Chapter 13 Vignettes

Chapter 13: Gender: Vignettes

Vignette 1, Birthing room

The scene is a birthing room, with the mother in the late stages of delivery, the excited father recording it all with his video camera, and the doctor ready to receive the newborn infant. "You have a beautiful baby…" The doctor's voice trails off. "A beautiful baby what?" demands the father. "I don't know," the doctor responds. "I can't tell."…. Subsequent tests reveal that the baby is chromosomally male; however, it would be easier medically to perform surgery to give him female genitalia (more extensive surgery would be needed for male genitalia, which could not be "fully functional" in adulthood)

Vignette 2, Client who is depressed

A new client comes in seeking counseling to deal with feelings of depression and helplessness related to a career transition. The transition includes resigning from a lucrative position in the corporate world at a Fortune 500 company to stay at home with three young children. The client mentions wanting to stay home with the children, yet reports frustration over leaving a rewarding career at a company that has offered a pay raise in order to entice the client to stay, and wasting so many years in college attempting to achieve this career. The client reports having many hobbies and interests, including cooking, sports, spending time with friends, spending time with family (including a spouse and three kids), and gardening, yet recently reports not having a desire to partake in any of them. The client has no history of depression, nor does the client's family of origin. When asked about family of origin, the client mentions that they are all healthy, alive, and living close to home. The client's mother was a full-time homemaker and the father worked as a corporate lawyer to support the family.

The first vignette describes a scene from a dramatic television series. This illustration of ambiguous biological sex demonstrates how important biological sex is. Sex is the primary category through which people automatically classify others. Classifying people by sex is an automatic response that has been found to develop within the first few years of life, earlier than other characteristics, such as skin color. When an individual encounters another person, she or he is typically categorized as male or female within seconds, and it is usually done unconsciously. Indeed, some readers may have found the second vignette, chosen to illustrate and stimulate thinking on topics covered in this chapter, frustrating to read because the vignette does not specify a biological sex of the client.

Activity 13-1: Beginning to Examine Gender

Take a moment and write down your thoughts on the following questions related to the second vignette before reading through this chapter. Other activities in this chapter will further explore your thinking about this client's situation.

Although more information is needed, what might a provisional diagnosis for this client be?

What do you think the prognosis is for this client? Explain your thoughts.

What are the strengths of the client?

What are some weaknesses that might hinder the client's prognosis?

What are a few goals that you would select to work with this client on?

What did you approximate the client's age to be?
The client's race?
The client's biological sex?

Explain your reasoning about how you came to the answers regarding the demographics of the client.

What aspects of the vignette caused you to come to these conclusions?

Sex classification is important because it helps people determine how to interact with each other and identify expectations of the other person. Have you ever been unsure of what someone's sex was? If so, what was your response to this person? Did you know how to interact? Did you find yourself attempting to figure out whether the person was female or male throughout the entire interaction? Were you uncomfortable?

Now take a moment to consider the second vignette earlier in the chapter, the one in which the client has left a corporate position. What biological sex did you assign to the client? Does the biological sex you assigned appear to align itself with the characteristic gender roles from your culture or society for males or females?

Activity 13-4: Stereotypical Assumptions?
Think back to the second vignette again. What biological sex did you assign – male or female – and did the "lucrative position at a Fortune 500 company" sway you in this decision?
Activity 13-4: Checking in on socialization
Look again at your responses to questions about the second vignette at the beginning of this chapter in Activity 13-1. Consider:
1. How were the client's parental roles related to the biological sex that you assigned to the client? (Did you assign "male" to the client since the client had worked in the corporate world, as did the client's father? Or did you assign the client "female" since the client had a desire to stay home, regardless of a rewarding career?)
2. Based on the reasons you selected the biological sex of the client in the vignette, what were the characteristics that drove you to the decision that you made? For example, what did you select as the strengths of the client?
3. Were the strengths more caring and family-oriented, or were they more ambitious and career-oriented?
4. Are these strengths, along with the biological sex you assigned to the client, associated with how you were socialized (regardless of whether your socialization is through Western society, family values, or cultural messages)?

Avoiding Gender Bias in Diagnosis : After taking demographic interactions into account, the counselor would look at the presenting concern (i.e., in the vignette at the beginning of the chapter, depression) and consider the possible life events and subsequent stressors related to gender (e.g., the client's beliefs about her or his current business professional role and her or his competing aspirations to take a larger child-rearing role).

Activity 13-6. Diagnostic Assessment

Respond to the following questions:

When thinking about the depressed homemaker in the vignette at the beginning of the chapter, what was your provisional diagnosis?
Did your diagnoses tend to relate to the "acting-in" or "acting-out" diagnoses as suggested by Cook et al. (1993) or did the severity increase and the prognosis decrease if the diagnosis crossed typical gender lines? For example, if client was male, was he not diagnosed with depression and instead considered to have more of an adjustment disorder? Or if he was diagnosed with a depressive disorder, was he considered to be more severe in terms of the level of depression or have a poorer prognosis)?
Comment on how the client's sex interacts with other demographic variables. Think of other chapters on ethnicities, race, social class, and religion in this book to determine what stereotypes might exist for men and women from different groupings.
Finally, how might current life events affect the client's depression?
Keep in mind that society's expectations of gender cannot be removed from this vignette. Thus, if the client is a woman, how might expectations to be a mother and homemaker versus being a career woman affect her decision and feelings? Or, conversely, how might these expectations play a role in the desire of a man to stay home with his children, and the expectations of his company, friends, and society impact his emotions and decisions?

Activity 13-7. Career & Gender

Reflect on the second vignette at the beginning of the chapter.

In what ways was your conceptualization of the client's sex and strengths influenced by their occupational choices?

Do you know both men and women who have non-traditional career choices?

How might you begin to pay attention to these issues in counseling?

Heterosexual Bias:

In addition to negative attitudes, or feeling ill-equipped to working with homosexual clients, heterosexual bias is also be applied in counseling when a therapist attempts to use heterosexual standards to make sense of homosexual relationships, or to attempt to apply male and female roles to homosexual partners in order to attempt to understand their relationship. For example, in the second vignette at the beginning of this chapter, the student might have assumed that the client's partner was the opposite sex. Thus, counselors need to assess their knowledge, biases, and assumptions in working with clients from different sexual orientations.

Implications for Practice:

Examining the Values and Beliefs of Counselor and Client : For the client in the second vignette, a counselor might ask how the client's parental roles of homemaker and corporate lawyer had an impact on her or his career choice and on the struggle with leaving her or his career and staying at home. In addition, the client might be asked what were the messages about life, career, and family the client received from his/her parents and how these messages align or conflict with society's messages.