men. In all cultures around the age of 5, boys and girls show keen awareness of social and cultural expectations of each gender across the lifespan! Males are to show more independence, more daring, more aggressive, less vulnerability. They are expected to be more sexually experienced have more partners. Women on the other hand are expected to be more interdependent, more hesitant, submissive, more vulnerable. They are held to a higher sexual standard in regard to sexual behaviors, number of partners, and fidelity. In most cultures, virginity is valued more by males!
In regards to communication patterns, the main tools of women are thoughts and emotions. In male actions are our core tools. Women are regarded as “rapport” communicators; and men are “report”. Women are more comfortable in revealing internal information; whereas men, focus more on external matters. Males tend to be more competitive in social situations. Women tend to show more collaboration, and transculturally, are viewed as more prosocial than their counterparts. Women generally desire intimacy; men tend to fear it! Girls tend to prefer one-to-one social interactions. Group/pack activities are preferred by boys. Further, women are likely better at reading non-verbal language than we men are.
So, what about the relationship of these unique differences as it plays out in behavioral healthcare?
Women are twice more likely to present with clinical depression, and we find a similar ratio in regards to some of the major anxiety spectrum disorders. The gender ratio in major eating disorders, such as anorexia and bulimia is about 9 females to every 1 male. In regards to suicide, women are three times more likely to try it; males are four times greater at completing it. In some disorders, like bipolar and schizophrenia, there is no known gender differential; however, there is in expression. Women with bipolar tend to show depression first. Men show mania more often. In schizophrenia, males show it earlier and its clinical course is less promising.
Pertaining to substance use disorder, we men are 4 to 5 times at greater risk; and our peak age range of this risk, is 18 to 26. However, the adverse consequences of SUD affect women greater.
As far as responses to psychotropic medications, women tend to respond better to lower doses than men. In respect to care compliance, women tend to be more cooperative, men less so.
Perhaps, as far as I am concerned, one of the most potent forces impacting and shaping women, is Carol Gilligan’s concept of the “relational self”. Essentially, women more define and understand themselves in the context of their many important relations than we men do. It is critical for clinicians to develop greater gender competence and to incorporate these “differentnesses” into our care plans in order to ensure more positive treatment outcomes.
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Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, & Kendler KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of general psychiatry, 51 (1), 8-19 PMID: 8279933
Rosenthal M. Human Sexuality: From Cells to Society. Wadsworth, Cengage Learning. (2012).
Substance Abuse Treatment: Addressing Specific Needs of Women. (TIP 51). US Dept. of Health & Human Services. Center for Substance Abuse Treatment. Rockville, MD. (2010).
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